Suboptimal clinical responses to metabolic and bariatric surgery include insufficient weight loss (WL), weight regain (WR), and/or comorbidity remission failure or relapse. Gut hormones' role in WR and Type 2 diabetes (T2D) relapse is not fully established. So, our aim was to evaluate the hormone profiles of patients with long-term optimal and suboptimal response after gastric bypass (RYGB).

This cross-sectional study included 43 individuals who underwent RYGB surgery over 10 years ago, divided into two groups: 23 participants with no T2D history but different WR trajectories (cohort 1), and 20 with prior T2D diagnosis and optimal WL (cohort 2), with post-RYGB T2D remission (n=10) or relapse (n=10).

Fasting and postprandial glucose, insulin, C-peptide, glucagon, GLP-1 and GIP levels were evaluated during a mixed-meal tolerance test. In cohort 1, fasting glucose, insulin, C-peptide, and glucagon, as well as the postprandial glucose and GIP levels, were significantly positively correlated with %WR. Additionally, postprandial GLP-1 and glucagon levels were negatively correlated with the %WR. In cohort 2, higher postprandial glucose and lower insulin were observed in participants with T2D relapse. No other significant differences were observed.

In sum, greater WR was associated with higher levels of postprandial glucose and GIP, along with lower GLP-1 and glucagon excursions. Whether these are cause or consequence of WR remains to be clarified. Additionally, GIP and GLP-1 profile of participants with T2D relapse did not differ from those with T2D remission.

Cardiovascular disease (CVD) is a major cause of mortality in patients with type 2 diabetes mellitus (T2DM). Statins are essential for the primary prevention of CVD in this high-risk group. Despite guideline recommendations, statin use remains suboptimal in clinical practice. Assessing statin utilization and identifying factors influencing their prescription are vital for enhancing evidence-based care, especially in resource-limited settings. Therefore, this study aimed to evaluate statin use and its predictors for primary CVD prevention among diabetic patients at Arsi Teaching and Referral Hospital in 2023.

A hospital-based cross-sectional study was carried out among 351 diabetic patients at Arsi Teaching and Referral Hospital (ARTH) between February and September 2022. Participants were selected using a systematic random sampling method. Data were collected through a pretested, interviewer-administered structured questionnaire and a checklist. Trained nurses from the diabetic clinic conducted data collection. The collected data were initially entered into Epi Data version 7.2, then exported to SPSS version 26 (IBM, USA) for analysis. The association between statin use and potential predictors was examined using odds ratios (ORs) with 95% confidence intervals (CIs). Variables with a p-value below 0.05 in the multivariable logistic regression were considered statistically significant.

The prevalence of statin utilization for the primary prevention of CVD among type 2 diabetic patients on follow-up at Asella Teaching Hospital was 189 [(53.8%, 95% CI: 48.6%, 59.0%)]. The most commonly prescribed statin was atorvastatin, followed by simvastatin. The probability of statin use was greater in participants with hypertension [AOR=4.8, 95% CI (2.0-11.5)], dyslipidemia [AOR=10.5, 95% CI (2.0-11.5)], and uncontrolled glycemic control [AOR=8.0,95% CI (3.8-17.7)].

Suboptimal statin utilization (53.8%) for primary CVD prevention in type 2 diabetes was observed, with utilization heavily influenced by comorbidities. Urgent quality improvement initiatives are needed to ensure statin access aligns with guideline recommendations for patients with hypertension, dyslipidemia, and poor glycemic control in the study area.

Diabetic foot ulcers (DFUs), a common complication of diabetes, are often accompanied by delayed wound healing, pain, psychological distress, and sleep disturbances.

To evaluate the effectiveness of personalized continuous care (PCC) compared to routine care in improving wound healing, symptom severity, and psychological/sleep outcomes in DFU patients.

A retrospective cohort study of 60 DFU patients (2021-2024) compared PCC (n=30) with routine care (n=30). Outcomes assessed included wound area reduction, granulation tissue coverage, symptom scores (ulceration, necrosis, pain), and validated psychological (SDS, SAS) and sleep (AIS) scales.

The PCC group showed superior wound healing (40.51% vs. 27.43% area reduction; 61.66% vs. 46.32% granulation coverage, p<0.05), lower symptom scores (ulceration: 3.18 ± 0.45 vs. 4.46 ± 0.6; pain: 2.01 ± 0.29 vs. 3.45 ± 0.58, p<0.01), and improved psychological (SDS: 32.1 ± 3.88 vs. 44.87 ± 4.05; SAS: 30.36 ± 3.77 vs. 43.25 ± 4.56, p<0.001) and sleep outcomes (AIS: 8.23 ± 0.6 vs. 11.33 ± 0.94, p<0.001).

PCC enhances DFU wound healing, alleviates symptoms, and improves psychological well-being and sleep quality, supporting its integration routine clinical practice.

In contemporary practice, a cardiac surgeon is often confronted with critical questions. Should the ascending aorta be replaced concomitantly when the aortic valve is replaced? Does simultaneous surgery significantly increase operative risk? Although the literature offers answers, the decision for simultaneous surgery remains individualized for every patient, taking into account clinical and nonclinical data. Concomitant replacement of the ascending aorta and aortic valve was first introduced in the 1960s, and since then, the debate has continued regarding the most appropriate surgical strategy for managing aneurysmal disease of the ascending aorta and the criteria guiding such interventions. We aim to present and compare our institutional data on isolated aortic valve surgery versus concomitant replacement of the aortic valve and ascending aorta and to compare our findings with the literature.

We retrospectively analyzed our database of adult patients (≥18 years) who underwent isolated aortic valve replacement (AVR) or concomitant AVR and ascending-aorta replacement from 2007 to 2023 at the Cardiac Surgery Service, University Hospital Center "Mother Teresa," Tirana. Data were extracted from operating-room registers and medical records. Demographic, pre-, intra-, and postoperative clinical variables were collected. Continuous variables are presented as mean ± standard deviation; categorical variables as percentages. Statistical analysis was performed with IBM SPSS Statistics for Windows, version 26.0.

The study included 491 patients who underwent isolated AVR and 131 patients who had concomitant AVR with ascending-aorta replacement. Sex (p < 0.001) and age (p < 0.001) differed significantly between the groups. Concomitant surgery involved 102 men (77.9%), whereas isolated surgery involved 311 men (63.3%). The mean age for isolated AVR was 62.28 ± 10.76 years; for concomitant surgery, 57.33 ± 11.90 years. New York Heart Association (NYHA) class was also significant, with 457 patients (94.8%) in NYHA II-III in the isolated group and 128 patients (97.7%) in the concomitant group. Arterial hypertension and diabetes mellitus were statistically significant comorbidities; renal insufficiency, smoking, obesity, and COPD were not. Cardiopulmonary bypass (CPB) time (83.85 ± 22.63 min vs. 111.09 ± 23.67 min; P < 0.001) and aortic cross-clamp time (65.22 ± 19.20 min vs. 89.56 ± 20.71 min; P < 0.001) differed significantly. Aortic annulus diameter, body-surface area, and indexed effective orifice area (SEPi) were also significant variables. Although hospital mortality was not statistically different, it was the most clinically relevant outcome in comparison with several international centers, underscoring the good results of our surgical team. Hospital mortality for isolated AVR was 1.6% (eight patients); for concomitant surgery, 2.29% (three patients). This analysis was limited to in-hospital outcomes. No long-term follow-up data, such as reoperation rates, late complications, or survival beyond discharge, were included.  Conclusion: Concomitant replacement of the aortic valve and ascending aorta markedly prolongs CPB and aortic cross-clamp times compared with isolated AVR, yet mortality remained low and comparable with leading international centers. Although concomitant surgery carries a higher operative risk than isolated AVR, our experience demonstrates that it can be performed with satisfactory outcomes.

Type 2 diabetes mellitus is a major health burden globally, with increasing use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) such as semaglutide for glycemic control and cardiovascular risk reduction. While generally well tolerated, GLP-1RAs have been associated with gastrointestinal side effects, including rare reports of bowel obstruction. We describe a case of a 39-year-old male with type 2 diabetes who presented with nausea, vomiting, and abdominal pain five weeks after starting semaglutide. He had four weekly subcutaneous doses of semaglutide 0.25 mg, followed by one dose of 0.5 mg on the fifth week. Examination demonstrated a tender, distended abdomen. Imaging revealed small bowel pseudo-obstruction accompanied by ileitis, with no mechanical cause identified. A diagnosis of bowel pseudo-obstruction was made after exclusion of other causes, including infection, inflammatory bowel disease, and mechanical obstruction. The patient improved with conservative management following drug cessation. Patient education and regular monitoring are crucial, especially for those reporting persistent abdominal symptoms while taking a GLP-1RA for the control of diabetes or weight loss.

Improving the health behaviors of older type 2 diabetes mellitus (T2DM) patients is crucial for promoting healthy aging worldwide. Given the significant role of expectations regarding aging (ERA) in fostering healthy behaviors and improving disease outcomes, understanding its status and influencing factors in this population is essential.

The cross-sectional study was conducted from December 2023 to February 2024 at a tertiary hospital in China, where 289 elderly T2DM patients were surveyed. Self-reported questionnaires were used to assess sociodemographic and clinical data, ERA, depression, social support, diabetes self-efficacy. Data were analyzed using SPSS 26.0 software, employing Pearson correlation analysis, univariate analysis, and multiple stepwise linear regression.

The ERA score in older T2DM patients was 39.72 ± 9.53, which was at a medium-low level. The level of ERA is negatively correlated with depression (r = -0.549, p < 0.01) and positively correlated with social support (r = 0.625, p < 0.01) and diabetes self-efficacy (r = 0.514, p < 0.01). Age, family monthly income, type of daily medication, number of sources for diabetes-related knowledge, as well as depression, social support, and diabetes self-efficacy are factors that influence ERA and can explain 59.2% of the total variance.

Efforts should be made to promote ERA in older patients with T2DM. Healthcare providers should develop intervention strategies based on identifying the factors that influence the ERA in elderly T2DM patients to improve their health outcomes and enhance their health management awareness, thereby improving the quality of their later years.

Suboptimal glycemic control in individuals with diabetes is one of the major contributors to the development of diabetic retinopathy (DR). However, the role of ambulatory blood pressure (ABP) in this association remains unclear. The purpose of this research was to assess the associations among ABP, glycosylated hemoglobin (HbA1c), and DR in a diabetic population, with an emphasis on individuals exhibiting suboptimal glycemic and BP control.

This study included 498 diabetic patients with comprehensive ABP data. The assessment of diabetes is based on the criteria of the American Diabetes Association (ADA). We adopted Least Absolute Shrinkage and Selection Operator (Lasso) regression to identify key variables and used logistic regression to investigate associations, followed by subgroup analyses.

After adjustment for covariance variables, HbA1c showed a strong correlation with DR (OR: 1.228, 95% CI: 1.010-1.368). Among participants with low ABP, the prevalence of DR rises significantly with higher HbA1c levels (OR: 1.217,95% CI:1.057-1.402), whereas in those with elevated ABP (OR:1.366,95% CI:1.122-1.662), this relationship was markedly stronger, particularly in the context of Awake systolic blood pressure (SBP). Comparable findings were noted in both categorical models, as well as in subgroup analyses. However, heterogeneity was observed in subgroup analyses stratified by age.

ABP may modify the relationship between HbA1c and DR; specifically, suboptimal glycemic management in patients at elevated ABP levels exacerbates the risk of DR. Therefore, it is imperative for diabetic patients to prioritize both BP regulation and glycemic management in their comprehensive disease management strategy.

gestational diabetes mellitus is a common complication of pregnancy. Diagnostic tests should be performed between 24-28 weeks of pregnancy; however, studies have shown that early or late screening could provide certain benefits in pregnancy outcomes. The study aimed to determine the impact of performing early or late screening tests for GDM in maternal and neonatal outcomes compared to the standard screening time.

we conducted a cross-sectional study including adult pregnant women with a high risk of GDM. Baseline characteristics, risk factors and differences in maternal and neonatal outcomes were evaluated (e.g. preeclampsia, infections, birth weight, etc.). Multivariable logistic regression analysis was performed to identify factors associated with adverse maternal outcomes and adverse neonatal outcomes.

a total of 803 patients were included, mean gestational age at the end of pregnancy was 37.6+4.4 weeks. 232/803 patients (28.9%) underwent screening in the standard time. A total of 79/232 (34.0%) from those that underwent screening at the standard time were diagnosed with GDM, and 102/286 (35.6%) and 111/285 (38.9%) were diagnosed in the early and late screening times, respectively. Age >30, BMI ≥25, and family history of DM were found as significant risk factors for gestational diabetes mellitus in the multivariable logistic regression analyses. Earlier gestational age, and caesarean section were significantly more frequent in women with GDM compared with women without GDM. No significant differences were found in the neonatal outcomes.

our results suggest a similar proportion of patients are diagnosed with GDM when comparing the three screening times and that early or late screening times do not provide any additional benefits on neonatal outcomes.

Medicinal plants and mushrooms have been used for the prevention and treatment of various diseases since ancient times. For thousands of years, they have attracted significant interest due to their broad spectrum of biological activities and drug-like properties. Their continued use in traditional medicine has evolved alongside, and increasingly been supported by modern scientific research. Diabetes mellitus poses a serious global health, social and economic challenge and is among the most rapidly growing health issues of the 21st century. Type 2 diabetes mellitus (T2DM), which accounts for 90-95% of diabetes cases, is largely attributed to sedentary lifestyles, unhealthy diets and obesity. Herbal medicine has already played a key role in the development of antidiabetic drugs, as exemplified by the plant-derived origins of metformin. The development of new therapeutics or therapeutic adjuvants from natural sources offers several advantages over synthetic drugs, including improved safety profiles for long-term use, efficacy, affordability and reliance on renewable raw materials. This review highlights the potential of bioactive compounds from medicinal plants and mushrooms, discussing their mechanism of action, extraction techniques and their significance for the prevention, management and treatment of T2DM.

To investigate the diagnostic sensitivity of sural sensory nerve action potential (SNAP) to medial femoral cutaneous nerve and dorsal sural to sural SNAP amplitude ratios in patients with diabetic polyneuropathy.

Sural/radial (SRAR), sural/medial femoral cutaneous (SMFAR), and dorsal sural/sural (DSSAR) SNAP amplitude ratios were calculated in 22 controls and 46 patients with type 2 diabetes mellitus. Combined sensory scores (superficial peroneal, sural, dorsal sural, and medial plantar SNAPs), and amplitude ratio scores (SRAR, DSSAR, and SMFAR) were assessed. The parameters were compared statistically between the patient and control groups.

All SNAP amplitudes were significantly lower in patients as compared with those of the controls. Reduced medial plantar SNAP amplitude was the most frequent abnormality in the patient group. DSSAR and SMFAR, but not SRAR were found to have significant value in differentiating patients from controls with low sensitivity and moderate specificity. The combined sensory score improved the diagnostic accuracy for diabetic polyneuropathy, while the other combined scores add no additional value in this respect.

Distal nerve conduction studies (NCSs) are most useful in diagnosing mild diabetic polyneuropathy. Although DSSAR and SMFAR can be moderately sensitive alternatives, particularly when used in combined scores, these ratios do not add any diagnostic value in patients with axonal polyneuropathies of similar severity.