As one of the serious chronic complications of diabetes, diabetic foot is characterized by high rate of disability and high burden of diseases. which require multi-disciplinary collaboration and long-term standardized management in the prevention and treatment of diseases. At present, there are many difficulties during the management of diabetic foot in all community-level medical and health care institutions, such as insufficient specialized resources and lack of continuous care.Through the analysis of a successful management path in diagnoses and treatments process of a case of type 2 diabetes patient complicated with diabetic foot, to investigate the feasibility of promoting the co-care management model based on the"Specialist-General Practitioner" family medicine team contractual services in the management of diabetic complications in community health service center.

Through combing and analyzing the whole treatment and management pathway of a diabetes foot patient under the new model of "Specialist-General Practitioner"family medicine team contractual services. we searched for relevant literature from 2004 to 2024 in the full-text journal of CNKI, Wanfang data, Vip and PubMed with the key words of "Diabetic foot, Community"in Chinese and"Diabetic foot and Management, Diabetic foot and Administration, Community diabetic foot"in English. The results showed that the new model for co-care management in diabetic foot had more obvious advantage and widespread concern than the existing community management models and contents.

Under the new model of "Specialist-General Practitioner"family medicine team contractual services, the patient's gangrenous toes linked to his diabetes were preserved and the foot infection associated with diabetes was cured. Meanwhile, the patient's blood sugar, blood lipids, and blood pressure gradually reached the standard of good control. According to the document retrieval results, it is found that most of the management models for community diabetes foot at home and abroad are still in the primary stage, including community-based management model, hospital-community linkage management model, hospital-community-family management model, Internet plus hospital-community-family intelligent nursing model, self-management model, multidisciplinary teams management, telemedicine model by using computer software, smartphones, apps running on tablets, network camera and other devices, artificial intelligence prediction model for diabetes foot ulcers and multi-disciplinary integration of diabetes foot management team.

The co-care model based on "Specialist-General Practitioner"family medicine team contractual services got remarkable effect on the management of diabetes foot in the community. Compared to the similar models in China and abroad, this model has a simple team structure, clear division of labor among members, emphasis on individualization of services, and work more efficiently, which is worth spreading and applying in the community health service center.

Childhood and adolescents obesity is a critical global public health challenge, posing immediate health risks and increasing the risk of cardiometabolic diseases in adulthood. In 2024, the Italian Society for Pediatric Endocrinology and Diabetology issued a position paper on Cardiometabolic Risk in Children and Adolescents with Obesity, offering significant guidance for the evaluation and management of cardiometabolic risk in obese children and adolescents based on the latest evidence. This article aims to interpret the core content of this document to provide references and recommendations for cardiometabolic risk management of obesity in Chinese children and adolescents.

Maturity-onset diabetes of the young (MODY) is a distinct class of diabetes mellitus characterized by a heterogeneous group of monogenic disorders caused by genetic defects primarily affecting insulin secretion, synthesis, or action mechanisms, accounting for 1%-5% of diabetic patients. It is the most common form of monogenic diabetes. This article reports a case of diabetes diagnosed in the Department of Endocrinology and Metabolism Diseases, First Affiliated Hospital of Anhui Medical University. Genetic testing revealed a mutation in the hepatocyte nuclear factor 4α(HNF4A) gene, specifically c.334 (exon4)C>T(p.Arg112Trp), leading to a definitive diagnosis of MODY1. The diagnostic and treatment process of this case is described, along with a review of relevant literature. Given the low prevalence of MODY1, this report of a family case expands the spectrum of known HNF4A gene mutations, which may enhance clinicians' understanding of the disease. This, in turn, can promote precise diagnosis, classification, and treatment of MODY.

Although the overall prevalence of chronic kidney disease (CKD) in China has decreased, patients with hypertension and type 2 diabetes mellitus (hereinafter referred to as "the two diseases") have a relatively high risk of developing CKD, and the status of their standardized management in primary medical institutions remains unclear.

To conduct a cross-sectional survey of patients with "the two diseases" in community health service centers regarding the prevalence and management status of CKD, so as to provide data support for optimizing the management of chronic kidney disease at the primary level.

From January to December 2024, a two-stage random sampling method was adopted. Taking 12 community health service centers in Wuhou District, Chengdu as the sampling frame, 6 institutions were randomly selected, and then 600 eligible patients with "the two diseases" were randomly extracted from these selected institutions (including 205 cases of isolated hypertension, 213 cases of isolated type 2 diabetes mellitus, and 182 cases of comorbidity of the two diseases). The prevalence and management status of CKD in these patients were calculated, covering outpatient management, metabolic intervention, pharmacotherapy, and comprehensive intervention. Data were entered using EpiData 3.1 software, and statistical analysis was performed with SPSS 21.0 software.

Among the included population with "the two diseases", 173 cases (28.8%) were diagnosed with CKD. Of these CKD patients, 55 cases (26.8%) were from the isolated hypertension group, 52 cases (24.4%) were from the isolated type 2 diabetes mellitus group, and 66 cases (36.3%) were from the comorbidity group of the two diseases. Among all the CKD patients, 39 cases (22.5%) were at CKD stage 3, 5 cases (2.9%) at CKD stage 4, and 1 case (0.6%) at CKD stage 5. However, only 9 cases (5.2%) were registered for the special outpatient service for chronic kidney disease, 70 cases (59.3%) achieved the target of blood glucose control, 112 cases (92.6%) reached the standard of blood pressure control, 64 cases (37.0%) took SGLT-2i/GLP-1RA drugs, and 90 cases (52.0%) administered ACEI/ARB drugs.

At present, the prevalence of CKD in patients with the two diseases (diabetes/hypertension) in community health service centers of Wuhou District of Chengdu City is relatively high, and the standardized management of CKD patients remains inadequate. These findings indicate that primary medical institutions should improve the capacity for early screening and intervention of CKD, strengthen the standardized management of CKD patients, and enhance the control of patients' metabolic indicators, which is of great significance for effectively preventing and delaying disease progression.

Diabetes is a global public health issue. The county medical consortium integrates medical resources within the county to improve the efficiency of chronic disease management and service accessibility, and reduce unnecessary hospitalizations.

To evaluate the impact of establishing a compact county medical consortium on the utilization and cost control of diabetes inpatient services, providing evidence for optimizing chronic disease hierarchical diagnosis and treatment policies.

In June 2025, diabetes inpatient case data from January 2016 to June 2020 were collected from the hospital discharge summary systems of Yangxi County, Guangdong Province (which implemented medical consortium reform in November 2017) as the intervention group, and Yangchun City (which implemented the reform in April 2020) as the control group. Interrupted Time Series Analysis (ITS) was adopted, and changes in hospitalization volume, readmission volume, average length of stay, and costs were analyzed through Ordinary Least Squares (OLS) regression, Poisson regression, and Generalized Linear Model (GLM).

After the implementation of the medical community, the intervention group showed a significant decrease in hospitalization volume (immediate effect β=-52.825, P=0.008); however, no improvement was observed in readmission volume (β=-3.978, P=0.271). The control group showed a significant increase in hospitalization volume (immediate effect β=57.473, P<0.001), and readmission volume also exhibited an increasing trend (immediate effect β=5.485, P=0.033). The average hospitalization cost in the intervention group increased slightly (long-term effect β=0.039, P<0.001), whereas the control group showed a downward trend in average hospitalization cost (long-term effect β=-0.010, P<0.001). No significant changes were observed in the average length of stay in either the intervention group or the control group (P=0.256 and P=0.101, respectively).

The medical consortium effectively diverted mild diabetes cases through resource integration. reducing unnecessary hospitalization services, but no significant effects have yet been observed in terms of medical service quality and cost control. It is recommended to establish a synergistic mechanism integrating "payment reform - capacity building at the primary level - digital empowerment" to improve hierarchical management of chronic diseases.

The National Basic Public Health Service Program aims to reduce the long-term burden on patients with chronic diseases. However, whether it can effectively reduce hospitalization costs and improve long-term survival outcomes remains to be systematically evaluated.

Using hospitalized patients with diabetes as an example, to assess the impact of standardized basic public health service management on hospitalization costs and mortality outcomes.

Medical record homepage data, Basic Public Health Service Program data, and mortality registration data from 10 counties in Henan Province from 2019 to 2024 were selected using cluster random sampling. A comparable cohort was constructed using propensity score matching (PSM). In the matched sample, multiple linear regression was used to analyze the effect of inclusion in standardized basic public health service management on hospitalization costs among patients with diabetes. Kaplan-Meier (KM) curves and time-stratified Cox regression were used to evaluate its impact on all-cause mortality, diabetes-related mortality, and cardiovascular and cerebrovascular mortality.

A total of 121 869 patients with diabetes were included, including 52 329 patients who were enrolled in standardized basic public health service management (management group) and 69 540 who were not (non-management group); 14 027 patients were in the death group and 107 842 in the survival group. Before matching, baseline characteristics differed between the management group and non-management group. After PSM, each group contained 52 329 patients, and all covariates were well balanced. Multiple linear regression analysis of factors affecting hospitalization costs in patients with diabetes showed that hospitalization costs in the management group were reduced by 2.86% compared with the non-management group (95%CI=2.08%-3.63%, P<0.001); sensitivity analysis yielded consistent results. The KM curves showed that the all-cause mortality rate, diabetes-related mortality rate, and cardiovascular and cerebrovascular mortality rate were all lower in the management group than in the non-management group (P<0.001). Time-stratified Cox regression showed that during follow-up <1 year, the HRs for all-cause mortality, diabetes mortality, and cardiovascular and cerebrovascular mortality in the management group were 0.19, 0.20, and 0.19, respectively, corresponding to mortality risk reductions of 81%, 80%, and 81%; during follow-up 1-2 years, the HRs for the three mortality outcomes were 0.22, 0.26, and 0.22, respectively, corresponding to risk reductions of 78%, 74%, and 78%; during follow-up >2 years, the HRs for the three mortality outcomes were 0.41, 0.43, and 0.41, respectively, corresponding to risk reductions of 59%, 57%, and 59%.

Inclusion in basic public health service management is associated with lower hospitalization costs and lower risks of all-cause mortality, diabetes mortality, and cardiovascular and cerebrovascular mortality among county-level hospitalized patients with diabetes, and the association with mortality risk varies across follow-up stages. It is recommended to continuously promote basic public health service management, pay attention to patients with a higher hospitalization economic burden and a higher risk of diabetes complications, and strengthen early identification, standardized referral, and continuous follow-up of high-risk diabetic complications at the primary care level, so as to further consolidate its benefits in reducing hospitalization economic burden and improving survival outcomes.

In August 2025, the BMJ published the Living Clinical Practice Guideline on the Effects of Pharmacological Agents for Type 2 Diabetes on Cardiorenal Outcomes and Weight Management. Compared with the 2021 version, three changes matter most for general practitioners: the guideline has become living and will be iteratively updated; finerenone and tirzepatide have been added; and risk stratification has been simplified from five to three strata with obesity incorporated into decision making. Importantly, the inclusion of finerenone indicates that treatment decisions in type 2 diabetes should focus on patient-important cardiovascular, kidney, and weight outcomes rather than glucose lowering alone. The accompanying visual evidence summaries and the Multiple and Treatment Comparison Health Intervention Tool (MATCH-IT) can help general practitioners intuitively present the absolute benefits, absolute risks, and treatment burden of different drugs to patients. Focusing on the primary care setting in China, this article interprets the clinical value of the living guideline, the rationale for incorporating finerenone into diabetes management guidelines, and the understanding and application of the new risk stratification in general practice outpatient settings.

With the development of the economy and society, the prevalence of diabetes has been increasing year by year. Diabetic patients require not only treatment services but also comprehensive and continuous integration of medical and preventive care. However, due to the fragmentation of "medical-preventive" services, there are certain deficiencies in the utilization of integration of medical and preventive care for diabetic patients. Therefore, improving the utilization of these services is crucial.

To understand the current status and influencing factors of the utilization of integration of medical and preventive care among diabetic patients in Shandong Province, and to provide references for further improving related policies and practices.

In August 2023, a multi-stage stratified cluster random sampling method was employed. Based on geographical location and economic development, Yantai City, Weifang City, and Liaocheng City were selected from the eastern, central, and western regions of Shandong Province, respectively. From each city, one county/county-level city was chosen as a sample area. Within each county/city, four townships were randomly selected. From each township, two villages were randomly chosen. In each village, 25 diabetic patients included in the basic public health service management were randomly selected for a questionnaire survey. A self-designed questionnaire was used to investigate the personal characteristics of diabetic patients and their utilization behavior of integrated medical and preventive care services. Multivariate Logistic regression analysis was used to explore the factors influencing diabetic patients' utilization behavior of integrated medical and preventive care services.

A total of 602 patients were surveyed, and 600 valid questionnaires were collected, with a validity rate of 99.67%. The good utilization rate of integration of medical and preventive care among diabetic patients was 54.5% (327/600). There were statistically significant differences in the utilization of these services among patients with different education levels, living conditions, awareness of integration of medical and preventive care, health beliefs, family doctor contracting status, presence of other chronic diseases, and self-rated health status (P<0.05). Multivariate Logistic regression analysis showed that patients with junior high school education (OR=1.896), good awareness of integration of medical and preventive care (OR=5.818), good health beliefs (OR=2.701), and those who had contracted a family doctor (OR=2.106) had better utilization behavior integration of medical and preventive care (P<0.05) .

At present, there is still significant room for improvement in the utilization of integration of medical and preventive care among diabetic patients in Shandong Province. Efforts should be made to further improve these services, improving the quality of family doctor services, and increase the publicity of integration of medical and preventive care and related policies.

Pulmonary mucormycosis (PM) is a highly invasive fungal infection, which is characterized by rapid progress and high mortality. Diabetes mellitus (DM) is a major predisposing factor, especially under the condition of poorly control. It is difficult to diagnose the disease early because of the lack of specificity in clinical manifestations and imaging features. This is easy to delay diagnosis and treatment, leading to poor prognosis. However, data on the clinical characteristics and prognostic factors of PM in patients with DM remain scarce.

To investigate the clinical characteristics of PM in patients with DM and to identify the independent risk factors for 28-day mortality.

This retrospective study included 51 hospitalized patients who were proven or probable PM diagnosed according to the European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria at Jinan Central Hospital between May 2015 and May 2025. Patients were divided into two groups: a PM with DM group (PM+DM, n=24) and a PM without DM group (PM+NDM, n=27). Clinical characteristics, laboratory findings, imaging features, and treatment regimens of the two groups were compared. Univariate and multivariable Cox regression analyses were performed to identify independent risk factors for 28-day mortality in the PM with DM group.

No significant differences were observed between the PM+DM and PM+NDM groups in baseline characteristics, clinical features, or treatment regimens (P>0.05). Compared with the PM+NDM group, the PM+DM group had significantly higher levels of high-sensitivity C-reactive protein, and arterial partial pressure of carbon dioxide, HbA_1c, fasting blood glucose, and serum galactomannan (GM) test results (P<0.05), but significantly lower albumin levels and thrombin time (P<0.05). There was no significant differences were found in the other laboratory parameters (P>0.05). In terms of imaging findings, the proportions of patients with involvement of three or more lung lobes and pulmonary cavitary lesions were significantly higher in the PM+DM group than that in the PM+NDM group (P<0.05). However, no significant between-group differences were found in reversed halo sign, pulmonary nodules, or other imaging manifestations (P>0.05). Multi-variable analysis identified HbA_1c and serum creatinine levels as independent predictors of 28-day mortality in the PM+DM group (P<0.05).

Patients with pulmonary mucormycosis complicated by diabetes mellitus are characterized by a heightened inflammatory response, hypoalbuminemia, poor glycemic control, pulmonary cavitary lesions, and multi-lobar involvement. HbA_1c and serum creatinine levels may serve as important predictors of 28-day mortality.

Metabolic Syndrome (MetS) exerts a significant adverse impact on human health, while the Lipid Accumulation Product (LAP) is capable of reflecting the degree of visceral fat accumulation in the human body. Previous studies investigating the relationship between LAP and MetS have mostly been cross-sectional studies, with a lack of evidence from cohort studies. Additionally, the predictive ability of LAP varies across different studies, and its value in predicting the future incidence of MetS requires further exploration.

To analyze the relationship between long-term exposure to the LAP and the risk of developing MetS, and to explore the predictive performance of this index for MetS, thereby providing evidence for the early prevention of MetS.

This study utilized data from the Guizhou Natural Population Cohort Study. The cohort was established between November 2010 and December 2012, and a follow-up survey was conducted on the baseline participants from April 2016 to October 2020. Participants were divided into 4 groups (Q1 to Q4) based on their baseline LAP levels: Q1 (LAP<8.52, n=1 003), Q2 (8.52≤LAP<15.44, n=1 001), Q3 (15.44≤LAP<27.85, n=1 006), and Q4 (LAP≥ 27.85, n=1 003). Cox proportional hazards models were used to analyze the relationship between LAP and MetS in the total population and in subgroups stratified by sex. Hazard ratios (HR) and their corresponding 95% confidence intervals (95%CI) were calculated. Restricted cubic splines were applied to evaluate the dose-response relationship between LAP and the incidence of MetS. Additionally, time-dependent receiver operating characteristic (ROC) curves for LAP in predicting MetS were plotted to assess the predictive performance of this index.

A total of 4 013 study subjects were enrolled, including 1 803 males (44.93%) and 2 210 females (55.07%). The baseline mean age was (43.7±14.6) years, with a mean BMI of (22.45±2.84) kg/m². The median follow-up duration was 6.54 years, during which 889 cases of MetS were observed. The MetS incidence rates in the overall population, males, and females were 31.62 per 1 000 person-years, 33.36 per 1 000 person-years, and 30.19 per 1 000 person-years, respectively. Cox proportional hazards regression analysis showed that after adjusting for relevant confounding factors, the risk of MetS increased with the elevation of the LAP (P _{for trend}<0.05). In the total population, compared with the Q1 group, the adjusted hazard ratios (aHRs) or MetS risk were gradually elevated in the Q2 (aHR=1.26, 95%CI=1.02-1.57), Q3 (aHR=1.35, 95%CI=1.08-1.68), and Q4 (aHR=1.55, 95%CI=1.24-1.94) (P<0.05). In the male, compared with the Q1 group, the Q2 (aHR=1.45, 95%CI=1.09-1.93), Q3 (aHR=1.52, 95%CI=1.12-2.05), Q4 (aHR=1.56, 95%CI=1.13-2.10) all exhibited an increased risk of MetS (P<0.05). In the female, however, a significant increase in MetS risk was only observed in the Q4 (aHR=1.44, 95%CI=1.03-2.01) relative to the Q1 group (P<0.05). Result s from restricted cubic splines indicated a linear dose-response relationship between LAP and MetS risk in the total population (P_overall<0.05, P_nonlinear=0.069) and the male subgroup (P_overall<0.05, P_nonlinear=0.255), while a non-linear dose-response relationship was observed in the female subgroup (P_overall<0.05, P_nonlinear=0.038). The results of time-dependent ROC curves showed that for the prediction of MetS after 7, 8, and 9 years of LAP exposure, the AUC values in the total population were 0.56, 0.56, and 0.57, respectively, in males, the AUC values were 0.55, 0.55, and 0.59, respectively, and in females, the AUC values were 0.57, 0.58, and 0.57, respectively.

Elevated LAP levels increase the risk of MetS in the general population and across different sex groups. However, its predictive efficacy for future MetS development is limited, making it an suboptimal prognostic marker. Thus, more indicators with higher predictive value should be explored.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a steatotic liver disorder closely linked to metabolic dysregulation. Insulin resistance (IR) plays a key role in its pathophysiology and is considered a significant component of cardiometabolic risk.

To investigate the association between different surrogate indicators of IR and the occurrence of major adverse cardiovascular events (MACEs) after percutaneous coronary intervention (PCI) in patients with MASLD and coronary heart disease (CHD), and to identify simple predictive indicators suitable for this population.

A total of 958 patients diagnosed with MASLD and CHD who underwent PCI at Northern Jiangsu People's Hospital from January 1, 2019 to October 31, 2023, were retrospectively enrolled. Baseline data were collected, cardiac function was assessed by echocardiography, and liver status was evaluated by ultrasound. IR surrogate indicators were calculated based on laboratory results. Patients were followed up to collect the occurrence of postoperative MACEs. Cox proportional hazards regression models were used to explore prognostic factors. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive efficacy of IR surrogate indicators. Kaplan-Meier survival curves were drawn to compare cumulative survival rates, with Log-rank tests for group comparisons. Restricted cubic spline (RCS) curves were used to explore the nonlinear trends between IR indicators and prognosis.

Based on follow-up results, patients were divided into the non-MACEs group (n=768) and the MACEs group (n=190). Significant differences were observed between the two groups in white blood cell count, neutrophil count, monocyte count, fasting plasma glucose (FPG), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), apolipoprotein A, apolipoprotein B, albumin, aspartate aminotransferase, TyHGB, TyG, TG/HDL-C, and METS-IR (P<0.05). Cox regression analysis showed that elevated TyG (HR=1.820, 95%CI=1.223-2.707) and METS-IR (HR=7.309, 95%CI=3.770-14.170) were risk factors for postoperative MACEs (P<0.05). Group analysis indicated that TyG Q2-Q4, TG/HDL-C Q4, TyHGB Q3-Q4, and METS-IR Q3-Q4 were risk factors for MACEs (P<0.05). Kaplan-Meier curves showed significant differences in MACEs risk across quartiles of TyG (χ²=17.428), TG/HDL-C (χ²=41.682), TyHGB (χ²=47.345), and METS-IR (χ²=104.233) (P<0.05). RCS curves indicated a nonlinear correlation of TG/HDL-C, TyHGB, and METS-IR with MACEs (P_nonlinear<0.001), while TyG showed a linear correlation (P_nonlinear=0.643). ROC analysis showed the AUC for TyHGB, TyG, TG/HDL-C, and METS-IR were 0.653(95%CI=0.611-0.696), 0.599(95%CI=0.553-0.644), 0.652(95%CI=0.608-0.695), and 0.741, respectively.

TyHGB, TyG, TG/HDL-C, and METS-IR are positively associated with the occurrence of MACEs after PCI in patients with MASLD and CHD and can serve as potential epidemiological predictive indicators, with METS-IR demonstrating the best predictive performance.

Lifestyle interventions can effectively lower blood glucose levels, promote weight control, improve quality of life, and reduce cardiovascular risk, and constitute a fundamental strategy for the prevention and management of diabetes and other chronic non-communicable diseases. In this context, the American College of Lifestyle Medicine released the Clinical Practice Guideline on Lifestyle Interventions for the Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults, representing the first multidisciplinary clinical practice guideline to position lifestyle intervention as the core therapeutic strategy. Based on available evidence from randomized controlled trials, systematic reviews, and observational studies, the guideline systematically integrates key lifestyle domains, including dietary optimization, promotion of physical activity, sleep management, stress reduction, avoidance of unhealthy substance use, and social support, and establishes a comprehensive management framework encompassing assessment, intervention, follow-up, and dynamic adjustment. The guideline emphasizes patient-centered care and multidisciplinary collaboration, highlights the potential for achieving diabetes remission in selected individuals through intensive lifestyle intervention, and provides principle-based recommendations on medication adjustment and long-term safety monitoring. In addition, practical assessment tools, intervention prescription templates, and follow-up strategies are provided to enhance clinical feasibility. This article interprets the core recommendations of the guideline, focusing on its evidence base, clinical implications, and implementation considerations, with the aim of informing the standardized application of lifestyle interventions in the management of prediabetes and type 2 diabetes in adults.

Exercise is the cornerstone of metabolic-associated fatty liver disease(MAFLD) management and a core approach to reversing hepatic steatosis and reducing cardiovascular risk. Currently, there are no effective therapeutic drugs approved by regulatory authorities for MAFLD, thus patients with MAFLD need more precise exercise prescription guidance. However, there are relatively few exercise guidelines specifically for MAFLD patients at present. With the continuous exploration of this field by experts and scholars, in the past two years, American College of Sports Medicine (ACSM) and Exercise and Sport Science Australia (ESSA) respectively released expert consensuses on exercise guidance recommendations for patients with MAFLD: American College of Sports Medicine (ACSM) International Multidisciplinary Roundtable Report on Physical Activity and Nonalcoholic Fatty Liver Disease and Exercise in the Management of Metabolic-associated Fatty Liver Disease (MAFLD) in Adults: a Position Statement from Exercise and Sport Science Australia. These two expert consensuses comprehensively put forward guiding opinions from the perspectives of the mechanism by which exercise improves hepatic steatosis, the impact of different types of exercise on MAFLD, the benefits of exercise for MAFLD patients, and the formulation of exercise prescriptions. This article interpreted the main contents of the expert consensus, aiming to provide more scientific exercise guidance for domestic MAFLD patients.

Cardiovascular diseases are prevalent in China, with cardiometabolic multimorbidity (CMM) being a common comorbidity pattern. Postmenopausal women represent a high-risk group for cardiovascular diseases, yet there is a lack of predictive models for CMM risk specifically in this population.

To develop an interpretable machine learning (ML) model to predict the risk of CMM among Chinese postmenopausal women, based on data from the China Health and Retirement Longitudinal Study (CHARLS).

The study included postmenopausal women aged≥45 years from the CHARLS cohort in 2011 who were free of CMM at baseline. Data on demographic characteristics, family background, health status, and laboratory indicators were collected at baseline and during follow-up in 2013, 2015, 2018, and 2020 to observe CMM incidence. Feature selection was performed using the least absolute shrinkage and selection operator (LASSO) algorithm. Seven ML algorithms were constructed for risk prediction. The optimal model was further optimized on the test set using a combined strategy of "class_weight='balanced' dynamic weighting+optimal threshold selection" and visually interpreted using Shapley Additive Explanations (SHAP). Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision, and F1-score.

A total of 5 575 participants completed the 4 rounds of follow-up and were included, comprising 4 363 in the non-CMM group and 1 212 in the CMM group. Over a median follow-up of 9 years, the cumulative incidence of CMM was 21.74%. LASSO regression identified 22 key features as significant predictors of CMM: self-rated health, mental disorders, arthritis, dyslipidemia, kidney disease, retirement status, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean pulse rate, waist circumference, BMI, headache, lower back pain, serum creatinine (Scr), triglycerides (TG), C-reactive protein (CRP), glycated hemoglobin (HbA_1c), uric acid (UA), age, Center for Epidemiologic Studies Depression Scale (CES-D) score, smoking status, and geographic region. Among the models, the Logistic regression (LR) model demonstrated the best predictive performance (test set AUC=0.758, accuracy =79.2%). The SHAP mean bar plot revealed core predictors: SBP, HbA_1c, geographic region, waist circumference, CES-D score, BMI, DBP, and age. The SHAP summary plot indicated that higher values of SBP, HbA_1c, waist circumference, and others were associated with increased predicted CMM risk.

This study develops a clinically interpretable prediction model for CMM in Chinese postmenopausal women, with the LR algorithm showing favorable performance. Key risk factors include SBP, HbA_1c, and waist circumference. The model provides an evidence-based tool for screening high-risk individuals and guiding personalized interventions.

Metabolic associated fatty liver disease (MAFLD), as the most prevalent chronic liver disease worldwide, features a complex and multifactorial pathogenesis, and no targeted therapeutics are currently available. This review focuses on the E3 ubiquitin ligase Parkin, providing a systematic analysis of its classical and non-classical functions during MAFLD progression. We particularly highlight Parkin's pivotal roles in multiple pathological processes, including the regulation of apoptosis and pyroptosis, mediation of endoplasmic reticulum-mitochondria crosstalk, reprogramming of lipid metabolism, and modulation of hepatic stellate cell activation. It is well established that Parkin-mediated mitophagy via the PINK1/Parkin pathway serves as a central mechanism for maintaining hepatic metabolic homeostasis and suppressing inflammatory responses. However, growing evidence from cross-disease model studies suggests that under lipotoxic stress, Parkin's functional repertoire extends far beyond mitochondrial quality control. Building on this evidence, we propose that Parkin likely participates may potentially participate in multiple MAFLD pathogenic pathways through a series of non-canonical ubiquitination events. Consequently, future therapeutic strategies in MAFLD should aim at coordinated multi-pathway intervention. This perspective opens new avenues for innovative drug discovery targeting Parkin.

Against the backdrop of China's ageing population and persistently rising diabetes prevalence, the health and socio-economic burden posed by diabetes among the elderly continues to intensify. Although multiple studies in China have reported diabetes prevalence among older adults, the evidence remains fragmented, lacking systematic reviews and meta-analyses to comprehensively quantify its epidemiological status. A thorough understanding of diabetes prevalence in this population is a crucial prerequisite for advancing targeted prevention and control measures and optimising the allocation of healthcare resources.

In accordance with systematic review and meta-analysis protocols, a systematic search of Chinese and English databases was conducted to identify studies published between 2000 and 2023 investigating diabetes prevalence among Chinese older adults (≥60 years). A meta-analysis was performed to synthesise prevalence estimates and conduct subgroup analyses.

A systematic search of Chinese and English databases (including CNKI, Wanfang Data, PubMed, Embase, Web of Science, and Scopus) was conducted to collect research literature published between 2000 and 2023 concerning the prevalence of diabetes among elderly individuals in China. Meta-analysis was performed using Stata software, with I² used to assess heterogeneity. Based on the results, either a fixed-effect model or random-effects model was selected to combine and calculate the overall prevalence and prevalence within subgroups.

This study included 20 publications, encompassing 872 633 participants from elderly populations across 31 provinces. Meta-analysis results indicated that the prevalence of diabetes among Chinese older adults was 18.67% (95%CI=15.86%-21.47%). After excluding standardised rates, the crude prevalence was 19.22% (95%CI=16.15%-22.30%). The prevalence rate was 18.20% (95%CI=14.74%-21.66%) among males and 19.06% (95%CI=15.98%-22.13%) among females. By age group, the prevalence among those aged 60-69 years was 17.60% (95%CI=13.73%-21.47%), 19.62% (95%CI=13.51%-25.73%) among those aged 70-79 years, and 19.52% (95%CI=15.41%-23.63%) among those aged≥80 years. The prevalence among urban elderly residents was 16.85% (95%CI=11.21%-22.50%), higher than that among rural residents at 14.20% (95%CI=8.97%-19.42%). By educational attainment, the prevalence was 18.58% (95%CI=15.84%-21.31%) among those with junior secondary education or above, and 13.93% (95%CI=9.18%-18.68%) among those with primary education or below. Stratified by BMI, the prevalence rates among individuals with BMI <18.5 kg/m², 18.5-23.9 kg/m², 24.0-27.9 kg/m², and≥28.0 kg/m² were 14.46% (95%CI=5.75%-23.16%), 17.73% (95%CI=14.60%-20.86%), 29.15% (95%CI=17.40%-40.90%), and 31.74% (95%CI=22.65%-40.83%), respectively. Sensitivity analyses yielded stable results, with no evidence of significant publication bias.

The prevalence of diabetes among the elderly population in China reached 18.67% between 2000 and 2023. Differences in diabetes prevalence were observed across gender, age, urban-rural location, educational attainment, and BMI subgroups. Overall, the prevalence was slightly higher among women than men, and increased with advancing age. Urban elderly individuals exhibited higher prevalence than their rural counterparts, while those with higher educational attainment had higher rates than those with lower educational attainment. Differences were particularly pronounced across BMI subgroups, with significantly higher diabetes prevalence among overweight and obese elderly individuals compared to those of normal or underweight status.

Metabolic associated fatty liver disease (MAFLD) and hypertension are prevalent chronic conditions in older adults, with accumulating evidence linking both to metabolic dysfunction. The cardiometabolic index (CMI) is a composite parameter that evaluates visceral adipose distribution and metabolic status, yet its association with incident hypertension among elderly MAFLD patients remains to be elucidated.

To investigate the association of CMI with incident hypertension in elderly patients with MAFLD, and to evaluate the predictive value of CMI for hypertension development in this population.

Elderly non-hypertensive patients diagnosed with MAFLD during health check-ups at Yingzhong and Zijin Community Health Centers affiliated with Changzhi People's Hospital between January and December 2021 were enrolled. Follow-up investigations were conducted from January 2022 to December 2024, and 426 elderly MAFLD patients who completed follow-up were ultimately included in this study. Baseline characteristics and relevant clinical data were collected, and CMI was calculated. Participants were stratified into three tertile groups based on CMI: T1 (CMI<0.467, n=141), T2 (0.467≤CMI<0.758, n=142), and T3 (CMI≥0.758, n=143). They were further categorized into non-hypertension (n=355) and hypertension (n=71) groups based on incident hypertension during follow-up. Kaplan-Meier survival analysis was performed to estimate the cumulative incidence of hypertension across CMI groups, with between-group differences assessed using the Log-rank test. Multivariate Cox proportional hazards regression and restricted cubic spline (RCS) analysis were used to evaluate the association between CMI and incident hypertension. Sex-stratified analysis and sensitivity analysis were performed to examine the robustness of this association.Furthermore, time-dependent receiver operating characteristic (ROC) curves were constructed to assess the predictive performance of CMI for hypertension development in elderly MAFLD patients.

During a median follow-up period of 36.00 (27.75, 38.00) months, 71 patients (16.7%) developed incident hypertension. There were statistically significant differences between the non-hypertension and hypertension groups in age, waist circumference, BMI, CMI, TC, TG, LDL-C, and HDL-C (P<0.05). Log-rank test demonstrated that the cumulative incidence of hypertension increased significantly across T1 to T3 groups with elevated CMI levels (χ²=26.468, P<0.001). Multivariate Cox proportional hazards regression analysis revealed that when analyzed as a continuous variable, CMI was significantly and positively associated with incident hypertension in elderly MAFLD patients after adjusting for relevant confounders (HR=1.927, 95%CI=1.381-2.689, P<0.001). When CMI was analyzed as a categorical variable with the T1 group as the reference, the risk of developing hypertension was significantly higher in the T3 group after adjusting for confounders (HR=5.453, 95%CI=2.268-13.109, P<0.001). Interaction analysis showed no statistically significant interaction between CMI and gender (P_interaction=0.557). Sensitivity analysis demonstrated that the association between CMI and hypertension remained significant after excluding participants with MAFLD remission. RCS analysis showed a non-linear dose-response relationship between CMI and the risk of hypertension in elderly MAFLD patients (P_{non-linearity}=0.005). The risk of hypertension exhibited a continuous upward trend with increasing CMI levels, which plateaued when CMI exceeded 1.185. Time-dependent ROC curve analysis showed that CMI demonstrated optimal predictive performance for hypertension at 24 months of follow-up, with an AUC of 0.722 (95%CI=0.618-0.827). Over time, the AUC decreased to 0.648 (95%CI=0.537-0.759) and 0.652 (95%CI=0.542-0.763) at 30 and 36 months, respectively.

CMI is significantly positively associated with incident hypertension in elderly MAFLD patients, and its measurement can be used to assess the short-term (24-month) risk of hypertension development in this population.

Primary health institutions serve as the frontline defense against hypertension and diabetes. Their capabilities are critical to China's ability to effectively prevent and control these two chronic conditions.

To analyze the current situation of health management and treatment services provided by community hospitals in China for patients with hypertension and diabetes to identify problems and make suggestions.

The "Quality Service Grassroots Activities Application System" collected information on hypertension and diabetes prevention and treatment capacity and service provision in 3 718 community hospitals. Descriptive statistical analysis and multiple linear regression analysis were carried out based on Stata15.0.

There were statistically significant differences in the allocation of electrocardiogram machines and peripheral blood glucose meters among primary health institutions across different regions (P<0.001). Similarly, significant regional disparities were observed in the availability of essential antihypertensive and hypoglycemic medications (P<0.001). The annual number of hypertension and diabetes diagnoses and treatments per institution also varied significantly by region (P<0.001). Additionally, significant differences were found in the renewal rates of hypertensive and diabetic patients across regions(P<0.001). Furthermore, significant variations were observed among regions in the standardized management rates of hypertensive and diabetic patients, as well as in blood pressure and blood glucose control rates (P<0.001). Multiple linear regression analysis revealed that factors such as region, institution type, the number of essential antihypertensive drugs available, the number of registered general practitioners, the proportion of medical income to total income, the proportion of medical insurance income to medical income, and the contract renewal rate significantly influenced the annual number of diagnosed and treated hypertensive patients (P<0.05). Similarly, region, institution type, the number of practicing (assistant) physicians, the proportion of medical income to total income, and the renewal rate were found to affect the standardized management rate of hypertensive patients (P<0.05). Moreover, region, institution type, the number of electrocardiogram machines, the number of practicing (assistant) physicians, and the proportion of medical income to total income had statistically significant effects on blood pressure control.

The hardware conditions of community hospitals in the western region are better, but the medical service capacity is not as good as that in the east, and the soft power still needs to be improved. The ECG machine is the best, but the peripheral blood glucose meter, drug equipment, diagnosis and treatment times and other indicators that reflect the ability of medical services are not as good as those in the east. The integration of medical prevention of hypertension and diabetes still needs to be implemented, and public health indicators such as standardized management rate and blood pressure and blood glucose control rate are "decoupled" from the medical service capacity of community hospitals, and the indicators related to medical services and public health services are "inverted", with the former being high in the east and the latter in the west, and the quality and service connotation of public health data need to be improved.

The prevalence of nonalcoholic fatty liver disease (NAFLD) is significantly higher in patients with type 2 diabetes mellitus (T2DM). However, there are few studies on the relationship between serum remnant cholesterol (RC) and NAFLD and liver fibrosis in T2DM patients.

To investigate the relationship between serum RC level and NAFLD and progressive liver fibrosis in patients with T2DM.

316 patients with T2DM hospitalized in the Second People's Hospital of Lianyungang from 2022 to 2024 were selected and divided into NAFLD group (195 cases) and Non-NAFLD group (121 cases) according to whether they were complicated with NAFLD. According to NAFLD fibrosis score (NFS), NAFLD group was divided into progressive liver fibrosis subgroup (92 cases) and non-progressive liver fibrosis subgroup (103 cases). General information and laboratory findings of patients were collected and RC levels were calculated. ROC curves were drawn to explore the diagnostic efficacy of RC for NAFLD and progressive liver fibrosis, and the area under ROC curve (AUC) was calculated.

Fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR), aspartate aminotransferase (AST), uric acid, triglyceride (TG), and serum RC levels were significantly higher in patients of NAFLD group than those in Non-NAFLD group (P<0.05), while high density lipoprotein cholesterol (HDL-C) was significantly lower in patients of NAFLD group than those in Non-NAFLD group (P<0.05). Compared with the non-progressive liver fibrosis subgroup, the patients in the progressive liver fibrosis subgroup were older, had longer diabetes duration, higher levels of FINS, HOMA-IR, AST, uric acid, TG, RC, and lower levels of alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase (GGT) (P<0.05). Spearman correlation analysis results showed that the serum RC level was positively correlated with BMI, FINS, HOMA-IR, glycosylated hemoglobin (HbA_1c), total cholesterol, TG, low density lipoprotein cholesterol, AST, GGT, uric acid and risk of NAFLD (P<0.05), and negatively correlated with age and HDL-C (P<0.05). Logistic regression analysis results showed that elevated RC was a risk factor for NAFLD (OR=1.879, 95%CI=1.026-3.443, P=0.041) and progressive liver fibrosis (OR=4.365, 95%CI=1.952-9.760, P<0.001) in patients with T2DM after adjusting for age, gender, duration of diabetes, BMI, systolic blood pressure, diastolic blood pressure, HOMA-IR and HbA_1c. The AUC for RC diagnosis of NAFLD was 0.604, with a sensitivity of 67.69% and a specificity of 49.59%. The AUC for RC diagnosis of progressive liver fibrosis in NAFLD patients was 0.629, with a sensitivity of 39.13% and a specificity of 91.26%.

Elevated serum RC is an independent risk factor for NAFLD and progressive liver fibrosis in patients with T2DM. It has certain diagnostic value for NAFLD and progressive liver fibrosis.

Diabetic foot (DF) is a common and severe chronic complication of diabetes mellitus, characterized by high incidence, high disability rate, and high recurrence rate. It severely affects the quality of life of affected people. Recent studies suggest that dysbiosis of the skin microbiota may play a critical role in the development of DF.

To investigate the differences in plantar skin microbiota composition among patients with varying risk degrees of DF using 16S rRNA gene sequencing, and to explore the association between microbiota imbalance and DF risk, thereby providing a microbial basis for early warning and intervention strategies.

A total of 64 patients with diabetes mellitus treated in the Second Affiliated Hospital of Zunyi Medical University from June 2023 to March 2024, and 16 healthy adults during the same period, were enrolled. According to the International Working Group on the Diabetic Foot (IWGDF) risk classification, participants were divided into five groups: control group (n=16), very low-risk group (VL, n=16), low-risk group (L, n=15), moderate-risk group (M, n=16), and high-risk group (H, n=17). Plantar skin swab samples were collected for DNA extraction. The V3-V4 region of the 16S rRNA gene was amplified and sequenced using the Illumina MiSeq platform. Operational taxonomic unit (OTU) clustering and annotation were performed using QIIME 2. Microbiota differences among groups were analyzed using the Linear discriminant analysis Effect Size (LEfSe) and Metastats methods.

The α-diversity indices (Chao1, ACE, Shannon, and Simpson) of plantar skin microbiota were significantly different among the five groups with varying risk levels of DF (P<0.001). Principal coordinate analysis (PCoA) based on Bray-Curtis distances revealed a significant separation of microbiota structures among groups (P=0.001). At the phylum level, the relative abundances of Bacteroidetes and Proteobacteria sequentially increased than the previous low-risk group, whereas those of Firmicutes and Actinobacteria sequentially decreased than the previous low-risk group (P<0.001). At the genus level, the abundances of Corynebacterium, Streptococcus, and Bacteroides significantly sequentially increased than the previous low-risk group, while the abundance of Staphylococcus gradually decreased than the previous low-risk group (P<0.001). LEfSe analysis identified group-specific biomarker genera, namely the Aquabacterium (VL), Bacteroides (L), Gardnerella (M), and Corynebacterium (H)(P<0.05).

The composition of plantar skin microbiota in diabetes mellitus patients is closely associated with the risk degree of DF. With the increasing DF risk, microbiota α-diversity significantly increases and microbial community structure diverges. High-risk patients exhibit elevated levels of Gram-negative bacteria like Bacteroidetes, Proteobacteria, and Bacteroides, along with reduced levels of Gram-positive bacteria like Firmicutes, Actinobacteria, and Staphylococcus, reflecting marked microbiota dysbiosis. Distinct microbial biomarkers are observed across DF risk levels, suggesting that microbial characteristics may serve as potential targets for DF risk assessment and intervention.

Exercise remains a cornerstone in the prevention and management of diabetic complications in patients with type 2 diabetes. However, there have been few discussions about the precautions and implementation key points of exercise intervention for diabetic complications. In this study, we presented some recommendations of exercise intervention, the precautions related to exercise intervention, the selection of exercise timing, and the interactive effects between sports and medications for patients with diabetic complications, based on the latest guidelines on diabetes prevention and management, the expert consensus, and the latest research trials, aiming to provide some practical guidance and evidence-based guidelines for exercise intervention in patients with diabetic complications.

The integration of medical care and preventive services is a key strategy in China's response to the growing burden of chronic diseases. However, existing research has predominantly focused on policy design and supply-side reforms, with limited attention to patient-centered demand analysis.

This study aimd to assess the demand for integrated medical care and preventive services among patients with type 2 diabetes and to identify associated factors, providing micro-level empirical evidence to inform policy and research.

A cross-sectional survey was conducted between November 13-15 and December 17-20, 2024, using stratified and random sampling in one county-level city in Shandong Province and one county in the Guangxi Zhuang Autonomous Region. A total of 2 004 patients with type 2 diabetes completed structured questionnaires covering socio-demographic characteristics, health status, healthcare utilization, diabetes-related health literacy, attitudes toward health responsibility, and demand for integrated medical care and preventive services. Multivariate linear regression models were employed to examine factors associated with overall and domain-specific demand.

The mean score for overall demand was (3.99±0.53) on a 5-point scale. Among the three domains, demand was highest for "medical-preventive-managed care" (4.02±0.57), followed by "patient empowerment care" (4.02±0.55), and lowest for "health determinants-focused care" (3.83±0.68). Significant predictors of overall and domain-specific demand included family doctor contract status, familiarity with community or village doctors, satisfaction with patient-centered care, and levels of agreement with personal, provider, and family's responsibility for health (P<0.05). Geographic region, self-rated health status, and quality of life were also significantly associated with all demand but health determinants-focused care (P<0.05). Higher diabetes health literacy was linked to increased demand in all but patient empowerment care (P<0.05). Agreement with fate-based health responsibility was associated with lower demand for medical-preventive-managed care and patient empowerment care (P<0.05).

Patients with type 2 diabetes exhibit strong demand for integrated care and preventive services, particularly for medical-preventive-managed care and patient empowerment care. Policymakers and providers should be attentive to patients' specific demand and service priorities while ensuring adequate attention to relatively underemphasized but essential care targeting health determinants. Interventions to strengthen patients' sense of health responsibility and leverage family doctor contract as a key entry point for integration should be prioritized in future policy design.

Obesity is a major risk factor for cardiovascular disease, but evidence regarding the impact of metabolic obesity phenotypes on the prognosis of acute coronary syndrome (ACS) remains insufficient.

Exploring the impact of diverse metabolic obesity phenotypes on the pognosis of prcutaneous coronary intervention (PCI) in ACS patients.

This study employed a prospective cohort design, consecutively enrolling patients who presented with chest pain at the First Affiliated Hospital of Xinjiang Medical University between June 2012 and June 2023, were diagnosed with ACS, and underwent PCI within 12 hours of symptom onset. Baseline data collected included general demographic characteristics, anthropometric measurements, laboratory test results, imaging findings, and procedural details. Participants were categorized into four groups based on the presence of obesity and metabolic syndrome: metabolically healthy normal weight (MHNW), metabolically healthy obesity (MHO), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy obesity (MUO). All patients underwent follow-up via telephone and/or outpatient visits every 12 months post-procedure to record major adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, non-fatal myocardial infarction, stroke, rehospitalization for unstable angina, and heart failure recurrence. Kaplan-Meier survival curves were used to analyze MACCE incidence across the four groups, with log-rank tests for comparisons. Multivariate Cox proportional hazards regression models were employed to assess the association between metabolic obesity phenotypes and MACCE risk.

A total of 1 913 ACS patients were included in this study, with an average age of (58.8±12.1) years. Among them, there were 1 588 males (83.0%) and 325 females (17.0%).There were 612 cases in the MHNW group, 878 cases in the MUNW group, 105 cases in the MHO group, and 318 cases in the MUO group. There were statistically significant differences in the comparison of age, gender, BMI, the prevalence of hypertension diabetes, and proportion of smoking, admission systolic blood pressure (SBP) and diastolic blood pressure (DBP), blood glucose, hemoglobin concentration, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), creatinine, urea, uric acid, and direct bilirubin levels among the 4 groups (P<0.05). Median follow-up time was 4.77 (2.26, 7.16) years, with 136 patients (7.1%) lost to follow-up. A total of 656 cases (34.3%) of MACCE occurred. There were statistically significant differences in the incidence of MACCE and the incidence of readmission for unstable angina pectoris between the 4 groups (P<0.05). Kaplan-Meier survival curve analysis showed that the difference in Cumulative risk probability of MACCE among the four groups was statistically significant (χ²=26.23, P<0.001). Multivariate Cox regression analysis showed that after adjustment for age, sex, smoking, SBP, DBP, TG, HDL-C, LDL-C, urea, and uric acid, the risks of MACCE in the MHO, MUNW, and MUO groups were 1.56, 1.28, and 1.94 times that of the MHNW group, respectively (P<0.05). The results of the sensitivity analysis demonstrated the stability of the association between metabolically obese phenotypes and the risk of developing MACCE in the prognosis.

Obesity significantly increases the risk of long-term adverse outcomes in patients with ACS undergoing PCI regardless of metabolic status, and the risk is even higher in those with concurrent metabolic abnormalities. Clinical management should emphasize the long-term adverse effects of obesity, and stratified evaluation and individualized intervention should be performed in combination with metabolic status.

Diabetic neuropathy (DN) is a common and serious long-term complication of diabetes, with autonomic neuropathy gaining considerable attention due to its effects on various organ systems. The dysfunction of autonomic nerves is caused by pathological mechanisms such as metabolic imbalances, oxidative stress, and microvascular damage due to high blood sugar levels, leading to clinical symptoms like resting tachycardia, delayed stomach emptying, and bladder issues. The management of diabetic autonomic neuropathy (DAN) involves a foundational approach of stringent glycemic control, complemented by a combination of aldose reductase inhibitors, antioxidants, and neurotrophic agents to synergistically alleviate clinical symptoms. Furthermore, the utilization of neuromodulation techniques and the implementation of personalized treatments enable targeted modulation of the systemic impairments. This article provides a comprehensive review of the pathophysiological mechanisms of DAN, its clinical manifestations across multiple tissues and organs, and treatment strategies based on autonomic nervous system regulation, aiming to establish a theoretical foundation for in-depth analysis of DN pathological mechanisms and optimization of clinical intervention approaches.

Diabetic kidney disease (DKD) is a typical microvascular complication characterized by insidious onset and poor prognosis. Conventional contrast-enhanced ultrasound (CEUS) can visualize the microvasculature; however, the bolus injection method involves a high contrast agent concentration and rapid infusion rate, which tends to produce a "flooding" effect. In contrast, the intravenous drip "flash-replenishment" CEUS technique can stably and accurately evaluate microcirculatory hemodynamic changes in renal tissue of DKD patients, potentially providing an imaging basis for the early identification of microcirculatory impairment in DKD.

To investigate the value of quantitative parameters derived from intravenous drip "flash-replenishment" CEUS in assessing DKD microcirculation, to construct and validate a CEUS parameter-based risk prediction model for DKD, and to evaluate its clinical value in the early diagnosis of DKD.

A prospective study was conducted enrolling 85 patients with type 2 diabetes mellitus (T2DM) who visited the outpatient clinic or were hospitalized at Dongzhimen Hospital, Beijing University of Chinese Medicine, from November 2024 to September 2025. Based on urinary protein levels, patients were categorized into the DM-only group (n=27), early-stage DKD group (n=38), and clinical-stage DKD group (n=20). Healthy subjects were concurrently recruited as the healthy control group (n=13). Baseline data were collected from all participants, followed by conventional ultrasound, Doppler ultrasound, and CEUS examinations. The LASSO regression was used for variable selection. The dataset was divided into a training set and a validation set at a ratio of 7∶3. Multivariate Logistic regression analysis was performed on the training set to develop a nomogram prediction model. The receiver operating characteristic (ROC) curve, Hosmer-Lemeshow (H-L) goodness-of-fit test, and decision curve analysis (DCA) were applied to the training and validation sets to evaluate the model's discriminative ability, calibration, and clinical utility, respectively.

Significant differences were observed among the healthy control, DM-only, early-stage DKD, and clinical-stage DKD groups in age, systolic blood pressure (SBP) (P<0.05). Doppler ultrasound: statistically significant differences were found in diastolic velocity (Vd) and resistive index (RI) of the renal artery, segmental artery, and interlobar artery among the four groups (P<0.05). CEUS: statistically significant differences were found in cortical time to peak (TTP), cortical wash-in rate (WiR), cortical half WiR, cortical mean transit time (mTT), medullary peak intensity (PKI), medullary WiR, and medullary half WiR among the four groups (P<0.05). LASSO regression analysis identified two predictors associated with DKD risk: duration of diabetes and cortical WiR. Multivariate Logistic regression analysis confirmed that duration of diabetes (OR=1.169, 95%CI=1.069-1.279) and cortical WiR (OR=0.694, 95%CI=0.499-0.964) were independent predictors of DKD (P<0.05). The ROC curves of the nomogram model showed an AUC of 0.880 (95%CI=0.790-0.969) in the training set and 0.838 (95%CI=0.678-0.998) in the validation set. The H-L goodness-of-fit test indicated mild calibration deviation in the training set (P=0.044) and good calibration in the validation set (P=0.209); combined with calibration curve metrics (training set Eavg=0.081, validation set Eavg=0.124), the overall model calibration was acceptable. DCA showed that the model achieved net benefit superior to the "treat-all" and "treat-none" strategies across a wide range of threshold probabilities (training set 0.09-0.99, validation set 0.08-0.83), demonstrating good clinical applicability.

This study found that longer duration of diabetes and lower cortical WiR are independent predictors of DKD. A nomogram prediction model incorporating these risk factors was established, demonstrating satisfactory overall performance and confirming the value of CEUS in the early diagnosis of DKD.

Effective utilization of chronic illness resources can help individuals with prediabetes adhere to healthy behavior changes and improve their health status. However, the current state of chronic illness resource utilization in this population remains unclear and requires further investigation.

To explore the latent categories of chronic illness resource utilization among individuals with prediabetes and their relationship with health-promoting behaviors.

A consecutive sampling method was used to select individuals with prediabetes who underwent physical examinations at two community health service centers in Nanjing from March to July 2024. Data were collected using a general information questionnaire, the Chronic Illness Resource Survey (CIRS), and the Health-Promoting Lifestyle ProfileⅡ (HPLP-Ⅱ). Latent profile analysis (LPA) was performed to classify chronic illness resource utilization, and hierarchical regression analysis was used to examine the relationship between resource utilization categories and health-promoting behaviors.

A total of 270 questionnaires were collected, with 263 valid questionnaires, yielding a 97.4% valid response rate.The mean score for chronic disease resource utilization in the prediabetes population was (49.1±8.7), and the mean score for health-promoting behaviors was (131.1±17.0). Chronic illness resource utilization was categorized into three latent groups: low-resource utilization (basic dependence type) (136 individuals, 51.7%), moderate-resource utilization (limited support type) (105 individuals, 39.9%), and high-resource utilization (multiple support type) (22 individuals, 8.3%). Hierarchical regression analysis showed that, after controlling for confounding factors, the category of chronic illness resource utilization was a significant predictor of health-promoting behaviors in individuals with prediabetes (P<0.001), explaining 13.8% of the variance.

There are three latent categories of chronic illness resource utilization in individuals with prediabetes, and these categories significantly influence health-promoting behaviors. In the future, healthcare providers can implement targeted interventions based on the categories of chronic illness resource utilization to improve health-promoting behaviors and enhance health outcomes.

Currently, the health management of diabetic patients in the community is still facing many challenges, and it is difficult to effectively improve the glycemic control rate, so exploring the factors affecting glycemic control to delay or reverse the development of complications in diabetic patients is important.

Exploring the characteristics of specific categories of glycemic control in community diabetic patients, the influencing factors, and the association with common complications to provide a scientific basis for the management of community diabetic patients.

A questionnaire survey conducted from March 2023 to April 2024 was used to collect demographic characteristics, health education, diseases, and health management of 417 community diabetes patients in three county-level regions of Qintong Town in Jiangyan District, Taizhou City, Jishi Town in Jingjiang City, and Chenbao Town in Xinghua City. The patients' glycemic control was categorized by potential category analysis, and the prevalence of diabetic complications and their influencing factors under different glycemic control categories were investigated by multiple Logistic regression analysis.

Based on the latent class analysis results, the 417 diabetic patients were categorized into three groups: Class 1: the older-age/low-health-literacy group (n=181, 43.40%); Class 2: the middle-age/moderate-health-literacy group (n=158, 37.89%); and Class 3: the younger-age/high-health-literacy group (n=78, 18.71%). Significant differences were observed among the three groups in the prevalence of hypertension, stroke, and neuropathic complications (P<0.05). Specifically, the older-age/low-health-literacy group and the middle-age/moderate-health-literacy group exhibited higher rates of comorbid hypertension, stroke, and neuropathy compared to the younger-age/high-health-literacy group (all P<0.01). Multiple Logistic regression analysis revealed that, compared to the younger-age/high-health-literacy group, having a junior high school education or above (OR=0.256, 95%CI=0.129-0.510, P<0.001; OR=0.355, 95%CI=0.181-0.696, P=0.003) and implementing more than three blood glucose control measures (OR=0.272, 95%CI=0.148-0.499, P<0.001; OR=0.542, 95%CI=0.298-0.986, P=0.045) were protective factors for blood glucose control in the older-age/low-health-literacy group and the middle-age/moderate-health-literacy group, respectively. Conversely, being unmarried/divorced/widowed (OR=3.303, 95%CI=1.208-9.035, P=0.020) was identified as a risk factor for blood glucose control in the middle-age/moderate-health-literacy group.

Glycemic control of diabetic patients in the Taizhou community has obvious categorical characteristics. The distribution of hypertension, stroke, and neurological complications is different among different potential categories, and the influencing factors are education level, marital status, glycemic control measures, etc. Categorical interventions should be carried out according to the characteristics of the different categories of the population.

Metabolic syndrome (MetS) is a global public health issue, with an increasing prevalence among the Yi ethnic group due to their unique lifestyle and genetic background. The uric acid (UA) to high-density lipoprotein cholesterol (HDL-C) ratio (UHR) is closely related to various metabolic diseases and requires further investigation.

This study aims to explore the association between UHR and MetS in the Yi ethnic group of Yunnan Province, and to assess the predictive value of UHR for the risk of MetS.

From May to November 2021, a stratified cluster sampling method was employed to select 1 100 Yi ethnic residents from 17 villages across 6 sample streets/towns in Anning City, Yunnan Province. After excluding 49 ineligible cases, a total of 1 051 subjects were ultimately included in the study. General demographic data and physical examination indicators were collected from all participants. The UHR was calculated, and Pearson correlation analysis along with Binary Logistic regression analysis were performed to examine the association between UHR and MetS. Additionally, the receiver operating characteristic (ROC) curve analysis was conducted to evaluate the predictive value of UHR for the risk of MetS.

Among the 1 051 participants, there were 335 (31.87%) males and 716 (68.13%) females, with a mean age of (70±7) years. The study identified 235 (22.36%) cases of MetS and 816 (77.64%) non-MetS cases. Significant differences were observed between MetS and non-MetS groups in age, BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), total cholesterol (TC), HDL-C, low-density lipoprotein cholesterol (LDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), UA, fasting blood glucose (FBG) and UHR levels (P<0.05). The UHR was significantly higher in the MetS group (P<0.05). Participants were stratified into quartiles (Q1-Q4) based on UHR levels (7.94%, 10.57%, and 14.75% as cut-off points). Cochran-Armitage trend test revealed a significant dose-dependent increase in the prevalence of MetS and its components with ascending UHR quartiles (P<0.001). Pearson correlation analysis demonstrated positive associations of UHR with age, height, body weight, BMI, waist circumference (WC), SBP, DBP, creatinine (Cr), urea, TG, FBG, ALT, and UA (P<0.05), while negative correlations were observed with TC, HDL-C, LDL-C, AST, and direct bilirubin (DBIL) (P<0.05). Binary Logistic regression analysis showed that the risk of MetS in the Q4 group was 27.31 times that of the Q1 group (95%CI=11.39-65.47, P<0.01). After adjusting for confounding variables, each 1-unit increase in UHR was associated with a 29% elevated risk of MetS (OR=1.29, 95%CI=1.22-1.35, P<0.01). ROC curve analysis confirmed a strong predictive value of UHRfor MetS (AUC=0.805).

High UHR is a risk factor for MetS in Yi ethnic group and has a good predictive value for the risk of MetS.

Resilience can effectively improve health outcomes and enhance the quality of life for adolescents with type 1 diabetes mellitus (T1DM). However, this population is plagued by multi-sourced stigma, which severely undermines their resilience. Currently, the mechanism of how stigma from different sources affects resilience remains unclear.

To explore the pathways of multi-sourced stigma on the resilience of adolescents with T1DM, and identify the core sources of stigma.

From July 2022 to July 2024, a total of 364 adolescents with T1DM were conveniently selected from two tertiary hospitals in Nanjing. The data were collected by the Type 1 Diabetes Stigma Assessment Scale, the Short Form of the Chinese version Diabetes Quality of Life for Youth Scale, and the Diabetes Strengths and Resilience Measure for Adolescents with Type 1 Diabetes. Complex network analysis was performed using the R software, and subgroup analysis was performed based on age.

Within multi-sourced stigma, "being perceived as defectiv" (1.248), "worrying about negative reactions from others" (1.132), and "being excluded by others" (1.125) had the greatest expected influence in the network. "Worrying about negative reactions from others" and "concealing diabetes" showed the strongest positive correlation (r=0.562). Concealment of the disease was negatively related with the resilience dimension "help-seeking" (r=-0.098), while parental over protection was positively related with the resilience dimension "family resources" (r=0.007). The network connections were tighter in the early adolescent group compared to the late adolescent group (S=0.10, GS_pre=10.47, GS_post=10.36, P=0.789).

Public misunderstanding, social exclusion, and individual anticipated discrimination are core sources of stigma that hinder the development of resilience in adolescents with T1DM. Moreover, the early adolescence group are more susceptible to stigma. Healthcare professionals should identify and address the core sources of stigma.

This review summarizes the effects of intermittent fasting on cardiometabolic diseases in humans and examines various fasting regimens-including alternate-day fasting, the 5∶2 diet, time-restricted eating, and the 16∶8 diet. These approaches may confer benefits for cardiometabolic health by reducing blood pressure, insulin resistance, and oxidative stress. Although large-scale randomized controlled trials investigating the relationship between intermittent fasting and cardiovascular outcomes are lacking, and some studies suggest a potential increase in cardiovascular risk, the majority of existing clinical evidence indicates that this dietary pattern may reduce the risk of cardiovascular disease by improving weight control, hypertension, dyslipidemia, and diabetes. Intermittent fasting is thought to exert its effects through multiple mechanisms, including reduced oxidative stress, optimized circadian rhythms, and ketogenesis. It is generally safe and is not associated with disruptions in energy levels or increased disordered eating behaviors, while also offering additional health benefits. In conclusion, intermittent fasting represents a relatively safe dietary intervention whose potential cardiovascular implications warrant further investigation.

Impaired awareness of hypoglycemia (IAH) is a prevalent issue among patients with Type 2 Diabetes Mellitus (T2DM). Recurrent hypoglycemic events may diminish hypoglycemia perception and elevate the risk of severe hypoglycemia. However, limited research have explored the prevalence and determinants of IAH in community-dwelling T2DM patients.

To investigate the prevalence of IAH and its influencing factors among community T2DM patients, providing scientific evidence for community health service institutions to optimize health management strategies.

This cross-sectional study adopted a multistage stratified random sampling method to select T2DM patients from 9 community health service centers (stations) in Fengtai District, Beijing. From May to August 2024, data on demographic characteristics, hypoglycemic experiences, hypoglycemia awareness, and diabetes self-management behaviors were collected via face-to-face questionnaires. The GOLD method was used to assess hypoglycemia awareness and diagnose IAH. Multivariate Logistic regression analysis was performed to identify the determinants of IAH.

Among 487 valid questionnaires, the self-reported prevalence of IAH was 27.1% (132/487). Multivariate Logistic regression analysis revealed that the independent risk factors for IAH were undiagnosed or unknown diabetes complications (OR=2.164, 95%CI=1.215-3.852) and achievement of glycated hemoglobin A_1c (HbA_1c) targets (OR=1.648, 95%CI=1.033-2.628). The independent protective factors included disease duration of 11-20 years (OR=0.320, 95%CI=0.152-0.672), disease duration≥20 years (OR=0.459, 95%CI=0.220-0.955), use of oral hypoglycemic agents (OR=0.052, 95%CI=0.01-0.274), insulin use (OR=0.199, 95%CI=0.050-0.803), no hypoglycemic medication use (OR=0.029, 95%CI=0.003-0.245), awareness of hypoglycemia diagnostic criteria (OR=0.498, 95%CI=0.265-0.935), having blood glucose monitoring tools with occasional use (OR=0.406, 95%CI=0.185-0.891), proficient and regular blood glucose monitoring (OR=0.410, 95%CI=0.173-0.974), and good tobacco control status (OR=0.498, 95%CI=0.272-0.909).

Stringent glycemic control and insufficient blood glucose monitoring knowledge are associated with increased IAH risk, whereas regular glucose monitoring, hypoglycemia awareness, and smoking cessation demonstrated protective effects. Community healthcare providers should implement comprehensive interventions targeting these modifiable factors, such as optimizing glucose monitoring protocols, strengthening health education, and promoting tobacco control, to reduce IAH incidence and improve patients' disease management outcomes and quality of life.

The incidence of type 2 diabetes mellitus (T2DM) has risen steadily in recent years. Cardiovascular disease is a common complication of T2DM, with left ventricular diastolic dysfunction (LVDD) often occurring at an early stage. Central (visceral) obesity is closely linked to cardiovascular risk; however, the performance of visceral-fat-focused indices in identifying LVDD among patients with T2DM remains under-studied.

To evaluate the association between the Chinese visceral adiposity index (CVAI) and LVDD in patients with T2DM and to assess CVAI's diagnostic utility.

This retrospective study enrolled 1 028 T2DM patients who attended the Second Affiliated Hospital of Kunming Medical University (Metabolic Management Center) from January 2019 to August 2024 (647 males, 381 females). Patients were classified as a T2DM group (n=257) or an LVDD group (n=771) based on the presence of LVDD. We assessed correlations between CVAI and other visceral-type obesity measures and echocardiographic structural and functional parameters. Multivariable Logistic regression evaluated the independent association of CVAI with LVDD. Diagnostic performance was assessed by receiver operating characteristic (ROC) curves. Subgroup analyses were conducted by sex, age, and BMI.

Compared with the T2DM group, the LVDD group had higher BMI, neck circumference, waist circumference (WC), hip circumference, visceral fat area (VFA), and CVAI (P<0.05 for all). When stratified by CVAI quartiles, LVDD prevalence increased across quartiles: Q1 64.2%, Q2 71.2%, Q3 79.4%, Q4 85.2% (χ²_trend=34.715, P<0.05). Correlation analyses demonstrated that WC, BMI, VFA, and CVAI were positively correlated with left atrial diameter (LAD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), and left ventricular end-diastolic diameter (LVDd), and negatively correlated with left ventricular ejection fraction (LVEF) (P<0.05). After adjustment for confounders, patients in the CVAI Q4 group had a 2.361-fold increased risk of LVDD compared with Q1 (95%CI=1.349-4.133, P=0.003). ROC analysis yielded an area under the curve (AUC) of 0.621 for CVAI in diagnosing LVDD, outperforming VFA (0.557), BMI (0.589), and WC (0.599). A combined predictive model achieved an AUC of 0.727 (95%CI=0.692-0.763, P<0.001), with sensitivity 0.726 and specificity 0.638. Subgroup analyses indicated that CVAI Q4 was a significant risk factor for LVDD in both male and female subgroups (OR=1.948 and 8.617, respectively; P<0.05). In participants aged<60 years, CVAI Q3 and Q4 were associated with increased LVDD risk (OR=2.387 and 4.371, respectively; P<0.05). In the normal-BMI subgroup, CVAI Q3 was associated with higher LVDD risk (OR=3.997, P<0.05).

CVAI is an independent risk factor for LVDD among patients with T2DM and demonstrates superior discriminative ability compared with conventional obesity indices. Its predictive value is particularly notable in women and in individuals under 60 years of age.

Hypertension, diabetes and dyslipidemia exhibit high prevalence rates in the population and frequently coexist as comorbidity within individuals. The weight-adjusted waist index (WWI) represents a novel obesity assessment metric; however, its association with the comorbidity of the three diseases remains inadequately studied.

To investigate the association and predictive role of WWI for the comorbidity of hypertension, diabetes and dyslipidemia among community-dwelling adults.

Based on the Chronic Disease and Risk Factor Surveillance, a cross-sectional survey was conducted using multi-stage random sampling method among permanent residents aged ≥18 years in Bao'an District from October to December 2023. Data were collected through questionnaires, physical examinations, and laboratory biochemical tests, based on which the WWI was calculated, and the comorbidity of hypertension, diabetes and dyslipidemia was documented. Logistic regression was employed to analyze the association between WWI and the comorbidity of the three diseases. Restricted cubic spline (RCS) analysis was applied to explore the dose-response relationship between WWI and the comorbidity. Stratified analyses were conducted by sex, age and BMI, and interactions were explored. Receiver operating characteristic (ROC) curves were used to evaluate and compare the predictive performance of WWI, BMI and waist circumference (WC) for these diseases comorbidities, utilizing DeLong's test comparing differences in area under the curve (AUC).

A total of 1 882 individuals were surveyed, after excluding participants with missing key indicators such as height, body mass and WC, a final total of 1 846 participants were included in the analysis. The comorbidity rates of hypertension, diabetes and dyslipidemia was 17.06% (315/1 846). The Logistic regression analysis results indicated that, after full adjusting for covariates, each 1-unit increase in WWI was associated with a 174% increased risk of the comorbidity (OR=2.74, 95%CI=2.08-3.59, P<0.05). Compared with the Q1 group (WWI<9.69 cm/), the risk of comorbidity increased progressively in the Q2 (9.69 cm/ ≤WWI<10.19 cm/), Q3 (10.19 cm/ ≤WWI<10.66 cm/), and Q4 (WWI≥10.66 cm/) groups, with OR values of 2.62 (95%CI=1.26-5.42, P<0.05), 4.68 (95%CI=2.31-9.48, P<0.05), and 8.09 (95%CI=3.95-16.56, P<0.05), respectively. RCS analysis revealed a significant linear dose-response relationship between WWI and the risk of comorbidity (P_overall<0.001, P_nonlinear=0.079). Subgroup analysis revealed that, with the exception of the BMI<24.00 kg/m² stratum, individuals in the highest WWI quartile (Q4) exhibited a significantly increased risk of the comorbidity across the following strata: male, female, age<45 years, age≥45 years and BMI≥24.00 kg/m² (all P<0.05). Interaction analysis showed a significant interaction between WWI and age, with a stronger association between WWI and the comorbidity in the <45 years group compared to the ≥45 years group (P=0.003). The ROC analysis yielded that among males, the AUC (95%CI) for WWI, BMI and WC in predicting the risk of the comorbidity were 0.742 (95%CI=0.705-0.778), 0.705 (95%CI=0.667-0.742), and 0.738 (95%CI=0.702-0.774), respectively. Among females, the corresponding AUC (95%CI) for WWI, BMI and WC were 0.806 (95%CI=0.768-0.844), 0.717 (95%CI=0.669-0.765), and 0.804 (95%CI= 0.766-0.842). In the female population, WWI demonstrated significantly higher predictive accuracy than BMI (Z=-3.134, P=0.002).

WWI exhibits a significant positive and linear dose-response association with comorbidity of the three diseases, demonstrating favorable predictive efficacy. As a novel obesity metric, WWI offers valuable insights for the early prevention and intervention targeting this comorbidity.

There exist structural issues in China's healthcare system, where secondary and tertiary medical institutions are more likely to attract medical professionals with advanced academic degrees and high professional qualifications. Guiding the outreach of superior medical resources through a combination of administrative requirements and moderate incentives is an important measure to improve the quality of primary care services in the short term, with personnel outreach as the core priority of this initiative.

The outreach of specialists from county-level hospitals is one of the key measures to strengthen primary-level medical services. This study analyzed the potential classes of specialist outreach activities in a certain city and explored the impact of different classes on the job perception and competence of primary care providers, aiming to provide references for improving the practice of personnel downward mobility.

The study was conducted in a city of Shandong Province in October 2022, using multistage cluster sampling. First, 6 counties/county-level cities were selected; next, 6 townships/towns/subdistricts were randomly sampled from each of them, totaling 36 sites. Questionnaires were distributed to all on-duty medical staff (general practitioners, nurses, public health workers, etc.) on the day of investigation at sampled township health centers/community health service centers, plus 15 village doctors (active in family doctor teams) from each institution. Data were collected via a general information questionnaire, an evaluation of medical personnel outreach practices scale (assessing opportunities for case discussions, outpatient consultations, joint home visits, and training with higher-hospital specialists), a job satisfaction scale, and a diabetes management competence scale. Latent class analysis (LCA) identified patterns of outreach participation, and multiple linear regression examined how these latent classes affected primary staff's job satisfaction and diabetes management competence. A multi-stage cluster sampling method was used to select primary care providers in a certain city. Data were collected using a general information questionnaire, an evaluation questionnaire on personnel outreach practices, a job satisfaction scale, and a diabetes management capability scale. Latent class analysis was conducted on the participation of primary care providers in outreach activities, and multiple linear regression was used to analyze the impact of potential classes of outreach on the job satisfaction and diabetes management competence of primary medical personnel.

A total of 2 233 primary medical personnel were surveyed. Their participation in specialist downward mobility activities could be clustered into 3 potential classes: the comprehensive support group (31.66%, n=707), the in-hospital support group (16.93%, n=378), and the overall support deficiency group (51.41%, n=1 148). Results of multiple linear regression analysis showed that compared with the overall support deficiency group, both the comprehensive support group (B=4.798, P<0.001) and the in-hospital support group (B=3.241, P=0.002) positively predicted job satisfaction scores. Additionally, both the comprehensive support group (B=3.922, P<0.001) and the in-hospital support group (B=1.659, P<0.001) positively predicted diabetes management capability scores.

There are 3 potential categories of primary medical personnel's participation in specialist downward mobility activities. The richness of practical support activities varies, and more abundant support activities are positively correlated with job satisfaction and diabetes management competence. It is suggested to focus on specific and diversified support content in the downward mobility of specialists to truly improve the professional fulfillment and diabetes management competence of primary care providers.

Prediabetes can be delayed or its progression to diabetes prevented through lifestyle interventions; however, the implementation of prediabetes management in primary care remains low.

This study aimed to examine the awareness and current management practices of primary care physicians and nurses regarding prediabetes, identify existing barriers and challenges, and determine key supportive factors to improve management quality.

From January to February 2025, semi-structured interviews were conducted with primary care physicians and nurses at a community health service center in Beijing regarding prediabetes management. The interviews were analyzed using thematic analysis to identify themes, which were subsequently mapped onto the Capability-Opportunity-Motivation Behavior (COM-B) model. Data were coded and analyzed with NVivo 11.0.

Fifteen primary care physicians and nurses were interviewed, resulting in eight core themes and fifteen subthemes. The findings revealed that systematic management pathways for prediabetes have not yet been established in China's primary healthcare system. Although healthcare providers generally demonstrated strong professional responsibility and motivation, key barriers included insufficient knowledge and skills, limited policy and incentive support, underdeveloped information systems, workforce shortages, and a lack of multidisciplinary collaboration.

Establishing a comprehensive diabetes prevention and control system at the primary care level, integrating performance evaluation frameworks, establishing a dedicated "prediabetes" module and general-specialist collaboration, strengthening training in behavioral interventions for primary care providers, and implementing feedback and incentive mechanisms to boost self-efficacy can collectively promote effective prediabetes management and advance the front line of diabetes prevention.

China has 148 million adult patients with diabetes, imposing a substantial disease burden, and patients' healthcare-seeking behaviors, as a core aspect of disease management, play a critical role in diabetes prevention and control.

Exploring multidimensional healthcare-seeking behavior patterns in diabetic patients and analyzing their associations with glycemic control and healthcare resource utilization to inform precision management strategies.

Based on the follow-up and diagnosis data of 30 509 patients with type 2 diabetes in Putuo District, Shanghai in 2023, latent class analysis (LCA) was used to identify the classification of medical-seeking behaviors. Multinomial Logistic regression was used to analyze the influence of demographic, behavioral and clinical characteristics on medical-seeking categories. Multivariate Logistic regression was used to analyze the influence of each medical-seeking category and other influencing factors on the annual blood glucose compliance.

LCA classified patients' medical-seeking behaviors into four types: specialist-dominated type (n=4 480, 14.68%), community-based type (n=7 161, 23.47%), community-intensive type (n=11 812, 38.72%), and comprehensive complex type (n=7 056, 23.13%). Multinomial Logistic regression showed that male patients had a significantly increased likelihood of choosing the community-intensive healthcare-seeking behavior (OR=1.133, P<0.001). Patients aged 60 years and above were more likely to select the community-based or community-intensive type (OR=2.117-2.667, P<0.001). Prolonged disease duration was associated with a decreased tendency for the community-based type (OR=0.983, P<0.001) and an increased tendency for the comprehensive complex type (OR=1.041, P<0.001). Patients with complications/comorbidities significantly tended toward the community-intensive type (OR=1.498, 2.506, P<0.001) and comprehensive complex type (OR=3.865, 3.003, P<0.001). Ever or current smokers had a decreased tendency for the comprehensive complex type (OR=0.772, P=0.011). Patients with regular physical activity had decreased tendencies for the community-based (OR=0.835, P<0.001), community-intensive (OR=0.674, P<0.001), and comprehensive complex (OR=0.672, P<0.001) types. Patients with glycated hemoglobin testing frequency ≥5 times/year showed reduced tendencies for the community-based and community-intensive types (OR=0.244, 0.356, P<0.01), but an increased tendency for the comprehensive complex type (OR=1.464, P<0.01). Patients with achieved glycemic control had a decreased tendency for the community-intensive type (OR=0.926, P=0.048) and comprehensive complex type (OR=0.776, P<0.001). Multivariate Logistic regression analysis revealed that, with the specialist-dominated type as the reference, the community-intensive type (OR=0.923, P=0.041) and comprehensive complex type (OR=0.791, P<0.001) were associated with decreased annual glycemic control achievement. Regular physical activity (OR=1.107, P=0.002) and glycated hemoglobin testing ≥2 times/year were protective factors for annual glycemic control achievement (OR=2.891-4.126, P<0.001). Smoking (OR=0.851, P=0.008), male gender (OR=0.906, P<0.001), complications (OR=0.790, P<0.001), comorbidities (OR=0.620, P<0.001), thyroid disease (OR=0.760, P<0.001), and diabetes with prolonged disease duration (OR=0.977, P<0.001) were identified as risk factors for annual glycemic control achievement.

There is significant heterogeneity in the medical-seeking behaviors of patients with type 2 diabetes. Advanced age, disease duration, and complications are the core driving factors for the differentiation of behavioral patterns. The blood glucose control effects vary significantly among different medical-seeking behavior categories. It is necessary to strengthen multidisciplinary collaboration for the specialist-dominated type, enhance comprehensive management capabilities for the community-based types, and optimize resource allocation for the comprehensive complex type, so as to achieve stratified and precise intervention.

Metabolic risk factors have become a primary driver of the increasing burden of cardiovascular diseases (CVD) in China.

To assess the temporal trends of CVD burden attributable to metabolic risk factors in China from 1990 to 2021 and project the future burden through 2035 using the Bayesian age-period-cohort (BAPC) model.

Based on data from the Global Burden of Disease Study 2021 (GBD 2021), we quantified the contributions of level 1 and major level 2 risk factors (e.g., high blood pressure, air pollution, smoking, high LDL cholesterol, and dietary risks) to CVD mortality and disability-adjusted life years (DALYs) using the population attributable fraction (PAF) method. Joinpoint regression was applied to estimate the average annual percent change (AAPC) of CVD burden attributable to metabolic factors from 1990 to 2021. A BAPC model was used to project future burden trends from 2022 to 2035.

From 1990 to 2021, the age-standardized DALYs rate of CVD attributable to metabolic factors declined, while the age-standardized mortality rate increased. In 2021, metabolic factors accounted for 68.6% of CVD-related DALYs and 70.1% of CVD deaths. Elevated systolic blood pressure remained the leading risk factor, contributing 53.3% and 55.4% to DALYs and deaths, respectively. Among the four main metabolic risks, high BMI showed the most significant increase, with the attributable age-standardized DALYs rate rising from 281.04 per 100 000 to 396.09 per 100 000 (AAPC=1.08%, P<0.000 1), and the age-standardized mortality rate increasing from 13.73 per 100 000 to 18.80 per 100 000 (AAPC=1.00%, P<0.000 1). In contrast, the burden associated with high fasting plasma glucose and high LDL cholesterol changed minimally, with most AAPC showing no statistical significance. Age-and sex-stratified analyses indicated the heaviest burden among older males, with widening gender differences at older ages. Projections based on the BAPC model suggest a continued decline in CVD burden by 2035: for males, the mortality rate is projected to decrease from 291.97 per 100 000 to 183.33 per 100 000 and the DALY rate from 5 296.99 per 100 000 to 3 274.07 per 100 000; for females, age-standardized mortality rate is projected to decline from 149.26 per 100 000 to 103.00 per 100 000 and age-standardized DALYs rate from 2 863.17 per 100 000 to 1 814.15 per 100 000. A clear downward inflection point is expected around 2030 in males, while a steady decline is projected for females. All model predictions had mean absolute percentage errors below 2%, indicating high predictive accuracy.

High BMI and high blood pressure remain the predominant metabolic risk factors for CVDs in China. The projected burden attributable to these risks is expected to continue rising, with males and older adults experiencing a higher burden. Younger adults are increasingly affected by BMI-related risks, highlighting the need for targeted, stratified prevention strategies.

The relationship between serum bilirubin and carotid plaque in elderly patients with type 2 diabetes mellitus (T2DM) remains unclear.

To investigate the association between serum bilirubin levels within the normal range and the risk of carotid plaque in elderly patients with T2DM, and to explore the potential underlying mechanisms.

A total of 2 885 elderly T2DM patients (aged≥65 years) with complete clinical data hospitalized in the Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January 2003 to December 2012 were recruited in this retrospective study. According to the quintiles of serum unconjugated bilirubin (UCB) levels, the patients were divided into five groups: Q1 (UCB<6.0 μmol/L, n=446), Q2 (UCB: 6.0-7.5 μmol/L, n=717), Q3 (UCB: 7.6-8.9 μmol/L, n=533), Q4 (UCB: 9.0-10.1 μmol/L, n=607), and Q5 (UCB>10.1 μmol/L, n=582). The detailed clinical data, physical examination findings, carotid ultrasound measurements, and laboratory test results were collected. The prevalence of carotid plaque was compared among the five groups. Partial correlation analysis was performed to examine the associations between serum C-reactive protein (CRP) and bilirubin levels. Binary Logistic regression was used to analyze the association of serum bilirubin including total bilirubin (TB), UCB, and conjugated bilirubin (CB) with the presence of carotid plaque.

Among 2 885 elderly hospitalized patients with T2DM, 1 296 were men (44.9%) and 1 589 were women (55.1%), with a mean age of 72.6±5.3 years. Significant differences were observed among the five groups with respect to age, sex, diabetes duration, smoking status, use of lipid-lowering medications, insulin or insulin analog therapy, diastolic blood pressure, and lipoprotein (a) levels (P<0.05). After adjustment for age, sex, and diabetes duration, the prevalence of carotid plaque in elderly T2DM patients across Q1 to Q5 was 76.9%, 71.8%, 68.5%, 65.9%, and 62.2%, respectively, showing a significant decreasing trend (χ²=30.900, P<0.001). Partial correlation analysis further demonstrated that serum TB (R=-0.090, P<0.001) and UCB (R=-0.100, P<0.001) were inversely correlated with CRP levels after adjustment for age, sex, and diabetes duration. After adjusting for multiple confounders, binary logistic regression analyses showed that serum TB (OR=0.833, 95%CI=0.721-0.963, P=0.013) and UCB (OR=0.831, 95%CI=0.725-0.952, P=0.008) were independently associated with a lower risk of carotid plaque in elderly patients with T2DM.

Higher serum bilirubin levels within the normal range are associated with a decreased risk of carotid plaque in elderly patients with T2DM. Lower levels of serum TB and UCB levels are independent risk factors for carotid plaque, which may be related to inflammatory status.

Diabetes has become a significant global public health issue. In China, the prevalence of diabetes has been steadily increasing, placing a substantial burden on healthcare resources. The primary healthcare system plays a crucial role in diabetes management, yet there are still deficiencies in improving the quality of diabetes management services and achieving adequate blood glucose control.

This policy brief aims to explore and analyze evidence-based quality improvement interventions for diabetes management in primary healthcare settings, providing practical recommendations for policy and practice.

During July to December 2024, a systematic search was conducted using the PubMed, Epistemonikos, and Health System Evidence databases to identify relevant systematic reviews published in the past 10 years. The focus was on quality improvement interventions for type 2 diabetes management in primary healthcare systems, with an additional analysis of their effectiveness in China.

A total of 33 international systematic reviews and 22 original studies from China were included. The interventions were categorized using the Chronic Care Model (CCM), which identifies six key strategies: (1) high-quality healthcare service organization; (2) community resource linkages; (3) self-management support; (4) delivery system design; (5) decision support; and (6) information systems. Regarding the primary health outcome—blood glucose control—two types of interventions, including high-quality integrated interventions focused on service organization optimization and self-management support, showed positive effects in all studies. The evaluation of other interventions was inconsistent or lacked sufficient evidence. Studies conducted in China validated the positive effects of four intervention strategies on blood glucose control. However, evidence for the effectiveness of "enhancing community resource linkages" and "strengthening decision support" remains insufficient in China.

This policy brief summarizes effective interventions for diabetes management in primary healthcare systems, based on the best evidence available and the results from their implementation in China. It recommends prioritizing two key strategies: fostering a culture of quality improvement across the entire system and implementing a comprehensive chronic disease management model, while in areas where a full system-wide approach cannot be implemented, prioritizing interventions that support patient or community self-management. Additionally, the brief emphasizes expanding multi-sector collaboration and exploring more practices to strengthen community resource linkages, while also providing primary healthcare personnel with more direct and actionable guidelines.

Type 1 diabetes mellitus in children is progressively younger, and there is a lack of quality standardized studies on specific self-reported outcomes scales for pediatric and adolescent patients.

To evaluate the measurements properties of children's type 1 diabetes-specific self-reported outcomes reports and the methodological quality of related researches based on the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN).

CNKI, Wanfang Data, VIP, Medline, Web of Science and Embase were searched for the studies on the development of children's type 1 diabetes-specific self-reported outcomes scales and validation of the measurements properties from inception to March, 2023. Two investigators cross-screened, checked and extracted the data, described and evaluated the included scales and researches by COSMIN list, to finally form the recommendations.

A total of 24 development or validation studies related to 11 children's type 1 diabetes-specific self-reported outcomes scales were included. Pediatric Quality of Life Inventory 3.2 Diabetes Module (PedsQL^TM3.2-DM), MIND Youth Questionnaire (MY-Q), Diabetes Quality of Life for Youths (DQOL-Y), Problem Areas in Diabetes-Teen Version (PAID-Teens), DISABKIDS Diabetes-Specific Module (DSM-10), FinDiab Quality-of-life Questionnaire (FDQL) and the Quality of Life Survey for Children and Adolescents with Diabetes in Chongqing are all recommended as Grade B, while PedsQL^TM3.0-DM, Problem Areas in Diabetes Survey-Pediatric Version (PAID-Peds), Type 1 Diabetes and Life (T1DAL) and ADDQoL-Teen are all recommended as Grade C. At the same time, the measurement properties of the children's type 1 diabetes-specific self-reported outcomes scales were insufficient and the reports were not comprehensive.

The methodological quality and measurement properties of the ratings of children's type 1 diabetes-specific self-reported outcomes scales at home and abroad are mostly grades B and C, which need to be further improved, and some potential scales deserve further study and application.