Diabetology

Background/Objectives: Diabetes-related stigma decreases treatment motivation. While subjective financial burden is a known barrier, the impact of actual medical costs on stigma remains unclear. We investigated the relationship between annual outpatient medical costs (total and out-of-pocket) and stigma in type 2 diabetes to explore whether this association might be more closely related to direct financial hardship or underlying treatment complexity. Methods: In a cross-sectional study, we evaluated stigma in 232 outpatients using the Kanden Institute Stigma Scale (KISS). Patients scoring ≥20 formed the high stigma group (n = 59). Annual medical costs were extracted from electronic hospital claims. We examined associations between medical costs and high stigma using multivariable logistic regression and restricted cubic spline (RCS) models. Results: Adjusted for sex and age, higher total medical cost (per 10,000 JPY/year) was significantly associated with high stigma (odds ratio [OR] = 1.03, 95% confidence interval [CI]: 1.01–1.05, p < 0.01). However, this significance was attenuated after additionally adjusting for HbA1c and antidiabetic agent count (OR = 1.02, 95% CI: 1.00–1.04, p = 0.05). RCS analysis confirmed this dose–response association disappeared upon adjusting for treatment intensity. Notably, out-of-pocket costs showed no significant association with high stigma in any fully adjusted models (OR = 1.03, 95% CI: 0.95–1.11, p = 0.45). Conclusions: While total medical costs are associated with high stigma, the attenuation of this relationship after adjusting for clinical factors suggests that this association may be closely intertwined with the psychosocial burden of treatment complexity, such as polypharmacy and insulin injections, rather than acting solely through direct economic pain from out-of-pocket expenses. Clinicians should prioritize shared decision-making to mitigate psychological distress when intensifying treatment. Full article

Introduction: Diabetic foot ulcers (DFUs) are a debilitating complication of diabetes, and management by multidisciplinary foot teams have been shown to reduce serious sequelae, such as amputations. There are stark racial and ethnic disparities in morbidity and mortality from DFUs, and multidisciplinary care has been shown to reduce lower extremity amputations, length of hospital stays and readmissions. This is a review of the impact of multidisciplinary care on DFUs, particularly regarding social determinants of health, with an illustrative case. Case Presentation: This is a case of a 32-year-old African American male with Type 1 Diabetes, a history of poor glycemic control, attention deficit hyperactivity disorder, tobacco and marijuana use disorder, and multiple social and structural barriers to care. He presented with bilateral Wagner grade 3 DFUs with osteomyelitis to the emergency department, requiring hospitalization. Upon discharge, he was referred to a multidisciplinary diabetes clinic and received coordinated support from endocrinology, podiatry, vascular surgery, infectious disease, pedorthics, and behavioral health. Comprehensive evaluation, intensive wound care with adjuvant hyperbaric oxygen therapy, offloading, blood glucose management and medical source control of infection were established for his treatment plan. At the three-month follow-up, the patient’s wound beds had significantly improved, and his Hemoglobin A1c declined from 12.6% to 9.3%. The right plantar wound completely epithelialized, and the left foot wound showed 90% contracture. Review and Discussion: This case highlights the importance of integrated, multidisciplinary care for DFUs, particularly in addressing both the clinical and social drivers of complications from diabetes. Full article

Background/Objectives: Therapeutic education for children and adolescents with Type 1 Diabetes Mellitus (T1DM) is a continuous and essential process in the effective management of the disease. These programs consider the unique characteristics and developmental needs of each child or adolescent, aiming to empower them to take responsibility for their disease self-management, improve quality of life, and prevent complications. The purpose of this systematic review was to evaluate the impact of therapeutic education in children and adolescents with T1DM on self-management of their disease. Methods: International bibliography was reviewed using electronic databases such as PubMed, Cochrane Library, and Scopus. Key words such as “Therapeutic Education”, “Type 1 diabetes”, “children”, “self-management”, “glycemic control”, and “educational programs” in combination with Boolean operators (AND, OR) were used in English language to search for studies conducted during 2014–2024. Results: A total of 23 studies met the inclusion criteria. Most reported improvements in glycemic control, though not all showed statistically significant reductions in glycated hemoglobin (HbA1c). Enhanced treatment adherence and increased diabetes-related knowledge were common outcomes. Combined educational approaches incorporating psychoeducational interventions demonstrated greater effectiveness in promoting self-management. Digital tools, such as Continuous Glucose Monitoring (CGM), further supported adherence. Quality-of-life improvements were noted but were not always sustained long-term. Parental involvement appeared to improve children’s confidence in disease management. The critical role of interdisciplinary diabetes care teams, particularly nurses’ role, was also highlighted. Conclusions: Therapeutic education appears to support self-management among children and adolescents with T1DM, particularly when programs are individualized, family-centered, multidisciplinary, and supported by psychosocial or technological components. However, effects on glycemic control were not consistent across studies, and further research is needed to confirm long-term outcomes. Full article

Background: Diabetic foot ulcers (DFUs) are a major cause of morbidity and lower extremity amputation. Numerous advanced wound therapies with various mechanisms of action have been developed to improve healing outcomes; however, the comparative certainty of evidence supporting these interventions remains unclear. This study evaluates randomized controlled trials (RCTs) of DFU therapies using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Methods: A narrative synthesis of RCTs published between January 2016-January 2026 evaluating therapies for DFUs was performed. For studies that reported 12–week healing outcomes, risk of bias was assessed using the Cochrane Risk of Bias 2 tool and certainty of evidence for each therapy subgroup was evaluated using the GRADE framework. Results: A total of 143 RCTs were included with 45 RCTs undergoing GRADE assessment. The proportion of studies demonstrating statistically significant improvements in 12-week healing rates relative to controls varied and was not reflected in the GRADE assessment. Moderate-certainty evidence was assigned to the hyperbaric oxygen therapy subgroup. Low-certainty evidence was assigned to silver dressings, biosynthetic scaffolds, stem cell therapy, and negative pressure wound therapy. Very low-certainty evidence was assigned to topical oxygen, synthetic structural scaffolds, moisture-retaining dressings, local antimicrobial delivery, placental-derived skin substitutes, platelet-rich plasma, acellular dermal matrices, allografts/xenografts, and off-loading devices. No therapy subgroup was assigned high-certainty evidence. Conclusions: The certainty of evidence supporting DFU therapies varies substantially across intervention categories. These findings highlight the need for larger, methodologically rigorous comparative trials to clarify the effectiveness of DFU therapies and guide evidence-based wound care. Full article

Introduction: As diabetes care becomes increasingly digitalized, stratified, and differentiated, psychosocial vulnerability risks becoming less visible within routine care and documentation. To ensure that differentiated care pathways meaningfully incorporate psychosocial stratification, vulnerability must be identifiable, documented, and revisited as part of routine clinical practice. Aim: The aim of this study is to explore how healthcare professionals identify psychosocial vulnerability in routine diabetes care and how such vulnerability is documented and followed up in the electronic medical record (EMR). Methods: This quality improvement audit with a descriptive analysis component was conducted at Steno Diabetes Center Copenhagen as part of the development of a new differentiated outpatient pathway. Healthcare professionals across disciplines submitted cases of persons with diabetes whom they considered psychosocially vulnerable. Documentation from the preceding six months was reviewed descriptively in order to find patterns of identification, documentation, care planning, and follow-up. Results: A total of 334 referrals representing 275 unique persons with diabetes were submitted. Psychosocial vulnerability extended beyond predefined high-risk categories, as 37% of identified cases did not align with any of the six vulnerability groups described in the Danish VIVE framework. Vulnerability often reflected cumulative everyday-life strain rather than formal diagnoses. While healthcare professionals demonstrated substantial relational attentiveness to psychosocial concerns, this knowledge was not consistently evident in formal documentation. Explicit care plans and longitudinal follow-up were uncommon, and psychosocial concerns were frequently documented as isolated observations rather than as part of structured ongoing care. Conclusions: Psychosocial vulnerability was frequently identified through clinical dialogue and professional judgement and often extended beyond predefined vulnerability categories. The findings highlight the importance of developing shared approaches and a shared understanding of psychosocial vulnerability across professional groups. If psychosocial stratification is to become an operational component of differentiated diabetes care, information about what burdens matter to the person must be identifiable, documented, and carried forward across encounters alongside biomedical information. Full article

Background/Objectives: Type 2 diabetes mellitus (T2DM) and menopause are associated with low levels of vitamin D (25[OH]D). Primary trials reported the effects of cholecalciferol supplementation on glycemia and T2DM incidence with conflicting results. This uncontrolled longitudinal prospective study aimed to evaluate changes in metabolic and cardiovascular parameters in postmenopausal women with T2DM during sequential cholecalciferol supplementation. Methods: Thirty-four postmenopausal women (mean of 63.8 ± 7.5 years) with T2DM received 1000 IU/day of cholecalciferol for 12 months, followed by 2000 IU/day for another 12 months. Fasting blood tests, anthropometric assessments, and physical examinations were performed at baseline, 12 months, and 24 months after the intervention. The levels of 25(OH)D, fasting glycemia, glycated hemoglobin, fasting insulin, homeostasis model assessment (HOMA) of insulin resistance, HOMA of β-cell function (HOMA-β), total cholesterol, high-density lipoprotein cholesterol (HDL-c), triglycerides, and C-reactive protein were evaluated. Systolic blood pressure (SBP), diastolic blood pressure, waist circumference (WC), waist-to-hip ratio, and body mass index were also assessed. Results: Serum 25(OH)D and HDL-c levels increased over time during the follow-up period. Lower WC and SBP values were observed across follow-up assessments. Although fasting blood glucose values showed a median of 120 mg/dL at baseline and 110 mg/dL after cholecalciferol supplementation, and HOMA-β values were approximately 35% higher at the end of follow-up, these differences were not statistically significant (p = 0.059 and p = 0.158, respectively). Conclusions: The long-term 25(OH)D dosing regimen had modest beneficial effects on glucose homeostasis, lipid profiles, and blood pressure in postmenopausal women with T2DM. This study contributes to the search for an optimal daily 25(OH)D dose in postmenopausal women with diabetes. Full article

Obstructive sleep apnea (OSA) is a common condition defined by recurrent upper airway collapse, intermittent hypoxia, and sleep fragmentation that leads to sympathetic activation and adverse cardiometabolic effects. OSA and type 2 diabetes mellitus (T2DM) share a complex, bidirectional relationship driven in part by obesity, but also by overlapping pathophysiologic mechanisms. Diabetes may worsen upper airway collapsibility, while untreated OSA may exacerbate hyperglycemia, contributing to a self-perpetuating cycle of metabolic abnormalities. Continuous positive airway pressure (CPAP) remains the first-line therapy for OSA, and improves symptoms and some cardiometabolic parameters, although effects on glycemic control have been mixed and may depend on patient factors. Alternative therapies play important roles in some patients. Incretin-based therapies, particularly tirzepatide, have emerged as promising treatments for obesity-related OSA following the SURMOUNT-OSA trial, demonstrating significant reductions in apnea–hypopnea index and cardiometabolic risk factors, though their effect in patients with T2DM remains unclear. Considerations such as sarcopenia with weight loss and evolving pharmacologic and procedural strategies further shape management decisions. This review synthesizes current evidence on the pathophysiologic overlap, therapeutic approaches, and future directions in optimizing care for patients with coexisting OSA and diabetes. Full article

Introduction: Previous research has suggested thiazolidinediones (TZDs) may be associated with certain solid tumors. We examined incidence rates over time for patients with solid tumors who received TZD treatment for diabetes. Methods: We identified medication use and diagnosis codes that were aggregated to phecode disease classifications derived from the nationwide Veterans Administration Health Record System from 2000 to 2021. We identified 148,139 patients who had ≥2 diabetes diagnoses and had no previous cancer diagnosis. Among these, 8981 subjects had ≥4 years of TZD exposure. We then identified subjects with ≥2 diagnosis codes for solid tumors including bladder (n = 3987), breast (n = 632), colorectal (n = 5139), esophageal (n = 482), glioma (n = 591), lung (n = 5142), melanoma (n = 1896), pancreatic (n = 726), prostate (n = 11,884), renal (n = 3145), testicular (n = 369), and thyroid (n = 513). We used multivariable Cox proportional hazards regressions to measure associations between TZD use and cancer incidence. TZD use was modeled as a time-varying covariate from the first to last prescription of TZD medication, and analyses were adjusted for age at diabetes diagnosis, self-reported race, self-reported ethnicity, sex, body mass index, and cancer site-specific polygenic risk scores. Results: Long-term (≥4 years) exposure to TZDs was significantly associated with increased risk of developing prostate cancer (HR = 1.24, p < 0.001) and decreased risk of developing lung (HR = 0.58, p < 0.001), bladder (HR = 0.51, p < 0.001), and renal cancer (HR = 0.75, p = 0.003). Conclusions: Decreased risk of developing several solid tumors (lung, bladder, and renal) indicate that TZDs may be strong candidates for drug repurposing strategies to manage these types of cancer. These results warrant replication attempts in external datasets. Full article

Background/Objectives: Patients with lymphoma are at increased risk of dysglycemia due to disease-related and treatment-associated metabolic alterations. This study aimed to characterize fasting capillary glucose patterns in patients with lymphoma undergoing routine capillary fasting blood glucose assessment before fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT). Materials and Methods: Consecutive patients with lymphoma undergoing clinically indicated FDG PET/CT at the University Hospital Zurich were included. Capillary fasting blood glucose (cFBG) was measured before tracer administration and categorized according to American Diabetes Association fasting glucose thresholds. Additional analyses were performed in patients examined before 11:00 AM and in patients without known diabetes mellitus. Multivariable linear regression was used to identify factors associated with cFBG. Results: The cohort included 210 consecutive patients with lymphoma (median age 64 years, IQR 48–73; 44% female, 92/210; median BMI 24 kg/m², IQR 22–28). Known diabetes mellitus was present in 12% (25/210). Median cFBG was 104 mg/dL (IQR 95–115; 5.8 mmol/L, IQR 5.3–6.4). Overall, 64% (135/210) had cFBG values above the normal range (≥100 mg/dL; ≥5.6 mmol/L). Among patients examined before 11:00 AM, this proportion was 69% (81/117). After excluding patients with known diabetes mellitus, 60% (111/185) had cFBG values above the normal range, and 7% (13/185) had values ≥126 mg/dL (≥7.0 mmol/L). In multivariable analysis, BMI and regular exercise were independently associated with cFBG. Conclusions: Almost two-thirds of patients with lymphoma undergoing FDG PET/CT had cFBG values above the normal range, including 60% of those without known diabetes mellitus. These findings highlight the need for improved dysglycemia screening and management in lymphoma care. Full article

Background/Objectives: Diabetes mellitus (DM) is a group of chronic metabolic disorders characterised by persistent hyperglycaemia and an increasing global prevalence, imposing a significant socioeconomic and healthcare burden. Among its associated complications, the diabetic foot is a critical condition that doubles the risk of mortality. Although therapeutic footwear is an essential preventive strategy, research on treatment adherence has predominantly focused on quantitative parameters. This protocol aims to explore the experiences, needs, and perceived barriers of people with DM regarding therapeutic footwear use from a qualitative perspective. Methods: A qualitative focus group study will be conducted in the province of Alicante, Spain. Participants will be adults with a confirmed diagnosis of DM recruited across IWGDF foot risk categories 1–3 through purposive sampling. A total of 8–10 focus groups of 10–12 participants will be conducted in separate in-person and online modalities. Data will be analysed using reflexive thematic analysis within a constructivist epistemological framework, following the six-phase approach proposed by Braun and Clarke. The study adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Ethical approval will be obtained from the relevant Ethics Committee prior to data collection. Results/Expected Outcomes: The findings are anticipated to generate patient-centred, evidence-based insights into the psychosocial and experiential dimensions of therapeutic footwear adherence, informing the development of novel educational strategies and improvements in footwear design to optimise treatment adherence and clinical outcomes. Conclusions: This protocol provides a rigorous and transparent methodological framework for qualitative investigation of therapeutic footwear adherence in people with DM, contributing to a more comprehensive and person-centred approach to diabetic foot prevention. Full article

Background: Type 2 diabetes mellitus (T2DM) is associated with impaired skeletal muscle mass and function; however, respiratory muscle involvement has not been fully investigated, particularly in Japanese patients. This study aimed to evaluate respiratory muscle strength and identify its associated factors in Japanese patients with T2DM. Methods: This cross-sectional study included 55 patients with T2DM without respiratory disease. Maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax) were measured and expressed as percentages of the predicted values (PImax %pred and PEmax %pred). Clinical variables, including age, sex, body mass index (BMI), diabetic polyneuropathy (DPN), skeletal muscle index (SMI), handgrip strength, and 6-min walk distance (6MWD), were assessed. Correlation and multiple regression analyses were performed to identify factors associated with PImax %pred. Results: PImax %pred was significantly lower than the predicted value (69.5% [95% CI: 63.1–75.9], p < 0.001), whereas PEmax %pred did not differ significantly from the predicted value (95.6% [95% CI: 86.8–104.3]). PImax %pred was significantly associated with age, BMI, SMI, handgrip strength, and 6MWD. In multiple regression analysis, age, sex, BMI, and handgrip strength were independently associated with PImax %pred, whereas DPN was not. These findings remained unchanged after adjusting for smoking habits. Conclusions: Inspiratory muscle strength was selectively reduced in Japanese patients with T2DM and was independently associated with general physical characteristics and overall muscle strength. Inspiratory muscle weakness may reflect generalized skeletal muscle dysfunction rather than solely a neuropathic impairment. This assessment of respiratory muscle strength may provide additional insights into the physical function of patients with T2DM. Full article

Background: Hypoglycemia has harmful effects on chronic complications of diabetes, and when it occurs at night, it is often asymptomatic. When oral hypoglycemic medications with different mechanisms of action that promote insulin secretion are used in combination in the individual with type 2 diabetes, hypoglycemia may occasionally occur. Therefore, we investigated blood glucose fluctuations with a focus on nocturnal hypoglycemia in the individuals with type 2 diabetes undergoing concomitant use of these medicines using continuous glucose monitoring (CGM) as a retrospective observational study. Methods: The participants consisted of 59 Japanese individuals with type 2 diabetes treated with a DPP-4 inhibitor and glimepiride (N = 30) or gliclazide (N = 29). Clinical factors including HbA1c were not significantly different between these groups. Blood glucose was monitored using CGM for 10 days. Hypoglycemia was defined as monitoring glucose less than 54 mg/dL for at least 15 min. Results: Asymptomatic nocturnal [from midnight to 6:00 AM (6 h)] hypoglycemia was observed more frequently in the glimepiride group (43.3%) than the gliclazide group (6.9%), p = 0.002. All hypoglycemia was unrecognized. Logistic regression analyses indicated that nocturnal hypoglycemia was significantly associated with concomitant use of a DPP-4 inhibitor and glimepiride. Conclusions: Among individuals with type 2 diabetes who had relatively good glycemic control, asymptomatic nocturnal hypoglycemia occurred more frequently in the group treated with a DPP-4 inhibitor and glimepiride than that treated with a DPP-4 inhibitor and gliclazide. Even when HbA1c levels were comparable, the use of CGM that could monitor nocturnal glucose fluctuation clearly identified this difference. Full article

The global prevalence of type 2 diabetes continues to rise at an alarming pace, challenging existing strategies for disease prevention and management. Beyond traditional risk factors, increasing evidence indicates that glucose metabolism is temporally regulated by the body’s 24 h biological clock and oscillates based on the time of day. Disturbances of the circadian clock function are linked to impairments in glucose homeostasis and increased risk of obesity and diabetes. This review explores the intricate relationship between the circadian system and glucose homeostatic control. We begin with an introduction to the hierarchical organization of the circadian system. Next, we examine the role of the circadian clock in regulating organs and tissues that are involved in glucose metabolism, i.e., the pancreas, skeletal muscles, the liver and adipose tissue. We next review evidence that supports the involvement of circadian disturbances in the pathogenesis of diabetes. Finally, we discuss chronotherapy and its potential application in clinical intervention of diabetes. As type 2 diabetes becomes increasingly common worldwide, understanding how the body’s internal clock shapes this disease may open new and powerful opportunities for its prevention and treatment. Full article

Background/Objectives: Type 2 diabetes (T2D) remission can be defined as a return to a HbA1c < 6.5% (<48 mmol/mol) sustained without ongoing treatment for at least 3 months. Prevalence estimates and factors associated remain unknown for LMIC and resource-limited settings. Methods: We conducted a retrospective observational analysis of electronic medical records from 8463 adults who received multidisciplinary care at Mexico’s primary care specialized units (UNEMES-EC) between 2015 and 2019 and who were referred for inadequate metabolic control. Remission was defined per 2021 ADA criteria as HbA1c <6.5% sustained for ≥3 months without glucose-lowering medications. After estimating the prevalence of T2D remission, logistic regression models were used to evaluate its sociodemographic and clinical predictors, with particular attention to weight change and baseline adiposity interactions. Results: RT2D prevalence was 0.87% (95% CI: 0.68–1.10) over a median 393-day follow-up. Weight loss ≥10% (adjusted OR 2.75; 95% CI: 1.21-6.27) and systolic blood pressure (tertile 3 vs tertile 1: OR 2.49; 95% CI: 1.17–5.26) were positively associated with RT2D, while elevated baseline HbA1c (tertile 3 vs. tertile 1: OR 0.09; 95% CI: 0.02–0.33), triglyceride levels (tertile 3 vs. tertile 1: OR 0.49; 95% CI: 0.24–0.98) and intensive pharmacotherapy were inversely associated with RT2D. No associations with HDL and total cholesterol were found. Age, sex, educational attainment, and income demonstrated no independent associations with remission. Among lifestyle-treated patients achieving ≥5% weight loss, remission prevalence reached approximately 11%. No significant interaction between baseline BMI and weight change was detected (p = 0.60). Conclusions: This first large-scale Mexican study establishes RT2D as an achievable endpoint in patients with poor baseline metabolic control. The findings suggest that remission could be achieved with equity-focused, weight-centered interventions even in resource-constrained health systems and populations. Full article

Background: Sedentary behavior is a major modifiable risk factor for chronic metabolic disorders, particularly type 2 diabetes mellitus (T2DM). Despite recommendations promoting regular physical activity (PA), adherence remains low. DIA/01 is a multidisciplinary study designed to promote healthy lifestyles for the prevention and management of T2DM, supporting healthcare systems. Methods: A total of 123 adults with T2DM diagnosed will be enrolled at the Diabetes Center of the University Hospital of Perugia throughout 2025. Inclusion criteria are age 25–80 years, ability to walk independently, being inactive, and BMI 18.5–40 kg/m². Exclusion criteria include severe cardiovascular, central nervous system, or musculoskeletal diseases contraindicating PA. Participants will be randomized into three groups: (1) standard care (SC); (2) SC plus theoretical PA counseling (TCPA); and (3) SC plus TCPA plus a 3-month supervised mixed exercise program. The assessment, conducted at baseline and at 6 and 12 months, includes total weekly PA (WPA) time, using IPAQ-SF and actigraphy. Moreover, glycated hemoglobin, sedentary time (ST), functional capacity, body composition, cardiometabolic risk factors, dietary adherence, perceived barriers and willingness to initiate PA, readiness to change, health-related quality of life, and sleep quality will be studied. This study is registered in the Clinical Trials Registry on 13 May 2026, with the identifier NCT07583355. Conclusions: Participants in groups (2) and (3) are expected to show greater improvements in WPA, reductions in ST, and favorable changes in metabolic and functional outcomes compared with SC. This approach may support long-term engagement in regular PA and contribute to improving the clinical management of T2DM. Full article

Background: Type 2 Diabetes Mellitus (T2DM) is associated with a vascular-executive cognitive decline profile that early impacts complex daily tasks. Despite the increased risk of Mild Cognitive Impairment (MCI) in this population, there is a critical shortage of instruments specifically validated for this group. This scoping review aims to identify the instruments used to assess functionality in individuals with T2DM and MCI and to map their psychometric properties. Methods: We conducted a scoping review based on the JBI methodology and PRISMA-ScR guidelines. The search was performed across several electronic databases (PubMed, Cochrane Library, Web of Science, Scopus and SciELO), up to March 2026, focusing on the intersection of T2DM, mild cognitive impairment, and the psychometric properties of functional scales. Results: Our search identified only three studies meeting the eligibility criteria. The functional instruments evaluated across these publications were the ADCS-ADL scale, the A-FAQ, and a predictive nomogram including the Lawton-Brody scale. Methodological approaches, sample configurations and reported outcomes varied substantially within the included literature, with no comparative validation studies conducted among homogeneous T2DM cohorts. Conclusions: The notable scarcity and marked heterogeneity of the available literature prevent any definitive conclusions regarding the comparative diagnostic superiority of current functional scales. While gradated instruments show conceptual compatibility with the executive-vascular cognitive decline profile of T2DM, their psychometric properties remain unvalidated in this specific population. Future research should prioritize longitudinal validation designs in homogeneous diabetic cohorts to standardize screening protocols calibrated to metabolic and vascular variations. Full article

Background/Objectives: The Diabetes-Specific Dementia Risk Score (DSDRS) integrates clinical and metabolic markers to predict cognitive decline in Type 2 diabetes mellitus (T2DM), yet its association with key modifiable risk factors remains unvalidated in Latin American cohorts. This study aimed to assess the relationship between the DSDRS and clinical, biochemical, anthropometric, and neuropsychological variables in older adults with T2DM. Methods: A cross-sectional study of 291 Mexican adults aged ≥ 60 with T2DM was conducted, including assessments of cognitive function (MoCA), depression (BDI), sleep quality (AIS), and metabolic parameters. Results: Higher DSDRS correlated with lower cognitive scores, poorer sleep quality, reduced muscle mass, and smoking status. Multiple regression explained 32% of DSDRS variance, highlighting these factors as significant contributors. Conclusions: The DSDRS reflects multifactorial influences on dementia risk in older adults with T2DM and may aid early identification of individuals at increased cognitive vulnerability in this population. Full article

Background/Objectives: Contemporary diabetes guidelines increasingly emphasize broader cardiometabolic risk stratification beyond glycemic control, but the national proportion of Peruvian adults with diagnosed diabetes who show obesity or hypertension is unknown. We estimated the prevalence of overweight/obesity, obesity, and hypertension; quantified the proportion meeting at least one cardiometabolic-profile criterion; and described recent acquisition of diabetes medications. Methods: We performed a cross-sectional analysis of the Peruvian Demographic and Family Health Survey (ENDES) 2022–2024. Adults aged ≥30 years with a prior medical diagnosis of diabetes were included (n = 2599; weighted population estimate = 1.51 million) from 49,363 eligible adults (weighted population estimate = 19.91 million). Survey-weighted prevalences of overweight (body mass index [BMI] ≥ 25 kg/m²), obesity (BMI ≥ 30 kg/m²), hypertension (primary definition: systolic blood pressure [SBP] ≥ 140 mmHg or diastolic blood pressure [DBP] ≥ 90 mmHg), and diabetes medication purchase in the previous 12 months were estimated. Results: Mean age was 60.0 years (95% confidence interval [CI]: 59.2–60.8), and 55.9% were women. Overall, 81.5% (95% CI: 79.2–83.7) had overweight/obesity, 41.1% (95% CI: 38.0–44.3) had obesity, and 31.8% (95% CI: 28.7–34.9) had hypertension by the primary survey definition. Among participants with complete data for obesity and hypertension (n = 2534; weighted population estimate = 1.45 million), 58.5% (95% CI: 55.4–61.6) met at least one cardiometabolic-profile criterion. Independently, 78.9% (95% CI: 76.4–81.3) reported purchasing diabetes medications, with lower proportions in rural populations and among uninsured adults. Conclusions: Nearly six in ten Peruvian adults with diagnosed diabetes had obesity or hypertension, a population-level profile consistent with substantial cardiometabolic complexity and the potential need for broader risk-oriented management beyond glucose alone. Persistent gaps in medication acquisition suggest that therapeutic modernization and equitable continuity of basic pharmacologic treatment should be addressed simultaneously. Full article

Background/Objectives: Acute care use (ACU)—emergency department visits, inpatient hospitalizations, and observation stays—drives morbidity and costs among adults with diabetes. We developed and evaluated machine-learning models to predict 1-year ACU risk using electronic health record (EHR) data and neighborhood-level data. Methods: We performed a retrospective cohort study using de-identified EHR data from a large urban academic health center, including adults (≥18 years) with diabetes (N = 23,052). The index date was defined as one year before each patient’s last encounter, and ACU was assessed during the subsequent year. We modeled 180 predictors spanning demographics, Area Deprivation Index (ADI), prior healthcare utilization, vitals/BMI, comorbidities, medications, and laboratory results. Decision tree and gradient-boosted models (XGBoost, LightGBM, CatBoost) were tuned with Optuna using 8-fold stratified cross-validation, optimizing area under the receiver operating characteristic curve (AUC). To improve class-balanced classification performance under outcome imbalance, we selected post hoc probability thresholds that maximized Macro F1 and quantified interpretability with permutation feature importance. Results: ACU occurred in 30.53% of patients (7039/23,052). Boosted models achieved AUC ≈ 0.78, with LightGBM performing best (AUC = 0.7839). Macro F1–optimized thresholds (<0.5; typically 0.375–0.40) improved class-balanced performance versus a 0.5 cutoff. Across boosted models, prior utilization features dominated, followed by discharge-related factors and neighborhood deprivation; comorbidities and laboratory results contributed. Conclusions: In this single urban academic health-system cohort of adults with diabetes, EHRbased boosted models demonstrated moderate discrimination for predicting 1-year ACU and identified interpretable predictive signals. Threshold optimization improved class-balanced statistical performance. Prior utilization, care transitions, and neighborhood deprivation emerged as dominant predictive features. External and temporal validation are needed before broader application. Full article