The trace elements selenium, zinc, copper, manganese, iodine, and iron are crucial for various physiological processes, including enzymatic reactions and immune responses. Dyshomeostasis of trace elements is associated with a variety of diseases including diabetes and cardiovascular diseases. It has not been clarified whether blood trace elements associate with the risk of diabetes-related vascular complications. We aimed to investigate the prospective associations between pre-diagnosis serum levels of trace elements with vascular complications in diabetes.

Participants with incident diabetes and free of micro- and macrovascular disease and with pre-diagnostic serum trace element measurements from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort (n = 627) were followed for microvascular and macrovascular complications (n = 212 and n = 69, respectively, median follow-up: 12.8 years). We used Cox Proportional Hazard models to investigate the associations between baseline trace element levels (per SD difference) and the risk of developing diabetes-related vascular complications. To investigate the interactions and nonlinear associations between TEs and risk of diabetes-related complications, we applied Bayesian kernel machine regression (BKMR).

In multivariable models, higher iodine levels were associated with higher risk of developing total vascular complications (HR per SD, 95% CI: 1.16, 1.02-1.31) and microvascular complications (1.18, 1.03-1.35). In sex-stratified analyses we observed significant positive associations between zinc and total vascular complications (1.35, 1.06-1.73) and microvascular complications (1.52, 1.15-2.02) in women, while higher zinc was associated with increased risk of macrovascular complications in men (1.33, 1.00-1.77). Copper-to-Zinc ratio was inversely associated with the risk of microvascular complications in women (0.69, 0.54-0.88), but with an increased risk in men (1.54, 1.17-2.02).

Our findings indicate that higher serum levels of iodine measured prior to the diagnosis of diabetes are associated with higher risk of subsequent microvascular complications in diabetes, while copper-to-zinc ratio is associated with microvascular complications in a sex-specific manner.

To characterize the associations between nighttime sleep duration and control of blood pressure (BP) and glycemia in individuals with comorbid hypertension and diabetes, we conducted a cross-sectional analysis of 2794 participants aged ≥ 50 years with confirmed diabetes and hypertension. Participants were categorized into five self-reported nighttime sleep duration groups: < 6 h, 6-7 h, 7-8 h, 8-9 h, and > 9 h. Multivariable logistic regression models were used to evaluate associations between sleep duration and BP/glycemic control, with adjustment for demographic, clinical, and behavioral confounders. We observed that prolonged sleep duration (> 9 h) was independently associated with uncontrolled BP after confounder adjustment. Subgroup analyses revealed that short sleep duration (< 6 h and 6-7 h) was linked to uncontrolled BP among males, whereas prolonged sleep duration was associated with uncontrolled BP among females, participants under 65 years, those with regular medication adherence, and non-nappers. For glycemic control, prolonged sleep duration conferred a protective effect among normal-weight individuals, but this association was not evident in the overall sample. Our results suggested that BP regulation may play a dominant role in competitive metabolic regulation demands compared to glycemic regulation. We recommended that individualized interventions aimed at modifying the habitual sleep duration of patients with comorbidities may be a crucial strategy to enhance BP and blood glucose management.

Diabetic foot ulcers (DFUs) represent a significant challenge in diabetic care, with variable prognoses influenced by factors such as ulcer location, depth, and the presence of infection or ischemia. The Site, Depth, and Infection/Ischemia (SDI) classification system is a potential tool for predicting DFU outcomes, but its prognostic value requires further investigation. This retrospective cohort study, conducted at Qingdao Haici Hospital between January 2021 and December 2022, included 261 diabetic patients with DFUs located at or distal to the ankle joint. The SDI classification system was applied to categorize ulcers based on site, depth, and infection/ischemia. Patient outcomes, including healing time, minor and major amputations, and mortality, were assessed, with follow-up conducted through telephone or outpatient visits. Statistical analysis was performed using SPSS version 27, with p-values < 0.05 considered statistically significant. The study included 240 patients after exclusions. Significant differences in healing time, amputation rates, and mortality were observed across different SDI classifications. Patients with hindfoot ulcers (S3) had the longest healing time (9.3 months) and the highest mortality (23.1%). Deeper ulcers (D3) also exhibited longer healing times (4.3 months) and higher mortality (18.5%). Patients with both infection and ischemia (I3) had the longest healing time (5.6 months), highest amputation rates, and increased mortality. Statistical analyses revealed significant differences in healing time (p < 0.001), amputation rates (p = 0.000), and mortality (p = 0.017) across classification groups. The SDI classification system effectively predicts outcomes in DFU patients, with higher SDI grades associated with longer healing times, higher amputation rates, and increased mortality. This study highlights the clinical utility of the SDI system and underscores the need for its further implementation in clinical practice for better patient management and prognostic assessment.

Objective: To investigate the prevalence, comorbidity patterns, and associated factors of cardiometabolic multimorbidity (CMM) in China. Methods: From 2012 to 2015, a total of 34 994 residents aged ≥35 years were enrolled using a stratified multistage random sampling method across 31 provinces, autonomous regions, and municipalities in China. Data were collected through questionnaires, covering demographic characteristics, behavioral and lifestyle factors, and self-reported history of cardiometabolic diseases. CMM was defined as the coexistence of two or more cardiometabolic diseases in the same individual. Association rule analysis using the Apriori algorithm from the arules package was employed to identify strong CMM patterns. Multivariable logistic regression was employed to explore factors associated with CMM. Results: The mean age of the participants was 55.6 years. Among them, 15 926 were male (45.51%). The prevalence of cardiometabolic multimorbidity (CMM) was 11.25% (3 937/34 994). A total of 35 distinct CMM combinations (each with a frequency ≥10) were identified. The most prevalent dyad, triad, and tetrad comorbidity patterns were hypertension+hyperlipidemia (1 036 cases), hypertension+hyperlipidemia+diabetes (352 cases), and hypertension+stroke+hyperlipidemia+diabetes (54 cases), respectively. Nine strong CMM patterns were identified using the Apriori association rule algorithm. Multivariable logistic regression analysis showed that older age (≥70 years: OR=17.39,95%CI 13.92-21.71,P<0.01), junior high school education (OR=1.31, 95%CI 1.17-1.48, P<0.01), senior high school or above education (OR=1.45, 95%CI 1.27-1.65, P<0.01), retirement (OR=3.09, 95%CI 2.76-3.46, P<0.01), unemployment or being laid-off (OR=1.16, 95%CI 1.06-1.28, P<0.01), a family history of cardiometabolic disease (OR=4.37, 95%CI 4.04-4.72, P<0.01), regular smoking (OR=1.38, 95%CI 1.24-1.53, P<0.05), and occasional smoking (OR=1.21, 95%CI 1.00-1.49, P<0.01) were significantly associated with an increased risk of CMM. Conclusion: The prevalence of cardiometabolic multimorbidity in China is relatively high, with the most common comorbidity patterns involving combinations of hypertension and hyperlipidemia, often accompanied by diabetes and stroke. Older age, retirement status, smoking, and a family history of cardiovascular disease are associated with an increased risk of both single and multiple cardiometabolic conditions. Greater attention should be paid to individuals with a single cardiometabolic disorder due to their elevated risk of developing multimorbidity.

High visceral fat mass (FM) is associated with a high risk of cardiometabolic morbidity. Meanwhile, loss of skeletal muscle (lean mass, LM) has been suggested to contribute to metabolic diseases.

We investigated associations between cardiometabolic diseases and dual energy X-ray absorptiometry (DXA)-measured body composition indices, including the FM index (FM/height²), percent body fat, trunk-to-appendicular fat ratio (TAR), trunk-to-leg fat ratio (TLR), LM index (LM/height²) and FM-to-LM ratio in 595 community-dwelling elderly Japanese men (mean age, 74 years; standard deviation, 6; range, 65 to 94). Hypertension was identified as high blood pressure and/or the use of antihypertensive drugs. Diabetes was identified as high hemoglobin A1c and/or the use of antidiabetic drugs. The ability of DXA-based indices to discriminate between the presence and absence of cardiometabolic diseases was evaluated using area under the curve (AUC) calculated by receiver operating characteristic curve analysis.

Body mass index, FM index, percent body fat, TAR, TLR and FM-to-LM ratio were significantly associated with hypertension (P < 0.05). TAR and TLR, but not body mass index, FM index, percent body fat, LM index and FM-to-LM ratio, showed significant positive associations with diabetes. The AUC for the LM index was significantly lower than those for the FM index, percent body fat and FM-to-LM ratio. No associations were observed between the LM index and hypertension, dyslipidemia and diabetes.

The association between cardiometabolic function and LM, which includes skeletal muscle, may not be as pronounced or stronger than associations between cardiometabolic function and FM. Further detailed studies are needed to clarify how skeletal muscle contributes to cardiometabolic disease.

The National Coordination Committee (NCC) for the National Tuberculosis Elimination Programme (NTEP) has mandated bi-directional screening for Tuberculosis(TB) and Diabetes Mellitus(DM). The study aims to validate a multidimensional tool to assess the correct knowledge of TB and the barriers and facilitators to TB screening in DM patients.

To develop and validate a tool for assessing knowledge, barriers, and challenges in TB screening among DM patients by figuring out the Content Validity Ratios and Indices.

A multidimensional scale using deductive methods was designed. Between January 2023 and March 2023, ten subject matter experts were contacted in person or by email to validate the tool. Item Impact Score (IIS, Face Validity), Lawshe's Content Validity Ratio (CVR), and Scale Content Validity Indices (CVI) for relevance were computed. For the final tool, only the items with Item Impact Scores of ≥1.5, CVRs of ≥0.62, and CVIs of ≥0.62 (p-value <0.05) were taken into consideration.

The Item Impact Score (Face Validity) of all the items accepted as knowledge, barriers, and challenges for TB among DM patients was ≥1.5. Content Validity Ratios (CVR) for the usefulness of all items related to knowledge, barriers, and challenges for TB was ≥0.62. The Scale Content Validity Indices (for relevance), i.e., S-CVI (Average) and S-CVI (Proportional relevance), were ≥0.62 and all the items were accepted.

The score for Item Impact (IIS), Ratios for Content Validity (CVR), and Indices measuring the content validity of a scale (CVI) in all domains of the final tool were accepted, which contained 38 items.

Lower extremity amputation (LEA) is a significant health concern in Jordan, yet comprehensive data on its demographic and clinical characteristics remain limited. This retrospective analysis evaluated 893 LEA cases collected from Al-Basheer Hospital and six private prosthetic clinics in Amman between 2017 and 2023. Transtibial amputations (68.99%) were the most common, followed by transfemoral amputations (24.53%). Males were three times more likely than females to undergo LEA, with an overall mean age of 48.43 years (SD = 20.42). Diabetes mellitus (55.88%) was the leading cause, followed by cancer (18.48%) and trauma (11.65%). Age and cause were significantly associated (p < 0.01); DM-related amputations were more prevalent among older adults (mean age 62.04 years). The findings highlight that TT amputations in older males with diabetes represent the most common LEA profile in Jordan. Targeted public health initiatives including diabetic foot care education, early detection, and regular screenings, are urgently needed to reduce LEA incidence in the country.

Aims/Background Data from randomized controlled trials (RCTs) comparing the efficacy and safety of thrice-weekly insulin degludec (IDeg 3TW) versus once-daily insulin glargine (IGlar OD) in patients with type 2 diabetes mellitus (T2DM) are scarce and not uniform. Moreover, no systematic review and meta-analysis (SRM) is available for such a comparison. This SRM aimed to compare the effectiveness and safety of IDeg 3TW versus IGlar OD in the available RCTs in T2DM. Methods Electronic databases and registers, which include MEDLINE (via PubMed), Scopus, Cochrane Central Register, and ClinicalTrials.gov, were searched for RCTs conducted among T2DM subjects with IDeg 3TW as intervention and IGlar OD as control from inception to 30 July 2024. The primary outcome was glycated haemoglobin (HbA1c) reduction from baseline; secondary outcomes were the changes in other glycemic parameters and adverse events (AEs). RevMan web was used to conduct meta-analysis using random-effects models. Outcomes were presented as mean difference (MD), odds ratio (OR), or risk ratio (RR) with 95% confidence intervals (CIs). Results Three RCTs (N = 1171) with study durations ranging from 16-26 weeks and minimal risk of bias were included. IDeg 3TW was less effective than IGlar OD in HbA1c reduction (MD 0.27%, 95% CI [0.14, 0.39], p < 0.0001), reduction in mean nine-point self-monitored capillary blood glucose profile (MD 0.45 mmol/L, 95% CI [0.22, 0.67], p < 0.0001), and HbA1c reduction <7% (OR 0.69, 95% [0.53, 0.89], p = 0.005). IDeg 3TW outperformed IGlar OD regarding the mean daily insulin dose (MD -0.07 U, 95% CI [-0.13, -0.01], p = 0.02). However, both groups achieved comparable fasting plasma glucose reduction (MD 0.37 mmol/L, 95% [-0.19, 0.93], p = 0.19), changes in body weight (MD 0.04 kg, 95% CI [-0.46, 0.55], p = 0.86), and overall physical (MD 0.21, 95% CI [-0.62, 1.04], p = 0.62) and mental health scores (MD -0.02, 95% CI [-1.05, 1.01], p = 0.97). The risks for confirmed hypoglycemia (RR 1.16, 95% CI [0.83, 1.62], p = 0.38), nocturnal hypoglycemia (RR 1.18, 95% CI [0.49, 2.84], p = 0.71), any AEs (RR 1.04, 95% CI [0.84, 1.30], p = 0.71), serious AEs (RR 1.43, 95% CI [0.77, 2.65], p = 0.25), and injection-site reactions (RR 1.29, 95% CI [0.56, 2.96], p = 0.55) were identical in the two groups. Conclusion In short-term follow-up, IDeg 3TW was less effective than IGlar OD in glycaemic control; however, their safety profile was comparable. Larger multicenter RCTs comparing the overall benefit-risk ratio are necessary for appropriate clinical practice decisions. Systematic Review Registeration PROSPERO: CRD42024593493.

 To evaluate changes in the vascular density of the deep and superficial capillary plexus of the retina, the area of the foveal avascular zone, central retinal thickness, and best corrected visual acuity in patients with diabetic macular edema treated with anti-VEGF agents.

 In a prospective study at the Ophthalmology Clinic of FNHK, we evaluated a group of 41 eyes of 30 patients (19 men and 11 women) with diabetic macular edema treated with Lucentis or Eylea. The average age of the patients was 61.7 ±11.3 years. Average initial visual acuity was 64.4 ±9.1 letters on ETDRS optotypes. During the one-year follow-up period we monitored the density of the deep and superficial retinal capillary plexus using OCTA. We evaluated OCTA scans with the ImageJ program at 3, 6, 9, and 12 months. Additionally, the area of the foveal avascular zone, central retinal thickness, and best-corrected visual acuity were measured.

 During the one-year follow-up period there was a statistically significant change in both retinal capillary plexuses, with the density of the deep capillary plexus increasing (p.

Diabetic myelopathy is the pathological changes in the spinal cord due to diabetes. Despite extensive histopathological evidence supporting spinal cord atrophy, only two in vivo studies have reported radiological spinal cord atrophy, without any electrophysiological correlation, in diabetic patients.

Our study aims to determine the radiological and electrophysiological patterns of spinal cord involvement in patients with and without nerve conduction study-proven neuropathy.

A cross-sectional analytical study was conducted on all consenting type 2 diabetic patients, 18-65 years old, admitted to our diabetic ward after executing stringent inclusion and exclusion criteria. After screening and categorizing the patients for neuropathy via clinical and electrophysiological methods, the patients were subjected to magnetic resonance imaging of the cervical spine and somatosensory evoked potential to trace radiological and electrophysiological evidence of spinal cord involvement and also to make a comparison between neuropathy and non-neuropathy subjects.

We demonstrated significant radiological spinal cord atrophy (P value 0.006) and electrophysiological slowing of conduction velocities within the spinal cord (P value <0.001) in patients with diabetic neuropathy as compared to diabetic patients without neuropathy. Furthermore, the post hoc analysis suggested a significant association of the severity of neuropathy with the severity of myelopathy (χ2 11.927, P value 0.003) and glycemic status (χ2 7.564, P value 0.023).

The study demonstrates significant radiological and electrophysiological spinal cord involvement in diabetic neuropathy patients than in non-neuropathy patients. The severity of spinal cord involvement is associated with the severity of neuropathy.