Post-chronic pancreatitis (CP) diabetes mellitus (PPDM-C) is a distinct form of diabetes, in which complex pathogenesis hampers adequate glycaemic control. This study aimed to identify risk factors for poor glycaemic status in PPDM-C to guide clinical management.

Cross-sectional study.

Shanghai, China.

Between January 2018 and March 2023, 1677 patients with CP were enrolled in the CP database of the National Clinical Research Center. After application of strict exclusion criteria, 302 patients diagnosed with PPDM-C were included in the study.

The primary outcome was glycaemic control. The secondary outcomes were factors that affect glycaemic control among patients with PPDM-C.

This retrospective study was conducted in patients with PPDM-C. Poor glycaemic status was defined as a glycated haemoglobin A1c level of >7% at admission. Patients were stratified into those with and without diabetes treatment. Multivariate logistic regression was performed to identify risk factors. The area under the curve (AUC) analysis was used to evaluate the predictive efficacy of these risk factors.

A total of 302 patients with PPDM-C were analysed. Poor glycaemic status was observed in 72.6% (61/84) of patients without diabetes treatment and 52.8% (115/218) of those with diabetes treatment. For those without diabetes treatment, a history of acute pancreatitis (AP) attacks (OR: 4.838, p=0.014) and smoking (1–20 pack-years, OR: 4.418; >20 pack-years, OR: 9.989; p0.001). In patients with diabetes treatment, AP attack history (OR: 5.640, p20 pack-years, OR: 11.395; p

Patients with PPDM-C in China exhibited a high prevalence of poor glycaemic status. Smoking and a history of AP attacks were significantly associated with an increased risk of poor glycaemic control. The early identification of patients with PPDM-C at elevated risk of poor glycaemic control may facilitate timely and optimised management of glycaemia.

To assess the time to first optimal glycaemic control and its predictors among adult patients with type 1 and type 2 diabetes at the University of Gondar Comprehensive Specialized Hospital in Ethiopia.

A retrospective cohort study.

University of Gondar Comprehensive Specialized Hospital, northwest, Ethiopia.

We recruited 423 adult diabetic patients who were diagnosed between 1 January 2018 and 30 December 2022 at the University of Gondar Comprehensive Specialized Hospital.

The primary outcome was the time from diagnosis to the achievement of the first optimal glycaemic control, measured in months. A Cox proportional hazards regression model was fitted to identify predictors of time to first optimal glycaemic control. Data were collected with KoboToolbox from patient medical charts and exported to Stata V.17. The log-rank test was used to determine the survival difference between subgroups of participants.

Median time to first optimal glycaemic control was 10.6 months. Among 423 adult diabetic patients, 301 (71.16%) achieved the first optimal glycaemic control during the study period. Age category (middle age (adjusted HR (AHR)=0.56, 95% CI 0.41 to 0.76), older age (AHR=0.52, 95% CI 0.33 to 0.82)), comorbidity (AHR=0.52, 95% CI 0.35 to 0.76), therapeutic inertia (AHR=0.20, 95% CI 0.13 to 0.30) and medication non-compliance (AHR=0.49, 95% CI 0.27 to 0.89) were significant predictors of time to optimal glycaemic control.

The median time to first optimal glycaemic control was prolonged. Diabetic care should focus on controlling the identified predictors to achieve optimal glycaemic control early after diagnosis.

The prevention of treatment discontinuation is crucial in mitigating the adverse consequences of diabetes. This study aimed to identify the psychosocial factors and patient experiences associated with the discontinuation of diabetes treatment.

A cross-sectional study was conducted.

A nationwide online survey with convenience sampling.

Participants, aged 40–79 years, who reported living with diabetes, were included.

Treatment continuation status was the outcome variable. Participants who previously received regular treatment but were not currently under medical care were classified as the treatment discontinuation group. Psychological factors (mood and anxiety disorders, self-esteem, procrastination), social factors (loneliness, economic difficulties, adverse childhood experiences) and patient experiences and opinions regarding diabetes were assessed.

A total of 4715 individuals were included in the analysis. After adjusting for confounders, psychological distress (adjusted OR (AOR)=1.87, 95% CI (1.06 to 3.30), p=0.032) and higher procrastination (AOR=2.64, 95% CI (1.25 to 5.56), p=0.011) were significantly associated with treatment discontinuation. Overall, 9.7% of participants reported financial hardship, and 12.1% reported diabetes burnout during their course of treatment. Financial hardships (p=0.002), difficulty with child or older adult care (p

Psychological distress and higher procrastination levels were significantly associated with diabetes treatment discontinuation, after adjusting for potential confounders. The treatment discontinuation group reported significantly more psychosocial challenges than the continuation group. Healthcare providers and systems should prioritise addressing the psychosocial characteristics, experiences and challenges faced by individuals with diabetes.

This study analysed the clinical outcomes and healthcare costs associated with diabetic foot ulcer (DFU) within a tertiary healthcare centre in Singapore.

This is a retrospective, single-centre study. Patient data were extracted from the hospital’s electronic health system, including demographic, clinical and hospitalisation information. Hospitalisation costs were categorised into DFU-related and other hospitalisation costs. A one-way sensitivity analysis was performed to estimate the total healthcare costs associated with DFU.

Tertiary centre within a population suffering from a diabetic epidemic.

All patients aged 18 years or older who received DFU treatment between January 2019 and December 2023 at the Singapore General Hospital were included.

A total of 2857 DFU patients were included in the study. In-hospital mortality remained stable at 5%–6% annually. Among the cohort, 39.1% underwent minor amputations, 19.6% had major amputations and 9.0% experienced both minor and major amputations. The median length of stay for surgical patients ranged from 10 (IQR 4–24) to 13 days (IQR 6–31), compared with 4 (IQR 2–8) to 5 (IQR 3–9.5) days for non-surgical patients. Total costs per admission for patients with DFU-related surgery ranged from US$28 588.96 to US$34 204.77, while for those without surgery, costs ranged from US$6637.59 to US$7955.23. Total hospitalisation costs for DFU during the study period ranged from US$65.87 million to US$72.16 million. All figures were inflation adjusted to 2023 US dollars.

DFU poses a significant clinical and economic burden in Singapore. Understanding the costs associated with DFU is essential for resource allocation and planning in DFU management.

To evaluate the association between the stress hyperglycaemia ratio (SHR) and baseline stroke severity in patients with acute ischaemic stroke (AIS) and to investigate whether the relationship is non-linear.

Retrospective cohort study.

A tertiary hospital in Zhejiang Province, China.

1479 consecutive AIS patients admitted within 24 hours of symptom onset between 2016 and 2022.

SHR was calculated as fasting plasma glucose (mmol/L) divided by glycated haemoglobin (HbA1c, %). Stroke severity was assessed by the NIH Stroke Scale (NIHSS) and categorised as mild (NIHSS ≤5) or moderate to severe (NIHSS >5). Associations between SHR and stroke severity were examined using multivariable logistic regression, generalised additive models and threshold effect analysis.

Patients with more severe strokes had significantly higher SHR values (median 0.99 vs 0.94; p

SHR is independently associated with greater stroke severity at admission. Values below 1.3 may reflect heightened metabolic stress and could help inform early risk stratification in AIS management, but their discriminative power is limited and should be interpreted in conjunction with other clinical indicators.

The waist-hip ratio (WHR) and waist-height ratio (WHtR) are associated with arterial stiffness (AS), yet there is limited research on this topic in patients with type 2 diabetes mellitus (T2DM). This study aims to investigate the relationship between WHR, WHtR and AS in patients with T2DM.

This cross-sectional study used data from patients with T2DM enrolled in the Metabolic Disease Management Center (MMC) at Changde Hospital, Xiangya School of Medicine, Central South University between May 2020 and October 2023.

A total of 3201 patients were collected, and after applying the exclusion criteria, data from 3006 patients were finally analysed.

The primary outcome of AS was assessed using brachial-ankle pulse wave velocity (baPWV).

After adjusting for gender and age, there was an increasing trend in baPWV across the quartiles of WHR and WHtR. In the multivariate regression analysis adjusting for confounding factors, it was observed that for each one-unit increase in the WHR z-score, baPWV increased by 18.1 cm/s (95% CI: 7.8 to 28.4). Similarly, for each one-unit increase in the WHtR z-score, baPWV increased by 28.6 cm/s (95% CI: 16.6 to 40.6). In the multivariate logistic regression analysis, after fully adjusting for confounding factors, it was found that for every one-unit increase in the WHR z-score, the OR for elevated baPWV was 1.2 (95% CI: 1.1 to 1.4). Similarly, for every one-unit increase in the WHtR z-score, the OR for elevated baPWV was 1.3 (95% CI: 1.1 to 1.5). According to the generalised additive model, we found that WHR and WHtR were positively correlated with baPWV and elevated baPWV. Subgroup analysis revealed that elevated WHR and WHtR are significant predictors of AS, with this association being substantially amplified by poor glycaemic control (glycated haemoglobin ≥7%).

In Chinese patients with T2DM, both WHR and WHtR are positively and independently associated with baPWV and the presence of elevated baPWV.

The application of artificial intelligence (AI) technology in the screening of diabetic retinopathy (DR) has made significant strides. However, there remains a lack of comprehensive validation and evaluation of AI-derived quantitative indicators in DR screening.

This study aims to assess the diagnostic performance of retinal microvascular indicators in the early detection of DR in patients with type 2 diabetes and to identify potential novel indicators for early DR screening.

This cross-sectional study included 533 community-recruited patients with type 2 diabetes mellitus who underwent fundus imaging. Based on the results of the fundus examination, the eyes were categorised into non-DR, mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR and severe NPDR groups. AI systems were employed to quantify various retinal microvascular indicators, including microaneurysms (MAs), haemorrhage count (HC), haemorrhagic area (HA), the ratio of HA to retinal area (HA/RA), the ratio of HA to MA (HA/MA) and HC and/or MA (H/MA). Multivariable logistic regression was used to analyse the association between fundus indicators and DR severity, and receiver operating characteristic (ROC) curve analysis was performed to assess the predictive and screening value of these indicators, determining sensitivity, specificity, ROC area under the curve (AUC) and optimal cut-off values.

Among the 533 participants (mean age 64.03±9.71 years; 51.6% female), the DR prevalence was 10.0%. After adjusting for age, gender, body mass index, hypertension, diabetes duration, glycated haemoglobin levels, smoking and alcohol consumption, multivariable logistic regression indicated that HA/RA (OR 1.873, 95% CI 1.453 to 2.416) and HA/MA (OR 1.115, 95% CI 1.063 to 1.169) were associated with mild NPDR. Similarly, HA/RA (OR 1.928, 95% CI 1.509 to 2.464) and HA/MA (OR 1.165, 95% CI 1.112 to 1.220) were associated with moderate NPDR, and HA/RA (OR 2.435, 95% CI 1.921 to 3.086) and HA/MA (OR 1.171, 95% CI 1.117 to 1.226) were linked to severe NPDR. ROC curve analysis revealed that before adjustment, HA/RA demonstrated the highest screening value for DR, with an AUC of 0.917, sensitivity of 86.14%, specificity of 93.41%, Youden’s index of 0.796 and an optimal cut-off value of 0.063. After adjusting for confounding factors, the AUC for HA/RA in diagnosing DR was 0.900, with sensitivity of 83.17%, specificity of 86.28%, Youden’s index of 0.695 and an optimal cut-off value of 0.093.

The HA/RA and HA/MA show robust screening performance for early DR. These indicators should be considered for inclusion in AI-based early DR screening systems in the future.

Gestational diabetes mellitus (GDM) is an emerging public health concern in low and middle-income countries, including Nigeria, because of the associated pregnancy complications, increased healthcare costs and long-term health sequelae among women of reproductive age and their offspring. We determined the cumulative incidence, risk factors and pregnancy outcomes of GDM in Ibadan, Nigeria.

Prospective cohort study.

Ibadan, Southwest Nigeria.

721 pregnant women from the Ibadan Pregnancy Cohort Study participated in the one-step 75 g-oral glucose tolerance test at 24–28 weeks’ gestation.

The primary outcome of the study is the cumulative incidence of GDM. GDM was diagnosed according to the International Association of Diabetes and Pregnancy Study Groups criteria. Secondary outcomes were pregnancy outcomes, which included modes of delivery (CS, spontaneous vaginal delivery), macrosomia (birth weight ≥4.0 kg), gestational age at delivery and birth asphyxia. The risk factors (exposures) examined included sociodemographic, obstetric, clinical, behavioural and lifestyle factors. Bivariate and multivariate Log-binomial regression models were used to identify the independent risk factors of GDM (adjusted for maternal age ≥35 years, income, maternal body mass index, history of pregnancy loss and congenital anomaly) and the associated pregnancy outcomes of GDM (adjusted for maternal age, income and maternal body mass index). Adjusted relative risk (aRR) and 95% CI, used to assess the strength of associations, were reported.

The cumulative incidence of GDM was 20.7%, 95% CI (17.9% to 23.9%). The mean time for the diagnosis of GDM is 25.4±1.42 weeks of gestation. After adjusting for other variables, maternal age ≥35 years: (aRR: 1.48). 95% CI (1.07 to 1.97) p=0.016), maternal obesity (aRR: 1.85, 95% CI (1.26 to 2.30) p=0.002) and a previous history of congenital anomaly (aRR: 2.83, 95% CI (1.97 to 4.07) p

The cumulative incidence of GDM is high among pregnant women in Ibadan. Maternal age ≥35 years, maternal obesity and a history of congenital anomaly were significant independent risk factors for GDM. These factors should be targeted for public health interventions, including lifestyle modification among pregnant women with obesity and early screening and diagnosis of GDM.

To estimate the frequency of antidiabetic prescriptions in type 2 diabetes mellitus (T2DM) in Spain and describe changes in prescription patterns between 2018–2022 and 2023-2024.

Observational study.

Patients from primary care centres newly diagnosed with T2DM in 2018–2022 and 2023–2024.

In each period, the prescription frequency of an antidiabetic medication at the diagnosis of T2DM was calculated and subsequently subdivided into monotherapy and combination therapy. The prescription frequency of the most common antidiabetic drugs was also calculated. Calculations were made for the entire group of subjects and stratified by sex and age (under 60 years and 60 years or older). Comparison of the frequencies between the two periods was performed using the chi-square test.

In 2018–2022 and 2023–2024, 78.4% and 88.9% of patients, respectively, were prescribed an antidiabetic medication. The prescription frequencies for monotherapy and combination therapy were 66.1% and 33.9% in the first period and 57.4% and 42.6% in the second. The prescription frequencies for metformin as monotherapy and combination therapy were 57.4% and 27.8% in the first period and 46.6% and 39.8% in the second. Prescribing metformin with sodium-glucose cotransporter-2 inhibitors (SGLT2i) and/or glucagon-like peptide receptor 1 agonists (GLP1a) was the most frequent combination therapy: 12.8% in 2018–2022 and 29.5% in 2023–2024. With a few exceptions, the prescribing pattern was similar by sex and age. The difference between the prescribing distributions in the two periods is significant.

Antidiabetic medication prescribing at the diagnosis of T2DM was high. Most prescriptions contained metformin. Monotherapy decreased in 2023–2024 compared with 2018–2022, while combination therapy increased due to increased prescriptions of metformin with SGLT2i and/or GLP1a.

To assess the knowledge, attitudes and practices (KAP) related to the management of gestational diabetes mellitus (GDM) among obstetric and gynaecological healthcare workers in Hubei Province, China, and to identify factors associated with these domains.

Cross-sectional study.

Online questionnaire administered in December 2023.

A total of 394 healthcare workers from 68 maternal and child health institutions across Hubei Province.

The questionnaire comprised 29 items covering four domains: demographic characteristics, knowledge, attitudes and practices.

None.

The overall awareness rate of GDM knowledge was 58.88%. The mean knowledge score was 5.60±2.23 (range: 0–12). The mean attitude score was 18.66±1.97 (range: 0–20), with 55.08% of participants reporting a positive attitude. The mean practice score was 19.26±2.40 (range: 0–21), with 58.63% reporting good practices. Knowledge scores were positively correlated with practice scores (rs=0.130, p=0.009), and a stronger correlation was observed between attitudes and practices (rs=0.393, p

Obstetric and gynaecological healthcare workers in Hubei Province exhibited limited knowledge but generally positive attitudes and good practices regarding GDM management. Targeted educational strategies are warranted to address knowledge gaps, particularly concerning the role of early pregnancy serum ferritin in GDM risk, and to strengthen support for younger and less experienced healthcare workers.

Diabetes mellitus (DM) and depression commonly coexist. Each condition increases the risk of developing the other and adversely affects treatment outcomes. Such complex interactions of diseases, referred to as syndemics, have not been well studied. This study aims to assess the syndemics of depression, sick role and activation status among newly diagnosed adults living with DM.

A prospective 6-month follow-up study will be conducted with 485 participants. Depression will be assessed with the 9-item Patient Health Questionnaire, applying a cut-off score of 10. The primary outcome will be glycaemic control, and the secondary outcomes will be health-related quality of life (HRQoL) and functional disability status. Depression, the primary outcome and the secondary outcomes, will be measured at baseline, 3 months and 6 months. The sick role, activation status and health system perspectives will be explored using qualitative methods following the second measurement. Data will be collected from adults living with DM, healthcare providers and healthcare managers. Qualitative sampling will continue until data saturation is reached.

Quantitative analysis will be done using STATA V.17. The prevalence of depression will be determined at baseline. Associated factors will be analysed using Poisson regression with a robust variance estimator. Incidence rate of depression, glycaemic control, HRQoL and disability status will be measured at 3 and 6 months. A multilevel mixed-effects generalised linear model will be fitted, with the three measurement time points nested within individuals, and individuals nested within health institutions. Qualitative data will be analysed thematically using NVivo V.12 software.

Ethics approval has been granted by the institutional review board of Bahir Dar University (protocol number 3098/25). Findings will be disseminated through peer-reviewed publications, conference presentations and local channels for community audiences.

Protocol number 3098/25.

This study aimed to determine the association between diabetes mellitus (DM) medication use and glycaemic control.

This was a retrospective diabetes registry-based cohort study.

Singapore.

Patients aged 18 and above with incident DM in the SingHealth Diabetes Registry from 2013 to 2020 were included. The entire study period included a 1 year baseline period, a 1 year observation period and a 3 month outcome period.

Drug use was measured using the proportion of days covered (PDC), and the changes in glycated haemoglobin (HbA1c) between the outcome and baseline periods were assessed. The associations between baseline HbA1c and PDC ≥0.80 and between PDC and change in HbA1c were analysed using logistic regression and the Kruskal–Wallis test, respectively.

Of 184 646 unique patients in the registry from 2013 to 2020, 36 314 met the inclusion and exclusion criteria and were included in the analysis. The median PDC for any DM drug, oral DM drugs and insulin during the observation period was 20.3%, 16.8% and 0%, respectively. Those who had good glycaemic control at baseline were less likely to receive DM drugs and those with poor baseline glycaemic control or missing baseline HbA1c were more likely to be consistent users (PDC >80%) (px 10^-16).

The relationship between DM drug use and glycaemic control is complex and non-monotonic. Higher PDC for any DM drug and oral DM drugs during the observation period was significantly associated with clinically relevant HbA1c improvements.

The increasing prevalence of overweight and obesity among individuals with type 1 diabetes (T1D) complicates glycaemic management and escalates insulin resistance, necessitating innovative therapeutic strategies. Tirzepatide, a dual agonist for glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide receptors, shows promise in managing weight and glycaemic control in type 2 diabetes but is unexplored in the context of T1D. This double-blind, placebo-controlled randomised trial will evaluate the efficacy of tirzepatide in adults with T1D and overweight/obesity over 32 weeks.

60 participants (aged 18–70 years) with a body mass index ≥27 kg/m² and HbA1c≤10% will be randomised 1:1 to receive either tirzepatide or a placebo, alongside standard insulin therapy. The primary outcome is the change in body weight (%). Secondary measures include change in HbA1c (%), proportion of body weight lost (>5%, >10%, >15% and >20%), changes in insulin dosage, time in range by continuous glucose monitoring (CGM) criteria and severity of comorbidities. Compliance, adverse events and medication interactions will be closely monitored, with adjustments made for tolerability. Patient-reported outcomes and experiences will be measured to capture the benefits of glycaemic management, weight management and quality of life. To compare the means of body weight reduction (%) between the tirzepatide and control groups, an independent samples t-test will be employed under the assumption that data are normally distributed. Secondary outcome measures will be analysed by Student’s t-test. All data will be reported as group means with confidence intervals, with default statistical significance assumed at p

Ethical approval has been obtained from the Northern Sydney Local Health District’s Human Research Ethics Committee (approval ID #2024/ETH00180).

NCT06180616.

Women with gestational diabetes mellitus (GDM) are at seven-fold to ten-fold increased risk of type 2 diabetes mellitus (T2DM) when compared with those who experience a normoglycaemic pregnancy, and the cumulative incidence increases with the time of follow-up post birth. This protocol outlines the development and validation of a risk prediction model assessing the 5-year and 10-year risk of T2DM in women with a prior GDM diagnosis.

Data from all birth mothers and registered births in Victoria and South Australia, retrospectively linked to national diabetes data and pathology laboratory data from 2008 to 2021, will be used for model development and validation of GDM to T2DM conversion. Candidate predictors will be selected considering existing literature, clinical significance and statistical association, including age, body mass index, parity, ethnicity, history of recurrent GDM, family history of T2DM and antenatal and postnatal glucose levels. Traditional statistical methods and machine learning algorithms will explore the best-performing and easily applicable prediction models. We will consider bootstrapping or K-fold cross-validation for internal model validation. If computationally difficult due to the expected large sample size, we will consider developing the model using 80% of available data and evaluating using a 20% random subset. We will consider external or temporal validation of the prediction model based on the availability of data. The prediction model’s performance will be assessed by using discrimination (area under the receiver operating characteristic curve, calibration (calibration slope, calibration intercept, calibration-in-the-large and observed-to-expected ratio), model overall fit (Brier score and Cox-Snell R2) and net benefit (decision curve analysis). To examine algorithm equity, the model’s predictive performance across ethnic groups and parity will be analysed. Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis-Artificial Intelligence (TRIPOD+AI) statements will be followed.

Ethics approvals have been received from Deakin University Human Research Ethics Committee (2021–179); Monash Health Human Research Ethics Committee (RES-22-0000-048A); the Australian Institute of Health and Welfare (EO2022/5/1369); the Aboriginal Health Research Ethics Committee of South Australia (SA) (04-23-1056); in addition to a Site-Specific Assessment to cover the involvement of the Preventative Health SA (formerly Wellbeing SA) (2023/SSA00065). Project findings will be disseminated in peer-reviewed journals and at scientific conferences and provided to relevant stakeholders to enable the translation of research findings into population health programmes and health policy.

This study aimed to develop a scale for nurses’ knowledge, attitudes and practices regarding the prevention and treatment of subcutaneous lipohypertrophy associated with insulin injections and evaluate its reliability and validity.

A Delphi research and cross-sectional survey.

Medical, education and nursing experts from seven different regions conducted Delphi consultation by E-mail or Wechat, whereas clinical nurses from primary, secondary and tertiary general hospitals in different regions of Sichuan Province were conveniently selected for the questionnaire survey.

A total of 16 female experts aged 35–58 years participated in the Delphi expert consultation process; 812 clinical nurses participated in the questionnaire survey.

Content validity, internal consistency reliability and construct validity of the scale.

The scale comprises 3 dimensions and 36 items, with a content validity index of 0.99, a Cronbach’s α coefficient of 0.93, a split-half reliability of 0.87 and a test–retest reliability of 0.93. Exploratory factor analysis revealed a cumulative variance contribution rate of 53.38%, whereas confirmatory factor analysis indicated a 2 degree of freedom 2 ratios of 2.65, a goodness-of-fit index of 0.86, a root mean square error of approximation of 0.06, a root mean square error of 0.04 and a comparative fit index of 0.90.

The developed scale demonstrated strong reliability and validity, enabling the assessment of nurses’ knowledge, attitudes and practices regarding the prevention and treatment of lipohypertrophy associated with insulin injections.

To examine trends in the prevalence of diabetes and pre-diabetes in Indonesia from 2013 to 2023 and to explore demographic and socioeconomic factors associated with these changes.

Secondary data analysis on multiseries cross-sectional study.

Three waves of the Indonesian National Health Survey (2013, 2018 and 2023), each employing nationally representative, stratified multistage sampling.

Nationally representative respondents aged 15 years and older who completed fasting plasma glucose (FPG) and oral glucose tolerance tests (OGTT).

Diabetes and pre-diabetes were defined based on FPG and OGTT tests and self-reported diagnosis. Multivariable and ordinal logistic regression models assessed associations between glycaemic status and demographic, socioeconomic and health-related factors.

From 2013 to 2023, the prevalence of diabetes rose from 10.7% (95% CI: 10.2% to 11.2%) in 2013 to 11.8% (11.3% to 12.3%) in 2018, before declining to 11.3% (10.7% to 11.9%) in 2023. Meanwhile, pre-diabetes prevalence decreased from 44.5% (43.6% to 45.3%) in 2013 to 39.2% (38.0% to 40.3%) in 2023. Age-standardised and synthetic cohort analysis revealed that younger birth cohorts had lower diabetes prevalence at the same age compared with older generations. In contrast, diabetes prevalence remained high and stable among older adults, suggesting that an increase in diabetes prevalence was due to the increase in older population size rather than increased risk. Multivariable regression confirms that higher age and BMI were strong predictors for diabetes, pre-diabetes and abnormal glycaemic states. Wealth quintiles showed different associations: higher wealth was linked to lower pre-diabetes odds, but not consistently to diabetes.

The ageing population drives the rise of diabetes prevalence in Indonesia. Generational improvements were shown among younger adults, while persistent high diabetes prevalence in older adults underscores ongoing challenges. These findings highlight the importance of age-targeted and cohort-targeted screening and prevention strategies.

To assess the knowledge and practices of community pharmacists regarding managing diabetes in fasting patients during Ramadan and the barriers the community pharmacists face when managing diabetic patients who fast in Ramadan.

A survey-based cross-sectional study.

A structured questionnaire was distributed online during April and May 2024.

Community pharmacists who are registered with the Jordan Pharmacists Association and working in Jordan.

The questionnaire consisted of four sections: sociodemographic characteristics, pharmacists’ knowledge of diabetes management during Ramadan, practices in managing diabetic patients during fasting, and barriers encountered in providing care. The knowledge level was classified according to the total score of 13 as poor (0–4), intermediate (5–8) or excellent (9–13). Practice was classified into three categories based on scores: low (0–12), moderate (13–24) and high (25–36). Continuous variables were expressed as mean±SD, while categorical variables were reported as frequencies and percentages. Logistic regression was employed to determine the significant factors influencing the knowledge and practice of pharmacists.

A total of 473 pharmacists participated in the survey. While 9.5% demonstrated excellent knowledge, the majority (72.3%) had intermediate knowledge, and 18.2% showed poor understanding of diabetes management during Ramadan. Key gaps in knowledge were in risk stratification, dose adjustment and patient counselling. Assessment of diabetes management practices revealed that most pharmacists demonstrated high practice levels (58.1%), while 35.1% showed moderate, and only 6.8% had poor practice. Assessment of diabetes management practices revealed that most pharmacists demonstrated high practice levels (58.1%), while 35.1% showed intermediate, and only 6.8% had poor practice. The least frequently performed practices were stratifying patients by their fasting risk level and adjusting medication doses for fasting patients. Pharmacists reported barriers to providing effective care, such as time constraints, high workload, lack of educational resources and insufficient clinical knowledge.

The study reveals moderate knowledge and high practice levels among community pharmacists in Jordan regarding diabetes management during Ramadan. However, gaps in medication adjustments and patient risk stratification remain. Continuous professional development programmes are needed to enhance pharmacists’ knowledge and skills in these areas. Strengthening pharmacy resources, such as access to updated guidelines and patient education tools, can support better care practices. Future research should explore interprofessional collaboration, compare practice settings and regions, and employ qualitative and interventional study designs to deepen understanding and improve management of diabetes during Ramadan.

Gestational diabetes mellitus (GDM) is common in pregnancy and is increasing in prevalence. It is associated with an increased risk of maternal and perinatal complications if not diagnosed and managed early. Most guidelines suggest making a diagnosis of GDM using an oral glucose tolerance test (OGTT) between 24 and 28 weeks of pregnancy at which stage there still is an increased risk of complications. Increased beta-cell secretory product concentrations have been observed prior to changes in glycaemia and can potentially be used as an early marker to diagnose and assess risk of developing GDM.

The study was a prospective, longitudinal cohort study. OGTTs were carried out at visit one: 16–18 weeks and visit two: 24–28 weeks gestation in pregnant women with at least one risk factor for GDM [Body Mass Index >30 kg/m², previous macrosomic baby (>4.5 kg), previous GDM, first degree relative with type 2 diabetes mellitus (T2DM)]. Blood sampling was performed at fasting, 30 min, 1 and 2 hours following a 75-g oral glucose load. Samples were analysed for glucose, total and intact proinsulin, insulin and C-peptide. Hormonal concentrations at visit 1 were compared between those that remained normal glucose tolerant (NGT) and those that progressed to GDM at visit 2 using receiver operator characteristic (ROC) area under the curve (AUC) to assess for discrimination between the two groups.

Unfortunately, a smaller than planned sample size was recruited due to the start of COVID-19 pandemic midway through the study. 83 pregnant women had OGTT at visit 1. Of these, 12 reached the threshold for GDM at visit 1 and were excluded. In total, data from 66 patients were included for analysis (5 Did Not Attend). Visit 1 hormone comparisons were carried out between 51 who remained NGT and 15 who progressed to GDM at visit 2. There were no significant differences at each time point in ROC AUC between the two groups for total and intact proinsulin and insulin. However, there were significant differences observed in C-peptide ROC AUC at 30 (p=0.041) and 60 min (p=0.003) between the two groups.

This study did not demonstrate significant increase in early proinsulin concentrations in patients that developed GDM. However, there were differences in C-peptide concentrations. The COVID-19 pandemic restricted the recruitment of patient numbers and further studies in a larger cohort will be needed to validate these findings.

ISRCTN16416602.

Young-onset type 2 diabetes (YOD), diagnosed before 40 years of age, entails a high disease burden and potential for early dependence on disability benefits. The risk of type 2 diabetes (T2D) varies with socio-economic status and ethnic background, yet the relationship between these factors and age at diagnosis is insufficiently explored. We aimed to study associations between YOD and living on disability benefits, educational level and country background.

Cross-sectional data on 8640 individuals with T2D, linked to data on educational level and country background, were compared with population data from the same residential areas. Similar comparisons were made for data on disability benefits among 3854 individuals of working age (

The risk of being dependent on disability benefits was three times higher in YOD (adjusted incidence rate ratio, aIRR (95% CI) 3.1 (2.7 to 3.5)) and twice as high in later-onset T2D (1.9 (1.8 to 2.1)) as in the general population. People of Norwegian background with low educational levels had threefold higher YOD risk (3.3 (2.4 to 4.4)) than those with a tertiary degree, while people of non-Western backgrounds with low educational levels had a smaller increase in YOD risk (1.5 (1.1 to 2.1)). People of non-Western backgrounds had higher YOD risk than those of Norwegian background (4.2 (3.5 to 5.0)), while people of south Asian background had an even greater relative YOD risk (9.0 (7.3 to 11.0)), threefold higher than for later-onset T2D (3.2 (2.8 to 3.7)).

Lifetime risk of being dependent on disability benefits was substantially higher for individuals with YOD than in later onset T2D. Non-Western and particularly south Asian backgrounds were associated with increased YOD risk. Low education was an important YOD risk factor only for people with Norwegian background.

To map, summarise and analyse the methodologies of corneal nerve fibre imaging in studies using in vivo confocal microscopy (IVCM) in diabetes and assess the potential for standardising methods and reporting.

A scoping review was conducted using five databases, MEDLINE, Embase, Cochrane, Web of Science and Scopus, with search terms related to IVCM, diabetes and corneal nerves. Two researchers independently screened the studies for eligibility. Relevant data were extracted and systematically analysed.

Out of 1533 screened articles, 195 met the inclusion criteria. Spanning from 2000 to 2024, the studies showed high variability in image acquisition, image processing, image analysis and reporting detail. Most studies used laser scanning confocal microscopy, examining the central cornea in both eyes in patients with type 2 diabetes, manually selecting 3–6 images from each eye, and using ACCMetrics and CCMetrics for quantifying corneal nerve fibre length in mm/mm². Many studies lacked sufficient methodological details for reproducibility.

IVCM studies of corneal nerve fibres in diabetes show substantial methodological heterogeneity and inconsistent reporting, limiting reproducibility. We propose a guideline to support standardisation and improve the reliability of future research.