Search Results (272)

Cardiovascular disease (CVD) remains Europe’s leading cause of mortality, responsible for >45% of deaths. Beyond established risk factors (hypertension, diabetes, dyslipidaemia, smoking, obesity), psychosocial elements—depression, anxiety, financial stress, personality traits, and trauma—significantly influence CVD development and progression. Behavioural Cardiology addresses this connection by systematically incorporating psychosocial factors into prevention and rehabilitation protocols. This review examines the HEARTBEAT model, developed by Greece’s first Behavioural Cardiology Unit, which aligns with current European guidelines. The model serves dual purposes: primary prevention (targeting at-risk individuals) and secondary prevention (treating established CVD patients). It is a personalised medicine approach that integrates psychosocial profiling with traditional risk assessment, utilising tailored evaluation tools, caregiver input, and multidisciplinary collaboration to address personality traits, emotional states, socioeconomic circumstances, and cultural contexts. The model emphasises three critical implementation aspects: (1) digital health integration, (2) cost-effectiveness analysis, and (3) healthcare system adaptability. Compared to international approaches, it highlights research gaps in psychosocial interventions and advocates for culturally sensitive adaptations, particularly in resource-limited settings. Special consideration is given to older populations requiring tailored care strategies. Ultimately, Behavioural Cardiology represents a transformative systems-based approach bridging psychology, lifestyle medicine, and cardiovascular treatment. This integration may prove pivotal for optimising chronic disease management through personalised interventions that address both biological and psychosocial determinants of cardiovascular health. Full article

Dyslipidaemia is one of the main causes of atherosclerotic cardiovascular disease (ASCVD) worldwide. Although statins remain the cornerstone of lipid-lowering therapy, many patients do not achieve optimal target levels of low-density lipoprotein cholesterol (LDL-C) due to intolerance or inadequate response. Bempedoic acid, an oral ATP citrate lyase inhibitor, provides a liver-specific mechanism that lowers LDL-C levels while minimising muscle-related side effects. Recent clinical trials, including the CLEAR Outcomes Study, have shown that bempedoic acid was able to reduce LDL-C by approximately 29 mg/dL and major adverse cardiovascular events (MACEs) by 13% in patients intolerant to statins. Combination therapy with ezetimibe further enhances this effect. However, adverse effects such as increased uric acid and gout have been reported, requiring careful patient selection and continuous monitoring. This review provides a comparative synthesis of the latest evidence on bempedoic acid, including its pharmacological profile, its efficacy in different patient groups, and its place within current treatment strategies for dyslipidaemia. It also identifies research gaps and directions for future studies. Full article

Background: Patients with chronic kidney disease (CKD) face an elevated risk of cardiovascular disease (CVD), particularly those with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m². Aims: To assess low-density lipoprotein cholesterol (LDL-C) values and the proportion of pre-dialysis patients achieving national and international targets. Methods: This was a retrospective audit (May–October 2024) of 272 patients aged >18 years attending pre-dialysis clinic (estimated glomerular filtration rate <30 mL/min/1.73 m²) at the Renal Unit, Birmingham Heartlands Hospital. Data on age, sex, ethnicity, body mass index, smoking status, CVD status, hypertension, diabetes, lipids (including LDL-C using the Friedewald and Sampson algorithms) and lipid-lowering therapy were collected from the hospital electronic records. Statistical analyses evaluated factors that were associated with LDL-C (linear/multiple regression) and statin therapy (Chi square). Results: The median (interquartile range) calculated LDL-C values were 2.2 (1.7–2.8) mmol/L and 2.3 (1.7–2.9) mmol/L using the Friedewald and Sampson algorithms respectively. Age and statin therapy were independently associated with LDL-C. Using the Friedewald algorithm, 83.8%, 70.6% and 60.3% did not achieve LDL-C targets of 1.4 mmol/L, 1.8 mmol/L and 2.0 mmol/L respectively, these figures were higher when the Sampson algorithm was applied. Only 18 and 3 of the patients were on ezetimibe and inclisiran respectively, whilst not a single patient was on bempedoic acid or proprotein convertase subtilisin/kexin type 9 inhibitors. Conclusion: Our data highlight deficiencies in the management of LDL-C in advanced CKD. We would recommend greater awareness of LDL-C targets and the use of combination lipid-lowering therapy following optimisation of statin therapy. Full article

Background and Objectives: Maternal dyslipidaemia and low-grade inflammation are recognised drivers of in utero vascular remodelling, yet composite dynamic markers that integrate lipid–glycaemic, inflammatory and endothelial signals have not been evaluated. We investigated whether eight-week trajectories in the triglyceride–glucose index (TyG), interleukin-6 (IL-6) and flow-mediated dilation (FMD) outperform single-timepoint lipids for predicting fetal aortic remodelling. Materials and Methods: In a prospective repeated-measures study, 90 singleton pregnancies were examined at 24–26 weeks (Visit-1) and 32–34 weeks (Visit-2). At each visit, we obtained fasting lipids, TyG index, hsCRP, IL-6, oxidative-stress markers (MDA, NOx), brachial flow-mediated dilation (FMD), carotid IMT and uterine-artery Doppler, together with advanced fetal ultrasonography (abdominal-aorta IMT, ventricular strain, Tei-index, fetal pulse-wave velocity). Mothers were grouped by k-means clustering of the visit-to-visit change (Δ) in TG, TyG, hsCRP, IL-6 and FMD into three Metabolic-Inflammatory Response Phenotypes (MIRP-1/2/3). Linear mixed-effects models and extreme-gradient-boosting quantified associations and predictive performance. Results: Mean gestational TG rose from 138.6 ± 14.1 mg/dL to 166.9 ± 15.2 mg/dL, TyG by 0.21 ± 0.07 units and FMD fell by 1.86 ± 0.45%. MIRP-3 (“Metabolic + Inflammatory”; n = 31) showed the largest change (Δ) Δ-hsCRP (+0.69 mg/L) and Δ-FMD (–2.8%) and displayed a fetal IMT increase of +0.17 ± 0.05 mm versus +0.07 ± 0.03 mm in MIRP-1 (p < 0.001). Mixed-effects modelling identified Δ-TyG (β = +0.054 mm per unit), Δ-IL-6 (β = +0.009 mm) and Δ-FMD (β = –0.007 mm per %) as independent determinants of fetal IMT progression. An XGBoost model incorporating these Δ-variables predicted high fetal IMT (≥90th percentile) with AUROC 0.88, outperforming logistic regression (AUROC 0.74). Conclusions: A short-term surge in maternal TyG, IL-6 and endothelial dysfunction delineates a high-risk phenotype that doubles fetal aortic wall thickening and impairs myocardial performance. Composite dynamic indices demonstrated superior predictive value compared with individual lipid markers. Full article

Background: Postmenopausal women face increased risk of developing metabolic syndrome (MetS) and cardiovascular disease (CVD) due to hormone changes during menopause. Life’s Essential 8 (LE8), a relatively new cardiovascular health assessment index by the American Heart Association, may impact MetS diagnostics and potential treatment strategies. This study investigated the association between LE8 and MetS among postmenopausal women. Methods: National Health and Nutrition Examination Survey (NHANES) data were extracted (2011–2020). LE8 comprised eight health behaviours and factors (score of 0–100) classified into low (0–49), moderate (50–79), and high (80–100) cardiovascular health status. MetS was defined as metabolic dysfunctions comprising insulin resistance, central obesity, dyslipidaemia, impaired glucose metabolism, and hypertension. Complex survey-adjusted regression models were used. Effect modification by race and female hormone use were investigated. Results: 5402 postmenopausal women were included (mean age: 63.0 y), and 3152 (58.3%) met MetS criteria. LE8 scores for those with and without MetS were 58 ± 13.8 and 70 ± 14.1 (p < 0.001), respectively (mean ± SD). Higher LE8 scores were associated with lower odds of having MetS (Odds ratio (OR) for a 10-score increase: 0.53, 95% CI: [0.48, 0.57], p < 0.001). Nicotine exposure score was inversely associated with the likelihood of having MetS (0.52 [0.34, 0.80], p = 0.022). The association between LE8 status and odds of MetS differed by race (p-interaction = 0.01); ‘moderate’ or ‘high’ cardiovascular health status lowered odds of MetS in all races except other/multi-racial. Conclusions: The inverse relationship between LE8 scores and MetS suggests that integrating LE8 components into management strategies may help prevent CVD in postmenopausal women. Full article

Background: Hypertension is one of the most common cardiovascular risk factors worldwide. Additionally, epidemiological studies show a worryingly high prevalence of treatment-resistant hypertension. Especially concerning is the frequent co-occurrence of other cardiovascular risk factors, including dyslipidaemia, smoking, and diabetes mellitus. Objectives: The aim of this study is to investigate the prevalence of arterial hypertension and other cardiovascular risk factors in patients aged 50–54 years. Methods: A retrospective study was conducted on patients participating in the Lithuanian High Cardiovascular Risk Primary Prevention Programme. Data were collected from self-report questionnaires, laboratory tests, and clinical assessment. Hypertension was confirmed if systolic blood pressure was ≥140 mmHg and/or diastolic blood pressure was ≥90 mmHg or the patient had been previously diagnosed. Results: In total, 49155 patients—32018 (62.4%) women and 17137 (37.6%) men—were enrolled in this study. A total of 24549 (49.9%) patients were diagnosed with arterial hypertension. The prevalence of non-resistant primary hypertension was 45.9%, while the prevalence of resistant primary hypertension was 4.1%. The prevalence of dyslipidaemia was 92.79% in the non-resistant primary arterial hypertension group and was 94.59% in the resistant primary arterial hypertension group. The prevalence of smoking was higher in the non-resistant primary arterial hypertension group compared to patients with resistant hypertension (22.43% and 17.09%, respectively). A total of 23.06% of patients with resistant primary arterial hypertension had diabetes mellitus. Conclusions: The prevalence of primary arterial hypertension in middle-aged Lithuanians was high, reaching almost 50% in both sexes. Patients tended to have many cardiovascular risk factors simultaneously, with dyslipidaemia being the most common (prevalence > 90%). Full article

Background and Objectives: Screening, primary prevention, and the early identification of high-risk individuals are crucial for minimising the burden of cardiovascular diseases (CVDs). In this study, we aimed to evaluate the association of retinal microvascular features with myocardial dysfunction and CVD risk factors in a group of patients with significant coronary artery disease (CAD) compared to patients with newly diagnosed isolated arterial hypertension and healthy controls. Materials and Methods: We performed a single-centre cross-sectional study on 214 individuals divided into three groups: a group of 99 cases diagnosed with significant CAD, a group of 61 cases with newly diagnosed isolated arterial hypertension, and a control group of 54 cases with no confirmed cardiovascular pathology. Colour optic disc-centred retinal photographs were taken in all cases, and the following parameters were quantified using MONA REVA 3.0.0 software (VITO Health, Mol, Belgium): central retinal arteriolar equivalent, central retinal venular equivalent, arteriovenous ratio, fractal dimension, tortuosity index, and lacunarity. Univariable and multivariable statistical analyses were performed to assess changes in retinal microvascular features in CVD. Results: Dyslipidaemia (p = 0.009), systolic blood pressure (p = 0.008), and LDL cholesterol (p = 0.003) were negatively associated while left ventricular (LV) strain (0.043) was positively associated with the CRAE. In the case of the CRVE, the coronary Agatston score (p = 0.016) proved a positive and HDL cholesterol (p = 0.018) a negative association. A lower fractal dimension was associated with the presence of diabetes mellitus (p = 0.006), dyslipidaemia (p = 0.011), and a history of acute myocardial infarction (p = 0.018), while a higher fractal dimension was associated with increased left ventricular ejection fraction (LVEF) (p = 0.006) and medical treatment (p = 0.005). Lacunarity was higher in patients of female gender (p = 0.005), with decreased HDL (p = 0.014) and LVEF (0.005), and with increased age (p < 0.001) and Agatston score (p = 0.001). The vessel tortuosity index increased with LV strain (p = 0.05), medical treatment (p = 0.043), and male gender (p = 0.006). Conclusions: Retinal microvascular features may serve as additional risk stratification tools in patients with CVD, particularly CAD, pending prospective validation. Full article

The term “big data analytics (BDA)” defines the computational techniques to study complex datasets that are too large for common data processing software, encompassing techniques such as data mining (DM), machine learning (ML), and predictive analytics (PA) to find patterns, correlations, and insights in massive datasets. Cardiovascular diseases (CVDs) are attributed to a combination of various risk factors, including sedentary lifestyle, obesity, diabetes, dyslipidaemia, and hypertension. We searched PubMed and published research using the Google and Cochrane search engines to evaluate existing models of BDA that have been used for CVD prediction models. We critically analyse the pitfalls and advantages of various BDA models using artificial intelligence (AI), machine learning (ML), and artificial neural networks (ANN). BDA with the integration of wide-ranging data sources, such as genomic, proteomic, and lifestyle data, could help understand the complex biological mechanisms behind CVD, including risk stratification in risk-exposed individuals. Predictive modelling is proposed to help in the development of personalized medicines, particularly in pharmacogenomics; understanding genetic variation might help to guide drug selection and dosing, with the consequent improvement in patient outcomes. To summarize, incorporating BDA into cardiovascular research and treatment represents a paradigm shift in our approach to CVD prevention, diagnosis, and management. By leveraging the power of big data, researchers and clinicians can gain deeper insights into disease mechanisms, improve patient care, and ultimately reduce the burden of cardiovascular disease on individuals and healthcare systems. Full article

Alterations in sympathetic nervous activity are evident in response to changes in body weight. Sympathetic nervous activity and sympathetic responses to weight change are regionalized, with alterations in end organ function dependent on the changes occurring in the brain regulatory pathways invoked and in the effector organs engaged. The obesity-induced activation of the sympathetic nervous system likely contributes to the initiation and worsening of cardiometabolic risk factors, including elevated blood pressure, cardiac dysfunction, dyslipidaemia, increased fasting blood glucose, insulin resistance, and non-alcoholic steatohepatitis. Unintended weight loss, as occurs in cachexia, is driven, at least in part, by the activation of sympathetic nervous-stimulated thermogenesis. The complexity of sympathetic nervous regulation renders the use of global measures of sympathetic activity problematic and the development of targeted therapies difficult, but these are not without promise or precedent. Knowledge of the central and peripheral pathways involved in sympathetic nervous regulation has opened up opportunities for pharmacological, surgical, and device-based approaches to mitigating the burden of disease development and progression. In this narrative review, we elaborate on sympathetic activity in response to changes in body weight, the brain pathways involved, and the cardiovascular and metabolic risks associated with perturbations in regional sympathetic activity. Full article

Background/Objectives: Metabolic syndrome (MetSy) comprises a cluster of risk factors—including obesity, dyslipidaemia, hypertension, and impaired glucose metabolism—that increase the risk of cardiovascular disease, type 2 diabetes, and other conditions. There are close ties between the complications and outcomes of obesity and MetSy. The practical value of MetSy as a distinct diagnosis in primary care remains uncertain. This study aimed to explore general practitioners’ (GPs) perspectives on the utility of MetSy for diagnosing and managing patients in light of evolving concepts in the field of metabolic health. Methods: A qualitative study design was employed, with semi-structured interviews conducted among 15 GPs in rural Western Australia. Participants were recruited via GP networks with convenience and snowball sampling. Transcribed interviews were thematically analysed using Braun and Clarke’s reflexive approach, with iterative coding, theme identification, and member checking to ensure trustworthiness. Results: GPs generally recognized MetSy as a constellation of risk factors that heighten the risk of cardiovascular disease. Insulin resistance was frequently identified as a unifying pathophysiological driver. Nevertheless, most participants did not routinely diagnose MetSy in clinical practice, rather focusing on treating individual component conditions (e.g., obesity, hypertension, dyslipidaemia) due to readily available disease-specific guidelines. Only a minority of GPs actively used the MetSy concept for patient education to highlight interconnected risks and the potential benefits of holistic lifestyle interventions. Paucity of dedicated MetSy management guidelines and uncertainty around diagnostic criteria further hindered routine application of the syndrome in practice. Conclusions: While GPs are aware of MetSy and its broad implications, few use it as a distinct clinical tool. Development of tailored guidelines and expanded educational resources would empower GPs to integrate a more holistic, MetSy-focused approach to patient care. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of chronic liver dysfunction worldwide, characterized by hepatic steatosis that may progress to nonalcoholic steatohepatitis and cirrhosis. Owing to its strong association with metabolic disorders, current management focuses on weight reduction via lifestyle modifications. Recently, the very-low-calorie ketogenic diet (VLCKD) has emerged as a promising intervention due to its potential for rapid weight loss and reduction in liver fat. This review aims to evaluate the clinical evidence regarding the impact of ketogenic diets on hepatic steatosis. We conducted an extensive MEDLINE literature search in databases including PubMed, Scopus, and Web of Science up to December 2024. Studies assessing the effects of ketogenic or low-carbohydrate high-fat diets on liver fat, evaluated by imaging, histology, or biochemical markers, were included. The analysis indicates that ketogenic diets significantly reduce hepatic fat content and improve metabolic parameters, including insulin sensitivity and liver enzyme levels. Evidence further suggests that substituting saturated fats with unsaturated fats or replacing carbohydrates with proteins may enhance these benefits. However, considerable variability exists among studies and long-term data remain limited. Although short-term outcomes are encouraging, potential adverse effects such as dyslipidaemia, gastrointestinal disturbances, and transient ‘keto flu’ symptoms require careful clinical monitoring. Future research should focus on elucidating underlying mechanisms, optimizing dietary composition, and assessing long-term safety to establish ketogenic diets as a robust strategy for managing MASLD. Full article

Background: There is a large overlap in the risk profiles and pathophysiologies of coronary artery disease (CAD) and cerebrovascular macroangiopathy. Therefore, this study aimed to analyse whether findings in CAD examination by coronary angiography or cardio-computer tomography (cardio-CT) are predictive of cerebrovascular macroangiopathy. Methods: Our study was a prospective, bicentric, cross-sectional cohort study. A total of 191 patients without earlier CAD diagnosis who underwent a cardio-CT scan or coronary angiography for the screening of CAD during clinical routine were serially included. Two groups were formed based on the criterion of CAD (yes/no), and both were subsequently examined using sonography of the carotids. The CAD scores Syntax score I, Agatston equivalent score, and CAD-RADS score as well as AHA classification were determined. In cerebrovascular examinations, plaques and stenoses of the internal carotid artery (ICA) and the intima-media thickness (IMT) of the common carotid artery were analysed. Demographic and medical data such as the presence of arterial hypertension, diabetes mellitus, obesity, nicotine abuse, and dyslipidaemia were documented. The primary endpoint was the nominal association between CAD and ICA stenosis controlled for age and gender; secondary endpoints were correlations between ICA stenoses and CAD scores. Results: Of the 191 serially recruited patients (58% male, 65 ± 11 yrs.), 101 fulfilled CAD criteria; 90 did not. Of all patients, 137 had ICA plaques, and 11 thereof had an ICA stenosis ≥ 50%. No association was found between CAD and ICA stenosis (Wald = 0.24; p = 0.624). Accordingly, there was no association between IMT and Syntax score I (Wald = 0.38; p = 0.706), Agatston equivalent score (Wald = 0.89; p = 0.380), CAD-RADS score (Wald = 0.90; p = 0.377), or AHA classification (Wald = 0.21; p = 0.837). Common cardiovascular risk factors, i.e., arterial hypertension (Wald = 4.47; p = 0.034), diabetes mellitus (Wald = 7.61; p = 0.006), and nicotine abuse (Wald = 0.83; p = 0.028), were associated with newly diagnosed CAD but not with ICA plaques, stenosis, or increased IMT. Conclusions: In our cohort, newly diagnosed CAD was associated with typical risk factors. However, neither CAD nor these risk factors were associated with cerebrovascular disease. This suggests that in patients without prior CAD diagnosis, findings from CAD examinations might not be reliably predictive of cerebrovascular disease. Full article

Background and Objectives: Cardiovascular diseases are the leading cause of death in Lithuania, with familial hypercholesterolemia being a significant risk factor. This study aimed to evaluate the prevalence of dyslipidaemia among healthy children and the relation with risk factors for familial hypercholesterolaemia. Materials and Methods: This study involved 127 children, aged 5 to 10 years, with a focus on the early identification of dyslipidaemia and familial hypercholesterolaemia. The relationship between body composition, dietary habits, physical activity, and dyslipidaemia was researched and statistically assessed. Results: Standard lipid profile analysis revealed that approximately one-third of participants had abnormal lipid profiles. Elevated total cholesterol (TC) was found in 19 participants (15%), elevated LDL cholesterol (LDL-C) in 24 participants (18.9%), elevated triglycerides (TGs) in 19 participants (15%), and reduced HDL cholesterol (HDL-C) in 9 participants (7.1%). Risk for familial hypercholesterolaemia was suspected for 12 participants with LDL-C elevated more than 4 mmol/L or family history of FH. While no significant link was found between dyslipidaemia and body composition, low levels of physical activity were associated with increased total cholesterol levels, suggesting a protective role for regular exercise. Dietary habits, including vegetable, sweet, and flour product consumption, did not show a significant association with dyslipidaemia. Conclusions: Dyslipidaemia is fairly common among Lithuanian children. Although this study does not show a significant effect of diet or body composition on lipid levels, it links low levels of physical activity to higher triglyceride values. Due to risk factors not always being present in children with dyslipidaemia, it should not be ruled out in apparently healthy children. Full article

Background: Antioxidants and prebiotics are popular functional foods known for their distinct physiological ameliorating benefits on type 2 diabetes mellitus (T2DM). Whether and how a combined antioxidant-prebiotic supplement affects primary and secondary T2DM outcomes is not known. Objectives: We investigated the therapeutic effects of an antioxidant (anthocyanin from riceberry rice) combined with prebiotics (dietary fibre from rice bran and Jerusalem artichoke) on glucose control, lipid profile, oxidative stress, inflammation, and cardiorespiratory fitness in T2DM patients. Methods: A total of 60 T2DM patients were randomly assigned to receive antioxidant/prebiotic (supplement group, SG) or maltodextrin (control group, CG), (two capsules (350 mg)/meal after three meals and before bedtime, 2.8 g/day), for 60 days. Venous blood samples were collected at baseline and after 60 days intervention to assess blood metabolic variables (glucose, insulin, and lipid profiles, renal and liver functions, oxidative stress, inflammation). Nutrition status, anthropometry, body composition (DEXA) and cardiorespiratory fitness were also measured. Results: Analysis of co-variance showed superior effects on T2DM’s glucose and lipid profiles in the SG compared with the CG including reduced fasting blood glucose (p = 0.01 within-group effects, p = 0.03 interaction effects), reduced glycated haemoglobin (p = 0.004 within-group effects, p = 0.002 interaction), and reduced low density lipoprotein (p = 0.006 within-group effects, p = 0.02 interaction effects). No significant change was found within the CG for any of these parameters. Kidney function’s glomerular filtration rate was also improved in the SG (p = 0.01 within-group effects), but not in the placebo CG. Intermediatory biomarkers of oxidative stress, inflammation, and cardiorespiratory fitness were not significantly affected in either group with no interaction effects. No adverse effects were detected following the 60-day supplementation intervention. Conclusions: The findings suggest that a combined anthocyanin-fibre may be promoted as an adjacent therapy in patients with T2DM, but the intermediary mechanisms of action require further research. Full article

Aim: Mobile health (mHealth) applications have been reported to be effective in improving glycaemic control and cardiometabolic health, but mainly as part of shorter-term intervention studies. The aim of this study is to examine the effect of the ongoing Defeat Diabetes mHealth low-carbohydrate diet (LCD) intervention on clinical markers and cardiometabolic risk after 6 months of intervention. Methods: Data were collected via primary care physicians as part of routine T2D monitoring. These included HbA1c (primary outcome), blood pressure, blood lipids, and markers of kidney and liver function. Anthropometrics, as well as changes in the prescription of diabetes, hypertension, and dyslipidaemia medication, were also recorded. Calculated variables, total cholesterol to HDL-c, triglyceride to HDL-c, and waist to height ratios, were analysed to examine changes in cardiometabolic risk profile. Three-day food records were used to assess dietary intake and intervention adherence. Univariate regression models examined changes from baseline to 6 months. Results: Ninety-four participants remained in the study out of the ninety-nine at baseline (mean age 59 ± 11 years, 55 females). After 6 months of intervention, there were significant reductions in HbA1c by −1.0% (95% CI: −1.3 to −0.6), as well as in the liver enzymes ALT (−9.3 U/L 95% CI −16.3 to −2.4) and GGT (−18.8 U/L 95% CI: −31.4 to −6.3) across the cohort. In addition, there was a significant reduction in cardiometabolic risk, as measured by the calculated variables and a decrease in waist circumference (−4.6 cm 95% CI: −8.9 to −0.2). Conclusions: People with T2D receiving LCD education and resources through the Defeat Diabetes mHealth app (version 3.3.8) improved their glycaemic control after 6 months of intervention. Cardiometabolic risk profile and liver function also showed significant improvement. These findings indicate that the use of an LCD digital app is a valuable adjunct in the management of T2D. Full article