Deep learning models leveraging electronic health records (EHR) for opportunistic screening of type 2 diabetes (T2D) can improve current practices by identifying individuals who may need further glycemic testing. Accurate onset prediction and subtyping are crucial for targeted interventions, but existing methods treat the tasks separately, thus limiting clinical utility. In this paper, we introduce a novel deep metric learning (DML) model that unifies both tasks by learning a latent space based on sample similarity. In onset prediction, the DML model predicts the onset of T2D 7 years later with an AUC of 0.754, outperforming logistic regression (AUC 0.706), clinical risk factors (AUC 0.693), and glycemic measures (AUC 0.632). For subtyping, we identify three subtypes with varying prevalences of obesity-related, cardiovascular, and mental health conditions. Additionally, the subtype with fewer comorbidities shows earlier metformin initiation and a greater reduction in HbA1c. We validated these findings using data from 300 U.S. hospitals in the All of Us program (T2D, n = 7567) and the Massachusetts General Brigham Biobank (T2D, n = 3298), demonstrating the transferability of our model and subtypes across cohorts.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) offer significant benefits for patients with type 2 diabetes mellitus (T2DM), including improved glycemic control, weight reduction, cardiovascular protection, and reduced all-cause mortality, which are particularly relevant to breast cancer survivorship. Disparities in access may worsen inequities in care. Using the TriNetX national electronic health record database, we conducted a retrospective cohort study of 119,430 breast cancer patients with type 2 diabetes (2005-2024; mean age 66.1 ± 11.4 years; 67.2% White, 22.9% Black, 5.7% Asian, 4.2% Other). After propensity matching, compared with White patients, Asian (HR 0.64, 95% CI 0.58-0.71), Black (HR 0.78, 95% CI 0.75-0.81), and Other race patients (HR 0.90, 95% CI 0.83-0.97) were significantly less likely to receive GLP-1RAs. These disparities persisted among overweight and obese subgroups: Asian (HR 0.78, 95% CI 0.68-0.88), Black (HR 0.78, 95% CI 0.74-0.81), and Other patients (HR 0.83, 95% CI 0.72-0.95). These findings underscore the urgent need to address inequitable access to GLP-1RAs in breast cancer survivorship care.

To describe screening programmes for early chronic kidney disease (CKD) in the USA and other English-speaking countries (Canada, Australia and UK) involving patients with diabetes or hypertension, in addition to high-risk racial or ethnic groups.

Systematic literature review.

Embase and MEDLINE (both via Ovid) between 1 January 2018 and 17 October 2023.

CKD screening programmes in patients with diabetes and/or hypertension in the targeted countries were included.

Publications meeting the review objectives and prespecified population, intervention, comparator, outcome and eligible study design types were identified. Full-text publications were assessed for quality by two independent reviewers. For randomised controlled trials, quality/risk of bias (ROB) was assessed using version 2 of the Cochrane ROB tool for randomised trials; for observational longitudinal or prospective studies and non-randomised trials, quality/ROB was assessed using the Newcastle-Ottawa Scale.

Of 5542 records identified from database searches, 21 studies were included. Of these, the majority (13 studies) screened patients with diabetes and/or hypertension. Screening programmes were described in 16 studies; the remaining 5 reported CKD prevalence. Of 30 643 162 pooled participants, 6 413 466 (weighted mean: 21%) received complete screening for CKD (ie, evaluation of albumin-to-creatinine ratio plus estimated glomerular filtration rate). The weighted mean prevalences of any type of CKD testing in patients with diabetes or hypertension were 33% and 12%, respectively. For the pooled population of 24 608 indigenous persons or underserved communities, the weighted mean prevalence of CKD screening was 91%. Weighted mean prevalences for any type of CKD testing were 22% (n=30 705 837) in primary care and 93% (n=26 640) in community outreach settings. Follow-up testing was infrequent or not reported in most studies.

These findings indicate a low prevalence of CKD screening of high-risk patients, particularly in primary care. Contrary to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, most high-risk patients studied received incomplete screening. Lack of adherence to KDIGO guidelines on CKD screening may result in delays in CKD diagnosis and missed opportunities for therapy.

CRD42023492433.

To develop and psychometrically evaluate a multidimensional Disaster Health Literacy Questionnaire (DHLQ) for diabetic patients in Iran, using advanced item response theory approaches. The questionnaire was designed in the Persian (Farsi) language.

A sequential mixed-methods study incorporating qualitative (scoping review and interviews) and quantitative (psychometric validation) phases.

Diabetes clinics and healthcare centres across Iran (2022-2023).

The study enrolled 570 patients with diabetes (56% female, mean age 45.57±16.33 years) for quantitative validation; 15 experts and 15 patients for qualitative validation.

The psychometric properties evaluated included content validity (using content validity ratio (CVR) and content validity index (CVI)), construct validity (assessed via multidimensional item response theory (MIRT)), and reliability (measured by Cronbach's alpha and test-retest Kappa). Additionally, item parameters (multidimensional difficulty (MDIFF) and multidimensional discrimination (MDISC)) and model fit indices (RMSEA, CFI and TLI) were examined.

The final 30-item DHLQ demonstrated excellent content validity (scale-level CVI=1; item-level CVI>0.79; CVR>0.49). Cronbach's alpha for the total scale was 0.606; test-retest reliability showed significant agreement (Kappa=0.35-1, p<0.05). MIRT confirmed a three-factor structure: Disaster Perception Risk (14 items), Medication-Nutritional Literacy (11 items), and Self-help and Emergency Literacy (five items). Model fit was excellent (RMSEA=0.016, CFI=0.96, TLI=0.95). Item analysis revealed that 73% of items had moderate-to-high discrimination (MDISC ≥0.65), and 83% had medium-to-low difficulty (MDIFF <0.5).

The DHLQ is a rigorously validated tool for assessing disaster health literacy in diabetic populations. Its multidimensional structure and strong psychometric properties support its use in clinical and emergency planning contexts to identify literacy gaps and tailor interventions.

Epidemiologic studies suggest that people who were exposed to famine during early life but now live in nutrient-abundant environments have an elevated risk of type 2 diabetes (T2D) and other cardiometabolic conditions. Although many individuals who were exposed to famine in early life have now immigrated to high-income countries, the association between early life famine exposure and cardiometabolic outcomes among immigrants is unknown.

To investigate the associations of early life exposure to the Great Chinese Famine with the incidence of T2D, hypertension, and cardiovascular hospitalization among immigrants.

This population-based cohort study in Ontario, Canada, used 3 cohorts (1 for each coprimary outcome of T2D, hypertension, and cardiovascular hospitalization) of adult Chinese immigrants aged 20 to 85 years living in Ontario from April 1, 1992, to March 31, 2019. Participants were followed up until 85 years of age, relocation from Ontario, or March 31, 2023 (whichever occurred first). Data were analyzed from April 22, 2024, to September 30, 2025.

Prenatal, childhood, and adolescent exposure to famine, classified by year of birth (1941-1952). Those born before 1941 or after 1962 served as the comparison group.

Incident T2D, hypertension, and cardiovascular hospitalization were the coprimary outcomes.

The T2D cohort included 188 292 individuals (exposed: mean [SD] age, 52.6 [10.8] years; 53.3% female; unexposed: mean [SD] age, 37.4 [12.5] years; 54.9% female), the hypertension cohort included 180 510 individuals (exposed: mean [SD] age, 51.8 [10.6] years; 52.3% female; unexposed: mean [SD] age, 36.6 [11.5] years; 55.0% female), and the cardiovascular hospitalization cohort included 208 921 individuals (exposed: mean [SD] age, 50.5 [12.0] years; 51.5% female; comparison: mean [SD] age, 37.8 [13.1] years; 54.6% female). Event rates among the famine-exposed group were 13.6% for T2D, 29.8% for hypertension, and 1.6% for cardiovascular hospitalization. Early life famine exposure was associated with increased hazards of T2D (prenatal: hazard ratio [HR], 1.58 [95% CI, 1.49-1.68]; childhood: HR, 1.45 [95% CI, 1.38-1.54]; adolescent: HR, 1.37 [95% CI, 1.28-1.46]) and hypertension (prenatal: HR, 1.22 [95% CI, 1.17-1.27]; childhood: HR, 1.25 [95% CI, 1.21-1.30]; adolescent: HR, 1.25 [95% CI, 1.20-1.31]). Prenatal and childhood exposure to famine were not associated with risk of cardiovascular hospitalization (prenatal: HR, 0.92 [95% CI, 0.76-1.12]; childhood: HR, 0.98 [95% CI, 0.86-1.11]), but adolescent exposure to famine was associated with a 14% decrease in risk of cardiovascular hospitalization (HR, 0.86 [95% CI, 0.75-0.98]).

In this cohort study of Chinese immigrants, early life famine exposure was strongly associated with increased risks of incident T2D and hypertension, but not cardiovascular hospitalization. Early life undernutrition is a novel cardiometabolic risk factor among immigrants associated with the burden of T2D and hypertension in high-income countries.

Diabetic foot ulcers (DFUs) are serious and prevalent complications of diabetes mellitus, affecting up to 34% of individuals and contributing substantially to morbidity, healthcare expenditures, and the risk of non-traumatic lower limb amputations. Despite the availability of standard treatment protocols, achieving complete and sustained healing remains a significant clinical challenge. This study investigates the safety and efficacy of allogeneic human umbilical cord mesenchymal stromal cell derivatives (hUC-MSCD), including conditioned media, extracellular vesicles, and exosomes, administered via perilesional injection in patients with chronic DFUs. In this single-center, phase I/II, open-label clinical trial (NCT06825884), ten adult patients (7 males, 3 females; mean age: 52.2 years) with type 2 diabetes mellitus and chronic DFUs classified as Texas Grade II-III (mean ulcer duration: 15 weeks), refractory to standard care, were enrolled. Participants received perilesional injections of allogeneic hUC-MSCD. Safety was evaluated through the monitoring of adverse events, and efficacy was assessed by the rate and duration of ulcer closure, as well as recurrence during follow-up. The intervention was well tolerated, with no significant adverse events observed. All patients achieved complete ulcer closure within a mean of 4.2 weeks (p < 0.00001). Importantly, no ulcer recurrence was documented during a 24-month follow-up period. These results provide strong preliminary evidence that allogeneic hUC-MSCD therapy is both safe and effective in promoting wound healing in refractory DFUs. Larger, randomized, double-blind, placebo-controlled trials are warranted to validate these findings and to further define the therapeutic potential of hUC-MSCD in this population.

Prediabetes is a global concern and is associated with increased morbidity and mortality. Early detection of prediabetes plays a crucial role since it is a reversible disease. Healthcare providers play a very important role in screening at-risk patients and implementing preventive measures early. This study aimed to assess healthcare professionals' knowledge, attitude and counseling practices regarding prediabetes which will serve as a tool to create targeted training in the future.

We conducted a cross-sectional study on 312 general practitioners and junior doctors. A structured questionnaire designed after detailed literature search was used to collect data on knowledge (23 questions), attitudes (6 questions) and counseling practices (8 questions) regarding prediabetes. The relationship between a range of factors with knowledge, attitude and counseling practices was studied using univariate and multivariate analyses.

Of total, 71.5% (223) of the study participants were males; the average age was 42.7 ± 15.1 years; Only 13.1% had adequate knowledge, 19.9% showed a positive attitude and 77.6% had good counseling practices for prediabetes and diabetes patients and their families. Compared to those with inadequate knowledge, participants with adequate knowledge had been practicing medicine for less than 10 years. Positive attitude and good counseling were however observed more in those with 20 or more years of clinical experience. Females were less likely to have adequate knowledge when compared to males (OR = 0.2, 95% CI 0.1-0.6, p-value = 0.004). A positive attitude toward prediabetes management was significantly higher among participants older than 40 years (OR = 18.6, p-value < 0.001), females (OR = 6.7, p-value < 0.001), and those with over 20 years of clinical experience (OR = 6.3, p-value = 0.014) in managing prediabetes/diabetes patients compared to their counterparts. Additionally, participants with more than 20 years of experience in managing diabetes patients were significantly more likely to exhibit good counseling behavior (OR = 9.1, 95% CI: 1.5-51.7, p = 0.013) compared to those with less than 10 years of experience.

This study identified significant gaps of knowledge among general practitioners. While general practitioners demonstrated poor attitudes, they exhibited commendable counseling practices toward patients with prediabetes and their families. The identified gaps and challenges stress the need for tailored educational initiatives and intervention but also targeted efforts to address attitudes alongside enhancing clinical skills. Limitations of the study, including the potential sampling biases and development of a new, non-validated questionnaire, should be considered when interpreting the results.

Diabetic Peripheral Neuropathy (DPN), affects 30% of type 2 diabetics, leading to severe foot problems. Existing treatments offer limited efficacy. This randomized controlled trial explores Neurodynamic Techniques (NDTs) for their impact on neuropathy severity, quality of life (QoL), nerve function, range of motion (ROM), and nerve mechanosensitivity in DPN patients.

Forty DPN patients, confirmed by electrodiagnostic and laboratory tests, were randomized into real and sham tibial NDT groups. Both groups received a basic complementary treatment plus their respective NDTs. Outcome measurements included Michigan Diabetic Neuropathy Score (MDNS), QoL, tibial nerve conduction velocity, distal latency, amplitude of compound muscle action potential, F-wave latency, plantarflexion straight leg raise (PFSLR) ROM and dorsiflexion SLR (DFSLR) ROM tested to the first onset of symptoms (P1) and maximally tolerated symptoms (P2), and nerve mechanosensitivity.

MDNS demonstrated a significant improvement, with a mean difference (MD) of -4.60, indicating a large effect size (Cohen's d: -0.93) and surpassing the minimal clinically important difference (MCID) of 2.48, with a P-value of 0.001. QoL improved significantly (MD: -13.25, Cohen's d: -0.73, MCID: 9.00, P-value: 0.006). Nerve conduction parameters remained unchanged. Small to medium effects were observed in PFSLRP1 ROM for both limbs (right limb MD: 3.35, Cohen's d: 0.38, MCID: 4.42, P-value: 0.05; left limb MD: 4.40, Cohen's d: 0.56, MCID: 3.88, P-value: 0.06), and both limbs' PFSLRP2 ROM (right limb MD: 2.10, Cohen's d: 0.21, MCID: 4.80, P-value: 0.07; left limb MD: 4.80, Cohen's d: 0.57, MCID: 4.17, P-value: 0.05). Left DFSLRP1 ROM also improved (MD: 2.35, Cohen's d: 0.29, MCID: 4.07, P-value: 0.04). Left tibial mechanosensitivity to P1 improved significantly (MD: 2.05, Cohen's d: 0.64, MCID: 1.57, P-value: 0.04). Other DFSLR ROM outcomes and other mechanosensitivity outcomes remained unchanged throughout this trial.

While NDTs did not enhance nerve conduction parameters, they significantly reduced neuropathy severity and improved QoL and PFSLR ROM in individuals with DPN.

This study has been pre-registered at https://www.irct.ir/ , (registration number: IRCT20220401054379N1) on October 13, 2022.

Semaglutide's disease-specific weight-reducing effects are well established, but its adverse effects, which may not be disease-specific, have not been systematically assessed. The aim of this review was to assess the adverse effects associated with semaglutide use compared with placebo in patients at increased risk of cardiovascular events.

We searched six electronic databases and other sources from inception to 31/03/2025. Randomized trials comparing semaglutide (oral or subcutaneous) with placebo in patients at increased risk of cardiovascular events were eligible. The search identified 8370 records. Two review authors independently screened all studies for eligibility. Data were synthesized using meta-analysis and Trial Sequential Analysis (TSA). Risk of bias was assessed with the Cochrane Risk of Bias tool - version 2; our eight-step procedure was used to assess if the thresholds for statistical significance were crossed, and the certainty of the evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluations. Primary outcomes were all-cause mortality and serious adverse events (SAEs). Secondary outcomes included myocardial infarction and non-serious adverse events (AEs).

The analysis included 50 trials, with a total of 54,972 participants randomized. Nineteen (38%) enrolled participants with type 2 diabetes (T2DM), 17 (34%) with overweight, 5 (10%) with T2DM and chronic kidney disease, 5 (10%) with T2DM and overweight, and 4 (8%) involved other patient populations. Meta-analysis and TSA showed evidence of beneficial effects of semaglutide on all-cause mortality (relative risk (RR) 0.85; 95% CI 0.79 to 0.91; I² = 0.0%; p < 0.01) and myocardial infarction (RR 0.77, 95% CI 0.69 to 0.85; I² = 0.0%; p < 0.01). None of these analyses showed signs of heterogeneity, and the evidence was of high certainty. Meta-analysis showed that semaglutide decreased the risk of SAEs (RR 0.93, 95% CI 0.88 to 0.98; I² = 24.1%; p < 0.01), but increased the risk of several non-serious gastrointestinal AEs including nausea (RR 3.00, 95% CI 2.63 to 3.42), vomiting (RR 4.12, 95% CI 3.47 to 4.90), and diarrhea (RR 1.88, 95% CI 1.68 to 2.11).

In patients at increased risk of cardiovascular events, semaglutide reduced the risk of mortality, SAEs, and myocardial infarction but increased the risk of several non-serious gastrointestinal AEs.

PROSPERO, CRD42024499511.

Arterial Hypertension (AH) and Type 2 Diabetes (T2DM) are common in obesity. However, there is no data on the influence of different degrees of obesity on the frequency of the two diseases.

In this cross-sectional study 3,486 patients (867 men and 2,619 women, aged 42.6 ± 11.48 years, minimum BMI 30.0 kg/m², mean BMI 41.9 ± 6.62 kg/m²), were evaluated at presentation for bariatric surgery (BS). BMI was expressed as a continuous variable, as BMI quartiles (BMIQ), as full obesity class (I-III), as reduced obesity class (II-III), Frequency of AH and T2DM, and of a comorbidity score (CS: AH + T2DM) was recorded, and univariable and multivariable stepwise regression analysis was employed to evaluate the association of BMI indexes with AH, T2DM, and CS.

AH, T2DM and CS showed increasing frequency with increasing BMI quartiles (p < 0.001), and with age (p < 0.001). AH and T2DM were frequently associated. At multivariable analysis, age and BMIQ were associated with AH (p < 0.001), T2DM (p < 0.001), and with CS (p < 0.001), more than BMI (NS for CS) full obesity class and reduced obesity class and BMI (NS for T2DM and for CS). The same results were observed at receiver operating curves (ROC), with greater area (AUC) for BMIQ than for BMI and obesity classes.

The frequency of AH and T2DM increases with increasing BMI levels. BMIQ outperforms BMI and obesity classes in modelling. This finding supports the use of fine stratification of BMI in clinical risk assessment. More specific studies are required to fully understand the impact of different BMI thresholds in determining the health status of obese patients, and to reduce the risks of BS in patients with extreme obesity.