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.

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.

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.

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.

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.

The incidence of diabetes has been increasing year by year, and the management of type 2 diabetes has been included into the basic community health services as an important disease in China. However, at present, there is still a gap in the standard management of diabetes at the grass-roots level, especially in quality and ability.

To understand the current situation of diabetes management in Shanghai community health institutions and conduct systematic quality evaluation, and to put forward corresponding optimization suggestions for existing problems.

The research was conducted in May 2022, and the target population included, (1) community health service centres: all community health service centres in 16 administrative districts of Shanghai, with a total of 249 institutions; and (2) community general practitioners: 3 875 community general practitioners were selected by simple random sampling according to the proportion of 50% of the registered population. The questionnaire for medical institutions and the questionnaire for general practitioners were designed to investigate the implementation of diabetes management in community health centres and the implementation of standardized diagnosis and management of diabetes by community general practitioners.

A total of 249 questionnaires concerning diabetes management in primary healthcare institutions were distributed, with 249 valid responses collected, representing a 100.00% response rate. Additionally, 3 875 questionnaires assessing standardised diabetes diagnosis, treatment, and management practices among community general practitioners were distributed, yielding 3 874 valid responses, corresponding to a 99.97% response rate. HbA_1c test was available in all community health institutions in Shanghai, but the screening program for diabetes complications was insufficient, and only 16.9% of community health service centercould test nerve conduction velocity. The types of oral hypoglycemic agents are relatively complete, but the types of insulin are single, and only 7.6% of community health service center are equipped with the new hypoglycemic drug glucagon-like peptide-1 receptor agonist. 57.4% of community health service center have set up diabetes clinics. Community general practitioners have a high degree of recognition for the standardized management of diabetes and have a good grasp of the guidelines for the basic management of diabetes, but they have a poor grasp of the basic knowledge of diabetestreatment drugs, and the correct rate of the application knowledge of oral hypoglycemic drugs and insulin is only 27.9% and 29.0%. When the blood sugar of newly diagnosed diabetic patients is high and the diagnosis of diabetic nephropathy is confirmed, the community general practitioners are more inclined to refer the patients directly to the superior hospital specialty.

The results of this survey showed that the infrastructure, equipment and drugs of diabetes management service in Shanghai community health service center have basically met the quality requirements; Gaps in knowledge of drug use; It is necessary to further improve the diabetes management quality and medical capacity of primary medical and health institutions by increasing the examination and testing items related to the screening of diabetes complications, increasing the types of new hypoglycemic drugs and insulin, strengthening the construction of diabetes specialized clinics, improving the diagnosis and treatment level of general practitioners, and standardizing the diagnosis and treatment behaviors of general practitioners.

Diabetes and depression have become two major public health challenges. Depression can reduce the treatment adherence of patients with diabetes, exacerbate diabetic complications and mortality, and severely affect the quality of life of patients. However, currently, clinicians tend to focus on biological factors while neglecting psychological factors. As a result, the diagnosis rate of depression in diabetic patients is low. Therefore, it is of great clinical significance to actively identify and screen type 2 diabetic patients at risk of depression and to conduct in-depth analysis of various influencing factors.

With the increasing incidence of diabetes, the related psychological problems are also becoming more and more concerned. In order to overcome the limitations of selection bias in single-center surveys, we conducted a nationwide multicenter survey to investigate the prevalence of depression and its influencing factors among patients with type 2 diabetes mellitus (T2DM) in China, and to provide a basis for developing mental health intervention strategies for diabetic patients.

A nationwide multicenter observational study was conducted using a probability proportional to size (PPS) sampling method. A total of 2 137 patients with T2DM were recruited from 52 hospitals across China. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms (PHQ-9≥10 indicated depression). Through a review of the literature, 29influential factors were identified: fasting blood glucose, 2-hour postprandial blood glucose, glycated hemoglobin, and lipid profiles, triglyceride-glucose index (TyG), diabetes duration, diabetes complications, anddiabetes comorbidities. Multivariate logistic regression analysis was performed to identify factors associated with depression in T2DM patients. Use the statistical software R package to analyze whether there is a nonlinear relationship between age, TyG, and depression and calculate the inflection point.

Among 1 659 patients with type 2 diabetes, the prevalence of depression was 13.3% (220 cases). Multivariate logistic regression analysis identified the following independent risk factors for depression in type 2 diabetes patients: gender (female OR=1.815, 95%CI=1.220-2.701), age (OR=0.969, 95%CI=0.952-0.987), education level (below high school: OR=1.488, 95%CI=1.049-2.11), marital status (unmarried and others: OR=1.864, 95%CI=1.068-3.254), BMI (OR=0.936, 95%CI=0.896-0.977), ecomomic difficulties (OR=3.654, 95%CI=2.403-5.558), duration of disease (OR=1.031, 95%CI=1.006-1.057), diabetic peripheral neuropathy (OR=2.17, 95%CI=1.275-3.693), cardiovascular disease (OR=1.844, 95%CI=1.248-2.723), hypertension (OR=1.625, 95%CI=1.163-2.271), and TyG (OR=1.717, 95%CI=1.026-2.874)(P<0.05). After controlling for confounding factors, TyG showed a linear positive correlation with depression (P_nonlinear=0.191), while age exhibited a linear negative correlation with depression in the male population (P_nonlinear=0.946). The age of women was not linearly related to depression (P_nonlinear=0.013), and the time inflection point of the relationship was 49 years old (OR=0.921, 95%CI=0.857-0.99, P_nonlinear=0.025; OR=1.036, 95%CI=1.003-1.07, P_nonlinear=0.0323).

The prevalence of depression among Chinese patients with T2DM was 13.3%. Patients with low education levels, non-marital status, financial difficulties, high TyG index, and comorbid conditions such as diabetic peripheral neuropathy, cardiovascular disease, and hypertension were more likely to develop depression. Among male patients, the prevalence of depression decreased with increasing age. Among female patients, the relationship between age and the incidence of depression in the diabetic population followed a J-shaped curve, The risk of depression increases again after the age of 49. Early screening and intervention for depression are recommended for these high-risk groups to improve the overall health status and quality of life of T2DM patients.

Currently, there are 537 million patients with diabetes mellitus in the world, with the greatest number of affected people in China. Accumulating studies have found that the lungs are also the target organs of diabetes mellitus. Previous cross-sectional studies on diabetes mellitus and lung function have consistently concluded that people with diabetes mellitus have lower lung function than unaffected individuals. However, longitudinal studies are scant on diabetes mellitus and the decline rate of lung function, and the existing conclusions are inconsistent.

To investigate the association between diabetes mellitus and lung function in male people.

From 2014 to 2020, 18 438 male employees receiving lung function test and other physical examinations in Kailuan General Hospital were involved in this study, including 12 448 who completed the second lung function test. They were assigned into the normal fasting plasma glucose group (FPG<6.1 mmol/L, n=15 727), impaired fasting glucose group (IFG group, 6.1 mmol/L≤FPG<7.0 mmol/L, n=1 490) and diabetes mellitus group (FPG≥7.0 mmol/L or a history of diabetes mellitus, or use of hypoglycemic drugs, n=1 221) based on the blood glucose levels. A generalized linear model was used to analyze the association of different blood glucose levels with lung function indicators [FVC%pred (percentage of predicted value for forced vital capacity), FEV₁%pred (percentage of predicted value for forced expiratory volume in one second), MMEF% (percentage of predicted value for maximum mid-expiratory flow), and FEV₁/FVC (the ratio of forced expiratory flow in one second to forced vital capacity)] and decline rate of lung function.

Among the 18 438 observed subjects, the average age was 42.90±9.73 years. FVC%pred and FEV₁%pred were significantly lower in the diabetes mellitus group than the normal FPG and IFG groups, and MMEF%pred was significantly higher in the IFG group than the normal FPG and diabetes mellitus group (P<0.05). No significant difference was found in the decline rate of lung function among the three groups (P>0.05). After adjusting for confounders, the generalized linear analysis showed that with the reference of the normal FPG group, diabetes mellitus was negatively correlated with FVC%pred (B=-1.000, 95%CI=-1.784 to -0.218, P=0.012) and FEV₁%pred (B=-1.266, 95%CI=-2.236 to -0.296, P=0.011), but not associated with MMEF%pred and FEV₁/FVC (P>0.05). There was no correlation between IFG and diabetes with the decline rate of lung function indicators (P>0.05).

Diabetes mellitus are negatively associated with lung function indicators (FVC%pred, FEV₁%pred) in male people. However, we did not find an association of diabetes mellitus with the decline rate of lung function in men.

Metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes mellitus (T2DM) frequently coexist and mutually reinforce one another through shared pathological mechanisms, including insulin resistance, disruptions in lipid homeostasis, and chronic low-grade inflammation. MASLD is now recognized as a major comorbid condition in individuals with T2DM and is associated with substantially increased risks of cardiovascular events, progression of hepatic fibrosis, and all-cause mortality. In 2025, the American Diabetes Association (ADA) released a consensus report that, for the first time, incorporates MASLD into the standardized management framework for T2DM. The report provides recommendations for screening, risk stratification, and therapeutic intervention, and highlights the potential hepatoprotective effects of glucose-lowering agents on steatosis, inflammation, and fibrosis. This review summarizes the bidirectional pathophysiological interplay between MASLD and T2DM, synthesizes clinical and translational evidence regarding the hepatic benefits of major antidiabetic drug classes-including incretin-based therapies, sodium-glucose cotransporter-2 inhibitors, and peroxisome proliferator-activated receptor agonists-and proposes individualized management strategies that span lifestyle modification and pharmacologic therapy, guided by fibrosis stage and metabolic comorbidities in alignment with ADA recommendations. The importance of multidisciplinary collaboration in the comprehensive management of patients with T2DM and MASLD is also emphasized.

Prediabetes is a condition where blood glucose levels have deviated from the normal range but have not yet reached the diagnostic criteria for diabetes. It represents a transitional phase between health and diabetes. Currently, there are no global guidelines for managing prediabetes. However, the use of metformin in prediabetes is largely based on clinical experience, and there is a lack of high-quality evidence-based medicine. There are uncertainties regarding its dosage and unknown adverse reactions, and its exact efficacy and safety still require further study. This article systematically reviews the current state of metformin in the treatment of prediabetic, analyzing differences in efficacy across different dosages, the guideline recommendations, clinical application experiences, potential adverse effects and irrational drug use. We aim to provide scientific basis and clinical practice guidance for the rational use of metformin in the management of prediabetes.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with type 2 diabetes mellitus (T2DM). MASLD and its associated liver fibrosis contribute to the onset and progression of T2DM through the induction of insulin resistance and direct disruption of hepatic glycogen synthesis. Additionally, MASLD significantly elevates cardiovascular risk and mortality in patients with T2DM, mediated by abnormality of vascular endothelial factors and dyslipidemia resulting from insulin resistance, as well as hypercoagulability. In terms of pharmacological treatment, certain novel multi-target hypoglycemic agents have been proven to be efficacious in reducing intrahepatic lipid deposition and improving liver enzyme levels, while also having the potential to mitigate the progression of liver fibrosis. Altogether, this article reviews the association, mechanism and pharmacological treatment of MASLD and its associated liver fibrosis with T2DM and its cardiovascular complications, aiming to provide novel insights for the clinical diagnosis and treatment of patients with T2DM and MASLD.

The CAPDCA Model of Personalized Patient Education is a new individualized health education model, and its effectiveness has been fully confirmed by theoretical and clinical verification. This model puts forward feasible solutions for the problems existing in the current clinical implementation of health education, such as content fragmentation; inability to large-scale individualization; lack of comprehensive and continuous management; lack of doctor-patient shared decision-making and continuous improvement. This model is suitable for chronic disease patients with poor compliance and poor effect of traditional health education management. In order to describe the application method of this model in detail, this article shows the specific process of the application of this model in the management of an elderly diabetic patient with poor blood glucose control, and explains each step in detail. After the intervention by CAPDCA Model of Personalized Patient Education, the patient's blood glucose was gradually stabilized and reached the target levels of treatment, medication compliance was improved, personal quality of life was improved, and self-management ability of diabetes was enhanced. CAPDCA Model of Personalized Patient Education can provide a new method for individualized health education of diabetic patients and improve the effect of health education. This model is suitable for further promotion and application in clinical institutions.

Diabetic macrovascular complications represent prevalent and severe consequences of diabetes mellitus, characterized by high morbidity and significant clinical impact. To date, the pathogenesis of the disease remains undefined. Inflammation and oxidative stress have long been the key research focuses in the pathogenesis. Multiple inflammatory mediators have been confirmed to contribute to the occurrence and development of diabetes-associated macrovascular disease. However, whether tryptase, an important inflammatory mediator, is involved in its pathogenesis has rarely been reported.

Serum tryptase levels were analyzed in patients with type 2 diabetes mellitus complicated by macrovascular disease. A non-interventional follow-up study was conducted in patients newly diagnosed with diabetes through oral glucose tolerance test (OGTT). A repeated survey was conducted after 10 years. This survey identified two groups of patients: those with type 2 diabetes complicated by macrovascular disease and those with type 2 diabetes alone. We aimed to explore baseline serum tryptase levels across these outcome groups, and to investigate factors influencing diabetic macrovascular disease progression.

A cluster random sampling method was employed to select residents from three communities in Luzhou for physical examinations, questionnaire surveys, and laboratory tests between April and November 2011. Three groups were established: healthy individuals were randomly selected as the normal control group (NG, n=30), newly diagnosed type 2 diabetes (B-T2DM) group (n=30), and type 2 diabetes mellitus with macrovascular disease (B-T2DM+CVD) group (n=30). During the baseline survey, newly diagnosed diabetes mellitus patients were enrolled in a 10-year non-interventional follow-up. An investigation was conducted between April and December 2021. It aimed to randomly select the type 2 diabetes mellitus group (R-T2DM) and R-T2DM+CVD.

Comparison of clinical and biochemical parameters among populations with different baseline statuses was performed. There were statistically significant differences in fasting plasma glucose (FPG), OGTT 2 h, glycated hemoglobin A1c (HbA_1c), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), body mass index (BMI), and tryptase levels among different groups (P<0.05). The B-T2DM+CVD group had higher levels of FPG, OGTT 2h blood glucose, HbA_1c, tryptase than the NG group and B-T2DM group, and higher levels of TG and BMI than NG group (P<0.05). Correlation between tryptase and baseline indicators: tryptase levels demonstrated positive correlations with FPG, OGTT 2 h blood glucose, HbA_1c, TC, LDL-C, BMI, and waist-to-hip ratio (WHR) (r=0.226, 0.296, 0.185, 0.272, 0.213, 0.245, 0.278), and negative correlations with HDL-C (r=-0.209) (P<0.05). The influence of tryptase on B-T2DM+CVD: univariate Logistic regression analysis showed that tryptase was a risk factor for B-T2DM+CVD (OR=1.832, 95%CI=1.015-3.308), while multivariate Logistic regression analysis showed that tryptase was not an influencing factor for type 2 diabetes mellitus complicated by macrovascular disease (P>0.05). After 10 years of follow-up, 26 of 331 diabetes patients developed type 2 diabetes mellitus complicated by macrovascular disease. At baseline, both the OGTT 2 h glucose level and HbA_1c were higher in the R-T2DM+CVD group than in the R-T2DM group (P<0.05) ; no statistically significant difference was observed in baseline tryptase levels between the two groups (P>0.05). Univariate Logistic regression analysis showed that OGTT 2 h blood glucose (OR=1.205, 95%CI=1.001-1.451) and HbA_1c (OR=1.699, 95%CI=1.009-2.863) were influencing factors for regression of type 2 diabetes mellitus complicated by macrovascular disease (P<0.05), while the multivariate Logistic regression analysis showed that OGTT 2 h glucose (OR=1.118, 95%CI=0.867-1.441), HbA_1c (OR=1.331, 95%CI=0.664-2.795) and tryptase (OR=1.003, 95%CI=0.513-1.961) were not influencing factors for regression of type 2 diabetic macrovascular disease.

Serum tryptase levels in patients with type 2 diabetic macrovascular disease were higher than those in the type 2 diabetes group and the normal group. Tryptase was a risk factor for type 2 diabetic macrovascular disease, but this effect disappeared after adjusting for FPG, OGTT 2h and HbA_1c. Tryptase might have no influence on the regression of type 2 diabetic macrovascular disease.

Type 2 diabetes mellitus (T2DM) onset is insidious in non-overweight/obese individuals, making early identification of risk factors for T2DM critically important. Muscle-to-fat ratio (MFR) is widely used in predicting metabolic diseases, but less analyzed in T2DM, especially in non-overweight/obese people with T2DM.

To investigate the correlation of MFR with T2DM in non-overweight/obese individuals, and its predictive value.

This study enrolled non-overweight/obese adults who underwent health examinations in Xiyuan Hospital of China Academy of Chinese Medical Sciences from 2021 to 2024. Participants were stratified based on the T2DM status, and baseline levels were compared. Logistic regression and linear regression were used to analyze the correlation of MFR with T2DM risk and fasting plasma glucose (FPG) levels in non-overweight/obese individuals. To assess the robustness of findings, subgroup analyses were conducted based on gender, age, smoking status, alcohol consumption, and hypertension status. A receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of MFR in T2DM risk among non-overweight/obese individuals.

A total of 1 021 non-overweight/obese participants were enrolled, including 113 T2DM patients. Logistic regression and linear regression results showed that in Model 1 (unadjusted for covariates), each 1-unit increase in MFR among non-overweight/obese individuals was associated with a 36% reduction in T2DM risk (OR=0.36, 95%CI=0.22 to 0.60, P<0.001), and a 0.26-unit decrease in FPG (β=-0.26, 95%CI=-0.39 to -0.14, P<0.001). In Model 3 with adjustments for all covariates, each 1-unit increase in MFR was associated with a 29% reduction in T2DM risk (OR=0.29, 95%CI=0.12 to 0.69, P=0.005) and a 0.28-unit decrease in FPG (β=-0.28, 95%CI=-0.49 to -0.08, P=0.007). When MFR was treated as a categorical variable in Model 3, the risk of T2DM in the MFR Q4 group was 0.34 times that in the MFR Q1 group (OR=0.34, 95%CI=0.12 to 0.93, P=0.036), and FPG levels decreased by 0.36 units (β=-0.36, 95%CI=-0.63 to -0.09, P=0.009). Subgroup analysis revealed the correlation between MFR and FPG levels was more pronounced among smokers and individuals with hypertension. The area under the curve (AUC) of MFR in predicting T2DM risk among non-overweight/obese individuals was 0.635 4 (95%CI=0.578 6 to 0.687 4), with an optimal cutoff of 1.080 1, a sensitivity of 46.90% and a specificity of 75.44%.

Among non-overweight/obese individuals, MFR exhibits a nonlinear negative correlation with T2DM risk and FPG levels. MFR demonstrates good predictive efficacy and can be used for early prediction of T2DM risk in non-overweight/obese populations.

Type 1 diabetes mellitus (T1DM) predominantly affects adolescents, drawing substantial research focus. Conversely, older adults with T1DM receive relatively little attention and research. Consequently, disease burden data for this population are scarce and urgently require filling.

To assess the disease burden and projected trends of T1DM among the elderly (age≥60 years) from 1990 to 2021, thereby providing essential evidence for public health decision-making.

Data on the incidence and disability-adjusted life years (DALYs) associated with T1DM in the elderly were extracted from the Global Burden of Disease (GBD) 2021 database from 1990 to 2021, focusing on globally, China, and five sociodemographic index (SDI) regions. Taking the GBD 2021 standard population as the reference, age-standardized incidence and DALY rates for elderly individuals with T1DM were calculated based on the direct standardization method. The trend of disease burden was analyzed via Joinpoint regression, with results reported as average annual percent change (AAPC). Subgroup analyses stratified the disease burden by age and sex, respectively. Additionally, a three-factor decomposition method was employed to dissect the relative influences of aging, population growth, and epidemiological change on the shifts in disease burden. Finally, a Bayesian model was utilized to forecast the disease burden of elderly T1DM from 2022 to 2040.

In 2021, the global and Chinese incidence of T1DM stood at 42 330 and 3 049 cases, respectively, representing increases of 199.47% and 427.50% compared to 1990. The total DALYs of the elderly T1DM reached 659 117 person-years globally and 57 663 person-years in China in 2021, marking increases of 91.80% and 78.25%, respectively, since 1990. Age-standardized DALYs rate exhibited a downward trend globally and within China from 1990 to 2021, with statistically significant differences (P<0.001). The proportion of T1DM incidence cases was highest in the 60-64 age group globally, in China, and across the five SDI stratified regions. The proportion of incidence cases in Chinese 60-64 age group (27.91%) fell between the high-middle SDI region (26.01%) and the middle SDI region (30.26%), but the proportion of DALYs among Chinese T1DM patients in the 60-64 age group (24.06%) was lower than that of all other regions. Notably, individuals aged 60-69 years constituted 53.51% of all elderly T1DM patients in China, and accounting for 55.25% of total DALYs. Population growth emerged as the primary contributing factor, responsible for 58.34% of the increase in T1DM incidence among the elderly in China. Furthermore, it was identified as the decisive factor driving DALYs increases, contributing to 178.96%. Projections indicate a continued rise in both incidence and DALYs for elderly T1DM patients globally and in China from 2022 to 2040, with a more gradual change in DALYs observed among Chinese women compared to men.

The incidence of T1DM and the associated DALYs burden in the elderly remain substantially high both globally and in China. This underscores the urgent need for the formulation and implementation of more scientifically informed and effective public health policies and clinical intervention strategies to address this pressing health challenge.

The value of "Integration of medical services and preventive services" has been expanded from improving the quality of chronic disease care to driving the transformation of the entire health system from a "treatment-centered" to a "health-centered" approach, while also contributing to cost control and efficiency improvement of the health system. However, the definition of "preventive services" remains unclear.

Using Type 2 diabetes care as a case, this study aims to conceptualize "preventive services" and specify corresponding service items, while exploring the pathways to implement these services.

Theoretical deduction was conducted based on the social determinants of health framework, the concept of tertiary prevention, policy implementation theory, and the Capability, Opportunity, Motivation-Behaviour (COM-B) model. Furthermore, a synthesis of published research and guidelines was performed to construct a conceptual framework and implementation pathways for preventive services.

The developed conceptual framework for type 2 diabetes "preventive services" features a cross-cutting structure, encompassing the entire disease continuum from health to rehabilitation after functional impairment, and incorporates interventions at macro, community, and individual levels. Services at the individual level also incorporate a family perspective. Regarding implementation, four key pathways are proposed, including "accountability" "capacity building" "financial incentives" and "resource allocation and enabling conditions".

Using type 2 diabetes as an example, this study defines "preventive service items" and explores pathways for their adoption and execution within the policy framework of a Compact Medical Consortium. The definition spans macro, community, and individual levels. The study posits that "accountability" "capacity building" "financial incentives" and "resource allocation and enabling conditions" can be used in Compact Medical Consortium to facilitate the implementation of preventive services. All these efforts will contribute to foster a shift in mindset and practice from "treatment-centered" to "prevention-centered", and to provide concrete, actionable suggestions to advance "integration of medical and prevention services".

The global rise in the prevalence of type 2 diabetes mellitus (T2DM) among the elderly has emerged as a significant public health concern. T2DM is known to exert detrimental effects on cognitive function. However, there remains a lack of simple and effective indicators for the early detection and monitoring of this condition, highlighting an urgent need for further investigation. The present study utilizes real-world cross-sectional data to explore the disease from the perspective of "physical disease-related adjustable constitution" offering potential clinical value for the diagnosis and treatment.

To investigate the prevalence of type 2 diabetes mellitus with mild cognitive impairment (MCI) among the elderly in the Sichuan region, and to identify the factors influencing its occurrence.

Elderly patients aged ≥60 years with type 2 diabetes mellitus were selected for the survey conducted from November 2021 to November 2023. The participants were recruited from various communities and three nursing homes across six cities in Sichuan Province, namely Chengdu, Deyang, Bazhong, Emeishan, Meishan, and Mianyang. A face-to-face survey was administered using a paper-based questionnaire, which collected basic demographic information, the Changsha version of the Montreal Cognitive Assessment (MoCA), and the Traditional Chinese Medicine constitution assessment. Univariate analysis, followed by multifactorial Logistic regression, was performed to identify potential independent factors influencing the occurrence of type 2 diabetes mellitus with MCI. Pearson correlation analysis was used to explore the correlation between different cognitive domains and yang deficiency constitution.

A total of 407 questionnaires were distributed, of which 397 were valid, yielding a response rate of 97.54%. Among the 397 participants, 348 (87.7%) were elderly individuals residing in communities, and 49 (12.3%) were from nursing homes. A total of 84 participants were identified with MCI, resulting in a prevalence of 21.2% for T2DM with MCI. Based on cognitive status, participants were divided into two groups: those with T2DM and MCI (n=84) and those with T2DM without MCI (n=313). Statistically significant differences were observed between the two groups in terms of education level, depression, reading books and newspapers, as well as Traditional Chinese Medicine (TCM) constitutions including qi deficiency, yang deficiency, phlegm-dampness, and damp-heat (P<0.05). Multivariate Logistic regression analysis identified educational level (junior high school: OR=0.487, 95%CI=0.253-0.939; university and above: OR=0.149, 95%CI=0.034-0.659) and a yang deficiency constitution (OR=2.284, 95%CI=1.220-4.279) as independent risk factors for MCI in elderly patients with T2DM (P<0.05). The results of the correlation analysis showed that the score of the yang deficiency constitution score was negatively correlated with the delayed memory domain score of cognitive function (r=-0.106, P<0.05).

The prevalence of MCI among elderly patients with type 2 diabetes mellitus in Sichuan Province is 21.2%. Low educational attainment and a yang deficiency constitution are significant risk factors for the development of MCI in this population. In line with the Traditional Chinese Medicine theory that constitution can be differentiated, constitution is related, and constitution can be adjusted, early identification and targeted intervention for yang deficiency constitution may help mitigate the progression of cognitive impairment in patients with diabetes.

Diabetes mellitus is a common chronic disease in postmenopausal women. However, little is known about whether early or delayed age at menopause increases the risk of postmenopausal diabetes.

To explore the correlation between the early or delayed age of menopause and fasting blood glucose and diabetes in natural postmenopausal women, so as to provide evidence for the prevention and control of diabetes in this population.

A cross-sectional study was conducted using baseline survey data from 4 905 postmenopausal women aged 50 and older in the Guangzhou Prospective Cohort Study on Chronic Diseases in Middle-aged and Elderly Adults. Data were collected between November 2017 and January 2020, covering demographic characteristics, socioeconomic status, lifestyle factors, medical history, and reproductive history. Physical examinations were conducted, including measurements of fasting blood glucose and blood lipid levels. The generalized linear regression (GLM) and Logistic regression models (LRM) were used to analyze the relationship of menopausal age with fasting blood glucose levels and diabetes.

The mean age of the participants was (60.1±5.8) years and the mean age of menopause (50.3±3.1) years. Among them, 351 women experienced early menopause (≤45 years), 4 157 had normal menopause (46-54 years), and 397 had delayed menopause (≥55 years). Results from GLM showed that a linear association between menopausal age ≥50 years and fasting blood glucose (β=0.024, 95%CI=0.001-0.046, P<0.05) was found, whereas no significant linear relationship was observed in those with menopausal age <50 years (β=0.019, 95%CI=-0.002 to 0.040, P>0.05). Comparing with the normal age of menopause, the delayed menopausal age was associated with a 41.0% higher risk of diabetes mellitus (OR=1.410, 95%CI=1.026-1.938, P<0.05) and a 97.1% increased risk of newly diagnosed diabetes mellitus (OR=1.971, 95%CI=1.186-3.276, P<0.01). In contrast, no significant associations were found between early menopause and diabetes risk (OR=0.882, 95%CI=0.612-1.273) or newly diagnosed diabetes (OR=0.760, 95%CI=0.410-1.407) (P>0.05).

The delayed menopausal age is associated with an increased level of fasting glucose and risk of diabetes among postmenopausal women. However, no significant correlation was found in those with early age of menopause. It is necessary to strengthen diabetes prevention and control for those with delayed menopausal age in advance.

With the rising prevalence of diabetes and the widespread adoption of intensive glucose-lowering therapies, the incidence of hypoglycemia has increased significantly. The hazards and management of hypoglycemia remain critical clinical challenges.

To investigate the effect of the "General-Specialty" graded precision management model on the physical and mental health of type 2 diabetes patients with hypoglycemia in the community.

A total of 120 T2DM patients with a history of hypoglycemia within 6 months, who attended Shanggang Community Health Service Center in Pudong New Area, Shanghai from January to July 2023, were enrolled. The patients were divided into a control group and an experimental group, with 60 cases in each group, using a random number table method. The control group received routine management, while the experimental group was subjected to the "General-Specialty" graded precision management model. Based on the severity of hypoglycemia and individual patient conditions, subjects in the experimental group were referred to general practice clinics, specialized diabetes clinics, or transferred to tertiary hospitals. Additionally, comprehensive interventions were implemented, including real-time data-driven precise management, psychological intervention, comprehensive health education, and the establishment of a family support system. After 6 months of intervention, the two groups were compared in terms of blood glucose control parameters [fasting plasma glucose (FPG), hemoglobin A_1c(HbA_1c), time in range (TIR), and blood glucose coefficient of variation (CV)], the number of hypoglycemic episodes (total, mild, moderate, and severe), scores on the Chinese Hypoglycemia Fear Survey-Worry Scale (CHFSⅡ-WS), and the total score and dimension scores of the Diabetes-Specific Quality of Life Scale (DSQL). To evaluate the impact of the "General-Specialty" graded precision management model on the blood glucose control and fear of type 2 diabetes patients with hypoglycemia, and then evaluate the significance of this management model on the management of type 2 diabetes patients with hypoglycemia in the community.

During the intervention period, 1 patient in the experimental group was lost to follow-up due to residential relocation. The results of repeated measures ANOVA showed that there was no interaction between group and time on BMI and waist circumference (F_interaction =1.922, 1.134; P_interaction =0.162, 0.320).Time exerted a significant main effect on BMI and waist circumference (F_time=7.507, 4.097; P_time=0.003, 0.021), whereas group had no significant main effect on these parameters (F_group=0.598, 0.138; P_group=0.441, 0.711). No interaction between group and time was observed for systolic blood pressure (SBP) or diastolic blood pressure (DBP) (F_interaction =0.868, 0.151; P_interaction =0.419, 0.860), and neither time nor group had a significant main effect on SBP or DBP (F_time=1.295, 1.267; P_time=0.276, 0.284; F_group=1.750, 0.337; P_group=0.188, 0.562). Significant interactions between group and time were detected for FPG, HbA_1c, and CV (F_interaction =36.662, 15.157, 10.767, P_interaction <0.001). Both time and group had significant main effects on FPG, HbA_1c, and CV (F_time=105.098, 60.155, 41.307; P_time<0.001; F_group=6.916, 4.357, 4.094; P_group=0.010, 0.039, 0.045). A significant interaction between group and time was also found for TIR (F_interaction =4.767, P_interaction =0.012). Time had a significant main effect on TIR (F_time=13.456, P_time<0.001), but group did not (F_group=3.405, P_group=0.068). After 6 months of intervention, the total number of hypoglycemic episodes, as well as the number of mild and moderate episodes, was significantly lower in the experimental group than in the control group (all P<0.05). Post-intervention scores of CHFSⅡ-WS, total DSQL, and all DSQL dimension scores were significantly lower in the experimental group than in the control group (all P<0.05). Furthermore, these scores were significantly lower in the experimental group post-intervention compared with pre-intervention (all P<0.05).

The "General-Specialty" graded precision management model improves glycemic control, reduces glucose variability, and lowers hypoglycemia risk, thereby enhancing community-based T2DM hypoglycemia management. It alleviates fear of hypoglycemia, improves self-management, and enhances quality of life.

The comorbidity of diabetes and depression is relatively common in clinical practice,with a significant bidirectional association between the two conditions. This comorbid state not only increases the disease burden and treatment complexity but also severely impacts patients' quality of life and long-term prognosis. The shared pathophysiological mechanisms of diabetes and depression may involve neuroendocrine dysregulation, chronic inflammation, and unhealthy lifestyle factors. Currently, clinical management faces several major challenges: insufficient awareness and recognition of the comorbidity among healthcare providers often leads to underdiagnosis or misdiagnosis of depression; lack of effective interdisciplinary collaboration hampers the implementation of integrated care; and the absence of specific diagnostic and treatment guidelines both domestically and internationally results in a lack of standardized clinical practice. To address these issues, the Psychosomatic Endocrinology Collaboration Group of the Psychosomatic Medicine Society of the Chinese Medical Association, in collaboration with experts from endocrinology and metabolism, psychiatry, neurology, psychology, psychosomatic medicine, and traditional Chinese medicine, has developed the first Chinese Expert Consensus on the Diagnosis and Treatment of Diabetes Comorbid with Depression. This consensus systematically elaborates on the clinical features, pathophysiological mechanisms, assessment tools, and intervention strategies for the comorbidity, underscores the importance of multidisciplinary collaboration, proposes a standardized screening and diagnostic pathway, and provides specific recommendations for collaborative care. The release of this consensus aims to offer scientific and practical clinical guidance, improve the recognition and management of this comorbidity, and ultimately enhance overall patient care and long-term outcomes.

Type 2 diabetes mellitus (T2DM) is often associated with metabolic fatty liver disease (MAFLD) , which significantly increases the risk of microanglopathy through the interaction of insulin resistance, abnormal lipid metabolism, chronic inflammation and other mechanisms. However, the quantitative analysis of related risk factors and the construction of predictive models are insufficient in existing studies. Identification of key biomarkers to guide early intervention‌ is urgently needed.

To investigate the correlation factors and predictive value of microangiopathy in T2DM patients with MAFLD.

A retrospective analysis was conducted on the clinical data of patients with T2DM combined with MAFLD admitted to the Lu'an Hospital Affiliated to Anhui Medical University from January 2021 to August 2023. According to the medical record system, 110 patients with microvascular complications and 110 patients without microvascular complications were selected as the modeling group at a 1∶1 ratio. Another 106 patients with T2DM combined with MAFLD during the same period were selected as the validation group. Patients with microvascular complications were assigned to the occurrence group (n=110) , and those without microvascular complications were assigned to the non-occurrence group (n=110) . General information and laboratory test results of the patients were collected through the medical record system. The non-alcoholic fatty liver fibrosis score (NFS) , liver fibrosis 4-factor index (FIB-4) , and triglyceride-glucose index (TyG) were calculated. Multivariate logistic regression analysis was performed on indicators with a variance inflation factor (VIF) <10 selected by collinearity analysis. The receiver operating characteristic (ROC) curve was constructed to evaluate the predictive effect of each indicator on the occurrence of microvascular complications in patients with T2DM combined with MAFLD.

There were no significant differences in baseline data between the modeling cohort and the validation cohort (P>0.05) . Among the patients with T2DM combined with MAFLD who developed microvascular complications, 44 (40.0%) had diabetic nephropathy, 29 (26.4%) had diabetic retinopathy, and 37 (33.6%) had both diabetic nephropathy and diabetic retinopathy. Significant differences were observed in smoking history, duration of diabetes, C-reactive protein (CRP) , TyG, triglycerides (TG) , FIB-4, and NFS between the non-occurrence and occurrence groups (P<0.05) . Multivariate logistic regression analysis showed that smoking history (OR=8.298, 95%CI=1.957-35.175) , long duration of diabetes (OR=2.638, 95%CI=1.515-4.596) , elevated CRP (OR=7.918, 95%CI=4.013-15.624) , elevated TyG (OR=1.533, 95%CI=1.171-2.006) , elevated TG (OR=2.055, 95%CI=1.475-2.862) , elevated FIB-4 (OR=29.598, 95%CI=9.179-95.437) , and elevated NFS (OR=3.433, 95%CI=2.113-5.576) were risk factors for microvascular complications in patients with T2DM combined with MAFLD (P<0.05) . The areas under the ROC curve (AUC) for predicting microvascular complications in patients with T2DM combined with MAFLD based on CRP, TyG, duration of diabetes, smoking history, TG, NFS, and FIB-4 were 0.964 (95%CI=0.944-0.984, P<0.001) , 0.620 (95%CI=0.546-0.693, P=0.002) , 0.795 (95%CI=0.737-0.853, P=0.001) , 0.605 (95%CI=0.530-0.679, P=0.004) , 0.663 (95%CI=0.592-0.735, P<0.001) , 0.730 (95%CI=0.664-0.796, P<0.001) , and 0.743 (95%CI=0.678-0.808, P<0.001) , respectively. The AUC (95%CI) of the predictive model based on the above indicators in the modeling cohort was 0.990 (0.990-1.000) , indicating good predictive value.

Clinically, the occurrence of microvascular complications in patients with T2DM combined with MAFLD can be effectively predicted by observing CRP, TyG, duration of diabetes, smoking history, TG, NFS, and FIB-4. This approach is conducive to identifying high-risk patients with microvascular complications among patients with T2DM combined with MAFLD.

The plasma atherogenic index (AIP) is a well-established risk factor for cardiovascular disease (CVD) . However, most existing studies have focused on single AIP measurements and primarily investigated general or diabetic populations. To date, limited research has examined the association between cumulative exposure to the cumulative atherogenic index of plasma (cumAIP) and incident CVD in non-diabetic individuals, both domestically and internationally.

This study aimed to investigate the relationship between cumAIP and the risk of incident CVD in non-diabetic individuals.

This prospective cohort study included 65 921 non-diabetic employees of the Kailuan Group who participated in and completed health check-ups in 2006, as well as at least two of the subsequent check-ups in 2008 and 2010. Participant data were collected and followed up to calculate cumAIP, which was categorized into quartiles. The cumulative incidence of CVD was calculated using the Kaplan-Meier method and compared across groups using the Log-rank test. The Cox proportional hazards model was employed to assess the association between cumAIP levels and CVD risk. Additionally, restricted cubic spline plots were used to explore the dose-response relationship between cumAIP and CVD risk.

The study population was divided into four quartiles based on cumAIP: Q1 (cumAIP <-0.93, n=16 480) , Q2 (-0.93≤cumAIP <-0.29, n=16 481) , Q3 (-0.29≤cumAIP <0.39, n=16 480) , and Q4 (cumAIP≥0.39, n=16 480) . Significant differences were observed in baseline characteristics, including gender, age, blood pressure, BMI, fasting glucose, lipid profiles, high-sensitivity C-reactive protein, smoking, alcohol consumption, physical activity, and medication use (all P<0.05) . During a mean follow-up of (10.32±2.07) years, 4 137 incident CVD events were recorded. The number of CVD events in Q1, Q2, Q3, and Q4 was 867, 947, 1 095, and 1 228, respectively. The Log-rank test revealed significant differences in cumulative CVD incidence across quartiles (χ²=73.33, P<0.05) . Multivariable Cox proportional hazards analysis showed that compared to Q1, individuals in Q3 (HR=1.11, 95%CI=1.00-1.24) and Q4 (HR=1.16, 95%CI=1.02-1.33) had a higher risk of CVD (P<0.05) . Restricted cubic spline analysis, adjusted for age, gender, and other confounders, indicated a linear association between cumAIP and CVD risk (overall trend P<0.05, non-linear P=0.97) . Sensitivity analyses excluding individuals on antihypertensive medications (n=12 785) , lipid-lowering medications (n=871) , and those with CVD events within the first two years of follow-up (n=546) confirmed that Q4 remained a significant risk factor for incident CVD (HR=1.18, 95%CI=1.03-1.35, P<0.05; HR=1.16, 95%CI=1.00-1.34, P<0.05) .

Higher levels of cumAIP are independently associated with an increased risk of incident CVD in non-diabetic individuals.

The elderly population in rural China is substantial, and health services are insufficient, leading to a lower level of self-management and a higher risk of mortality among patients with type 2 diabetes mellitus (T2DM). Improving diabetes knowledge can enhance self-efficacy, diabetes self-management (DSM), and quality of life (QoL). Therefore, diabetes knowledge and self-efficacy are pivotal for DSM and QoL of T2DM patients.

To elucidate the pathways through which diabetes knowledge and self-efficacy influence DSM and QoL among rural T2DM patients.

A cross-sectional study design was used to sample 2 193 rural T2DM patients from Binhai County, Jiangsu Province, in August 2022, employing randomized whole-cluster sampling. The Diabetes Patient Knowledge Scale (ADKnowl), the Self-Efficacy Scale for Chronic Diseases (SECD6), the Self-Management Behavioral Scale for Diabetic Patients (SDSCA), and the Diabetes Survival Quality Specificity Scale (DSQL) were utilized to assess the participants. A total of 2 010 (91.66%) valid questionnaires were obtained. A model was developed based on the Integrated Theory of Health Behavior Change (ITHBC), and multiple linear regression analyses were conducted to explore the impact of the ADKnowl and SECD6 scores on the SDSCA and DSQL scores.

The ADKnowl, SECD6, SDSCA, and DSQL scores of rural T2DM patients were (52.5±16.5), (6.4±1.2), (37.9±6.9) and (48.3±8.6). The results of multiple linear regression analysis showed that the direct effect of ADKnowl scores on SDSCA scores was 0.156 (P<0.05), the mediating effect of SECD6 scores in it was 0.012 (P<0.05), and the indirect effect accounted for 7.1% of the total effect; the direct effect of ADKnowl scores on DSQL scores was -0.048 (P<0.05), in which the indirect effects of SECD6 score and SDSCA score were -0.041 and -0.012 (P<0.05), accounting for 40.6% and 11.9% of the total effect, respectively. In addition, foot care (β=0.352) and diet (β=0.161) dimension scores in ADKnowl had a positive effect on SDSCA scores (P<0.05), and reducing the risk of complications (β=-0.213), exercise (β=-0.117), and diet (β=-0.197) dimension scores had a negative effect on DSQL scores (P<0.05). Symptom management self-efficacy (β=-0.115), and disease co-management self-efficacy (β=-0.397) dimension scores in SECD6 had a negative effect on DSQL scores (P<0.05) .

Diabetes knowledge improves the level of DSM and QoL in rural T2DM patients, with a positive mediating effect of self-efficacy and self-management. Additionally, the acquisition of diabetes-related knowledge, such as diet, exercise, and foot care, significantly improves the level of DSM and QoL of patients. It is recommended that multisectoral collaboration, long-term health education, and social support resources be provided to enhance healthcare professionals' attention to the knowledge and self-efficacy of diabetic patients, effectively improving DSM and QoL of rural T2DM patients.

Nucleoside (acid) analogues (NAs) have become the primary treatment for chronic hepatitis B (CHB), but the impact of type 2 diabetes (T2DM) on the efficacy was unclear.

To identify the effect of T2DM on the efficacy of NAs antiviral therapy in CHB patients.

Patients with CHB who underwent liver biopsy in Tianjin Second People's Hospital from January 2015 to June 2023 and newly treated with NAs were included (n=350) .The patients were divided into T2DM-CHB group and CHB group according to their medical history. After matching according to gender, age, HBV DNA level, HBeAg status, ALT and AST level, 238 patients were finally included (T2DM-CHB group: n=70; CHB group: n=168). The patient's medication status, as well as liver and renal function, virological indicators and other data were reviewed once every 6 months for a total of 5 years. To evaluate the effectiveness of early treatment of NAs, follow-up was conducted once at the first and third months after the initiation of antiviral therapy.

After receiving NAs treatment, the serum lgHBV DNA level in T2DM-CHB group was significantly higher than that in CHB group at 1, 3, 6 and 18 months (P<0.05). The HBsAg value of T2DM-CHB group was significantly higher than that of CHB group at 12, 30 and 36 months (P<0.05). Kaplan-Meier survival curve showed that there was a significant difference between the two groups in the time to achieve complete virological response (CVR) for the first time (χ²=14.144, P<0.001), and the median time of first CVR in T2DM-CHB group and CHB group was 18.9 months and 14.3 months respectively. The cumulative clearance rate and seroconversion rate of HBeAg in T2DM-CHB group were lower than those in CHB group at 6, 12, 18, 24 and 30 months after treatment (P<0.05). In terms of liver function recovery, the accumulation rate of normal liver function in T2DM-CHB group was also lower than that in CHB group at 1, 3, 6, 12, 18 and 24 months after treatment (P<0.001). The results of multivariate Cox regression showed that T2DM (HR=0.706, 95%CI=0.584-0.854), HBV DNA (HR=0.624, 95%CI=0.534-0.730), eGFR (HR=1.197, 95%CI=1.017-1.409) were the factors influencing the time of the first CVR in patients with CHB (P<0.05) .

The combination of T2DM weakened the virological response of CHB patients to NAs, and prolonged the time to achieve CVR and liver function recovery.

Heart rate variability (HRV) is associated with cerebral infarction, although this association has been less studied in patients with type 2 diabetes mellitus (T2DM) .

To explore the correlation between HRV and cerebral infarction in T2DM patients.

A total of 577 T2DM patients hospitalized in Ningbo No.2 Hospital between January 2020 and August 2022 were selected. According to the presence or absence of cerebral infarction, patients were divided into the cerebral infarction group and non-cerebral infarction group. The general data and laboratory results were collected. All patients received 24-hour Holter monitoring. HRV parameters, including the standard deviation of normal-to-normal intervals (SDNN), the root mean square of successive RR interval differences (rMSSD), and the percent of adjacent RR intervals with a difference more than 50 ms (PNN50) were recorded. Multivariate Logistic regression analysis was used to analyze the correlation between HRV and cerebral infarction. Patients were further divided into the decreased SDNN group (SDNN<100 ms) and normal SDNN group (SDNN≥100 ms) based on the SDNN measurements in HRV, and the correlation with cerebral infarction was explored.

A total of 577 T2DM patients were enrolled, including 287 cases in the cerebral infarction group and 290 cases in non-cerebral infarction group. Multivariate Logistic regression analysis showed that SDNN was the independent influencing factor for cerebral infarction in T2DM patients (OR=0.970, 95%CI=0.961-0.979, P<0.05). There were 264 cases in the decreased SDNN group and 313 cases in the normal SDNN group. Multivariate logistic regression showed a significantly higher risk of cerebral infarction in the decreased SDNN group than the normal SDNN group (OR=4.164, 95%CI=2.769-6.262, P<0.05) .

The reduction of HRV parameters in T2DM patients is closely correlated to cerebral infarction. With the reduction of SDNN, the risk of cerebral infarction in patients increases.

Hypertension, diabetes, and dyslipidemia-commonly referred to as the "three highs" —are significant risk factors for cardiovascular and cerebrovascular diseases. Co-managing these conditions is crucial for reducing the morbidity and mortality associated with cardiovascular and cerebrovascular diseases; however, there is a notable lack of relevant research on the comorbidities of the "three highs" in Xinjiang.

To analyze the comparison of prevalence and comorbidity of hypertension, diabetes and dyslipidemia in Xinjiang residents, thereby providing data support for the co-management of the "three highs" within the local population.

Data were collected from the baseline of the Chronic Disease Prevention and Control Project of the Xinjiang Production and Construction Corps. A total of 5 673 residents aged 18 years and older participated in a questionnaire survey, physical examination, and laboratory examination conducted in 2022. In this study, the survey data of 4 990 eligible residents (87.96%) were included. The prevalence of the "three highs" (hypertension, hyperglycemia, and hyperlipidemia) and the comorbidity rate were analyzed. Multivariate Logistic regression analysis was employed to identify the risk factors associated with comorbidity of the "three highs" .

A total of 4 990 cases were included in the study, comprising 2 043 (40.94%) Han individuals, 2 666 (53.43%) Uygur individuals, and 281 (5.63%) from other ethnic groups. The standardized prevalence rates for hypertension, diabetes, and dyslipidemia were 32.66%, 14.03%, and 39.20%, respectively. The standardized prevalence of comorbidities was as follows: hypertension with diabetes (8.83%) , hypertension with dyslipidemia (15.31%) , and diabetes with dyslipidemia (8.05%) . The standardized comorbidity rate of the "three highs" was 5.36%. The rates of comorbidity for two and three diseases increased with age and body mass index (BMI) while decreasing with higher levels of education (P<0.05) . The dyslipidemia of the residents primarily characterized by elevated triglyceride levels (TG) (16.47%, 822/4 990) and low high-density lipoprotein cholesterol (HDL-C) levels (15.29%, 763/4 990) , with the prevalence of high total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) being significantly lower in men than in women (P<0.05) . Results from multivariate Logistic regression analysis indicated that age, BMI grade, and educational level were influencing factors for the comorbidity of "three highs" (P<0.05) .

The prevention and control of comorbidities associated with the "three highs" in Xinjiang remains challenging. Advanced age, overweight/obesity, and low educational attainment were risk factors for the comorbidity of the "three highs" . The joint management of the "three highs" and the comprehensive management of risk factors are crucial for the prevention and control of chronic diseases in the region.