Diabetic corneal neuropathy and diabetic retinopathy are ocular complications occurring in the context of diabetes mellitus. Diabetic corneal neuropathy refers to the progressive damage of corneal nerves. Diabetic retinopathy has traditionally been considered as damage to the retinal microvasculature. However, growing evidence suggests that diabetic retinopathy is a complex neurovascular disorder resulting from dysfunction of the neurovascular unit, which includes both the retinal vascular structures and neural tissues. Diabetic retinopathy is one of the leading causes of blindness and is frequently screened for as part of diabetic ocular screening. However, diabetic corneal neuropathy is commonly overlooked and underdiagnosed, leading to severe ocular surface impairment. Several studies have found that these two conditions tend to occur together, and they share similarities in their pathogenesis pathways, being triggered by a status of chronic hyperglycemia. This review aims to discuss the interconnection between diabetic corneal neuropathy and diabetic retinopathy, whether diabetic corneal neuropathy precedes diabetic retinopathy, as well as the relation between the stage of diabetic retinopathy and the severity of corneal neuropathy. We also endeavor to explore the relevance of a corneal screening in diabetic eyes and the possibility of using corneal nerve measurements to monitor the progression of diabetic retinopathy.

The changes in amino acid (AA) levels have been observed in pregnant women with gestational diabetes mellitus (GDM). However, it remains unclear whether the AA levels in offspring of GDM mothers are affected by GDM. This study aimed to investigate the changes in AA metabolism in offspring of pregnant women with GDM undergoing different glycemic control treatment regimens.

272 pregnant women treated at our hospital were selected and divided into the GDM and the non-GDM groups. The GDM group was further subdivided into three treatment groups: exercise-diet therapy, metformin therapy, and insulin therapy. The levels of 11 AAs of their offsprings were detected using tandem mass spectrometry and the differences in neonatal AA metabolism between the three treatment groups and the non-GDM group were compared.

There were significant differences in the levels of Arg, Cit, Met, Orn, and Pro of their offsprings between different treatment groups and the non-GDM group (P < 0.05). After controlling for relevant confounding factors, the differences in Arg and Orn remained statistically significant in the three treatment groups compared to the non-GDM group (P < 0.05); Cit remained statistically significant in the exercise-diet group (P < 0.05); and Met and Pro remained statistically significant in the exercise-diet group and insulin group (P < 0.05).

Regardless of the glycemic control treatment regimens used for GDM, AA metabolism related to the arginine family is influenced.

Recent evidence links diet and physical activity with type 2 diabetes mellitus (T2DM) remission, but emerging findings suggest that immune system dysregulation may play a crucial role. This study aimed to investigate the associations between neutrophils and T2DM remission.

We conducted a comprehensive analysis of newly-diagnosed T2DM patients (N = 183) from the CORDIOPREV study, without glucose-lowering treatment, and were randomized to follow either a Mediterranean or low-fat diet. Patients were classified into two groups: Responders, who achieved T2DM remission (n = 73), and Non-Responders, who did not achieve remission during the 5-year dietary intervention (n = 110). Neutrophil count and their related-ratio (NER, NBR, NLR and NHR, normalized with erythrocytes, basophils, lymphocytes, and HDL respectively) were measured at the baseline and 5 years of follow-up.

The lowest baseline tertile of neutrophil count was associated with an increased likelihood of T2DM remission among patients following a Mediterranean diet (but not for low-fat diet) when compared with the highest tertile [adjusted HR of 4.23 (95% CI: 1.53-11.69)], in which similar results were observed for NER and NHR. When considering clinical and neutrophil variables, the predictive capacity of this model yielded an AUC of 0.783 (95% CI: 0.680-0.822). Furthermore, after 5-years, Responders exhibited lower neutrophil count compared to Non-responders (p = 0.006) and a significant decrease in neutrophil count (p = 0.001) compared to baseline. This decrease in neutrophil count in Responders who consumed a Mediterranean diet exhibited a significant increase in Insulin Sensitivity and Disposition Index (p = 0.011 and p = 0.018) after the follow-up period.

These findings suggest that neutrophil count can help in identifying patients that are more likely to achieve T2DM remission following a Mediterranean diet, suggesting a role on insulin sensitivity and β-cell function. Further research holds promise for providing valuable insights into the pathophysiology of T2DM.

ID: NCT00924937; URL Clinical trial: https://clinicaltrials.gov/study/NCT00924937?cond=NCT00924937&rank=1 .

C-reactive protein-triglyceride-glucose index (CTI) has been proposed as a novel biomarker for insulin resistance and inflammation. However, the association between CTI and the risk of stroke, particularly in individuals with different glycemic status, remains unclear.

A total of 10,443 middle-aged and elderly participants were enrolled from the China Health and Retirement Longitudinal Study (CHARLS). The primary endpoint was the occurrence of stroke events. The CTI was calculated using the formula 0.412* Ln (CRP [mg/L]) + Ln (TG [mg/dl] × FPG [mg/dl])/2. The Kaplan-Meier curves, Cox proportional hazard models, and restricted cubic spline analysis were applied to explore the association between CTI and the risk of stroke according to gender, age and glycemic status.

During a median follow-up of 9 years, 960 (9.2%) participants experienced a stroke. Our findings revealed a significant positive linear relationship between CTI and the occurrence of stroke. The association was similar between male and female, despite the HR tended to be higher in females (HR 1.22, 95% CI 1.09, 1.36) than males (HR 1.15, 95% CI 1.02, 1.29), and similar in middle-aged (HR 1.25, 95% CI 1.11, 1.41) and elderly participants (HR 1.12, 95% CI 1.00, 1.26). In different glycemic status, high levels of CTI were found to be linked to an increased risk of stroke in individuals with normal glucose regulation (NGR) (HR 1.33, 95% CI 1.11, 1.59) and prediabetes mellitus (Pre-DM) (HR 1.20, 95% CI 1.04, 1.39). However, this association was not observed in individuals with diabetes mellitus (DM).

Our findings revealed a significant positive linear relationship between CTI and the occurrence of stroke. The association between CTI and stroke was similar between male and female, and similar in middle-aged and elderly participants. In different glycemic status, the association was significant in individuals with NGR and Pre-DM.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with an elevated risk of cardiovascular conditions, such as lower extremity arterial disease (LEAD). The Fibrosis-4 (FIB-4) index, a non-invasive marker of liver fibrosis, may have predictive value for LEAD in patients with MASLD. This study aimed to explore the association between FIB-4 and LEAD in a cohort of patients with MASLD.

This cross-sectional study included 481 participants with MASLD, selected from a comprehensive health check-up database. Participants were categorized into three groups based on their FIB-4 index (< 1.3, 1.3-2.66, > 2.66) and underwent duplex ultrasonography to diagnose LEAD. Logistic regression models were employed to evaluate the association between FIB-4 and LEAD, adjusting for demographic, metabolic, and lipid-related factors. Subgroup analyses were performed by sex, age, diabetes mellitus status, hypertension, dyslipidemia, smoking status.

The prevalence of LEAD increased with FIB-4 levels, from 51.3% in the low FIB-4 group to 86.5% in the high FIB-4 group (p < 0.001). In fully adjusted models, higher FIB-4 levels were significantly associated with LEAD (adjusted odds ratio [OR]: 3.54, 95% confidence interval [CI]: 1.39-9.01) in the high FIB-4 group compared to the low group. As a continuous variable, each unit increase in FIB-4 was associated with a 66% higher likelihood of LEAD (adjusted OR: 1.66, 95% CI: 1.12-2.26, P < 0.001). Subgroup analyses did not reveal significant interactions (P for interaction > 0.05).

Higher FIB-4 levels are independently associated with the prevalence of LEAD in MASLD patients, although subgroup analyses did not reveal significant interactions. This suggests that further studies with larger sample sizes are needed to explore these relationships more comprehensively.

The prevalence and clinical characteristics of chronic kidney disease (CKD) among patients with ketosis-onset diabetes (also known as ketosis-prone diabetes) remain unclear. Furthermore, the classification of ketosis-onset diabetes remains controversial and requires further investigation.

To investigate the prevalence and clinical features of CKD in patients with newly diagnosed ketosis-onset diabetes.

This real-world study included 217 patients with type 1 diabetes mellitus (T1DM), 698 with ketosis-onset diabetes, and 993 with non-ketotic T2DM. The prevalence and clinical characteristics of CKD were compared among the three groups. Risk factors associated with CKD were evaluated using binary logistic regression for each group.

After adjusting for age and sex, the prevalence of CKD among patients with ketosis-onset diabetes (17.8%) was significantly higher than that in those with T1DM (8.3%, P = 0.007), but was not statistically different compared to those with non-ketotic T2DM (21.7%, P = 0.214). Furthermore, some risk factors for CKD, including age, and serum uric acid and C-reactive protein levels, in patients with ketosis-onset diabetes were similar to those with T2DM, but significantly different from those with T1DM.

The prevalence, clinical characteristics, and risk factors for CKD among patients with ketosis-onset diabetes were more similar to those with non-ketotic T2DM but considerably different from those with T1DM. These findings further support the classification of ketosis-onset diabetes as a subtype of T2DM rather than idiopathic T1DM.

Cardiovascular-Kidney-Metabolic (CKM) syndrome is characterized by the interrelatedness of chronic kidney disease (CKD), cardiovascular disease (CVD), and metabolic disorders. The relationship between estimated glucose disposal rate (eGDR) and CVD risk in CKM syndrome remains unclear.

We analyzed data from 7,849 participants aged ≥ 45 years in the China Health and Retirement Longitudinal Study (CHARLS). The eGDR was calculated using waist circumference, hypertension, and HbA1c. Cox regression and restricted cubic spline (RCS) regression analyses examined the association between eGDR and CVD (stroke or cardiac events).

During a mean follow-up of 8.29 ± 1.67 years, among 7,849 participants (mean age 62.4 ± 8.7 years; 52.82% male), 1,946 CVD events occurred, including 1,504 cardiac events and 663 strokes. CKM stages 0-3 comprised 492 (6.27%), 1,404 (17.89%), 5,462 (69.59%), and 491 (6.26%) of participants, respectively. A U-shaped relationship between eGDR and CVD risk was identified (turning point: 11.82 mg/kg/min). Below this turning point, each unit increase in eGDR decreased CVD risk by 12% (HR: 0.88, 95% CI: 0.86-0.90, P < 0.0001); above it, each unit increase raised the risk by 19% (HR: 1.19, 95% CI: 1.04-1.37, P = 0.0135).

Our findings reveal a U-shaped relationship between eGDR and CVD risk in CKM syndrome stages 0-3. A higher or lower eGDR was associated with an increased CVD risk.

Type 2 diabetes (T2D) complications pose a significant global health challenge. Omics technologies have been employed to investigate these complications and identify the biological pathways involved. In this review, we focus on four major T2D complications: diabetic kidney disease, diabetic retinopathy, diabetic neuropathy, and cardiovascular complications. We discuss advancements in omics research, summarizing findings from genetic, epigenomic, transcriptomic, proteomic, and metabolomic studies across different ancestries and disease-relevant tissues. We stress the importance of integrating multi-omics techniques to elucidate the biological mechanisms underlying T2D complications and advocate for ancestrally diverse studies. Ultimately, these insights will improve risk prediction for T2D complications and inform translation strategies.

Gestational diabetes mellitus (GDM) increases maternal risks such as hypertension and future type 2 diabetes while also contributing to fetal complications such as large-for-gestational-age infants and stillbirth. The placenta which is crucial for fetal development, exhibits structural and functional changes in GDM, but the impact of these alterations on placental trophoblast function remains unclear. During their differentiation villous cytotrophoblast display several characteristics of senescent cells however the role of senescence pathways in placental function remains unexplored in GDM. Here we investigate whether placental senescence pathways are altered in GDM, utilizing term villous tissue and primary trophoblasts to assess molecular changes, and determined fetal sex-based differences. Our data suggest that both p21 and p16 mediated senescence pathways are activated during trophoblast differentiation and are dysregulated in GDM placenta in a sexually dimorphic manner. We also provide evidence for increased activation of p53-Lamin A/C and p16-RB pathways in trophoblast from GDM placentas. Reduced expression of p21 and its downstream effects on GCM1 expression and βhCG secretion outline how altered physiological senescence can affect trophoblast differentiation and function. This is a seminal study highlighting how placental senescence pathways are altered in pregnancies complicated by GDM.

Type 1 diabetes (T1D) is an autoimmune disease caused by T-cell mediated destruction of the pancreatic insulin-producing beta cells. Currently, the development of autoantibodies is the only measure of beta-cell autoimmunity used in the clinic. Despite T-cells' well-accepted role in the autoimmune pathogenesis of human T1D, autoimmune T-cell responses against beta cells remain very difficult to measure. An assay capable of measuring beta-cell antigen-specific T-cell responses has been a long-sought goal. Such an assay would facilitate the direct monitoring of T1D-associated T-cell responses facilitating, earlier diagnosis and rapid evaluation of candidate immune therapies in clinical trials. In addition, a simple and robust assay for beta-cell antigen-specific T-cell responses would be a powerful tool for dissecting the autoimmune pathogenesis of human T1D. Here, we review the challenges associated with measuring beta-cell antigen-specific T-cell responses, the current assays which are used to achieve this and, finally, we discuss BASTA, a promising emerging assay for measuring human beta-cell antigen-specific CD4+ T-cell responses.

Machine learning (ML) models are being increasingly employed to predict the risk of developing and progressing diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM). However, the performance of these models still varies, which limits their widespread adoption and practical application. Therefore, we conducted a systematic review and meta-analysis to summarize and evaluate the performance and clinical applicability of these risk predictive models and to identify key research gaps.

We conducted a systematic review and meta-analysis to compare the performance of ML predictive models. We searched PubMed, Embase, the Cochrane Library, and Web of Science for English-language studies using ML algorithms to predict the risk of DKD in patients with T2DM, covering the period from database inception to April 18, 2024. The primary performance metric for the models was the area under the receiver operating characteristic curve (AUC) with a 95% confidence interval (CI). The risk of bias was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST) checklist.

26 studies that met the eligibility criteria were included into the meta-analysis. 25 studies performed internal validation, but only 8 studies conducted external validation. A total of 94 ML models were developed, with 81 models evaluated in the internal validation sets and 13 in the external validation sets. The pooled AUC was 0.839 (95% CI 0.787-0.890) in the internal validation and 0.830 (95% CI 0.784-0.877) in the external validation sets. Subgroup analysis based on the type of ML showed that the pooled AUC for traditional regression ML was 0.797 (95% CI 0.777-0.816), for ML was 0.811 (95% CI 0.785-0.836), and for deep learning was 0.863 (95% CI 0.825-0.900). A total of 26 ML models were included, and the AUCs of models that were used three or more times were pooled. Among them, the random forest (RF) models demonstrated the best performance with a pooled AUC of 0.848 (95% CI 0.785-0.911).

This meta-analysis demonstrates that ML exhibit high performance in predicting DKD risk in T2DM patients. However, challenges related to data bias during model development and validation still need to be addressed. Future research should focus on enhancing data transparency and standardization, as well as validating these models' generalizability through multicenter studies.

https://inplasy.com/inplasy-2024-9-0038/, identifier INPLASY202490038.

Saponins are compounds composed of lipophilic aglycones linked to hydrophilic sugars. Natural saponins are isolated from plants and some Marine organisms. As important cholesterol-lowering drugs, natural saponins have attracted wide attention for their therapeutic potential in a variety of cholesterol-related metabolic diseases. To review the effects of natural saponins on cholesterol-related metabolic diseases, and to deepen the understanding of the cholesterol-lowering mechanism of saponins. The literature related to saponins and cholesterol-lowering diseases was collected using keywords "saponins" and "cholesterol" from PubMed, Web of Science, and Google Scholar from January 2000 to May 2024. The total number of articles related to saponins and cholesterol-lowering diseases was 240 after excluding irrelevant articles. Natural saponins can regulate cholesterol to prevent and treat a variety of diseases, such as atherosclerosis, diabetes, liver disease, hyperlipidemia, cancer, and obesity. Mechanistically, natural saponins regulate cholesterol synthesis and uptake through the AMPK/SREBP2/3-hydroxy-3-methyl-glutaryl coenzyme A reductase pathway and PCSK9/LDLR pathway, and regulate cholesterol efflux and esterification targeting Liver X receptor/ABC pathway and ACAT family. Natural saponins have broad application prospects in regulating cholesterol metabolism, for the development of more cholesterol-lowering drugs provides a new train of thought. However, it is still necessary to further explore the molecular mechanism and expand clinical trials to provide more evidence.

Chronic kidney disease (CKD) is a well-recognized complication in patients undergoing liver transplantation (LT), particularly those with metabolic dysfunction-associated steatohepatitis (MASH), a leading cause of cirrhosis in the modern era. This study sought to refine risk stratification for CKD events post-LT in cirrhosis patients with MASH by leveraging baseline renal function at transplant.

A total of 717 MASH cirrhosis patients who had LT (1997-2017) at 7 US centers (NailMASH Consortium) were analyzed. Patients were categorized by estimated glomerular filtration rate (eGFR) at transplant: low (LGFR, eGFR ≤30 mL/min/1.73 m²), medium (MGFR, eGFR >30-≤60 mL/min/1.73 m²), and high (HGFR, eGFR >60 mL/min/1.73 m²). Time-related eGFR intercepts, slopes, and assessments of advanced-stage CKD (aCKD) events, defined as 2 eGFR levels <30 mL/min/1.73 m² separated by ≥90 d, were examined.

Post-LT, LGFR group showed increased eGFR, whereas the HGFR group experienced a decline. The 3-mo mark was identified as a "reset point," signifying a new reference level, beyond which a different rate of decline was observed. After 3 mo, mean eGFRs of the LGFR group approached MGFRs, whereas the mean eGFR of the HGFR group continued to decrease but remained higher than other groups during a 60-mo follow-up. LGFR patients had significantly higher aCKD probability than MGFR and HGFR groups. Subanalysis at 3 mo post-LT revealed more aCKD events in the LGFR group compared with MGFR and HGFR groups ( P  < 0.0001).

The study underscores renal impact of LT in MASH cirrhosis, indicating unique eGFR trajectories post-LT tied to baseline eGFR, with a reset point at 3 mo. Monitoring post-LT renal function, especially in those at aCKD risk, is crucial. Renal-sparing immunosuppression may help, regardless of baseline eGFR. Further studies are needed for interventions addressing renal dysfunction of patients with MASH post-LT.

Progression of prediabetes to type 2 diabetes has been associated with β-cell dysfunction, whereas its remission to normoglycemia has been related to improvement of insulin sensitivity. To understand the mechanisms and identify potential biomarkers related to prediabetes trajectories, we compared the proteomics and metabolomics profile of people with prediabetes progressing to diabetes or reversing to normoglycemia within 1 year.

The fasting plasma concentrations of 1,389 proteins and the fasting, 30-min, and 120-min post-oral glucose tolerance test (OGTT) plasma concentrations of 152 metabolites were measured in up to 134 individuals with new-onset diabetes, prediabetes, or normal glucose tolerance. For 108 participants, the analysis was repeated with samples from 1 year before, when all had prediabetes.

The plasma concentrations of 14 proteins were higher in diabetes compared with normoglycemia in a population with prediabetes 1 year before, and they correlated with indices of insulin sensitivity. Higher levels of dicarbonyl/L-xylulose reductase and glutathione S-transferase A3 in the prediabetic state were associated with an increased risk of diabetes 1 year later. Pathway analysis pointed toward differences in immune response between diabetes and normoglycemia that were already recognizable in the prediabetic state 1 year prior at baseline. The area under the curve during OGTT of the concentrations of IDL particles, IDL apolipoprotein B, and IDL cholesterol was higher in new-onset diabetes compared with normoglycemia. The concentration of glutamate increased in prediabetes progressing to diabetes.

We identify new candidates associated with the progression of prediabetes to diabetes or its remission to normoglycemia. Pathways regulating the immune response are related to prediabetes trajectories.

Background/Objectives: Type 1 diabetes (T1D) is a chronic autoimmune condition characterized by the destruction of pancreatic β-cells, leading to insulin deficiency. Current therapies, such as islet transplantation, face significant challenges, including limited donor availability and the need for lifelong immunosuppression. Encapsulation technologies offer a promising alternative, providing immune protection and maintaining β-cell viability. In this study, we propose an encapsulation device featuring a spiral tubular semipermeable polyethersulfone (PES) membrane reinforced with a rigid biocompatible resin scaffold. Methods: The PES membrane was engineered with a tailored porosity of 0.5 µm, enabling efficient nutrient and oxygen exchange while preventing immune cell infiltration. Using INS-1E insulin-secreting cells aggregated into size-controlled islet-like spheroids (ILSs), we evaluated the device's performance. Results: The device achieved high ILS viability and insulin secretion over 48 h at therapeutic densities, maintaining functionality comparable to free-floating ILSs (control). The PES membrane, with its mechanical stability and biocompatibility, ensured durability without compromising diffusion dynamics, overcoming a critical limitation of other encapsulation approaches. Importantly, the device geometry allowed for the encapsulation of up to 356,000 islet equivalents (IEQs) in a single capillary fiber, reaching therapeutic thresholds for T1D patients. Conclusions: this device, with its innovative design, enables high-density encapsulation while preserving ILS functionality and scalability, making it a potential platform for clinical application. This work highlights the potential of PES-based encapsulation devices to overcome key barriers in T1D treatment, paving the way for personalized, long-term solutions to restore insulin independence.

The study aimed to assess the effect of COVID-19 on hepatic lipid (HL) content, fibrosis risk, and adiposity in persons with type 2 diabetes.

Participants with type 2 diabetes with a history of mild COVID-19 (n=15, age 58±12 years, body mass index 30.9±5.2 kg/m2) were examined before (baseline) and 1 year (12±2 months) after (follow-up) recovery from COVID-19. Investigations for changes in metabolic risk comprised clinical examination, fasting blood sampling and MR-based measurements. Potential changes were corrected with the time course of the respective parameters in a group of participants who did not contract COVID-19 over the same time course (n=14, 61±6 years, 30.0±4.6 kg/m2).

COVID-19 resulted in a relative increase in HL content of 56% (95% CI 18%, 106%; p=0.04) measured as proton density fat fraction (HL-PDFF), corrected for the time course in the absence of COVID-19. While no changes in hepatic stiffness and volume, intramyocellular lipids, whole-body, subcutaneous and visceral adipose tissue volumes as well as homeostatic model assessment of insulin resistance and beta-cell function were observed.

History of COVID-19 in persons with type 2 diabetes is associated with higher HL-PDFF after 1 year following recovery from infection.

NCT01055093.

Non-alcoholic fatty liver disease (NAFLD) is a prevalent liver disorder strongly associated with metabolic dysfunction, particularly in elderly populations where it presents with higher prevalence and severity. This study aimed to investigate the association between serum uric acid (SUA) levels and NAFLD in older adults, focusing on the independent effect of hyperuricemia on NAFLD risk. We enrolled 469 individuals aged ≥ 65 years who underwent community health checkups. The exposure variable was baseline SUA levels, while the outcome variable was the occurrence of NAFLD. Covariates included age, sex, BMI, blood pressure, diabetes status, lipids (TC, TG, LDL, HDL), glycemic indices (FPG, HBA1C), and physical activity. Multivariable logistic regression was applied to estimate the independent effect of SUA levels and hyperuricemia on NAFLD. Hyperuricemia was significantly associated with increased NAFLD risk (adjusted OR 2.16, 95% CI 1.28-3.67). Stratified analysis revealed a stronger association in individuals with elevated triglycerides (TG ≥ 2.26 mmol/L, OR 7.07, 95% CI 1.72-29.18). However, the association between SUA as a continuous variable and NAFLD risk was attenuated after adjusting for metabolic factors. Hyperuricemia independently increases NAFLD risk in older adults, particularly in those with elevated triglycerides, suggesting a potential synergistic effect. These findings highlight the importance of incorporating SUA assessments into routine metabolic evaluations and developing targeted interventions to mitigate NAFLD risk.

Type 2 diabetes accounts for over 90% of all diabetes cases and is caused by a combination of behavioral risk factors. It is currently a serious health issue, particularly among women of reproductive age, as it is associated with reproductive disorders. Preventing it requires knowledge, but there is limited data on behavioral risk factors in Ethiopia.

To assess knowledge of the behavioral risks of type 2 diabetes mellitus and its associated factors among women of reproductive age.

A community-based cross-sectional study was conducted, with all women in the town serving as the source population. A multistage sampling method was utilized to recruit kebeles, and a systematic random technique was employed to select households at every 13th interval. We completed interview questionnaires for 623 samples. The crude odds ratio was calculated using a bivariate logistic model, and multivariate analysis was performed to control for confounding and identify associated factors among model-fitting variables using an adjusted odds ratio (AOR).

The knowledge of behavioral risk factors (BRF) among women of reproductive age (WRA) is 47.0% [95% CI, 43.5-50.9], and significant associations were found with the following factors: average family income of between 3000 and 5000 Ethiopian Birr(ETH) 1.81 [95% CI, 1.03-3.18], > = 5001 ETH 1.93 [95% CI, 1.02-3.68], diabetes mellitus (DM) in the friend or relatives 4.03 [95% CI, 1.56-10.46], family history of DM 9.47 [95% CI, 4.74-18.90], source of information: health workers 1.87 [95% CI, 1.04-3.34] and friend or relatives 1.65 [95% CI, 1.04-2.62].

Knowledge of behavioral risk factors for type 2 diabetes was poor among study participants. Factors such as family income, diabetes mellitus (DM) in friends or relatives, family history of DM, and sources of information were strongly associated with good knowledge. It is essential to emphasize health education about behavioral risk factors for women.

Multimorbidity is a highly prevalent phenomenon whose presence causes a profound physical, psychological, and economic impact. It hinders help seeking, diagnosis, quality of care, and adherence to treatment, and it poses a significant dilemma for present-day health care systems.

This study aimed to assess the effectiveness of improved treatment as usual (iTAU) combined with a blended low-intensity psychological intervention delivered using information and communication technologies for the treatment of multimorbidity (depression and type 2 diabetes or low back pain) in primary care settings.

A 2-armed, parallel-group, superiority randomized controlled trial was designed for this study. Participants diagnosed with depression and either type 2 diabetes or low back pain (n=183) were randomized to "intervention + iTAU" (combining a face-to-face intervention with a supporting web-based program) or "iTAU" alone. The main outcome consisted of a standardized composite score to consider (1) severity of depressive symptoms and (2a) diabetes control or (2b) pain intensity and physical disability 3 months after the end of treatment as the primary end point. Differences between the groups were estimated using mixed effects linear regression models, and mediation evaluations were conducted using path analyses to evaluate the potential mechanistic role of positive and negative affectivity and openness to the future.

At 3-month follow-up, the intervention + iTAU group (vs iTAU) exhibited greater reductions in composite multimorbidity score (B=-0.34, 95% CI -0.64 to -0.04; Hedges g=0.39) as well as in depression and negative affect and improvements in perceived health, positive affect, and openness to the future. Similar positive effects were observed after the intervention, including improvements in physical disability. No significant differences were found in glycosylated hemoglobin, pain intensity, or disability at 3-month follow-up (P=.60; P=.79; and P=.43, respectively). Path analyses revealed that the intervention had a significant impact on the primary outcome, mediated by both positive and negative affect (positive affect: indirect effect=-0.15, bootstrapped 95% CI -0.28 to -0.03; negative affect: indirect effect=-0.14, bootstrapped 95% CI -0.28 to -0.02).

This study supports the efficacy of a low-intensity psychological intervention applied in a blended format on multimorbidity in primary care. It justifies the exploration of the conceptualization of depression in type 2 diabetes as well as the analysis of the implementation of such interventions in routine clinical practice.

ClinicalTrials.gov NCT03426709; https://clinicaltrials.gov/study/NCT03426709.

RR2-10.1186/S12888-019-2037-3.

Insomnia characterised by difficulties in falling asleep and maintaining sleep, and early awaking, is a prevalent worldwide sleep disorder. While previous studies have suggested an association between insomnia and adverse glycaemic control, the evidence remains inconclusive. Therefore, this meta-analysis aims to explore this association.

Insomnia was assessed based on defined criteria, including related symptoms such as poor sleep quality and low sleep efficiency. Glycaemic control was evaluated using indicators such as fasting plasma glucose, haemoglobin A1c, and the presence of diabetes. A literature search was performed in PubMed, Web of Science, and Scopus. The quality of the included studied was assessed using The Newcastle-Ottawa Scale. Effect sizes, including odds ratio, relative risk, mean difference, and standard mean difference, were chosen based on data type. Forest plots visually displayed pooled effect sizes and corresponding 95% confidence intervals, while the I2 test calculated heterogeneity. Meta-regression and subgroup analysis explored potential sources of heterogeneity. Leave-one-out sensitivity analysis assessed result robustness, and Begg's and Egger's tests evaluated publication bias.

Ninety-one articles, comprising 84 are cross-sectional studies, (five are case-control studies, and two are cohort studies) with 2 217 521 participants, were included. Ten separate meta-analyses were conducted based on variable type (binary/continuous), study design (cross-sectional, case-control, or cohort), and measurement of exposures/outcomes. All meta-analyses indicated a positive association between insomnia (related symptoms) and adverse glycaemic control. However, three meta-analyses showed significant heterogeneity, and three lacked robustness. No publication bias was detected across any of the analyses.

Insomnia is likely associated with adverse glycaemic control. As the included studies are observational, future research should prioritise diverse methodologies and robust study designs to further explore this complex relationship.

insomnia, insomnia related symptoms, glycaemic control, systematic review, meta-analysis.

PROSPERO CRD42024491688.

Multimorbidity is associated with negative effects on the health of individuals, increasing the complexity of health care. This study aimed to determine the prevalence of multimorbidity and associated factors in the adult Indigenous population living in villages in Aracruz, Espírito Santo State, Brazil. This is a cross-sectional study using data from the project called Assessment of the Prevalence and Severity of Chronic Diseases in the Indigenous Population of Espírito Santo State. Data were collected from 2020 to 2022. Multimorbidity was defined as the presence of two or more chronic morbidities in a group of eight morbidities. As a measure of association, the prevalence ratio (PR) and its 95% confidence interval (95%CI), calculated by Poisson regression with robust variance, in crude models and models adjusted for covariates were used. The prevalence of multimorbidity was 52.1% (95%CI: 49.1-55.2), being significantly higher among women (PR = 1.47; 95%CI: 1.29-1.67), those aged ≥ 40 years (40-59 years: PR = 1.49; 95%CI: 1.28-1.73; ≥ 60 years: PR = 1.85; 95%CI: 1.55-2.20) and lower for individuals with higher education (PR = 0.65; 95%CI: 0.47-0.89). The prevalence of multimorbidity in the Indigenous population living in villages in Espírito Santo State was higher than that found in other studies in the general Brazilian population. There was association between the presence of multimorbidity and sex, age and education level.

Dyslipidemia was strongly linked to stroke, however the relationship between dyslipidemia and its components and ischemic stroke remained unexplained.

To investigate the link between longitudinal changes in lipid profiles and dyslipidemia and ischemic stroke in a hypertensive population.

Between 2013 and 2014, 6094 hypertension individuals were included in this, and ischemic stroke cases were documented to the end of 2018. Longitudinal changes of lipid were stratified into four groups: (1) Normal was transformed into normal group; (2) Abnormal was transformed into normal group; (3) Normal was transformed into abnormal group; and (4) Abnormal was transformed into abnormal group. To examine the link between longitudinal changes in dyslipidemia along with its components and the risk of ischemic stroke, we utilized multivariate Cox proportional hazards models with hazard ratio (HR) and 95%CI.

The average age of the participants was 62.32 years ± 13.00 years, with 329 women making up 54.0% of the sample. Over the course of a mean follow-up of 4.8 years, 143 ischemic strokes happened. When normal was transformed into normal group was used as a reference, after full adjustments, the HR for dyslipidemia and ischemic stroke among abnormal was transformed into normal group, normal was transformed into abnormal group and abnormal was transformed into abnormal group were 1.089 (95%CI: 0.598-1.982; P = 0.779), 2.369 (95%CI: 1.424-3.941; P < 0.001) and 1.448 (95%CI: 1.002-2.298; P = 0.047) (P for trend was 0.233), respectively.

In individuals with hypertension, longitudinal shifts from normal to abnormal in dyslipidemia-particularly in total and low-density lipoprotein cholesterol-were significantly associated with the risk of ischemic stroke.

Aldosterone is the effector hormone in the renin angiotensin aldosterone system and existing data suggest aldosterone affect cognitive function. However, the relationship between plasma aldosterone concentration (PAC) and cognitive performance remains unexplored in community dwellers. Therefore, we aimed to explore whether PAC is associated with cognitive performance in this population.

We cross-sectionally enrolled adults using multistage random sampling from Emin, China in 2019. Participants underwent questionnaires and data collection. Cognitive status was assessed using mini-mental state examination (MMSE) questionnaire. Multi-variable linear and logistic regression were used to explore the association between log PAC and log MMSE score, and between tertiled PAC (the higher PAC as the exposure) and low cognitive performance, respectively, in total, apparently healthy and diseased participants. Subgroup analyses also were performed by age, gender, BMI, living region, ethnicity and education attainment status.

27,707 subjects were included, of whom, 12,862 were apparently healthy and 14,845 had disease. Log-PAC was positively associated with log-MMSE score in the multivariable linear regression in the total (B = 0.01, 95%CI: 0-0.01, p < 0.001), apparently healthy (B = 0.01, 95%CI: 0-0.01, p = 0.007) participants, and the diseased without taking medicine (B = 0.01, 95%CI: 0.01-0.02, p = 0.004) participants. In logistic regression, the highest third tertile of PAC group showed significantly lower odds for the presence of low cognitive performance in total (OR = 0.83, 95%CI: 0.73-0.93, p = 0.002) and diseased without taking medicine participants (OR = 0.70, 95%CI: 0.57-0.86, p < 0.001). Various sub-group analysis showed largely consistent results with the main analysis.

There was a positive correlation between plasma aldosterone and cognitive functions in community dwellers, whereas further studies are need when considering the cross-sectional nature of the current study.

Diabetic patients frequently face difficulty in identifying and adhering to dietary regimen, including its quality and quantity. This study assessed the knowledge and attitude to dietary regimen among patients with type 2 diabetes mellitus in Delta State University Teaching Hospital, Oghara, as implication for glycemic control. The objectives of the study were to evaluate the knowledge on dietary regimen, assess the attitude to dietary regimen among diabetic patients, and determine the relationship between the knowledge and attitude to dietary regimen among diabetic patients.

Descriptive survey design was used for the study. Convenience sampling technique and a sample size of 150 were used. Self-developed questionnaire was administered. Data was collected, analyzed, and presented in tables.

Findings from the study shows that 80% of the respondents have knowledge on adherence to dietary regimen while 61.3% of the respondents finds keeping to dietary regimen for managing diabetes difficult. Meanwhile, highest responses were attributed to family support, this was followed by support group and enlightenment programs, while the least measure was found in mass campaign.

It therefore shows that although there is high knowledge base on dietary regimen, diabetic patients often find difficulty in adhering to the prescribed regimen. Hence, it is important that measures to promote positive attitude to dietary regimen among diabetic patients be devised to enhance management outcomes.

To determine the rate of prediabetes among and the pre-transplant plasma high-sensitivity C-reactive protein (hs-CRP) value predictive of prediabetes in patients during their first year post-living donor kidney transplant.

A total of 538 patients underwent living donor kidney transplantation between January 2018 and December 2020, 413 of whom met the inclusion criteria for this study. All patients underwent oral glucose tolerance tests (OGTTs) with 75 g glucose/200 mL solution, starting 3 months post-transplant and repeating the test every 3 months for the first year. Clinical and paraclinical indicators and plasma hs-CRP concentrations were quantified the day prior to the transplant. Prediabetes was diagnosed according to the American Diabetes Association 2018 criteria as a 2-h OGTT result between 140 mg/dL (7.8 mmol/L) and 199 mg/dL (11.0 mmol/L).

The rate of prediabetes among the study subjects was 38.3 % (158/413). Body mass index (BMI) and pre-transplant plasma triglycerides, high-density lipoprotein cholesterol (HDLC), and hs-CRP levels were related factors predictive of prediabetes in patients within the first year post-kidney transplant based on multivariate logistic regression and receiver operative characteristic curve models. Hs-CRP was the factor with the best predictive value (area under the curve = 0.89; p < 0.001).

Pre-transplant plasma hs-CRP levels were a good predictor of prediabetes in the first year post-living donor kidney transplant.

To investigate the association between the Weekend Warrior (WW) pattern and diabetes prevalence in American adults.

Cross-sectional analysis of data from the 2007-2016 National Health and Nutrition Examination Survey (NHANES).

We examined the relationship between four physical activity (PA) patterns-inactive, insufficiently active, WW, and regularly active-and diabetes prevalence. Multivariable logistic regression, marginal average population effects (MAPE), subgroup, and sensitivity analyses were performed to assess these associations. Odds ratios (ORs) and average marginal effects (AME), along with 95 % confidence intervals (CIs) were calculated.

Individuals engaging in the WW pattern (OR = 0.60, 95 % CI: 0.40 to 0.89, p = 0.013; AME = -0.05, 95 % CI: -0.09 to -0.02, p = 0.004) and the regularly active pattern (OR = 0.69, 95 % CI: 0.60 to 0.80, p < 0.001; AME = -0.04, 95 % CI: -0.06 to -0.03, p < 0.001) showed significantly lower diabetes prevalence than those classified as inactive. Compared to individuals classified as inactive, those categorized as insufficiently active demonstrated no significant difference in diabetes prevalence. No significant difference was observed between the WW and regularly active patterns (OR = 0.86, 95 % CI: 0.56 to 1.35, p = 0.5; AME = -0.01, 95 % CI: -0.06 to 0.03, p = 0.501). Subgroup interaction analyses revealed no significant effect modification (all p for interaction >0.05), and sensitivity analyses confirmed the robustness of these findings.

Both the WW and regularly active patterns are associated with a lower prevalence of diabetes compared with inactive individuals.

Populations with serious mental illness are less likely to receive evidence-based care for cardiovascular disease (CVD) risk factors. We sought to characterize the implementation of an adapted team-based quality improvement strategy to improve mental health providers' delivery of evidence-based CVD risk factor care.

In a 12-month, single arm pre/post pilot study in four behavioral health homes embedded within psychiatric rehabilitation programs, sites implemented an adapted Comprehensive Unit Safety Program (CUSP). Primary measures examined changes in organizational quality improvement culture and provider self-efficacy for CVD risk factor care. Secondary measures examined changes in acceptability, appropriateness, and feasibility of CUSP and receipt of guideline-concordant care for hypertension, dyslipidemia, and diabetes.

Provider self-efficacy to coordinate care for hypertension and diabetes improved, but organizational quality improvement culture did not change. Acceptability, appropriateness, and feasibility were rated highly but did not change pre/post CUSP. The percentage who reached goals per national guidelines improved for those with dyslipidemia but not for those with hypertension or diabetes. CUSP teams implemented processes to build staff capacity, standardize communication, elicit feedback, and deliver education on coordination for CVD risk factors.

This pilot study showed no effects of CUSP on organizational quality improvement culture or provider self-efficacy, the mechanisms by which CUSP is expected to improve care processes. Long term investments are needed to support organizational quality improvement work and providers' efficacy to delivery - evidence-based CVD risk factor care delivery.

http://www.ClinicalTrials.gov, identifier NCT04696653.

The aim of this study was to investigate the impact of diabetes on mortality and adverse outcomes in COVID-19 patients and to analyse the associated risk factors.

This is a retrospective cohort study in 500 hospitalized patients with COVID-19 infection (214 with diabetes and 286 without diabetes) admitted to a tertiary hospital in China from December 2022 to February 2023. Demographic information, clinical characteristics and outcomes were collected. Survival status was investigated at discharge and at 6 months after discharge.

The mortality rate of COVID-19 patients with diabetes was higher than the rate of non-diabetic COVID-19 patients, both at discharge, and at 6 months after discharge. Body mass index (BMI), C-reactive protein (CRP), pH, D-dimer, blood osmotic pressure, serum creatinine, white blood cell count, creatine kinase and hospitalization expenses were significantly different between diabetic group and non-diabetic group (p < 0.05). Compared with the survivors, non-survived COVID-19 patients with diabetes had worse diabetes control indicators, with random blood glucose increased by 3.58 mmol/L (p < 0.05), and fasting blood glucose increased by 2.77 mmol/L (p < 0.01). In addition, there were significant differences in age, heart rate, CRP, pH, potassium (K+), serum creatinine, white blood cell count, creatine kinase, the proportion with diabetic complications, treatment in ICU and mechanical ventilation between survivors and non-survivors of COVID-19 patients with diabetes. By multivariate logistic regression analysis, the death of COVID-19 patients with diabetes is positively correlated with age and CRP (p < 0.05), and has a trend towards significance with fasting blood glucose (p < 0.1).

Infection with COVID-19 on the basis of diabetes can significantly increase mortality, which was further associated with diabetes control indicators.

The purpose of this integrative review was to identify effective diabetes self-management education and support for increasing adult primary care referrals, participation rates and improving health outcomes for persons with diabetes.

Integrative review.

A systematic literature search of PubMed/MEDLINE, Embase and CINAHL was performed by applying the PRISMA guidelines. Following Whittemore and Knafl's method, 11 papers were included for review.

Integration of diabetes self-management education and support in primary care clinics and a multifaceted approach resulted in improved referral and participation rates, ameliorated glycated haemoglobin A1C and boosted patient, provider and staff satisfaction.

Patient-centred multifaceted interventions can boost current diabetes self-management education referrals and participation rates and enhance health outcomes for persons with diabetes. Nurses in their role as primary care providers, diabetes educators and clinic staff are well-positioned to undertake this intervention. Further investigation is needed to explore the impact of these interventions among individuals with type 1 diabetes, gestational diabetes and those living across various global regions.

Along with other healthcare providers, nurses are qualified to advocate for, and lead programmes that increase referrals for persons with diabetes to improve health outcomes. Additionally, as primary care providers, nurse practitioners are well placed to positively impact the outcomes of individuals with diabetes by referring them to diabetes self-management education. Nurses, as diabetes educators, are well positioned to implement diabetes self-management education which can improve patient outcomes.

Improved referral of persons with diabetes to diabetes self-management education and increased participation have the propensity to contribute to the achievement of positive health outcomes for individuals living with Type 2 Diabetes.

There is no patient or public contribution for this review.

The impact of diabetes on incident cardiovascular disease in relation to the extent of atherosclerotic disease remains unclear. We aimed to investigate major adverse cardiovascular events (MACE) in patients with or without type 2 diabetes (T2DM) presenting with two extremes of atherosclerotic disease, those with angiographically documented minor coronary atherosclerotic lesions and those with symptomatic peripheral artery disease. We included 1238 patients from two prospective, long-term cohort studies. Patients underwent coronary angiography and/or sonography in order to assess the grade of atherosclerosis and were defined as having no signs of Atherosclerosis (n = 332; Group I), minor atherosclerosis (n = 425; Group II) and major atherosclerosis (n = 481; Group III). Cardiovascular events were recorded over a median follow-up period of 7.1 years (Q1 = 3.6 years, Q2 = 7.1 years, Q3 = 11.3 years), covering a total of 9533 patient years. We tested the hypothesis that T2DM infers the same relative risk increase irrespective of the atherosclerosis stage, considering 3-point MACE as the primary endpoint. Incident MACE was reported in 681 patients (51%). MACE occurred more frequently in patients with T2DM than in patients without T2DM (p < 0.001). Further, MACE occurred more frequently in group III (58.1%), than group II (34.1%) or group I (19.1%) (group I vs. group II vs. group III, p < 0.001). In a cox-regression-model, T2DM was a significant predictor of MACE in univariate analyses (HR = 2.43 [1.88-3.14], p < 0.001) and after multivariate adjustment for cardiovascular risk factors, as well as the different grades of atherosclerosis (HR = 1.37 [1.02-1.84], p = 0.034). Also, atherosclerosis grades predicted MACE (HR = 3.19 [2.75-3.70], p < 0.001) in univariate analyses, and also after multivariate adjustment for known cardiovascular risk factors, including T2DM (HR = 1.61 [1.31-1.98], p < 0.001). Finally, when testing for interactions between T2DM and stages of atherosclerosis on MACE we could not find any significant interaction (HR = 1.14 [0.86-1.52], p = 0.364). We conclude that T2DM infers an increased risk for MACE across anatomically and morphologically distinct stages of atherosclerosis.

As the global prevalence of diabetes mellitus rises, traditional treatments like insulin therapy and oral hypoglycemic agents often fail to achieve optimal glycemic control, leading to severe complications. Recent research has focused on replenishing pancreatic β-cells through the transdifferentiation of α-cells, offering a promising therapeutic avenue. This review explores the molecular mechanisms underlying α-cell to β-cell transdifferentiation, emphasizing key transcription factors such as Dnmt1, Arx, Pdx1, MafA, and Nkx6.1. The potential clinical applications, especially in type 1 and type 2 diabetes characterized by significant β-cell dysfunction, are addressed. Challenges, including low transdifferentiation efficiency, cell stability, and safety concerns, are also included. Future research directions include optimizing molecular pathways, enhancing transdifferentiation efficiency, and ensuring the long-term stability of β-cell identity. Overall, the ability to convert α-cells into β-cells represents a transformative strategy for diabetes treatment, offering hope for more effective and sustainable therapies for patients with severe β-cell loss.

The Estimated Glucose Disposal Rate (eGDR) serves as a surrogate marker for insulin resistance, with numerous studies highlighting its significant prognostic value. This paper aims to analyze the impact of eGDR on cardiovascular and all-cause mortality across different glycemic metabolic statuses, including normal fasting glucose (NFG), prediabetes, and diabetes.

This study included 46,016 American adults who underwent health examinations as part of the National Health and Nutrition Examination Survey from 1999 to 2018. Multivariable Cox regression was employed to explore the relationships between eGDR and mortality rates under varying glycemic states. Additionally, Kaplan-Meier curves were used to compare the cumulative incidence of cardiovascular and all-cause mortality across different metabolic statuses. Finally, the predictive value of eGDR for mortality was assessed using receiver operating characteristic curves.

During an average follow-up of 115 months, a total of 6,906 (15.01%) participants experienced all-cause mortality, with 1,798 (3.91%) deaths attributed to cardiovascular causes. Kaplan-Meier analysis revealed that higher eGDR levels were associated with gradually reduced mortality rates. After adjusting for confounders, elevated eGDR levels were protective against both cardiovascular and all-cause mortality; the protective effect was notably stronger for cardiovascular mortality [Cardiovascular mortality hazard ratio: 0.92; All-cause mortality hazard ratio: 0.94]. Further interaction tests indicated that glycemic status significantly modified the protective effect of eGDR (P-interaction<0.0001); specifically, high eGDR conferred stronger protection against cardiovascular and all-cause mortality in individuals with NFG and prediabetes compared to those with diabetes. Receiver operating characteristic analysis suggested that eGDR had superior predictive value for mortality in the NFG and prediabetic populations compared to the diabetic group.

eGDR is a straightforward surrogate for insulin resistance, acting as a protective factor against cardiovascular and all-cause mortality in American adults, with glycemic status modifying this protective effect. Specifically, high eGDR levels offer stronger protection in individuals with NFG and prediabetes compared to those with diabetes; moreover, eGDR appears to be more suitable for predicting mortality events in the NFG and prediabetic populations.

MODY, or maturity-onset diabetes of the young, is a group of monogenic diseases characterized by autosomal dominant inheritance of a non-insulin-dependent form of diabetes that classically manifests in adolescence or in young adults under 25 years of age. MODY is a rare cause of diabetes, accounting for 1% of all cases, and is often misdiagnosed as type 1 or type 2 diabetes. It is of great importance to accurately diagnose MODY, as this allows for the most appropriate treatment of patients and facilitates early diagnosis for them and their families. This disease has a high degree of phenotypic and genetic polymorphism. The most prevalent forms of the disease are attributed to mutations in three genes: GCK (MODY 2) and (HNF)1A/4A (MODY 3 and MODY 1). The remaining MODY subtypes, which are less prevalent, have been identified by next generation sequencing (NGS) in the last decade. Mutations in the GCK gene result in asymptomatic, stable fasting hyperglycemia, which does not require specific treatment. Mutations in the HNF1A and HNF4A genes result in pancreatic β-cell dysfunction, which in turn causes hyperglycemia. This often leads to diabetic angiopathy. The most commonly prescribed drugs for the treatment of hyperglycemia are sulfonylurea derivatives. Nevertheless, with advancing age, some patients may require insulin therapy due to the development of resistance to sulfonylurea drugs. The strategy of gene therapy for monogenic forms of MODY is still an experimental approach, and it is unlikely to be widely used in the clinic due to the peculiarities of MODY structure and the high genetic polymorphism and clinical variability even within the same form of the disease. Furthermore, there is a lack of clear gene-phenotypic correlations, and there is quite satisfactory curability in the majority of patients. This review presents the main clinical and genetic characteristics and mutation spectrum of common and rarer forms of MODY, with a detailed analysis of the field of application of AVV vectors in the correction of hyperglycemia and insulin resistance.

The risk of non-communicable diseases (NCDs) in conflict and post-conflict settings in Northeastern Nigeria has not been evaluated to date. As this region undergoes recovery, understanding the prevalence of NCDs, such as hypertension, diabetes, depression, and obesity, and the associated behavioral coping mechanisms, is crucial for developing tailored healthcare solutions. Therefore, this study aimed to assess the impact of conflict on the prevalence of NCDs in conflict-exposed areas in Northeastern Nigeria compared with non-conflict regions.

This study was an unmatched cross-sectional study. The participants were selected from inpatients and outpatients at general hospitals in Mubi (conflict-exposed) and Jada (non-conflict), which are local government areas in Adamawa, a state in Northeastern Nigeria. The study was conducted over four months, and data on various health indicators were collected. Multivariable binary logistic regression and complementary log regression were performed to investigate the effects of individual risk factors and regional settings on the prevalence of NCDs.

A sample of 463 individuals from both locations was analyzed. The prevalence of hypertension, diabetes, abdominal obesity, and depression in the entire cohort was 22.92%, 5.04%, 44.19%, and 17.94%, respectively. The rates of hypertension and abdominal obesity in the conflict-exposed Mubi were lower, and the rate of depression was higher than those recorded in Jada. Females showed higher rates of hypertension, obesity, and depression than males. The residents of Mubi had lower odds of having abdominal obesity (adjusted odds ratio (aOR) = 0.18; 95% confidence interval (CI) [0.11-0.28]) but a higher risk of depression (incidence risk ratio (IRR) = 4.78; 95% CI [2.51-9.22]) than those in Jada. However, the participants affected by insurgency showed higher odds of having both abdominal obesity (aOR = 1.95; 95% CI [1.23-3.08]) and depression (IRR = 1.76; 95% CI [1.08-2.88]) than those who were not affected by the conflict.

The findings of this study underscore the urgent need for mental health support in conflict-affected regions and comprehensive healthcare strategies for the aging population. As adjustment of lifestyle factors is crucial for addressing NCDs, effective case management and food security are essential for reducing the risk of NCDs in conflict-exposed populations.

Strategies to address suboptimal weight loss after Roux-en-Y gastric bypass (RYGB) can be developed if at-risk patients are identified in advance. This study aimed to build a pre-surgery prediction nomogram for early prediction of insufficient weight loss (IWL) or weight regain (WR) after bariatric surgery in Chinese patients.

In this retrospective study, 187 patients with obesity and type 2 diabetes who underwent laparoscopic RYGB were followed yearly for 3 years. Suboptimal weight loss included IWL and WR. IWL was defined as a total weight loss percentage of <25% at 1 year postoperatively, and WR was defined as a maximum weight loss percentage of >20% at 3 years postoperatively. Multivariate logistic regression was performed to identify independent predictors and to establish a nomogram to predict the occurrence of suboptimal weight loss.

Multivariate logistic regression revealed that male sex (OR 4.268, 95% CI: 1.413-12.890), body mass index (OR 0.816, 95% CI: 0.705-0.946), and glycated hemoglobin (OR 1.493, 95% CI: 1.049-2.126) were independent predictors of IWL/WR. The AUC value of the nomogram constructed from the above three factors was 0.781. The Hosmer-Lemeshow test showed that the model had a good fit (p = 0.143). The calibration curve of the nomogram is close to an ideal diagonal line. Furthermore, the decision curve analysis demonstrated the good net benefits of the model.

A nomogram based on pre-surgery factors was developed to predict postoperative IWL/WR. This provides a convenient and useful tool for predicting suboptimal weight loss before surgery.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the effects of psychological interventions for depression in people with diabetes mellitus.