We hypothesise that women with type 2 diabetes and hypertension are less likely than comparable men to receive renin–angiotensin system (RAS)-inhibiting antihypertensive treatment, particularly as first-line therapy. This study’s main aim is to investigate the delivery of RAS inhibitor treatments by sex and number of antihypertensive treatments used.

Cross-sectional study in a cohort.

Constances cohort, France, 2012–2019.

2541 participants with type 2 diabetes among the 196 477 individuals aged 18–69 included in the Constances cohort.

Proportion of individuals treated with RAS inhibitors by sex and number of antihypertensive treatments dispensed. Factors associated with the use of RAS inhibitors.

Among 2541 diabetics, 1742 (68.6%) had received at least one antihypertensive treatment during the year preceding inclusion—a percentage that did not differ significantly between men and women (p=0.07). In analyses stratified by the number of antihypertensive classes, RAS inhibitors were delivered significantly less often to women than men for single-drug therapy (OR 0.46, 95% CI 0.25 to 0.81; p=0.008) and two-drug therapy (0.35, 95% CI 0.16 to 0.75, p=0.007) but not in regimens of three or more drugs (0.29, 95% CI 0.05 to 1.56; p=0.15). In the multivariate analysis, women received RAS inhibitors significantly less often than men (0.41, 95% CI 0.27 to 0.62; p

Women with type 2 diabetes are less likely than men to receive a prescription for RAS inhibitors, although this drug class is recommended as first-line therapy in this population.

To explore dietary intake, diet-related challenges in glucose management and perceived needs for dietary support among Swedish adults with type 1 diabetes (T1D).

Cross-sectional observational study based on an electronic survey that included the validated Meal-Q food frequency questionnaire and additional questions on dietary habits and management. Participant characteristics were retrieved from the Swedish National Diabetes Register. Descriptive and correlation analyses were conducted.

Three diabetes specialist clinics in Sweden.

375 adults with T1D.

Dietary intake and diet-related challenges in glucose management.

A total of 191 persons (mean age 48 years; 48% female) consented to participate. The mean (SD) glycated haemoglobin A1c was 56 (13) mmol/mol, mean glucose 8.8 (2.2) mmol/L, time in range (TIR) 64% (18%) and BMI 27 (4.3) kg/m²; 41% used insulin pumps. Mean carbohydrate intake was 183 g/day (41% of energy, E%). Fibre intake was 23 g/day (3.1 g/MJ), and saturated fat intake was 29 g/day (15 E%), both inconsistent with dietary recommendations. About half (51%) found carbohydrate counting challenging, with 53% estimating carbohydrate intake visually and only 18% using advanced methods. Additionally, 48% reported reducing carbohydrate intake, and 61% avoided certain carbohydrate-rich foods due to glucose management difficulties. Approximately 40% of participants reported insufficient dietary guidance from their healthcare providers since diagnosis, 33% expressed interest in further dietitian support and 39% believed dietary changes could improve glucose control.

Participants reported lower fibre intake and higher saturated fat intake compared with dietary guidelines. Many found carbohydrate counting and carbohydrate-rich meals challenging. One-third expressed a wish for additional dietary support. These findings highlight the importance of improving access to tailored dietary counselling in routine T1D care.

This study aimed to assess construct validity against commonly used patient-reported outcome measures (PROMs), test–retest reliability and responsiveness of seven Dutch-Flemish Patient-Reported Outcomes Measurement Information System (PROMIS) computerised adaptive testing (CATs) in Dutch adults with type 2 diabetes (T2D), and assess their acceptability in healthcare providers and people with T2D.

A cross-sectional observational study in people with T2D and qualitative study involving both people with T2D and healthcare professionals.

Participants with T2D were recruited from the ongoing Hoorn Diabetes Care System cohort in the West-Friesland area of the Netherlands. Additionally, people with T2D and advanced chronic kidney disease were recruited at the outpatient clinics of Amsterdam University Medical Centre and ‘Niercentrum aan de Amstel’, both in the Amsterdam area of the Netherlands. The healthcare professionals involved in the qualitative part were recruited at the Amsterdam University Medical Centre.

314 people with T2D (age 64.0±10.8 years, 63.7% men).

Participants completed seven PROMIS CATs (assessing (1) Physical Function, (2) Pain Interference, (3) Fatigue, (4) Sleep Disturbance, (5) Anxiety, (6) Depression and (7) Ability to Participate in Social Roles and Activities), and PROMs measuring similar constructs. After 2 weeks and 6 months, participants completed the CATs measures again, together with seven Global Rating Scales (GRS) on perceived change in each domain. Construct validity was assessed using Pearson’s correlations. Test–retest reliability was assessed by the intraclass correlation coefficient (ICC). Measurement error was assessed by the standard error of measurement (SEM) and minimal detectable change (MDC). Responsiveness was assessed by correlations between change scores on the PROMIS CAT and GRS. Acceptability was assessed through focus groups and interviews in healthcare providers and people with T2D.

Except for Fatigue, all PROMIS CAT domains demonstrated sufficient construct validity, since ≥75% of the results was in accordance with a priori hypotheses. All seven PROMIS CATs showed sufficient test–retest reliability (ICCs 0.73–0.91). SEM and MDC ranged from 2.1 to 2.7 and from 5.7 to 7.4, respectively. Responsiveness was rated as insufficient in this study design as there was almost no change in participants’ own rating of their health compared with 6 months ago according to a global rating of change.

During the focus groups and interviews, healthcare providers and people with T2D agreed that CATs could serve as a conversation starter in routine care, but should never replace personal consultations with a doctor. If implemented, participants would be willing to spend 15 min to complete the PROMIS CATs.

The PROMIS CATs showed sufficient construct validity and test–retest reliability in most domains in people with T2D. Responsiveness needs to be evaluated in a population with poorer diabetes control or in a study design with longer follow-up. The CATs are well accepted to be used in care to identify relevant topics, but should not replace personal contact with the doctor.

To assess the early risk of diabetic foot ulcer (DFU) among adult patients with diabetes and to identify clinical and behavioural correlates associated with DFU risk using Inlow’s 60-Second Screening Tool.

A cross-sectional analytical study.

Conducted at a tertiary-level referral hospital in Southwest Ethiopia.

The study included 164 adult patients with diabetes (aged ≥18 years) who attended routine follow-up visits at the diabetic clinic between February and March 2025. Patients who were critically ill, unable to communicate during data collection or pregnant were excluded. The median age of participants was 55 years (IQR 46–60), and 54.9% were male.

The primary outcome was early DFU risk, categorised as ‘at risk’ or ‘not at risk’ using Inlow’s 60-Second Screening Tool. Secondary outcomes included factors associated with DFU risk, such as glycaemic control, lipid profile and foot care practices.

Of the 164 participants, 32.3% (n=53) were found to be at risk for DFU. Participants who performed foot self-checks infrequently had more than threefold higher odds of DFU risk compared with those who practiced daily foot care (adjusted OR (AOR)=3.35; 95% CI 1.48 to 7.58; p=0.004). Poor glycaemic control (AOR=2.39; 95% CI 1.03 to 5.55; p=0.042) and dyslipidaemia (AOR=2.63; 95% CI 1.18 to 5.85; p=0.018) were also significantly associated with increased DFU risk.

Nearly one-third of patients with diabetes in this Ethiopian hospital setting were at early risk for DFU. Factors such as inadequate foot care, poor glycaemic control and dyslipidaemia were associated with increased risk. Incorporating rapid foot screening tools like Inlow’s 60-Second assessment into routine diabetes care, together with strengthened patient education and metabolic management, may help reduce the risk of DFU in resource-limited settings.

Current pharmacological treatment options for painful diabetic neuropathy (PDN) often fail to provide adequate pain relief. However, in the recent SENZA-PDN study, high-frequency 10 kHz spinal cord stimulation (SCS) demonstrated significant long-term improvements in lower limb pain and health-related quality of life (HRQoL) in a PDN population. Furthermore, more than half of 10 kHz SCS recipients showed improved sensory function based on non-blinded clinical assessments in post hoc analysis. We report the design of the PDN-Sensory study, which aims to evaluate changes in pain and neurological function with 10 kHz SCS in the treatment of PDN. The study will include objective measures of neurological function, including the modified Toronto Clinical Neuropathy Score (mTCNS) and intraepidermal nerve fibre density (IENFD).

This multicentre, prospective, randomised controlled trial will compare conventional medical management (CMM) with 10 kHz SCS+CMM in individuals with diabetes and chronic, intractable lower limb pain due to PDN. Participants will be randomised 1:1 to CMM alone or 10 kHz SCS+CMM, with optional crossover at 6 months. The primary outcome is the proportion of participants at 6 months achieving ≥50% pain relief from baseline. The key secondary endpoint is the proportion of participants at 6 months with a reduction in mTCNS of ≥3 points from baseline (excluding changes in foot pain). Additional endpoints at 6 and 12 months include changes from baseline in mTCNS, IENFD, 7-day averaged pain score, pain-related interference, HRQoL, sleep, psychological outcomes, functional status and metabolic parameters.

The study protocol received central approval from the Western Institutional Review Board (IRB #20230954). Local IRB approval will be required before initiation of the study at each participating clinical site. The study complies with Good Clinical Practice guidelines (ISO 14155), the Declaration of Helsinki, and all applicable national, federal and local regulatory requirements. Dissemination plans include presentations at national and international conferences and publication in a peer-reviewed journal with open access.

NCT05777317.

To assess the level of knowledge, attitudes and practices (KAP) among patients with type 2 diabetes mellitus (T2DM) regarding cardiovascular risk factors (CVRF) and diabetes-related complications in two hospitals in the West Region of Cameroon during the COVID-19 pandemic.

This was a prospective cross-sectional study conducted over 5 months from April to September 2022.

This study was conducted in two tertiary hospitals in the West Region of Cameroon, in Central Africa.

It included all patients with T2DM receiving care at these two hospitals, having agreed to participate and followed up in both hospitals for at least 3 months.

Sociodemographic, clinical and treatment data were collected using a data sheet, and KAP scores were based on the Essi and Njoya framework. Data collection and analysis were performed using SPSS V.23.0 software. Logistic regression was used to identify the factors associated with unacceptable KAP (p

A total of 140 participants (71 women) with an average age of 63 years and an average diabetes duration of 6.14±5.7 years were included. Most (55%) were managed by general practitioners. The main CVRFs identified were hypertension (11%) and overweight (6%), while the leading complications included visual disorders (10.7%), hypoglycaemia (6.4%) and erectile dysfunction (2.1%). Knowledge was good in 34.3% of participants, only 25.7% demonstrated correct attitudes, and merely 15.7% engaged in adequate practices. Unacceptable knowledge was associated with diabetes duration between 3 months and 5 years (OR: 0.34 (95% CI 0.14 to 0.85), p=0.021), follow-up by a specialist (OR: 0.31 (95% CI 0.13 to 0.74), p=0.009), the presence of at least one CVRF (OR: 0.03 (95% CI 0.00 to 0.23), p

Few people with T2DM presented good knowledge, right attitudes and adequate practices. Enhanced patient education and increasing specialist numbers are essential to promote self-management of the condition and to decrease the incidence of complications and mortality.

Type 2 diabetes (T2D) is a complex disease with a heterogeneous clinical presentation. Recently, five distinct clusters of T2D have been identified in the Emirati population of long-standing T2D with complications. This study aimed to validate these clusters in newly diagnosed T2D patients without any complications and determine whether severe and mild phenotypes are detectable early in the disease course.

Retrospective, cross-sectional, non-interventional study.

Primary healthcare centres in Dubai, UAE.

A total of 451 adults, including both Emiratis and expatriates, diagnosed with T2D in the last 5 years and without T2D-related complications at the time of visit, were enrolled. Patients with complications, incomplete clinical data or higher duration of T2D were excluded from the study.

Identification of distinct T2D clusters using machine learning-based clustering analysis. Five clinical variables: age at diagnosis, body mass index, glycated haemoglobin, fasting serum insulin and fasting blood glucose served as predictors. Overlap between clusters was assessed via the Silhouette Index and Bayesian probability.

Five clusters were identified, replicating prior findings: severe insulin-resistant diabetes (SIRD), severe insulin-deficient diabetes (SIDD), mild age-related diabetes (MARD), mild obesity-related diabetes (MOD) and mild early-onset diabetes (MEOD). As confirmed by a Silhouette Index and Bayesian probability of 1, 55.43% of the patients showed cluster-exclusiveness, while 44.56% of the cohort showed overlap between clusters. The highest overlap was recorded for mild forms of T2D in the order MOD>MARD>MEOD.

The study confirms that both severe and mild T2D phenotypes are present in newly diagnosed, complication-free patients, supporting the applicability of cluster-based classification early in disease. These results highlight the potential for personalised treatment strategies to optimise management and prevent complications. Future studies should investigate longitudinal outcomes and therapeutic response across clusters.

Osteoporosis represents a growing public health concern in the Middle East and North Africa (MENA) region, where ageing populations and limited healthcare access contribute to high fracture rates and poor treatment adherence. Despite the existence of clinical practice guidelines, these often lack integration of stakeholder perspectives such as those of patients, healthcare providers, insurers and systems. Understanding knowledge, attitudes and practices (KAP) related to osteoporosis is essential to inform inclusive, culturally relevant strategies for prevention and management. This systematic review aims to evaluate the knowledge, attitudes (preferences) and practices (behaviours) of key stakeholders, including adults aged 50 years and older and healthcare providers, regarding the prevention, diagnosis and treatment of osteoporosis in the MENA region.

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines, we conducted comprehensive searches of MEDLINE and Embase for studies published from January 1994 to January 2025. Two reviewers independently screened titles, abstracts and full texts in duplicate. Title/abstract and full-text screening were completed by September 2025. Data extraction will begin in October 2025 and will be performed in duplicate using piloted standardised forms. Risk of bias assessment and data synthesis will follow, using validated design-specific tools and a narrative approach guided by the Synthesis Without Meta-analysis framework. The review was initiated in June 2025, and completion of analysis and manuscript preparation is anticipated in June 2026.

This review synthesises data from publicly available literature and does not involve primary data collection with human participants; therefore, ethics approval is not required. Findings will be disseminated through peer-reviewed publications, conference presentations and deposition of study materials on the Open Science Framework.

This protocol is registered on the Open Science Framework.

Continuous Glucose Monitoring (CGM) supports Type 2 Diabetes (T2D) management, but healthcare professionals (HCPs) often face challenges interpreting data. E-learning platforms can enhance knowledge, skills and confidence. This systematic review identified enablers and barriers to e-learning for CGM interpretation.

Systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

PubMed, Ovid MEDLINE, Ovid Embase, Cochrane Library, Scopus, Web of Science and CINAHL were searched on 7 February 2024.

Studies of HCPs using e-learning for T2D management were included, both comparative and non-comparative. Outcomes included enablers and barriers. Eligible designs were randomised, quasi-experimental, controlled before-and-after and observational studies. No restrictions on setting or language; conference abstracts included if full text was available

Two reviewers independently screened and extracted data using a predefined form; disagreements were resolved by a third reviewer. Thematic analysis identified key enablers and barriers. Methodological quality was assessed using the Downs and Black checklist, and findings were synthesised narratively.

Four studies met inclusion criteria, including 6790 participants (physicians, nurses, midwives and medical residents). E-learning improved knowledge and skills. Emami et al reported increased knowledge of T2D diagnosis and treatment (p=0.001), while Okuroğlu and Alpar found improvements in diabetes care knowledge and skills (pet al noted enhanced self-reported performance (p=0.03) and 84% satisfaction. Enablers included flexibility and accessibility, while barriers involved time constraints, resistance to change and methodological limitations (self-selection bias, lack of blinding). Study quality ranged from fair (three studies) to poor (one study).

Based on current evidence, it is unclear if e-learning can significantly enhance HCPs’ knowledge, skills and confidence in T2D management. Barriers such as time constraints and resistance to change remain, and the limited number and quality of studies restrict the generalisability of these findings. E-learning may offer potential benefits, but further robust randomised controlled trials are needed to evaluate long-term outcomes and strategies to overcome these challenges.

CRD42023455156.

A healthy diet improves glycaemic control and reduces cardiovascular risk in type 2 diabetes (T2D). However, access to dietitians is limited. Several countries have implemented mandatory interpretive front-of-pack labelling to guide consumers towards healthier food choices, but Sweden has not. Smartphone applications may offer an alternative platform to provide such information. This study evaluates the dietary and clinical impact of a novel application providing interpretive labelling to Swedish adults with T2D.

This is a fully decentralised randomised controlled trial. 900 individuals with T2D for ≥2 years who regularly shop for groceries will be recruited via general practices and community advertisements. Participants will be randomised to receive either: (1) access to the FoodSwitch mobile application plus standard written dietary advice, or (2) standard written dietary advice only. The FoodSwitch application allows users to scan barcodes on packaged foods to receive recommendations of healthier alternatives within the same category. The primary outcome is the difference in change in mean self-measured glycated haemoglobin between groups after 6 months. Secondary outcomes include differences in changes in waist circumference, body weight, quality of life, medication use, hospitalisations and all-cause mortality at 26 weeks. Exploratory outcomes include omics analyses. Recruitment is ongoing. Expected study completion on 31 December 2026.

The trial has received ethical approval from the Swedish Ethical Review Authority (2023-06622-01, 2024-06668-02, 2024-07357-02 and 2025-01095-02) and is performed in line with World Medical Association Declaration of Helsinki and the General Data Protection Regulation. Results will be published in a peer-reviewed international journal.

NCT05977218.

Graves’ disease (GD) is the most common form of hyperthyroidism in Sweden with an incidence of 21/100 000 individuals, the majority of whom are women of working age. GD can be overwhelming for the affected patient. A way to improve health outcomes is to better understand patients’ experiences of their illness. We therefore aimed to explore patients’ experiences of GD during the initial phase of the disease.

A qualitative study based on semistructured interviews was conducted and analysed using qualitative content analysis, following Graneheim and Lundman’s description of the method.

The study was carried out within specialised care at the secondary level in a Swedish healthcare context.

15 patients (12 women and 3 men; aged 29–74 years) within the first 3 months after GD diagnosis were included in the study.

Being affected by GD means facing a range of new and often incomprehensible symptoms contributing to an experience of change in one’s personality. In contact with healthcare, they experienced challenges such as an overwhelming amount of information, a lack of energy, and feelings of being a burden. These factors were described as having a negative impact on daily life, well-being, and psychological and psychosocial functioning. The participants highlighted the need to be listened to, to receive tailored information, to have continuous contact, and to have fatigue and other symptoms more thoroughly addressed.

The findings indicate that symptoms have a significant impact on patients with GD, influencing their care experience, information processing, decision-making abilities, and daily functioning. The application of person-centred care can be one way to support patients with GD, as it facilitates a collaborative approach and enhances the comprehension of each patient’s needs and resources. By acknowledging the patient’s experiences, situation, and expectations, as well as the comprehensive impact of the disease, and by modifying support strategies, patient well-being and health outcomes may be significantly improved.

To develop and validate a polycystic ovary syndrome (PCOS) case definition using administrative health data sources.

A validation study.

Secondary care centre outpatient gynaecology clinic in Calgary, Alberta, Canada.

3951 electronic health records of women aged 18–45 years who presented to a gynaecology clinic in Calgary, Canada, between January 2014 and December 2019 were reviewed. We identified 180 patients with PCOS using the Rotterdam criteria. Participants were excluded if they were biologically male, pregnant at the time of the consultation, did not meet the date criteria or if their consultation note was missing. The chart data were connected to the Practitioner Claims and the Discharge Abstract Database by personal health number.

Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 68 case definitions for PCOS were estimated. Case definition performance was graded.

Of the 68 case definitions tested, none had high validity. The best performing case definitions were: (1) ≥3 instances of International Classification of Diseases-9 code 256.4 (polycystic ovaries) with exclusion codes (sensitivity 23.89%, specificity 99.59%, PPV 74.14%, NPV 96.35%) and (2) 626.X (irregular menstruation), 704.1 (hirsutism) and ≥3 instances of code 256.4 with exclusion codes (sensitivity 2.78%, specificity 99.97%, PPV 83.33%, NPV 95.40%).

We identified several case definitions for PCOS of moderate validity with high PPV (>70%) for case ascertainment in PCOS research in jurisdictions with similar administrative health data. These case definitions are limited by low sensitivity, which should be considered when interpreting research findings.

Type 1 diabetes is characterised by progressive loss of pancreatic beta cells. Studies have shown that interleukin (IL)–17 is likely a mediator for this destruction. Whether inhibition of IL-17 could preserve beta cell function in people with new-onset type 1 diabetes is unknown.

In this phase 2, randomised, multicentre, placebo-controlled, double-blind trial conducted at 17 study sites in Sweden, 127 adults aged 18–45 years old with newly diagnosed type 1 diabetes will be enrolled. Participants will be randomised to receive either subcutaneous IL-17 inhibitor or placebo for 52 weeks, in addition to their conventional therapy. The primary endpoint will be change in residual insulin secretion measured by the area under the curve for C-peptide in response to 2-hour mixed meal tolerance test between baseline and week 52. Additionally, masked continuous glucose monitoring will be performed during 14 days at the run-in period, week 13, week 26 and week 52. Secondary endpoints will be change in time in glucose range (3.9–10 mmol/L), time in hypoglycaemia (

Approvals were obtained from the Swedish Ethical Review Authority (Dnr 2020–05098) and the Swedish Medical Products Agency (Dnr 5.1-2021-105808) before participant enrolment. Participants provide informed consent before inclusion. Results of this study will be submitted for publication in international peer-reviewed journals and key findings will be presented at international scientific conferences.

ClinicalTrials.gov, NCT04589325.

Diabetic kidney disease (DKD) is the most common complication of diabetes. It is the leading cause of end-stage renal disease and an important risk factor for cardiovascular disease. The mechanism and clinical efficacy of the combination therapy of finerenone and sodium-glucose cotransporter 2 inhibitors (SGLT2i) for DKD have been confirmed, but there is a lack of a comprehensive systematic review of its efficacy and safety. This protocol outlines the methods and procedures for a systematic review and meta-analysis to evaluate the efficacy and safety of the combination therapy of finerenone and SGLT2i for DKD.

Eight databases (PubMed, Embase, Cochrane Library, Web of Science, China Science and Technology Journal Database (VIP), China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM) and Wanfang Database) will be searched from the database inception to 31 December 2025. Additional sources like the WHO International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov will also be searched. All randomised controlled clinical trials investigating Finerenone combined with SGLT2i for DKD treatment will be included. Data extraction will encompass study characteristics, participant demographics, intervention protocols, outcome measures and adverse events. Primary outcomes will focus on serum creatinine, estimated glomerular filtration rate and urine albumin-to-creatinine ratio. Cochrane Collaboration’s Risk of Bias 2 (RoB 2) tool will be employed to assess methodological quality. Study selection, data extraction and bias evaluation will be conducted independently by two reviewers. Meta-analyses will be performed using statistical software packages including RevMan V.5.4 and STATA V.16.0. Where quantitative synthesis is precluded, descriptive analyses will be undertaken. The Grading of Recommendations, Assessment, Development and Evaluations framework will systematically evaluate the certainty of evidence for all primary and secondary outcomes.

This study requires no ethical approval as all data are derived from publicly accessible databases. The research findings will be disseminated through publication in peer-reviewed scientific journals.

CRD420251068323.

To explore the associations between arterial stiffness (AS) onset age and type 2 diabetes mellitus (T2DM) risk.

Large-scale cohort study.

The largest medical centre in central China.

This study enrolled 22 588 participants free of T2DM at baseline. All participants took an annual physical examination from 2012 to 2016, with fasting blood glucose and brachial–ankle pulse wave velocity measurements.

Cox proportional model was used to investigate the association between AS onset age and T2DM risk. Sex-specific analysis was also performed, and the association between early vascular ageing (EVA), normal vascular ageing (NVA), supernormal vascular ageing (SUPERNOVA) onset age and diabetes risk was also examined.

A total of 757 (3.4%) participants were diagnosed with T2DM. Compared with participants free of AS in each specific age group, the earlier AS onset age was more strongly associated with T2DM risk, especially for middle age, with the fully adjusted hazard risk (HR) and 95% CI of 4.63 (2.79–7.67) for AS onset age at 50. Similar results were observed both in males and females, with the fully adjusted HR and 95% CI of 4.54 (2.60 to 7.93) for males and 4.86 (1.48 to 16.01) for females, with AS onset age at 50. Such an association was also observed in the exploration of EVA, NVA and SUPERNOVA onset age and incident T2DM risk.

This study revealed that the middle-aged onset of AS was more significantly associated with a higher T2DM risk. Early screening of AS, especially in middle age, may assist in T2DM detection and postpone diabetic vascular complications.

This study aims to investigate the predictive value of stress hyperglycaemia ratio (SHR) for 28-day all-cause mortality in elderly patients with hip fractures.

A retrospective study.

Beijing Jishuitan Hospital, Capital Medical University.

This study included elderly patients with hip fractures treated at our hospital between January and April 2023.

The receiver operating characteristic curve analysis and Youden index were employed to ascertain the optimal predictive threshold for SHR and to evaluate its predictive accuracy for 28-day all-cause mortality.

A total of 443 elderly patients with hip fractures was analysed, with a mean age of 78.11±7.83 years in the survival group and 88±5.48 years in the non-survival group. Deceased patients exhibited higher rates of pulmonary infection, acute coronary syndrome, acute kidney injury, cardiac insufficiency and renal insufficiency than survivors. They also had older age, lower body weight, hypoalbuminaemia, elevated admission glucose, increased N-terminal pro-brain natriuretic peptide and higher SHR. The cohort comprised 121 men (27.3%), and all-cause mortality was observed in 17 patients (3.84%). Multivariate logistic regression analysis showed that SHR (p

The SHR is associated with 28-day all-cause mortality in elderly patients with hip fractures, suggesting its potential as a predictive marker for this outcome.

To ascertain the clinical impact, prevalence and associated determinants of delayed treatment intensification, defined as delaying the escalation of treatment plans for individuals with type 2 diabetes mellitus who fail to attain ideal glycaemic control, at the University of Gondar Comprehensive Specialised Hospital in Northwest Ethiopia.

A mixed-methods study.

University of Gondar Comprehensive Specialised Hospital.

420 patients with type 2 diabetes mellitus with poor glycaemic control after the index date were included in this study. A simple random sampling technique was employed to select the required sample size. Data were collected retrospectively and entered into EpiData V.4.6 and exported to Stata V.14.2 for analysis.

Multivariable logistic regression was used to identify factors associated with delayed treatment intensification. A p value of 0.05 in the multivariable analysis was considered statistically significant. Qualitative data were collected through in-depth interviews with eight selected healthcare providers, and thematic analysis was undertaken to identify the underlying barriers to timely treatment intensification.

Delayed treatment intensification.

The prevalence of delayed treatment intensification was 51.4% (95% CI 46.6% to 56.2%), with a median delay of 14 months (IQR: 7.5–42 months) from the index date. Among those experiencing delayed treatment intensification, 43.1% developed new chronic diabetic complications, including retinopathy (18.1%), neuropathy (14.4%) and nephropathy (6.0%). Other complications (hypertension, stroke, heart failure and diabetic foot ulcer) accounted for 4.64% of the cases. Significant predictors of delayed treatment intensification included longer duration of diabetes (adjusted ORs (AOR) 1.68; 95% CI 1.13 to 2.5), presence of comorbidities (AOR 1.83; 95% CI 1.04 to 3.2) and use of cardioprotective medications (AOR 1.59; 95% CI: 1.04 to 2.43). The qualitative findings revealed additional barriers contributing to delayed treatment intensification, including financial limitations, insufficient patient awareness and non-adherence among patients. Additionally, healthcare provider-related factors, including professional fatigue and knowledge gaps, as well as health institution-related factors such as inadequate healthcare infrastructure.

This study found a high prevalence of delayed treatment intensification (51.4%), associated with comorbidities, longer disease duration, low patient awareness, cardioprotective drug use and barriers related to the system and providers. To address these gaps, priorities should include strengthening patient education, scheduling regular reviews for high-risk patients and improving clinical decision support tools for timely treatment intensification. Enhancing healthcare infrastructure, such as medication supply and diagnostic services, and offering refresher training to reduce provider fatigue, are also crucial for improving the delivery of diabetes care.

We aimed to explore the patient-related and organisational characteristics associated with late cancellations and non-attendance in diabetes outpatient care and present our findings organised as a risk matrix based on these characteristics.

A cross-sectional study.

Our study was conducted at an endocrinology outpatient clinic based on data extracted between January and December 2019 from electronic medical records.

Adult patients with type 1 diabetes with late cancellations or non-attendance. We compared our sample with national data for comparison and to assess representativeness.

Main outcome was late cancellations or non-attendance, while secondary outcomes included type of cancellations and reason for cancellation.

In total, 541 patients had late cancellations or non-attendance across 5040 diabetes consultations. These patients had a mean age of 43 years, 57.9% were men and half (n=301, 55%) were employed. The mean diabetes duration was 18 years, and the mean HbA1c level was elevated at 72 mmol/L. The outpatient clinic had a higher number of consultations, but the patient characteristics were comparable to the national average. Half of the patients (n=258, 52.3%) had late cancellations ahead of their consultations. Most cancellations occurred during the winter, mainly due to illness being the most frequent reason. Unemployed men with poorly regulated diabetes were more likely not to attend compared with employed females.

Characteristics such as being male, unemployed and having elevated HbA1c levels were significantly associated with non-attendance. Our findings contribute to understanding the reasons for at-risk patients missing consultations.

Cystic fibrosis-related diabetes (CFRD) is one of the most clinically impactful comorbidities associated with cystic fibrosis (CF). Current recommended management with insulin therapy is challenging due to variable daily insulin requirements and adds to the significant burden of self-management. This study aims to determine if hybrid closed-loop insulin delivery can improve glucose outcomes compared with standard insulin therapy with continuous glucose monitoring (CGM) in young people (≥16 years) and adults with CFRD.

This open-label, multicentre, randomised, two-arm, single-period parallel design study aims to randomise 114 young people (≥16 years) and adults with CFRD. Following a 2–3 weeks’ run-in period, during which time participants use a masked CGM, participants with time in target glucose range (3.9–10.0 mmol/L) 10.0 mmol/L), mean glucose and HbA1c. Other secondary efficacy outcomes include glucose and insulin metrics, change in forced expiratory volume in 1 s and body mass index. Safety, utility, participant experiences and participant-reported outcome measures will also be evaluated. The trial is funded by the National Institute for Health and Care Research.

Ethics approval has been obtained from East of England–Cambridge South Research Ethics Committee. Results will be disseminated by peer-reviewed publications and conference presentations, and findings will be shared with people living with CF, healthcare providers and relevant stakeholders.

NCT05562492.

This study compared the effectiveness of first-time use of faster aspart with rapid-acting insulin analogues in patients with type 1 diabetes (T1D) or type 2 diabetes (T2D).

This retrospective cohort study used data from 1 January 2017 to 8 May 2021 captured in the Clinical Practice Research Datalink Aurum database in the UK.

Patients with T1D or T2D either initiating faster aspart or another rapid-acting insulin analogue (‘new users’) or switching from a rapid-acting insulin analogue to faster aspart or to another rapid-acting insulin analogue (‘switchers’) were included. The index date was the date of first prescription of faster aspart or a rapid-acting insulin analogue, or of switching to a different rapid-acting analogue or to faster aspart.

A total of 9695 and 2170 patients were included in the new users (T1D, 1737; T2D, 7958) and switchers cohorts (T1D, 1764; T2D, 406), respectively.

Glycated haemoglobin (HbA1c) change at 6 months, occurrence of hypoglycaemia from index to 12 months post-index and treatment persistency from index to discontinuation or censoring.

Numerically greater reductions were observed with faster aspart than rapid-acting insulins in T1D switchers and new users in change in HbA1c at 6 months. Patients with T1D who switched to faster aspart experienced a significant reduction in rate of hypoglycaemia (p=0.0021). Treatment persistency was higher with faster aspart than with rapid-acting insulins among T1D switchers. No distinction in treatment persistency was observed between the treatment groups for T1D new users or T2D switchers.

Reductions in HbA1c were numerically larger with faster aspart in three of four subgroups. There was higher treatment persistency with faster aspart vs rapid-acting insulin analogues among T1D switchers.

NN1218-4967.