Pregnant women with type 1 diabetes mellitus (T1DM) are at higher risk of complication development in both mothers and their children. The present study aims to describe changes in circulating and umbilical cord concentrations of recently described predictors of pregnancy complications in a group of women with T1DM. Sixty-seven cases and 34 healthy pregnant controls were included in the study and circulatory levels of TGF-alpha, HB-EGF, BDNF, sFlt-4, PDGF, SCF, galectin-1, Fas ligand, CCL-20, P-selectin, IFNgammaR1, IL-10, IL-8, leptin, and insulin were assessed in 10 to 13, (V1), 18 to 21 (V2), 28 to 31 (V3) and 34 to 36 weeks of gestation (V4), and immediately after delivery (V5). BDNF, sFlt-4, HB-EGF, SCF, Fas ligand, galectin-1, IL-8, leptin, and insulin were higher in women with T1DM compared to controls during pregnancy (all p<0.05). While HB-EGF, CCL-20, and P-selectin correlate with maternal glucose control, circulatory SCF, P-selectin, galectin-1, PDGF, IFNgammaR1, sFlt-4, and TGF-alpha levels positively correlated with IL-10 levels suggesting that their expression is altered in the presence of inflammation. Leptin and insulin cord blood levels were higher in newborns of the mothers with T1DM relative to those without T1DM. Pregnancy of women with type 1 diabetes mellitus is associated with numerous changes in circulatory factors, but these changes are not reflected in the cord blood. The observed variations in trophic and inflammatory mediators may be linked to adverse pregnancy outcomes and could potentially be incorporated into predictive models for pregnancy complications in women with type 1 diabetes. Key words Type 1 diabetes mellitus " Serum " Plasma " Cord blood " Pregnancy complications.

To compare the effectiveness of tropicamide and its biosimilar drug in normal and diabetic patients.

The prospective cohort study was conducted at Amanat Eye Hospital on March 5, 2023 to 5 December, 2023, and comprised individuals aged 40-50 years. Diabetic patients formed group A, while healthy controls were in group B. Tropicamide 1% was used for mydriasis in the left eye of all the subjects, and a biosimilar drug was used for mydriasis in the right eye. After administration, the size of the pupil was analysed. Data was analysed using Paired t-tests for continuous variables and McNemar's test for categorical variables.

Of the 300 subjects (150 males, 150 females), 150(50%) were in each of the two groups. In group B, 29(19.33%) eyes were perfectly dilated in response to tropicamide compared to 23(15.43%) with biosimilar drug. In group A, the corresponding values were 53(35.33%) and 25(16.66%), respectively.

Tropicamide was found to be more effective compared to its biosimilar drug. Besides, tropicamide was more effective in healthy individuals compared to diabetic individuals.

To explore the knowledge and perceptions of primary care physicians about clinical inertia in the management of type 2 diabetes, and to identify the contributing factors.

The cross-sectional study was conducted in Madinah, Saudi Arabia between April and May 2020, and comprised qualified doctors working in primary care centres as general practitioners or board-certified family physicians. Data was collected using a questionnaire on participants' demographics, knowledge and practices related to diabetes management, and their perceptions regarding clinical inertia in the management of type 2 diabetes. The questionnaire was distributed online. Data was analysed using SPSS 28.

Of the 250 subjects approached, 200 (80%) completed the questionnaire; 105(52.5%) males and 95(47.5%) females. There were 78 (39%) subjects aged 41-50 years. Overall, 90(45%) subjects were general practitioners, 41(20.5%) were family medicine specialists, and 62(31%) were family medicine consultants. Of the total, 96(48%) respondents were aware of the concept of therapeutic inertia. Factors contributing to inertia were identified at the patient, physician and system levels. Physician-related factors included concern about hypoglycaemia 129(64.5%), complexity of treatment 111(55.5%), and patient refusal 67(33.5%). Patient-related barriers were resistance to lifestyle modifications 132 (66.0%), fear of weight gain 105(52.5%), and fear of injections 101(50.5%). System-level barriers included lack of multidisciplinary teams 137(68.5%), time constraints 107 (53.5%), and high workload 104(52.0%). A significant association was found between professional classification and awareness of therapeutic inertia (p<0.05).

Addressing barriers at the physician and system levels could help reduce clinical inertia in insulin prescription, potentially leading to improved diabetes outcomes.

Haemodialysis access patterns differ internationally. This can not only be explained by differences in patient cohorts. What is considered the right access for the right patient is debated and it is unclear which patient-related factors affect the choice of access. The aim of the study was to investigate how patient-specific factors as body size and comorbidities influenced the choice of haemodialysis access in a real-life setting.

Retrospective cohort study including all patients receiving a haemodialysis access in Sweden between 2013 and 2022. Data from the Swedish Renal Registry (SNR) and the National Patient Register (NPR) was used. Data regarding age, sex, cause of kidney failure, previous kidney replacement therapy, height and weight (after dialysis), were collected from SNR. Data on comorbidities were extracted both from SNR and the NPR. AV-accesses were grouped into four categories depending on location of artery. Changes in arteriovenous access creation over time and patient-related factors affecting the choice of first access were analysed.

Of 10,170 patients, 9706 with 17,709 accesses were included. The creation of upper-arm fistulas (p = 0.042) and arteriovenous grafts (p = 0.007) increased. Small body size, female sex, diabetes mellitus, vintage, previous haemodialysis treatment (all p < 0.001), age (p = 0.002) and peripheral arterial disease (p = 0.031) led to more central venous catheters. Small body size, female sex, peripheral arterial disease, vintage, previous haemodialysis treatment (all p < 0.001) and diabetes mellitus (p = 0.023) decreased the probability for selecting a forearm fistula. Upper-arm fistulas were preferred over arteriovenous grafts for those with small body size (p < 0.001 for body surface area), female sex (p = 0.003) and previous haemodialysis (p < 0.001).

The use of upper-arm fistulas and arteriovenous grafts is increasing, while forearm arteriovenous fistulas remain the primary access modality. Patient-related factors influencing the choice of access seemed to be related to vessel size and quality, rather than age and cardiovascular comorbidities.

We aimed to systematically review and quantify risk factors for first-ever diabetes-related foot ulcer (DFU). Four English and three Chinese electronic databases were searched for cohort and case-control studies reporting risk factors for first-ever DFU. Two researchers independently screened titles, abstracts and full text, extracted data and assessed the quality of included studies. Meta-analyses were performed for risk factors reported in at least two studies, using unadjusted odds ratios and standardised mean differences for dichotomous and continuous variables. Of 6736 potential studies screened, 23 were included in the meta-analysis and 24 in the systematic review. Twenty-eight significant risk factors for first-ever DFU were identified, including older age, obesity, male gender, unmarried status, alcohol consumption, current smoking, insufficient physical activity, longer diabetes duration, increased HbA1c, fasting plasma glucose, creatinine and triglyceride, decreased eGFR and high-density lipoprotein, high vibration perception threshold, albuminuria, low ankle-brachial pressure index ratio, cardiovascular, cerebrovascular and peripheral artery disease, retinopathy, nephropathy, neuropathy, myocardial infarction, foot deformity, skin dryness, insulin treatment and anti-hypertensive treatment. This study provides the first comprehensive synthesis of risk factors for first-ever DFU. Identifying high-risk individuals based on these factors can enhance early intervention strategies, reducing the burden of DFU in diabetes management.

Peripheral neuropathy (PN) is a common complication of type 2 diabetes mellitus (T2DM). In this study, we determined the independent and combined associations of T2DM and PN with device-based measures of physical activity levels and sedentary behaviour.

Cross-sectional data from The Maastricht Study were used (N: 6471, age 59.8 ± 8.8). T2DM was determined with an oral glucose tolerance test and PN was, using a neurothesiometer, defined as an impaired vibration perception threshold (iVPT), that is exceeding 25 V in either one or both halluces. Physical activity and sedentary behaviour outcomes were derived through 8 days of activPAL accelerometer measurement, worn 24 h/day. Multiple linear regression analyses were used with adjustment for demographic, lifestyle and health-related indicators.

In the fully adjusted model, the combined presence of T2DM and iVPT presented the lowest step count (-1407 steps/day [95% CI: -1851, -963]), and showed the lowest time in light-intensity (-27.2 min/day [-38.6, -15.8]) and moderate-to-vigorous physical activity (-9.5 min/day [-12.6, -6.5]). Moreover, those with both conditions had the highest sedentary time (+33.3 min/day [21.4, 45.2]) and longest sedentary bout durations (+1.0 min/bout [0.6, 1.4) compared with those without these conditions.

T2DM and PN were both independently associated with lower levels of physical activity and higher levels of sedentary time. The combination of T2DM with PN was associated with particularly low levels of physical activity and higher levels of sedentary time, indicating an additive association. Strategies to improve physical activity in these individuals should address both conditions.

Cirrhosis and diabetes mellitus can develop and influence each other. We conducted this study to compare the hepatic outcomes of sodium-glucose cotransporter 2 (SGLT2) inhibitor use versus no-use in patients with liver cirrhosis and type 2 diabetes.

We identified patients diagnosed with type 2 diabetes and liver cirrhosis from the Taiwan's National Health Insurance Research Database between 1 January 2000 and 31 December 2021. Multivariable-adjusted Cox proportional hazard models were used to compare the risks of decompensated cirrhosis, liver failure, cardiovascular events and mortality between SGLT2 inhibitor users and nonusers.

The mean follow-up period for SGLT2 inhibitor users and nonusers was 2.86 and 2.66 years, respectively. The incidence rates of mortality during follow-up were 29.97 versus 63.18 per 1000 person-years for SGLT2 inhibitor users and nonusers, respectively. The multivariable-adjusted models showed that SGLT2 inhibitor users had lower risks of all-cause mortality (aHR 0.47, 95% CI 0.42-0.52), decompensated cirrhosis (aHR 0.67 95% CI 0.58-0.77), liver failure (aHR 0.58, 95% CI 0.49-0.69), hepatorenal syndrome (aHR 0.54, 95% CI 0.35-0.85) and major adverse cardiovascular events (aHR 0.80, 95% CI 0.52-0.70) than nonusers. A longer cumulative duration of SGLT2 inhibitors had further lower risks of mortality and decompensated cirrhosis.

This nationwide cohort study showed that SGLT2 inhibitor use was associated with a significantly lower risk of mortality, decompensated cirrhosis, liver failure and cardiovascular events in patients with compensated liver cirrhosis and type 2 diabetes. SGLT2 inhibitors may be an option for diabetes management in patients with compensated liver cirrhosis.

Immune checkpoint inhibitor-induced type 1 diabetes mellitus (ICI-T1DM) is a rare but serious immune-related adverse event associated with programmed cell death-1 inhibitors such as nivolumab. While previous reports have documented its occurrence, the relationship between nivolumab dosing and the onset of ICI-T1DM remains unclear. This study presents a case of ICI-T1DM following a nivolumab dose and includes a literature review.

A man in his 50s (weight: 49.4 kg, body mass index: 17.65 kg/m2) with advanced esophageal cancer had been receiving nivolumab (240 mg every 14 days) for over 2 years without adverse effects. Because of treatment adjustments, the dose was increased to 480 mg and administered every 28 days. Ninety-six days after the dose increase, he developed acute-onset fatigue, anorexia, and thirst.

Laboratory tests confirmed diabetic ketoacidosis with hyperglycemia (582 mg/dL), low C-peptide levels, and negative islet-associated antibodies, leading to the diagnosis of nivolumab-induced fulminant type 1 diabetes mellitus.

The patient was treated with insulin and discharged after stabilization.

This case suggests that higher dose nivolumab may increase the risk of ICI-T1DM, especially in low body-weight individuals.

Given that nivolumab remains effective at lower doses, dose optimization may help mitigate immune-related adverse events while maintaining therapeutic efficacy.

Insulin antibody-mediated insulin resistance is a rare autoimmune mechanism that can cause severe hyperglycemia.

A 52-year-old male patient was admitted to our hospital with complaints of polydipsia, polyuria, and weight loss (8 kg in 6 months). He was diagnosed with type 2 diabetes mellitus at age 33.

Type 2 diabetes mellitus with antibody-mediated insulin resistance syndrome.

Rituximab infusion in a 500 mg dose was given 2 times in a 2-week interval.

A significant response was achieved 1 month later with fasting plasma glucose: 120 mg/dL (6.7 mmol/L), glycosylated hemoglobin A1c: 7.6% (59.6 mmol/mol), and anti-insulin antibodies: 0.001 U/mL. Clinically improved response persisted for about 6 months.

Clinicians should be aware of the antibody-mediated insulin resistance, recognize suggestive signs and symptoms, pursue appropriate diagnostic evaluation, and treatment approach.

Cardiovascular autonomic neuropathy (CAN) is a frequently underdiagnosed complication of diabetes mellitus that contributes to increased mortality and morbidity rates. This multicenter study investigated the epidemiology and clinical characteristics of CAN in patients with long-term diabetes.

Retrospective data were collected from 884 individuals with diabetes who were assessed for CAN across eight hospitals in Korea. CAN was diagnosed using electrocardiography and cardiovascular autonomic function tests, including the heart rate-corrected QT interval and Ewing's method. This study evaluated the clinical characteristics, cardiovascular autonomic nerve function test results, and risk factors associated with CAN.

Among the 884 patients, 778 (88%) were diagnosed with CAN (DCAN), while 106 (12%) were not (non-DCAN). Individuals with DCAN were older, had a longer duration of diabetes, and had higher creatinine levels. The DCAN group showed decreased time and frequency parameters of heart rate variability (HRV). A multiple logistic regression analysis revealed that a longer diabetes duration, older age, and higher creatinine level were significant risk factors for CAN.

CAN was associated with advanced age, a longer duration of diabetes, higher creatinine levels, and lower time and frequency HRV parameters.