This research examined the association between the triglyceride-glucose (TyG) index and metabolic, hepatic, and hematologic variables in a population of severely obese subjects, with a focus on the assessment of glycemic control.

This retrospective study included 315 adult patients with a body mass index (BMI) ≥ 35 kg/m² who were evaluated for bariatric surgery. Participants were grouped according to HbA1c levels: those with HbA1c ≥ 6.5% and those with HbA1c < 6.5%. TyG, atherogenic index of plasma (AIP), fibrosis-4 (FIB-4), aspartate aminotransferase-to-platelet ratio index (APRI), and hematological inflammation markers were assessed and compared between groups. To investigate associations, correlation and regression analyses were conducted.

Individuals with HbA1c ≥ 6.5% had significantly higher TyG, AIP, APRI, and FIB-4 values than those with lower HbA1c. The TyG index showed a strong correlation with both HbA1c (r = 0.403, p < 0.001) and AIP (r = 0.866, p < 0.001), and was identified as an independent predictor of HbA1c, explaining 20.5% of its variance. Moderate correlations were also found between liver fibrosis scores and systemic inflammatory indices. No significant differences were observed in hematologic markers across HbA1c groups, suggesting a closer link between inflammation and obesity rather than glycemic status.

The TyG index may serve as a practical and accessible marker for metabolic risk and glycemic control in obese individuals. Its integration with other noninvasive indices like AIP, APRI, and FIB-4 may support a more comprehensive evaluation of cardiometabolic and hepatic risk profiles in clinical settings.

Chronic kidney disease (CKD) and oral health are important public health problems worldwide, resulting in various complications. This study aimed to confirm the association between CKD and the number of teeth using data from the Korea National Health and Nutrition Examination Survey (KNHANES), which is representative of Korean adults. This study used raw data from the 6th and 7th (2013-2018) KNHANES and targeted 16,125 adults aged 40 years or older in Korea. Chronic kidney disease was defined as 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Multiple logistic regression analysis was used to examine the association between CKD and the number of teeth. The prevalence of CKD was significantly higher in the group with fewer than 20 teeth. In the multivariate logistic regression analysis, CKD was associated with having fewer than 20 teeth after adjusting for age, sex, household income, education, alcohol consumption, smoking, body mass index, hypertension, diabetes mellitus, angina, myocardial infarction, stroke, dyslipidemia, and performance of an oral examination within 1 year, daily toothbrushing frequency, and hygiene product use (Odds ratio = 1.34; 95% Confidence Interval = 1.03-1.74). Therefore, CKD may contribute to an increased risk of tooth loss. Implementing an integrated healthcare approach for oral health management in individuals with CKD could help reduce their burden of oral diseases.

Malignant otitis externa (MOE) is a rare, potentially life-threatening disease. It involves inflammation of the external auditory canal with concomitant osteomyelitis of the temporal bone, usually with evidence of Pseudomonas aeruginosa. The patient population is often immunocompromised, mostly due to inadequately treated type 2 diabetes mellitus or the use of immunosuppressants. Erosion of the temporal bone is common and can lead to complications such as peripheral facial nerve paralysis, meningitis, and/or cochlear and vestibular damage. The treatment of choice is usually several weeks of antibiogram-controlled intravenous antimicrobial therapy and possibly surgical treatment. Furthermore, if available, optimization of antidiabetic therapy is essential. A retrospective, descriptive, single-center study was performed to characterize consecutive real-life patients with MOE at the University Hospital Munich, Ludwig-Maximilians University, Germany. Thirteen patients with MOE were included in this study. Patient data concerning age, sex, comorbidities, pathogen spectrum, radiological imaging, antibiotic and surgical treatment and other variables were analyzed. In this study, we present a detailed description of a cohort of patients with MOE and propose a therapeutic algorithm that focuses on a combination of antibiotic therapy and surgical debridement of the affected tissue.

Diabetic carotid atherosclerosis is a prevalent vascular disease in individuals with diabetes mellitus, imposing a significant global burden. A lesser-known risk factor for the development of diabetes and its associated atherosclerosis is sleep disturbance. Obstructive Sleep Apnea Syndrome has been confirmed by many studies to affect atherosclerosis, but the mechanism of other nonobstructive sleep disorders such as the number of awakenings on atherosclerosis is still unclear. This study aims to investigate the relationship between sleep patterns and carotid atherosclerosis in diabetic patients.

Experiments were designed, and Huawei Band 9 bracelets were utilized to monitor the sleep patterns of patients. Specific sleep indicators such as number of nighttime awakenings, time taken to fall asleep, waking time, duration of deep sleep, duration of shallow sleep, rapid eye movement (REM) duration, and sleep breathing quality were recorded. Carotid artery ultrasound was performed to assess the severity of carotid atherosclerosis in all patients, followed by statistical analysis to examine the correlation between sleep parameters and carotid atherosclerosis grades in diabetic individuals.

Spearman correlation analysis revealed that age, duration of hypertension, number of nighttime awakenings, proportion of shallow sleep, average duration of shallow sleep per night, hypertension severity, years of smoking, and duration of diabetes were identified as risk factors for diabetic carotid atherosclerosis. Ordinal logistic regression analysis showed that diabetic carotid atherosclerosis was more severe in patients with a sleep score of less than 76 compared to those with a score greater than or equal to 76 (OR = 2.497, 95%CI 1.034-6.032). Patients with a shallow sleep duration of greater than or equal to 5.4 h had a higher grade of diabetic carotid atherosclerosis than those with a duration of less than 5.4 h (OR = 6.475, 95%CI 1.573-26.656), and patients with more than 4 awakenings had more severe diabetic carotid atherosclerosis than those with less than 4 awakenings at night (OR = 2.933, 95%CI 1.035-8.314). The degree of carotid atherosclerosis in diabetic patients over 60 years old is higher than that in diabetic patients under or equal to 60 years old (odds ratio = 4.019, 95% confidence interval: 0.496-2.285). (P < 0.05, Table 3, Fig. 4). The results of the multivariate ordinal logistic model showed that compared to patients with a shallow sleep duration of less than 5.4 h, patients with a duration of greater than or equal to 5.4 h had higher grades of diabetic carotid atherosclerosis (OR = 4.50, 95% CI 1.010-20.045) (P < 0.05).

Prolonged periods of shallow sleep are associated with diabetic carotid atherosclerosis.

ChiCTR2300069928.

Diabetic foot ulcers (DFU) typically exhibit impaired healing due to dysregulated re-epithelialization and excessive inflammation. Succinate, a key metabolic intermediate, is now understood to regulate inflammation through G Protein-Coupled Receptor 91 (GPR91) and succinate dehydrogenase (SDH), although its role in DFU remains unclear.

Co-cultures of M2 macrophages and epithelial cells, along with clinical samples, were used to analyze the expression of GPR91 and SDH. Functional assays were performed using high glucose (HG)-treated M2 macrophages (HG-M2) and an in vivo model. Cytokine and growth factor levels in cell supernatant were measured, and molecular mechanisms were explored via qRT-PCR, flow cytometry, and western blot analysis.

Elevated glucose concentrations increased succinate levels and disrupted M2 macrophage-epidermal stem cells (EpSCs) interactions. GPR91 knockdown worsened HG-M2 dysfunction, while GPR91 overexpression (OE-GPR91) enhanced anti-inflammatory responses and reduced succinate. OE-GPR91-conditioned medium preserved EpSCs stemness and promoted migration mediated by hepatocyte growth factor (HGF). SDH inhibition (via Dimethyl malonate, DMM) boosted M2 macrophage activity by reducing reactive oxygen species (ROS) and upregulating Gpr91 expression. Mechanistically, GPR91 activated the pAkt/pGSK3β/β-catenin pathway, while DMM enhanced M2 macrophage function via the PI3K-Akt/pERK1/2 pathway.

GPR91 upregulation and SDH inhibition improve HG-M2 macrophage function, reduce inflammation, and enhance HGF-mediated EpSCs repair. Targeting both pathways may represent a promising approach to promote DFU healing.

Increased angiogenesis and vascular permeability are hallmarks of microvascular retinal diseases such as diabetic retinopathy and diabetic macular edema (DME). Periodic intravitreal injections of inhibitors of the vascular endothelial growth factor (VEGF) are first-line therapy, but their invasiveness and associated risks often lead to poor compliance and outcomes. Here, we investigate VIAN-c4551, a highly potent antiangiogenic cyclic heptapeptide, as a non-invasive topical ophthalmic alternative to the current standard of care for DME. VIAN-c4551 demonstrated high potency (IC₅₀ = 137 pM) to inhibit the permeability of human umbilical vein endothelial cell monolayers induced by VEGF. VIAN-c4551 eye drops potently (0.005% minimum effective dose) prevented, for up to 24 h, the retinal vascular leakage induced by VEGF injected intravitreally and reversed the increased retinal vascular permeability due to diabetes in rats and mice. VIAN-c4551 exhibited high penetrability across MDCK epithelium and, after a single eye drop in rabbits, reached the vitreous and the retina-choroid at concentrations several orders of magnitude above its IC₅₀ (C_max ~239 nM and ~ 6.7 µM, respectively, after 6 h) that lasted at least 24 h. In conclusion, VIAN-c4551 is a non-invasive, once-a-day potential intervention for preventing and reversing retinal vascular leakage in DME and other vascular retinopathies and preserving sight.

To identify risk factors associated with noninvasive prenatal testing (NIPT) failures due to a low fetal fraction (LFF, < 4%) and to evaluate appropriate management strategies.

This was a single retrospective cohort study conducted on consecutive NIPT procedures performed at a national prenatal diagnosis center between April 2016 and June 2022.

Among the 41,693 NIPT procedures conducted at Peking Union Medical College Hospital, 524 cases (1.3%) failed due to LFF. Testing failures were associated with an increased risk of rare fetal chromosomal abnormalities (OR 18.9). Independent risk factors for NIPT failure included antiphospholipid syndrome (OR 19.7), rare fetal chromosomal abnormalities (OR 17.9), body mass index ≥ 25 kg/m² (OR 8.1), low molecular weight heparin administration (OR 7.7), systemic lupus erythematosus (OR 6.1), and dichorionic twins (OR 2.1). NIPT failure was also associated with a higher incidence of gestational hypertension (2.9% vs. 0.7%; OR 4.0), preeclampsia (9.1% vs. 1.0%; OR 10.4), gestational diabetes mellitus (26.0% vs. 11.8%; OR 2.6), fetal growth restriction (4.7% vs. 0.9%; OR 5.4), spontaneous abortion (2.4% vs. 0.6%; OR 4.1), and preterm birth (10.0% vs. 3.6%; OR 3.0).

Pregnancies with NIPT failures are at a heightened risk for fetal chromosomal abnormalities and placenta-mediated complications, highlighting the need for enhanced monitoring and individualized management during perinatal care.

Consumer involvement in the co-design of diabetes self-management smartphone apps is vital. This scoping review explored how consumers are involved in the co-design processes and methods and approaches guiding this research.Our review was guided by Arksey and O'Malley's five-stage framework, PRISMA-ScR guidelines, and Witteman and colleagues' 11-item user-centered design (UCD-11) framework. We searched literature across five databases and examined types of consumer involvement in co-design and frequency of methods and approaches (i.e., co-design approaches, behavioral theories, and other frameworks), synthesizing findings in SPSS and Excel.Of the 14,206 initial items, 283 articles were included. Most studies were conducted in Asia (33.2%) and focused on type 2 diabetes (43.1%). All articles addressed at least one UCD principle, and prototype evaluation (UCD-3) was the most frequent (82.3%); 85.2% addressed iterative responsiveness (factor 2). Most articles (66.8%) did not report a particular method or approach; 20.5% used design-related approaches, with user-centered design being the most common (7.4%). Few articles (3.9%) utilized social cognitive theory.Overall, co-design activities were isolated by phase. Consumers were primarily involved in evaluating prototypes and had limited engagement in the early stages. Iterative responsiveness factor activities were underreported or limited in scope. The use of approaches, theories, and frameworks was inconsistent. Consumer involvement in the co-design of diabetes self-management apps is often limited to later phases, with minimal engagement during the critical preprototype phase. To enhance the relevance, effectiveness, and adoption of diabetes self-management apps, app designers should improve the reporting of co-design activities and engage consumers across all co-design phases.

Diabetic retinopathy (DR) is a prevalent microvascular complication of diabetes mellitus (DM) and remains the leading cause of blindness among the working-age population. Neurodegeneration, microvascular dysfunction, gliosis, and neovascularization are key hallmarks of DR. Emerging evidence has highlighted the involvement of protein post-translational modifications (PTMs) in DR progression. PTMs, including glycosylation, phosphorylation, ubiquitination, methylation, and acetylation, regulate protein stability, localization, and activity in response to hyperglycemic stress and oxidative damage, thereby perturbing the function of retinal vascular endothelial cells, neurons, and glial cells. A systematic literature search was performed in PubMed for studies published up to June 2025, using a combination of the term "Diabetic retinopathy" with keywords related to post-translational modifications, including "glycosylation", "phosphorylation", "ubiquitination", "methylation", "acetylation", and "SUMOylation". Eligible studies were limited to English-language publications that specifically examined the interaction between PTMs and DR, including both original research and review articles. Studies were excluded if they only mentioned PTMs and DR without investigating the direct relationship between them. This review did not involve formal statistical analysis or meta-analytic techniques. In this review, we first outlined the physiological roles of PTMs in vascular leakage, neovascularization, reactive gliosis, and retinal neuronal degeneration during DR. Next, we examined the contributions and interplay of distinct PTM types in these pathological events. Lastly, we explored the potential of PTMs as biomarkers and therapeutic targets in DR. A deeper understanding of the role of PTMs in DR may provide novel mechanistic insights and facilitate early diagnosis and treatment of DR.

Gestational diabetes mellitus (GDM) is a known risk factor for dyslipidaemias. Insulin resistance and the associated dyslipidaemia, particularly hypertriglyceridaemia, have been less frequently linked to peripheral nerve dysfunction, including small fibre sensory neuropathy. The relationship between metabolic disturbances, such as hypertriglyceridaemia, and neuropathy warrants further exploration and has gained increasing recognition in recent studies. This case highlights the potential neurological consequences of lipid abnormalities in women with a history of GDM. A 38-year-old woman presented to an endocrinologist with a 4-week history of paraesthesias and incidental findings of significantly elevated triglycerides (78.4 mmol/L) and total cholesterol (14.7 mmol/L). Initially, numbness began in her left first toe, spreading to other toes on the left foot, and then to the right foot, accompanied by hyperalgesia in fifth fingers bilaterally. She had no history of trauma or back injuries. Her medical history included insulin-dependent GDM and HELLP syndrome 4 years prior, endometriosis, and adenomyosis. With persistently high lipid levels (cholesterol: 12.1 mmol/L; triglycerides: 18.5 mmol/L), she was admitted to ICU for urgent lipid-lowering treatment but experienced hypoglycaemia on an insulin-dextrose infusion. Repeat triglycerides the next day were 13.1 mmol/L. A neurologist diagnosed her with small fibre sensory neuropathy secondary to hypertriglyceridaemia. Treatment with fenofibrate, high-dose fish oil, and a low-fat, low-carbohydrate diet was initiated with outpatient endocrinologist follow-up. Hypertriglyceridaemia is a significant health concern, potentially leading to severe complications such as peripheral neuropathy. Early intervention to optimise lipid levels is essential to prevent adverse outcomes.

GDM is known to be a risk factor for dyslipidaemias. Hypertriglyceridaemia can contribute to small fibre sensory neuropathy via mechanisms including microvascular ischaemia, oxidative stress, and inflammation affecting peripheral nerves. Diagnosis requires clinical correlation with lipid profiles and neurological findings, and exclusion of other causes through targeted investigations such as nerve conduction studies and autoimmune screening. Early recognition of hypertriglyceridaemia is essential to prevent complications such as neuropathy. Acute management may involve insulin-dextrose infusion in cases of severe elevation, while long-term treatment includes fibrates, omega-3 fatty acids, and dietary modifications.