Search Results (478)

Background: Accurate diagnosis and cause of death ascertainment are essential for effective disease surveillance and epidemiological research. This study aimed to validate prostate cancer diagnostic accuracy (PCa) and the accuracy of cause of death information among veterans with type 2 diabetes mellitus (T2DM). Methods: We conducted a retrospective cohort study of veterans with T2DM diagnosed during the baseline period (2008–2009) and followed from 2010 to 2019 using data from the Veterans Health Administration (VHA) Corporate Data Warehouse (CDW). Diagnostic codes and cause of death data were obtained from the Prostate Cancer Data Core (PCDC) and the National Death Index (NDI), which served as the gold standards for validating PCa diagnosis and mortality information in the CDW. Concordance between data sources was assessed using Cohen’s Kappa statistic. Results: Among 763,424 veterans with T2DM, 37,048 (4.9%) were diagnosed with PCa in the CDW and 36,861 (4.8%) in the PCDC, with a concordance rate of 36,361 (98.6% of patients diagnosed in the PCDC). Mortality data from the NDI identified 2723 deaths with PCa listed as the underlying cause of death, of whom 75.4% had a corresponding PCa diagnosis recorded in the CDW. For all-cause mortality, 328,165 veterans were identified as deceased in the CDW Vital Status File (VSF), compared with 326,707 deaths recorded in the NDI. Of these, 324,567 deaths were concordant between the two sources, representing 99.3% of NDI-recorded deaths. Compared with the PCDC, the CDW demonstrated high accuracy for identifying incident PCa diagnosis, with a sensitivity of 98.6% and a specificity of 99.9%. Conclusions: The findings demonstrated a high level of concordance in key outcomes, including PCa diagnosis between the CDW and PCDC, and all-cause mortality between the CDW VSF and NDI. Full article

Background: Diabetic foot ulcer (DFU) recurrence remains a primary challenge in diabetes care. Although wound closure is the conventional therapeutic endpoint, it does not equate to risk resolution. Despite the implementation of evidence-based preventive strategies, a significant proportion of patients experience recurrent ulceration, highlighting an efficacy gap in current management. Objectives: This narrative review aims to quantify the residual recurrence risk and to provide a clinical framework for risk stratification in patients in remission. Methods: A structured narrative review of PubMed and Google Scholar (up to May 2026) was conducted to evaluate the residual burden associated with standard preventive interventions. Only English-language publications were considered. Results: Our analysis reveals that even with optimal adherence to established preventive protocols, a substantial residual risk persists, ranging from 16.7% to 41.4%. Clinical data indicate that the frequency of podiatric follow-up is a critical determinant of outcomes, with a 4-week screening interval limiting residual risk to 18.4%, significantly outperforming less frequent assessments. Conclusions: The persistence of residual risk mandates a paradigm shift in diabetic foot management: from a “healing-centered” approach to a “remission-focused” model. We propose an integrated, multidisciplinary strategy—anchored by 4-week podiatric surveillance—to mitigate the multifactorial drivers of recurrence and narrow the efficacy gap in clinical practice. Full article

Background: This study aimed to determine the prevalence of osteosarcopenia and evaluate the diagnostic performance of phase angle, derived from bioelectrical impedance analysis, in identifying osteosarcopenia among older adults with type 2 diabetes mellitus. Method: A cross-sectional study was conducted with 147 participants aged 60 years or older, recruited from an outpatient clinic in Thailand between during 2024. Osteosarcopenia was diagnosed when criteria for both sarcopenia, defined by low skeletal muscle mass and either reduced handgrip strength or impaired physical performance, and osteoporosis, defined by a T-score of −2.5 or lower on dual-energy X-ray absorptiometry, were met. Participant characteristics, physical function, laboratory values, and body composition data were collected. Univariable Firth’s penalized logistic regression identified low body mass index and a lower phase angle as independent predictors of osteosarcopenia. Results: The overall prevalence of osteosarcopenia was 7.5 percent. Receiver operating characteristic curve analysis showed strong diagnostic performance of phase angle, with an area under the curve of 0.865. A cutoff value of less than 4.0 degrees achieved 100% sensitivity, 62.5% specificity, and 100% negative predictive value. These findings suggest that phase angle may be a practical, noninvasive screening tool for identifying older adults with type 2 diabetes mellitus who are at risk for osteosarcopenia. Its application in routine clinical settings could enable earlier intervention and reduce long-term complications associated with musculoskeletal decline in this vulnerable population. Full article

Background/Objectives: The prevalence of obesity is increasing among Japanese patients with type 2 diabetes (T2D); however, the impact of obesity history and severity on microvascular complications remains poorly understood. This study aimed to investigate the association of lifetime maximum body mass index (BMI) and BMI at the first clinical visit with the development and progression of diabetic nephropathy and retinopathy. Methods: This retrospective cohort study included T2D patients who first visited the clinic of the Institute for Medical Sciences, Asahi Life Foundation between 2005 and 2022. Patients were categorized into five groups based on both lifetime maximum and first-visit BMI: underweight, normal weight, class I obesity, class II obesity, and severe obesity. The primary endpoints were renal events (sustained increase in proteinuria or ≥40% decline in eGFR) and retinal events (worsening of diabetic retinopathy by ≥1 stage). Results: A history of severe obesity, based on the lifetime maximum BMI, was an independent risk factor for proteinuria progression. While a history of severe obesity was associated with all endpoints in unadjusted analyses, these associations with eGFR decline and retinopathy were not significant after adjusting for covariates. In contrast, the BMI at the first visit was significantly associated with retinal events but not with renal events. Conclusions: A history of maximum lifetime obesity is a critical predictor of the proteinuria progression. A history of obesity, a simple clinical metric, is a valuable tool for identifying high-risk patients and may contribute to more effective preventative strategies. Full article

Objectives: We assessed the test–retest reliability, criterion validity, and agreement of the Global Physical Activity Questionnaire (GPAQ) against accelerometry for estimating physical activity (PA) and sedentary behaviour (SB) among Indian adults at high risk of type 2 diabetes. Methods: We validated the original GPAQ in a subsample of 196 participants from the Kerala Diabetes Prevention Program. Participants were identified as being at high risk based on an Indian Diabetes Risk Score (IDRS) ≥ 60 and the absence of diabetes on an oral glucose tolerance test. To assess test–retest reliability, participants completed the GPAQ on two occasions, one week apart. Criterion validity and agreement were evaluated by comparing GPAQ responses with seven days of concurrent ActiGraph GT3X accelerometer data. Statistical analyses included intraclass correlation coefficients (ICCs) for reliability, Spearman’s correlation coefficients (ρ) for criterion validity, and Bland–Altman plots for agreement. Results: The mean (SD) age of participants was 47.0 (7.4) years, and 51% were female. ICCs for test–retest reliability ranged from 0.37 for moderate-intensity PA to 0.61 for vigorous-intensity PA. Spearman’s ρ for criterion validity ranged from 0.14 for SB to 0.38 for overall moderate-to-vigorous PA. Bland–Altman plots showed that the GPAQ consistently overestimated PA across all intensity levels while underestimating SB. Conclusions: The GPAQ demonstrated poor-to-moderate test–retest reliability, low criterion validity, and poor agreement with accelerometry for assessing PA and SB among Indian adults at high risk of type 2 diabetes. Full article

Background and Objectives: Physical inactivity is a modifiable risk factor for vascular complications in individuals with diabetes mellitus. The aim of this study was to evaluate the predictive capacity of physical activity level for peripheral arterial disease (PAD) in patients with diabetes. Methods: A multicentre cross-sectional study was conducted in adults with diabetes undergoing vascular screening. Physical activity was assessed using the Spanish short version of the Minnesota Leisure-Time Physical Activity Questionnaire (VREM), with energy expenditure expressed as metabolic equivalents (MET-min/14 days). PAD was defined according to standard vascular criteria. Analyses included bivariate tests, Spearman correlation, multivariable logistic regression, and receiver operating characteristic (ROC) curve analysis. Results: Fifty-four participants were included, with a mean energy expenditure of 4031.8 ± 3986.9 MET-min/14 days. Physical activity was inversely correlated with PAD (ρ = −0.380; p = 0.005). Participants without PAD had significantly higher activity levels than those with PAD (p = 0.006). After adjustment for age, body mass index, glycated haemoglobin, and diabetes duration, higher physical activity remained independently associated with lower odds of PAD (OR = 0.621; 95% CI: 0.392–0.983; p = 0.042). The model showed good discrimination (AUC = 0.840). Conclusions: Higher leisure-time physical activity is associated with a reduced likelihood of PAD in individuals with diabetes, although the findings should be interpreted cautiously due to the study design and sample size. Full article

Background/Objectives: To determine the association between post-pancreas transplantation weight gain and graft dysfunction. Methods: Retrospective analysis of pancreas transplantation from 1 August 2008 to 1 November 2022. All patients > 18 years old who underwent simultaneous kidney pancreas transplant (SPK), pancreas after kidney transplant (PAK), and pancreas transplant alone (PTA) with at least one year of follow up were included. The association between post-transplant weight gain and graft dysfunction was assessed. Graft dysfunction was defined as HbA1c > 6.5% or use of antihyperglycemic medication. Results: Twenty-five percent of recipients had substantial weight gain (SWG), defined as >7% weight increase, by 1 year post-transplant. Recipients with T2D and SPK recipients were more likely to gain weight. SWG within the first year was significantly associated with the development of graft dysfunction at most recent follow up (Cox HR = 3.3, p = 0.005), but not at 1 year. Recipients with SWG in the first year had significantly higher HbA1C at most recent follow up (5.3 ± 0.7% vs. 5.9 ± 0.9%, p = 0.009), but not at 1 year. Among recipients with SWG occurring after 1 year, there were no differences in graft dysfunction or HbA1C at 1 year and no difference in graft dysfunction or HbA1C at most recent follow up. Conclusions: In this single-center study, SWG at 1 year post-transplant was associated with the development of graft dysfunction and elevated HbA1C in the long term. Full article

Background: Osteoprotegerin (OPG) is best known for regulating bone remodeling, vascular calcification, apoptosis, and immune responses. Recent studies also suggest that OPG may play an important role in diabetic microvascular complications such as diabetic retinopathy (DR). Objectives: The aim of our cross-sectional case–control study was to assess the relationship between the OPG variants (rs2073618 and rs3134069) and DR in a large cohort of subjects with type 2 diabetes (T2DM). Methods: A total of 1554 subjects with T2DM were enrolled in this cross-sectional case–control study: 577 with DR and 977 without DR. Genotyping was performed using StepOne Real-Time PCR with TaqMan genotyping assays. Results: Our data indicated that the prevalence of the C minor allele was significantly higher among patients with DR and type 2 diabetes in both polymorphisms. Furthermore, individuals carrying the CC genotype of the rs2073618 had a 1.42-fold increased likelihood of DR, while carriers of the CC or CA genotypes of the rs3134069 exhibited a 1.55-fold higher likelihood of DR. Conclusions: Taken together with existing evidence, these results suggest that OPG polymorphisms may be involved in the development of DR. 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

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: 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