Perioperative high-dose steroids are widely used to reduce postoperative inflammation, pain, and complications but remain controversial in patients with insulin-treated diabetes due to concerns about hyperglycemia and infections. This study aimed to examine the use of perioperative high-dose steroids and its effect on discharge glucose concentration, length of stay (LOS), and 30-day readmissions in insulin-treated patients with diabetes undergoing fast-track hip or knee arthroplasty.

We conducted a prospective observational study in patients with insulin-treated diabetes undergoing fast-track hip or knee arthroplasty across eight Danish centers. Patient demographics, including diabetes treatments, perioperative steroid, discharge blood glucose concentration, LOS, and 30-day readmissions were prospectively extracted from the electronic health records through chart review. Our primary outcome was differences in mean discharge blood glucose concentration between patients with insulin-treated diabetes receiving perioperative high-dose steroid and no/antiemetic steroid. Secondary outcomes included the fraction with a LOS > 2 and 30-day readmissions between the groups. As a sensitivity analysis, discharge blood glucose concentration was compared between the insulin-treated patients and a propensity-score matched cohort of non-insulin-treated patients with diabetes all receiving high-dose steroids.

Of 292 registered patients with insulin-treated diabetes, 64% received high-dose steroids. Median discharge blood glucose was 11.0 mmol/L [IQR 8.9-13.5] in the high-dose steroid group versus 9.7 mmol/L [IQR 7.4-12] in the no/antiemetic steroid group (p = 0.011). LOS > 2 days occurred in 10.1% (95% CI: 6.6-15.3) of the high-dose group and 15.2% (95% CI: 9.6%-23.3%) of the no/antiemetic steroid group (p = 0.200). The 30-day readmission rates were 8% (95% CI: 4.8-13) and 8.3% (95% CI: 4.3-15.6), respectively (p = 0.923). Compared to propensity-matched patients with non-insulin-treated diabetes receiving high-dose steroids, patients with insulin-treated diabetes had a 2.1 mmol/L (95% CI: 1.3-2.8) higher mean discharge blood glucose concentration (p = < 0.001).

Glucose levels at discharge were slightly, but significantly higher in insulin-treated patients with diabetes receiving high-dose steroids compared to those receiving no/antiemetic doses and to non-insulin treated diabetes patients receiving high-dose steroids. However, there was no increase in fraction with LOS > 2 days or 30-day readmissions in the patients having high-dose steroids. Despite increased discharge glucose concentration, this suggests no evident safety concerns using high-dose steroids in insulin-treated diabetes patients having fast-track arthroplasty.

This multicenter study addresses the debated use of a high-dose perioperative glucocorticoid in insulin-treated patients with diabetes undergoing fast-track arthroplasty. Despite modestly increased discharge glucose levels, no safety signals were observed regarding length of stay or readmissions. These findings support cautious use of a single high-dose perioperative glucocorticoid in this population. However, larger randomized studies are needed to confirm these findings.

Breast cancer (BC) is the most common tumor worldwide and it has been recognized that up to one third of BC patients have co-existing diabetes mellitus (DM) (BC-DM). Although many observational studies have indicated an association between DM and BC, the causal relationship of DM and BC prognosis remained uncertain and the molecular mechanisms underlying BC-DM are largely unclear. In this study, we used causal inference methods, including g-computation (GC), inverse probability of treatment weighting (IPTW), targeted maximum likelihood estimation (TMLE), and TMLE-super learner (TMLE-SL), to comprehensively analyze the association of DM with BC mortality in a cohort of 3386 BC patients. We found that the adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for 5-year mortality in BC-DM patients were 1.926 (1.082, 2.943), 2.268 (1.063, 3.974), 1.917 (1.091, 2.953), and 2.113 (1.365, 3.270), respectively. Further transcriptomic and qPCR analyses identified that FIBCD1 was highly expressed in BC-DM tumor tissues and in BC cells under hyperglycemia conditions. Functionally, upregulation of FIBCD1 promoted proliferation, migration, and invasion capacities of BC cells in a glucose level-dependent manner. While knockdown of FIBCD1 suppressed BC tumor growth in diabetic mice. Integrated RNA-seq and Ribo-seq analysis revealed that MCM5 was a target of FIBCD1. Mechanistically, hyperglycemia-activated FIBCD1 promoted MCM5 expression to induce S-phase cell cycle arrest by upregulating histone H3K27ac levels in MCM5 promoter via the PDH-acetyl-CoA axis. Our findings provide new evidence that co-existing DM has a causal effect on overall mortality in BC-DM patients. Targeting FIBCD1 may be a promising therapy for BC-DM.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors were originally developed as glucose-lowering agents for patients with type 2 diabetes mellitus (T2DM). However, a growing body of robust clinical evidence has demonstrated their profound cardioprotective and nephroprotective effects that extend beyond glycemic control. This review summarizes the current understanding of the mechanisms underlying these benefits and the clinical implications across a wide range of patient populations. We discuss landmark cardiovascular and renal outcome trials, evaluate the physiological and molecular mechanisms, including hemodynamic modulation, anti-inflammatory and antifibrotic effects, and improvements in myocardial and renal energetics, and assess the role of SGLT2 inhibitors in heart failure with reduced and preserved ejection fraction, as well as in chronic kidney disease with and without diabetes. The translation of these findings into clinical guidelines has reshaped therapeutic strategies in both endocrinology and cardiology, underscoring the importance of SGLT2 inhibitors as a cornerstone in cardiorenal protection.

Clinical guidelines recommend that patients with diabetes mellitus (DM) are screened annually for kidney disease with estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR). To improve screening, we implemented clinical decision support (CDS) at UVA Health in April 2022. This included: (1) auto-enrollment of primary care patients with DM in an electronic health record (EHR)-based health maintenance plan; and (2) prompting one-click ordering of the Kidney Profile (KP; panel including UACR and eGFR) or UACR alone, as needed.

We assessed effectiveness of the CDS using an interrupted time series approach across 3 periods (pre-COVID-19 control: January 2019-February 2020; post-COVID-19 control: March 2021-April 2022; post-CDS: May 2022 to April 2023). All non-acute office and telehealth encounters in primary care for patients aged ≥22 years with DM, no coded diagnosis of CKD in the prior 4 years, and due for screening (i.e., not screened for CKD in past 365 days). Screening was assessed as orders placed for UACR within 30 days of the encounter and aggregated by calendar months.

There were 66,388 encounters (23,419 pre-COVID-19 control; 22,611 post-COVID-19 control; 20,358 post-CDS). The screening trend in both control periods was similar, therefore only the post-COVID-19 control was considered further. Demographics, encounter types, and clinic distribution were similar in the control and post-CDS periods. There was an immediate screening difference of 3.02% (95% CI, 0.37- 5.68; p=0.03) after the CDS, and screening acceleration with a difference in screening rate of 0.57% each month compared to 0.06% per month prior to the CDS (p<0.01). Results were similar if encounters for patients with prior CKD by laboratory criteria were removed.

Roll out of CDS coincided with immediate and ongoing improvement in annual screening for CKD among adult patients with DM. These results suggest that simple CDS may be an effective intervention to promote CKD screening.

Insulin resistance (IR) is central to metabolic syndrome and contributes to the development of type 2 diabetes mellitus (T2DM) as well as mild cognitive impairment (MCI). Several low-cost surrogate markers have been proposed to assess IR, such as the triglyceride-glucose (TyG) index, TyG-BMI, TG/HDL-C, metabolic score for insulin resistance (METS-IR), and single-point insulin sensitivity estimator (SPISE). This study aimed to develop nomogram models integrating these indices with clinical data to predict MCI in patients with T2DM.

A total of 600 patients diagnosed with T2DM were recruited. Demographic, clinical, and biochemical parameters were documented, and cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). Logistic regression analyses identified predictors of MCI, and receiver operating characteristic (ROC) curves evaluated their predictive accuracy. Two nomogram models were constructed: Model 1 included METS-IR, age, sex, education level, and hypertension; Model 2 substituted SPISE for METS-IR, retaining other clinical variables.

All IR surrogate indices were significantly associated with MCI and reduced MMSE scores (P < 0.001). METS-IR and SPISE exhibited higher predictive accuracy (AUC: METS-IR = 0.809, SPISE = 0.805) compared to TyG, TyG-BMI, and TG/HDL-C, particularly among female participants. Nomogram models demonstrated robust predictive performance (AUC: Model 1 = 0.846; Model 2 = 0.838).

Nomogram models incorporating METS-IR or SPISE alongside key clinical parameters effectively predicted the risk of MCI among patients with T2DM. These indices notably outperformed other surrogate markers, highlighting their clinical value for early assessment of cognitive risk.

While antidepressants are routinely prescribed to manage depression and anxiety, their long-term ramifications on reproductive health and the well-being of offspring are still shrouded in ambiguity. This review meticulously sifted through clinical trials pinpointing antidepressant usage among individuals of childbearing potential, highlighting safety concerns regarding reproductive health and the subsequent effects on offspring. We delved into studies spanning from January 1, 2000, to December 30, 2023, inclusively analysing randomized controlled trials, cohort studies, and case-control studies. Our synthesis illuminates a concerning correlation between antidepressant intake and an array of sexual dysfunction. Among pregnant users, an alarming connection was noted with heightened incidences of miscarriage, preterm births, postpartum haemorrhage and gestational diabetes mellitus. Newborns subjected to antidepressant exposure were at an elevated risk of low birth weight, necessitated more frequent admissions to neonatal intensive care units, small for gestational age, malformation and other adverse outcomes in newborns. The underpinning mechanisms triggering these adverse outcomes seem to intertwine with GABA receptor interactions, induced oxidative stress, and disruptions in mitotic spindle assembly. The surfacing evidence of antidepressants' potential reproductive toxicity underscores the need for circumspection in their prescribing practices. It becomes crucial to not only clearly communicate these risks to patients but also to tailor treatment decisions to meticulously balance individual needs against potential risks. Looking ahead, future endeavours should pivot towards a deeper understanding of the detrimental effects antidepressants may harbour on reproductive health and offspring vitality. This necessitates devising innovative strategies that mitigate these risks, thereby safeguarding treatment efficacy for generations to come.

Falls are commonly reported incidents that affect the safety of patients during inpatient hospitalization. Inpatient rehabilitation (IR) units report the highest fall rates when compared with other hospital units. Falls commonly result in patient injury and elevate episode costs. There is a dearth of information regarding characteristics of patients who fall during physical therapy sessions, which represents a unique subset of falls.

The aim of the study was to describe the nature of falls, characteristics of fallers, and characteristics of therapists who experienced patient falls, which occurred during physical therapy sessions in IR.

This was an observational study which included a retrospective analysis of medical records.

This study examined falls occurring within 2 IR departments at a large hospital system located in an urban setting in the United States.

This study involved patients receiving adult IR with diagnoses including, but not limited to, stroke, traumatic brain injury, and spinal cord injury.

This study examined characteristics of patients who fell as compared with patients who did not fall, quantified the conditions surrounding falls, and described physical therapists who experienced patient falls.

Mann-Whitney U tests, chi square tests, and binomial logistic regression analyses were performed to compare characteristics of faller and non-faller groups.

Among the 6238 unique patient admissions, a total of 40 falls were identified. The rate of falling was 0.43 falls per 1000 patient days. The majority of falls occurred because of buckling (47.5%) and during gait training (40.0%). Falls most often occurred close to discharge (mode = 6 days prior). Fallers were younger than nonfallers [exponential power of B, ie, Exp(B), = 1.02; 95% CI = 1.01-1.04]. Diagnoses representing the largest proportion of fallers included brain dysfunction/stroke (30.0%) and spinal cord injury/peripheral nerve injury (30.0%). Fallers had comorbid diabetes mellitus type 2 [Exp(B) = 2.70; 95% CI = 1.45-5.04] and received renal dialysis [Exp(B) = 3.23; 95% CI = 1.14-9.17] in a higher proportion than nonfallers. Fallers were often high functioning, the majority receiving at most minimal assistance (72.5%). Falls most often occurred with therapists who had 1 to 2 years of experience (27.5% of falls).

The rate of falls during therapy was lower than the rate of falls previously reported in similar settings. Therapists should exercise caution when managing younger patients and patients with certain diagnoses. Therapists should screen for buckling risk when prescribing higher-risk activities. Therapists with various levels of experience should receive fall prevention training.

Therapists can use frequently occurring patient characteristics to screen for falling and use additional precautionary measures, particularly for patients with specific diagnoses, at higher risk for knee buckling, and of a younger age.

Diabetic ulcers resulting from neural and vascular perturbations represent a large proportion of non-traumatic lower limb amputations. Conventional treatments have limited efficacy. The non-invasive use of low-dose light treatments, termed photobiomodulation (PBM), has shown therapeutic benefits in diabetic patients. This study aimed to explore the response of endothelial cells to PBM treatment under hyperglycemic conditions in vitro. The major goal was to gain mechanistic insights into the biological effects of low-dose light, with the aim of optimising clinical treatment strategies. Therefore, human umbilical vein endothelial cells were exposed to hyperglycemic conditions (150-300 mM glucose) and incubated at 37°C with 5% CO₂ for 24 h. The cells were then treated with low-dose light (660 nm, CW, 10 mW/cm², 200 s and 0.84 Einstein). Cell responses were assessed through key signalling pathways, evaluating proliferation using the AlamarBlue assay, migration through the wound scratch assay and angiogenesis via the tubulogenesis assay, with assessments after 24 or 48 h. Data were analysed using one-way ANOVA followed by Tukey's post-test. Data showed that PBM treatments performed under controlled thermal conditions significantly improved endothelial cell proliferation, migration and tubulogenesis under hyperglycemic conditions. Crosstalk among platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF) and transforming growth factor beta (TGF-β1) signalling modulated these critical responses involving matrix metalloproteinases (MMP-2 and 9) activity. These findings showed that PBM treatments exert positive endothelial cell responses under hyperglycemic conditions that could contribute to improved diabetic wound healing. These observations provide mechanistic insights into enabling PBM as a novel and adjacent therapy for diabetic wound management.

Prolonged air leak (PAL) is a well-known issue that frequently results in extended hospitalization following pulmonary lobectomy. There have been many suggestions for preventing air leaks, but no one method has yet achieved definitive success. The purpose of this research was to determine the efficacy of autologous blood patch pleurodesis (ABPP) to treat PAL.

This retrospective study was conducted on 60 patients aged ≥ 18 years, involving both sexes, with PAL after pulmonary lobectomy. Patients were categorized into two groups: group A received ABPP for PAL, and group B did not receive ABPP.

Group A had a significantly lower invasive procedure rate than group B (P = 0.023). The incidence of reoperation was not significantly different between the two groups. Ten (33.33%) patients in group B required computed tomography (CT) scans to identify the residual air pockets, of whom six (20%) patients treated with bronchoscopy and CT-guided chest drain insertion in the residual air pocket. The mean ± standard deviation (SD) of chest tube removal after surgery was 7.77 ± 1.52 days in group A and 9.53 ± 3.48 days in group B (P = 0.014). Group A had a significantly shorter hospital stay after surgery than group B (P < 0.05). In linear regression, the amount of blood used was an independent predictor of chest tube removal after surgery (P = 0.003), while age, smoking, global initiative for obstructive lung disease, diabetes mellitus, and the Charlson comorbidity index were not.

ABPP is a prompt, safe, and successful method to treat post-lobectomy PAL, which shortens the time patients spend in the hospital and allows for the early removal of chest tubes.

Immune checkpoint inhibitors (ICIs) have transformed the treatment of metastatic solid tumors; however, they induce immune-related adverse events, such as ICI-induced type 1 diabetes mellitus (ICI-T1DM), a rare but serious condition requiring lifelong insulin therapy. We aimed to identify the risk factors and survival outcomes associated with ICI-T1DM to optimize screening and mitigate adverse effects.

This retrospective cohort study analyzed 6,956 patients treated with ICIs at a tertiary care center between January 1, 2017, and February 28, 2023. ICI-T1DM was classified based on the need for persistent insulin therapy post-ICI and a C-peptide level <1.0 ng/mL. Patient demographics, clinical characteristics, treatment details, and survival outcomes were examined.

ICI-T1DM was identified in 32 patients (0.46%) with a median onset time of 41 weeks. Significant risk factors included pre-existing diabetes (hazard ratio [HR], 2.352; 95% confidence interval [CI], 1.140 to 4.854), combination therapy with anti-programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) and anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitors (HR, 3.666; 95% CI, 1.224 to 10.979), prolonged ICI treatment (≥12 weeks; HR, 4.789; 95% CI, 1.806 to 12.701), and thyroid dysfunction (HR, 4.027; 95% CI, 1.847 to 8.779). ICI-T1DM occurrence and thyroid dysfunction were associated with improved survival (HR, 0.224; 95% CI, 0.093 to 0.539; and HR, 0.616; 95% CI, 0.566 to 0.670).

Patients with pre-existing diabetes, combined anti-PD-1/PD-L1 and anti-CTLA-4 therapy, prolonged ICI treatment (≥12 weeks), and thyroid dysfunction are at high risk of developing ICI-T1DM. The observed survival benefits in patients with ICI-T1DM underscore the importance of aggressive glucose monitoring and patient education for early detection and management.