Deprescribing is important because inappropriate polypharmacy increases the risk of adverse drug events, treatment burden, reduced adherence and healthcare costs, while potentially compromising patient safety and quality of life. This study aimed to investigate the perceived barriers and enablers experienced by healthcare professionals (HCPs) in Indonesia regarding deprescribing in patients with type 2 diabetes (T2D) and polypharmacy.

A qualitative study using focus group discussions (FGDs) and thematic analysis.

Four FGDs were conducted with general practitioners, specialists (internists) and pharmacists from healthcare facilities in West Java Province, Indonesia. Each group included 3–4 participants from the same discipline, with one mixed group that included one participant of each profession. In total, 13 participants were included in the study.

HCPs across disciplines recognised the goals of deprescribing as optimising treatment, reducing polypharmacy risks and preserving treatment outcomes. However, implementation was hindered by the lack of clear guidelines, hierarchical dynamics, limited training and resource constraints, particularly in rural and high-volume settings. Enablers included clinical competence, effective communication, access to comprehensive clinical data and interprofessional collaboration. Patient education level, family support and community engagement were also key, underscoring the need for system-level support and shared decision-making to achieve effective deprescribing.

Deprescribing in T2D with polypharmacy is shaped by clinical competence, interprofessional collaboration, patient engagement and system-level resources. Improving practice in Indonesia requires clear guidelines, targeted HCP training, stronger interprofessional communication, better access to patient data and active involvement of patients and families. These strategies could provide context-specific insights to guide practice and policy on deprescribing initiatives.

766/UN6.KEP/EC/2024

Metformin is the first-line treatment for type 2 diabetes mellitus (T2DM). Long-term use of metformin has been associated with vitamin B₁₂ deficiency, which may lead to serious complications such as anaemia and neuropathy. Although international bodies have recommended screening for vitamin B₁₂ deficiency in patients on long-term metformin, it is unclear how aware clinicians are of this adverse effect and to what extent such guidance is being followed in practice.

A scoping review was conducted using Joanna Briggs Institute (JBI) methodology. Databases searched included MEDLINE, Medical Literature Analysis and Retrieval System Online (PubMed), British Nursing Index (BNI), Google Scholar, Cochrane, Embase, Web of Science and CINAHL, Cumulative Index to Nursing and Allied Health Literature (EBSCO) alongside searching for grey literature such as EThOS (Electronic Theses Online Service), DART (Digital Access to Research Theses) European and Kings College London Research Portal. Studies published in English from 1990 onwards were included if they addressed clinician awareness or screening practices. Data were extracted and summarised using a structured tool, with themes mapped visually. The literature search was conducted between 1 August 2025 and 1 November 2025 and included studies published from January 1990 onwards.

23 sources were included in the review. 7 studies directly assessed clinician awareness of metformin-associated vitamin B₁₂ deficiency, all conducted outside the UK. Across 15 studies reporting screening practices, routine vitamin B₁₂ monitoring was uncommon, with annual testing rates in general below 20% of eligible patients (range 2.6%–19.8%). In a large retrospective cohort study of patients on long-term metformin, 44.9% underwent vitamin B₁₂ testing, with a mean delay of 990 days from treatment initiation. Screening was predominantly symptom-triggered rather than preventive, and older adults and other high-risk groups were consistently less likely to be tested. Reported barriers included lack of clinical prompts, competing priorities and testing costs.

Clinician awareness of the link between long-term metformin use and vitamin B₁₂ deficiency is present but inconsistently translated into practice. Screening practices remain suboptimal despite recent guideline updates. Interventions, such as checklists, prompts and updated training, may support improved adherence. However, no UK-based studies were identified, highlighting a gap in national evidence. Routine, risk-based screening in primary care could prevent significant morbidity associated with undiagnosed vitamin B₁₂ deficiency in this population.

Indigenous peoples living with diabetes face unique challenges accessing comprehensive specialty diabetes care. A small diabetes virtual care clinic oriented towards Indigenous individuals, and those in rural and remote communities, has provided care to over 400 individuals.

We characterised the distinguishing features of care provided at this clinic and used the Consolidated Framework for Implementation Research 2.0 (CFIR) to explore the enablers and barriers to implementing this model of care, from the perspective of the clinic’s staff and providers.

Guided by CFIR, we conducted eight semi-structured interviews with six clinic staff members. Deductive thematic analysis was used to identify relevant enablers and barriers.

The aspirational features of care were cultural safety, comprehensiveness and virtual delivery. The implementation of this model of care was enabled by an internal culture of relational care; a nimble, resourceful, pragmatic and client-centred approach to virtual delivery; wayfinding and resources from key external organisations; community engagement and a small team of motivated and independent providers. Key barriers included the lack of physical interactions and uncertain or limited resources and funding.

The identified enablers and barriers to implementing an Indigenous-focused virtual diabetes care clinic have implications for future interventions to improve rural Indigenous chronic disease care, and for governments and adjacent organisations tasked with meeting Canada’s Truth and Reconciliation Commission’s calls to action in healthcare. Further research examining the effectiveness of virtual diabetes care at this clinic is ongoing.

Diabetic foot is an infection, ulceration or destruction of the tissue of the foot of a person diagnosed with diabetes mellitus (DM). Diabetic foot ulcer (DFU) is a major and preventable complication of DM. Adequate knowledge and foot self-care practices are crucial to reduce the risk of DFU complications, particularly in resource-limited healthcare settings.

To assess the knowledge and practices related to foot self-care and associated factors among individuals diagnosed with diabetes attending diabetic clinics at all base hospitals in Colombo District, Sri Lanka.

An analytical cross-sectional study was conducted among 423 individuals diagnosed with diabetes attending the diabetic clinic at all three base hospitals in Colombo district, from January 2023 to March 2024 (study period). Participants were selected by using a systematic random sampling. Data were collected using a validated and pre-tested interviewer-administered questionnaire. Descriptive and inferential analyses were performed using Statistical Packages for Social Sciences V.26 software. Associations were examined using ² tests, independent sample t-tests and one-way ANOVA (Analysis of Variance), with a p value

The majority of the participants were females (71.2%). Among the participants, 33.8% of them had a poor level of knowledge regarding foot self-care. Knowledge level was significantly associated with the participants’ family history of diabetes and the hospital where they attended the clinic (p

Nearly one-third of participants demonstrated poor knowledge of foot self-care, despite over half exhibiting satisfactory foot-care practices. This gap highlights the need for targeted education to boost awareness and promote consistent foot care, which is a key step in preventing diabetic foot complications and improving long-term outcomes for individuals diagnosed with diabetes.

Circadian regulation modulates metabolic and hormonal processes throughout the day, yet it remains unclear whether these diurnal fluctuations are reflected in exhaled volatile organic compound (VOC) profiles and whether such temporal patterns differ between individuals with and without diabetes. Previous breath analysis studies in diabetes have shown heterogeneous results, which may reflect differences in analytical approaches and the lack of standardised sampling times.

This prospective, single-centre observational study examines daytime VOC dynamics from 08:00 to 16:00 among adults without diabetes, and individuals with type 1 diabetes or type 2 diabetes. 60 participants will complete one in-person visit with repeated breath measurements using a BreathSpec^® gas chromatography–ion mobility spectrometry system (GC-IMS) device, capillary glucose testing, body composition assessment, questionnaires, and oral and stool microbiota sampling. A standardised breakfast is provided; subsequent meals follow structured timing but are not standardised. The primary outcome is temporal variation in VOC intensities. Secondary outcomes include between-group differences and associations with glucose levels, body composition and microbiota composition. Analyses will use established GC–IMS tools and exploratory multivariate approaches.

Ethics approval was granted by the Ethics Committee of the Canton of Bern (BASEC 2023-01143). Results will be shared via peer-reviewed publications, conferences and lay summaries.

NCT05984979.

To assess the effect of three educational interventions on self-management behaviours among individuals at risk of diabetes in Burkina Faso, Comoros and Mali, using cluster analysis to identify distinct respondent profiles.

Single-arm before–after longitudinal study with 6-month follow-up.

Community screening initiatives and antenatal clinics in Burkina Faso, Comoros and Mali.

540 adults at risk of diabetes (body mass index ≥25 kg/m² and/or family history of diabetes and/or impaired fasting glucose ≥1.10 g/L; mean age 38.2 years, 69% female) recruited through community screening initiatives and antenatal clinics in Burkina Faso, Comoros and Mali.

Three educational interventions: (1) social media video broadcasting, (2) peer educator outreach and (3) gestational diabetes education at antenatal clinics.

Changes in domain-specific Health Education Impact Questionnaire scores over 6 months assessed using Cohen’s d effect sizes.

Of the 540 initial participants, 528 responded to the follow-up survey 6 months later. Cluster analysis revealed two distinct self-management profiles: cluster 1 showed significant improvement in only two domains, self-monitoring (d=0.35, p=0.006) and skill acquisition (d=0.30, p=0.020), indicating limited but focused gains. In contrast, cluster 2 suggested significant progress in seven out of eight domains, including large gains in positive engagement in life (d=0.74, p

Distinct self-management profiles among diabetes-risk populations revealed critical heterogeneity that demands tailored, context-specific public health strategies to effectively address diverse needs and optimise prevention efforts.

The global prevalence of type 2 diabetes (T2D) is rising and disproportionately affects South Asian adults, including those in the United Kingdom. South Asians develop T2D at a higher rate and at a younger age than their white British counterparts, at a lower body mass index. Active efforts to reduce adiposity can improve glycaemic control and in some cases achieve T2D remission. However, a substantial proportion of lean mass is lost while achieving weight loss, which may have physiological and metabolic consequences, affecting long-term health outcomes and quality of life for people living with T2D and obesity. We are examining the impact of a combined low energy diet and supervised exercise intervention versus a low energy diet alone for the preservation of lean mass in an understudied South Asian population living with T2D and excess adiposity.

This prospective, randomised, two-arm parallel-group, open-label, blinded-endpoint trial is being conducted in Leicester, UK. 36 South Asian adults aged 40–65 years within 10 years of T2D diagnosis and not on insulin therapy will be enrolled. Both intervention arms will receive an 800–900 kcal/day low energy diet for 12 weeks. Those randomised to the exercise group will additionally receive a mixture of supervised and home-based resistance and aerobic exercise training three times per week. The primary outcome is the difference in the change of lean mass between groups measured using dual-energy X-ray absorptiometry at baseline and 12 weeks and will be analysed using linear regression modelling.

The trial was approved by the NHS research ethics service (23/WM/0201). All participants will provide informed consent prior to enrolment, and the study will be conducted in accordance with the Declaration of Helsinki. Findings will be shared widely (publications, presentations, press releases, social media platforms) and will inform an effectiveness trial.

ISRCTN11175684.

This study aimed to examine the impact of type 1 diabetes (T1D) on the sexual functioning of young women and men, concerning demographic and social factors.

Cross-sectional quantitative survey study.

Online survey distributed via internet forums for people with T1D in Poland (March 2021).

344 individuals completed the survey; 329 sexually active participants were included in the analyses (15 excluded due to sexual inactivity), of whom 177 had T1D (aged 20–60 years; mean age 31.31±7.40) and 152 were healthy controls (mean age 35.43±7.46).

Sexual functioning was assessed using the CSFQ-14 (Changes in Sexual Functioning Questionnaire), available in female and male versions. Additional author-designed questions were included to enhance understanding of the problem.

34.4% of men and 28.4% of women with T1D reported sexual dysfunctions. Women with T1D showed significantly lower overall sexual functioning compared with controls (mean difference: –4.09 points, 95% CI (–6.29 to –1.90), Cohen’s d=–0.54). Men with T1D demonstrated substantially greater impairment (mean difference: –11.15 points, 95% CI (–14.89 to –7.41), Cohen’s d=–1.47). Among men with T1D, significant differences were found in the total CSFQ score (²=8.98, p=0.003, V=0.26) and the orgasm subscale (²=11.91, p

Sexual dysfunction in young adults with T1D is more common than in healthy individuals. Men with T1D are more likely to report difficulty achieving orgasm and decreased desire for their partner, whereas women with T1D are more likely to report difficulty experiencing pleasure and lower levels of arousal.

To evaluate the effect of lobeglitazone on renal disease progression in patients with type 2 diabetes mellitus using longitudinal real-world data.

Retrospective cohort study.

Hospital-based Common Data Model database.

A total of 14 712 adults with type 2 diabetes mellitus who visited the Diabetes Center of Ewha Womans University Mokdong Hospital between 2013 and 2019 were identified. A 1:2 propensity score matching was performed to compare patients treated with lobeglitazone plus metformin with those receiving metformin monotherapy, sulfonylurea plus metformin, or a dipeptidyl peptidase-4 (DPP4) inhibitor plus metformin.

Treatment with lobeglitazone plus metformin compared with metformin monotherapy, sulfonylurea plus metformin or DPP4 inhibitor plus metformin.

Renal progression, defined as initiation of renal replacement therapy, a sustained ≥30% decline in estimated glomerular filtration rate (eGFR) from baseline, or doubling of serum creatinine with a concurrent eGFR ≤45 mL/min/1.73 m².

The HR of renal progression was 0.84 (95% CI 0.58 to 1.21) in the lobeglitazone plus metformin compared with metformin monotherapy, 1.00 (95% CI 0.79 to 1.27) compared with sulfonylurea plus metformin group, 1.10 (95% CI 0.84 to 1.44) compared with DPP4 inhibitor plus metformin group after adjusting for multiple variables. Subgroup analyses demonstrated significant interactions by sex in the comparison with metformin monotherapy (P for interaction=0.0179) and by glycaemic control in the comparisons with sulfonylurea plus metformin (P for interaction=0.0161) and DPP4 inhibitor plus metformin (P for interaction=0.0006), suggesting potential heterogeneity in treatment effects.

Lobeglitazone showed renal outcomes comparable to those of other antidiabetic medications, with a possible heterogeneity in treatment effects according to sex and glycaemic control.

To address whether eating disorders (ED) or insulin omission (IOM) in adult persons living with type 1 diabetes (pwT1D) are associated with impaired glycaemic control.

Cross-sectional analysis.

The French-Speaking Diabetes Society—Type 1 Diabetes Cohort (SFDT1) is an ongoing epidemiological cohort study that includes pwT1D in France who attend hospitals or private ambulatory diabetes centres.

Adult participants from the SFDT1 study, with data on ED and IOM. The current analysis was performed on data collected during the baseline visit in participants enrolled between December 2020 and March 2024.

Using the SCOFF, a self-reported questionnaire to screen for ED, and a single question on IOM to screen for IOM, we described four categories of pwT1D: no ED & no IOM, ED & no IOM, no ED & IOM and ED & IOM. We performed unadjusted and adjusted (for age, sex, diabetes duration, social vulnerability, smoking, alcohol status and insulin treatment) multinomial logistic regression models with the four categories as the outcome and glycaemic variables as explanatory variables, including continuous glucose monitoring (CGM) variables and HbA1c. No ED & no IOM was the reference outcome for all comparisons. We stratified each model by sex and fear of hypoglycaemia.

We included 1113 participants, 51% males, median (IQR) age 38 (29–50) years, diabetes duration 21 (12–32) years. Prevalences were as follows: no ED & no IOM: 68% (n=758), ED & no IOM: 11% (n=124), no ED & IOM: 16% (n=177) and ED & IOM: 5% (n=54). With the fully adjusted model, and compared with the group no ED & no IOM, time in range (OR (95% CI) 0.5 (0.4 to 0.7)) and time below range (0.5 (0.3 to 0.8)) were inversely associated with ED & IOM. Moreover, time in range (0.4 (0.4 to 0.5)) was associated with IOM & no ED. Time above range (2.2 (1.6 to 2.9)), Glycaemic Risk Index (1.8 (1.3 to 2.5)), glucose monitoring indicator (2.2 (1.7 to 2.9)) and HbA1c (2.0 (1.5 to 2.5)) were directly associated with ED & IOM. We did not observe associations between CGM variables and ED & no IOM. Most associations were valid in both men and women. The associations were stronger in participants with a fear of hypoglycaemia. However, the associations remained even in people with a fear of hypoglycaemia.

Both ED and IOM are frequent in pwT1D, and IOM seems to be associated with impaired glycaemic control. As our analysis was cross-sectional, we cannot infer causality and cannot know whether IOM was a result of glycaemic control or the inverse (reverse causality). Our results suggest that IOM should be systematically screened in clinical practice. Further research is needed to better identify and care for EDs, with or without IOM, in T1D.

NCT04657783.

Accurate assessment of insulin resistance, sensitivity and β-cell function is essential for early detection and management of metabolic disorders. However, reference intervals (RIs) commonly used in Nepal have been adapted from Western populations, which may not accurately reflect local physiological characteristics. Thus, this study aimed to establish population-specific RIs for fasting insulin and key insulin-related indices using a direct priori method in healthy adults from Gandaki Province, Nepal.

This cross-sectional study recruited 135 healthy adults (20–69 years, body mass index 18.5–24.9 kg/m²) representing different districts of Gandaki Province, Nepal. Fasting blood samples were analysed for glucose, insulin and lipids using standardised assays. Insulin was measured using the chemiluminescence immunoassay method. Nineteen different insulin-derived indices (Homeostasis Model Assessment 1 of Insulin Resistance (HOMA1-IR), Homeostasis Model Assessment 2 of Insulin Resistance (HOMA2-IR), Homeostasis Model Assessment for Triglycerides, Fasting Insulin to Glucose Ratio, Fasting Insulin Resistance Index, Metabolic Score for Insulin Resistance (METS-IR), InsuTAG, HOMA1-%S, HOMA2-%S, Quantitative Insulin Sensitivity Check Index (QUICKI), McAuley, Bennett, Raynaud, Glucose-to-Insulin Ratio, Fasting Insulin Sensitivity Index, Single Point Insulin Sensitivity Estimator (SPISE), reciprocal insulin, HOMA1-%B and HOMA2-%B) were calculated. Non-parametric 95% double-sided RIs (2.5th–97.5th percentiles) were established following outlier removal per Clinical and Laboratory Standards Institute-International Federation of Clinical Chemistry and Laboratory Medicine EP28-A3c guidelines.

The RI for fasting insulin was 2.63–14.56 µIU/mL (median 7.69 µIU/mL). Among the 19 mathematically correlated insulin-derived indices which are calculated from core measurements (fasting serum insulin and glucose), consistent patterns emerged across functional categories. Insulin resistance indices (HOMA1-IR: 0.56–3.50; HOMA2-IR: 0.30–1.70; METS-IR: 25.14–38.94) exhibited concordant right-skewed distributions with elevated upper limits. Conversely, insulin sensitivity indices (QUICKI: 0.32–0.42; HOMA2-%S: 58.83–233.20; SPISE: 5.75–10.86) demonstrated inverse, left-skewed patterns. Beta-cell function indices (HOMA1-%B: 0.54–322.21; HOMA2-%β: 40.74–159.52) also exhibited right skewed characteristics and revealed wide interindividual variability, reflecting preserved pancreatic reserve despite varying insulin resistance. Composite indices incorporating lipid parameters showed broader ranges, capturing additional metabolic heterogeneity.

This is the first study to define the RIs of fasting insulin and a spectrum of insulin derived indices in a Nepalese population. These findings offer a valuable framework for early detection and management of metabolic disorders in South Asian populations.

Adults with type 1 diabetes (T1D) are at markedly elevated risk of atherosclerotic cardiovascular disease (ASCVD). Guidelines recommend statin use for ASCVD prevention in diabetes between the ages of 40 and 75 years. This study aimed to evaluate statin prescribing rates for primary and secondary prevention of ASCVD in this age range with T1D and to identify disparities and barriers to optimal statin use.

A retrospective cross-sectional study of 266 adults with T1D aged 40–75 years was conducted at an integrated health system between 2020 and 2024. Demographic features, statin prescribing patterns, low-density lipoprotein (LDL) cholesterol levels and use of additional lipid-lowering agents were extracted from medical records. Barriers to prescribing were identified via endocrine physician documentation.

Among 266 adults with T1D aged 40–75 years, only 43.2% (95% CI 0.37 to 0.49) were prescribed guideline-recommended statin and 39.3% of those with a history of ASCVD received a high-intensity statin. Overall, 47.7% (95% CI 0.42 to 0.54) of patients achieved the latest LDL cholesterol targets, and 53.0% (95% CI 0.47 to 0.59) if using pre-2023 targets. Deferral to another healthcare professional (23.3%), statin intolerance (15.8%), and clinical inertia (9.0%) were the most common barriers to therapy. In multivariable analyses, female sex was independently associated with lower odds of receiving guideline-recommended statin therapy (aOR 0.45, 95% CI 0.24 to 0.85, p=0.015) and lower odds of achieving LDL targets (OR 0.43, 95% CI 0.28 to 0.64, p=0.046), while ASCVD history was associated with higher odds of statin use (aOR 2.75, 95% CI 1.34 to 5.57, p=0.005). Very few patients received adjunctive lipid-lowering agents (ezetimibe 4.1%, PCSK9 inhibitor 0.4%, none on bempedoic acid).

Notable gaps exist in statin prescribing and LDL goal attainment among adults with T1D, particularly women. Efforts to enhance care coordination, promote healthcare professional education and expand the use of adjunctive lipid-lowering therapies may help improve cardiovascular prevention in this high-risk population.

To evaluate the longitudinal association between medication adherence and glycaemic control among patients with Type 2 diabetes (T2D) in Luzhou City, identify modifiable factors and provide actionable evidence to inform targeted diabetes management strategies.

Retrospective cohort study.

Western China.

Data from 30 508 T2D patients in the Luzhou City Health Information Management System (2018–2023).

Primary outcome measure: glycaemic control rate. Secondary outcome measures: medication adherence, hypertension comorbidity and lifestyle factors.

Patients with consistent adherence achieved significantly higher glycaemic control rates (39.6%, 95% CI 38.8% to 40.4%) compared with intermittent adherents (20.8%, 95% CI 19.9% to 21.7%, p

While medication adherence remains fundamental for glycaemic control, its association with glycaemic control varied according to hypertension comorbidity and lifestyle factors. These findings advocate for integrated care models that simultaneously address cardiovascular risk factors and promote behavioural modifications, particularly in resource-constrained settings experiencing rapid epidemiological transitions.

To estimate the prevalence of potential overtreatment of type 2 diabetes mellitus (T2DM) among older adults and to develop and compare predictive models to identify patient and physician characteristics associated with overtreatment.

Population-based retrospective cohort study with predictive modelling.

A province-wide, publicly funded healthcare system in British Columbia, Canada, using linked administrative health claims data from 2016 to 2023.

Residents of long-term care facilities over age 65, and community-dwelling individuals over age 75, with a diagnosis of T2DM and a glycated haemoglobin (A1C) laboratory value ≤7.0%. Participants were required to have ≥365 days of continuous provincial health insurance coverage prior to their index A1C test. Patients receiving palliative care and those with missing physician information were excluded.

Potential overtreatment of T2DM, defined a priori as overlapping prescriptions for ≥2 glucose-lowering medications or ≥1 insulin or sulfonylurea dispensing within 90 days after the index A1C test.

Model performance outcomes included discrimination (area under the curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value). Performance metrics were calculated with 95% CIs using a 25% temporally distinct test dataset (2021–2023). No changes were made to outcome definitions after protocol development.

Among 133 773 patients with an A1C≤7.0%, 38 074 (28.5%) were classified as overtreated. These patients had a mean age of 79.6 years, were 47% female, and had a median A1C of 6.4%. The gradient boost model was the best performing model overall, using a combination of expert-selected variables and data-driven variables, achieving an AUC of 0.87, sensitivity of 0.81 and negative predictive value of 0.89. The top predictors of overtreatment included use of blood glucose test strips, A1C test volume, polypharmacy, specialist involvement and measures of diabetes severity.

Overtreatment of T2DM was prevalent among older adults in our cohort. Machine learning algorithms that integrate clinical expertise with data-driven variable selection performed the best in predicting T2DM overtreatment. We identified several patient and physician characteristics as key contributors that may inform future clinical practice and quality improvement initiatives, although external validation is required before clinical implementation.

Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine disorders globally, affecting 11–13% of women during reproductive age. PCOS is associated with an elevated risk of reproductive, metabolic, endocrine and mental health features. While lifestyle changes are first-line treatment for managing PCOS, metformin is often recommended for individuals with a body mass index (BMI) ≥25 kg/m². The aim of the metformin use in polycystic ovary syndrome (MET-PCOS) trial is to determine whether a metformin dose of 1500 mg per day or 2250 mg per day is superior in managing biochemical and clinical outcomes in PCOS.

MET-PCOS is a double-blind randomised controlled trial with two arms. It will be carried out at the Reproductive Medicine Unit at Helsinki University Hospital, starting from November 2025. Participants aged 18–37 years with a BMI≥25 kg/m² meeting the updated 2023 Rotterdam criteria for a PCOS diagnosis will be included. The participants (n=184) will be allocated (1:1) to a metformin dose of 1500 mg or 2250 mg per day. Outcomes include anthropometry, metabolic outcomes, hyperandrogenism, polycystic ovary morphology, menstrual cyclicity, mental health and gastrointestinal adverse effects. Measurements for study endpoints will be undertaken at baseline, 14 and 26 weeks.

The Finnish Medicines Agency has authorised the clinical trial (FIMEA/2025/00755) and the Regional Committee Medical Research Ethics, Finland (T7323/2024) has approved the trial protocol. This study will guide care providers in selecting the ideal metformin dose for individuals with PCOS.

NCT07120815, EU trial number: 2023-509259-15-01.

This qualitative study aimed to explore the self-management dilemmas faced by patients with diabetes in Chinese primary care and collect suggestions for improvement.

Qualitative methods are used in this study. Thematic analysis was used to analyse the transcripts.

Four primary care communities in Beijing. The interviews were conducted between April and August 2025.

This qualitative study used face-to-face, semi-structured interviews with 32 patients with type 2 diabetes. Data collection continued until information saturation was reached.

Four core themes and multiple subthemes were identified. The first theme, ‘Inadequate Disease Cognition and Health Literacy’, showed that patients had a limited understanding of diabetes, often delaying diagnosis and only learning about complications after they appeared. Misconceptions about diet and a lack of medication management knowledge were also common. The second theme, ‘Suboptimal Daily Management’, highlighted that physical activity was unstructured, glucose monitoring was irregular and emergency response capabilities were poor. The third theme, ‘Fragmented Healthcare Resources and Inadequate Family Support’, revealed systemic barriers such as limited primary care competencies, homogeneous health education formats that failed to meet patients’ needs and insufficient family support. The fourth theme, ‘Limitations in Self-Management Decision-Making’, demonstrated that patients’ decision-making processes were predominantly experience-driven, relying on personal or communal anecdotes rather than scientific medical evidence.

The self-management challenges among Chinese patients with diabetes in primary care are a complex interplay of inadequate individual cognition, suboptimal daily practices and fragmented support systems. The study suggests that future interventions should focus on enhancing general practitioner training, developing culturally sensitive health education and rebuilding family and community support networks to sustainably resolve these management dilemmas.

People with type 1 diabetes may be at increased risk of disordered eating, which may increase risk of elevated poor outcomes and high-risk complications. Type 1 diabetes disordered eating (T1DE) services were set-up to integrate diabetes and mental healthcare to better support people with T1DE and improve longer-term outcomes. A rapid evaluation was conducted to explore the implementation of T1DE services. Specifically, we aimed to: describe service delivery models; investigate staff experiences of impact and delivery of implementation; explore patient experiences of T1DE services; and to report health outcomes and associated costs.

Rapid evaluation using mixed methods (service mapping, staff and patient interviews, staff survey, analysis of clinical and economic data). Health outcome data was reported at baseline and 6 months.

This study explored the implementation of five new T1DE services and three existing services.

Staff working within T1DE services and patients who received care from T1DE services.

Assessment of our mixed methods study identified four key findings: (1) T1DE delivery models: The T1DE services displayed modest variation in models of delivery, but similarities were more evident, with a focus on direct delivery to patients involving joint meetings between diabetes and mental health staff. Nevertheless, some services also took on a ‘consultation’ role, providing advice and support to wider staff outside the service also managing these patients. Delayed implementation of the services slowed the formation of fully integrated teams and the ability of services to operate at scale. (2) Staff experience: Workforce issues were a crucial aspect of T1DE pilots. Managing this patient population is associated with high levels of anxiety for staff. Nevertheless, once formed, staff reported a very positive experience of working in integrated teams. (3) Patient experience: Although only a small sample of patients were interviewed, they reported a profoundly different experience to their previous care, which was now perceived as supportive and relationship focused. Although such improvements were aligned with the integrated care model underlying T1DE, it was less clear how such changes in patient experience would feature in decisions about commissioning. (4) Health outcomes and associated costs: There were 139 patients accepted onto the care pathway. Improvements were seen for all health outcomes. Compared with baseline measures, there was a mean 0.97% reduction in HbA1c (glycated haemoglobin) from 11.2% to 10.2% at 6 months. Improvements were also seen in other outcomes, including the diabetes eating problem scale and the diabetes distress scale. However, the number of patients on the care pathway with follow-up at 6 months was relatively small (n=29–47) and definitive statements about clinical or cost-effectiveness were not possible.

Overall, T1DE services were well received by both staff and patients. Due to a number of logistical challenges, the implementation of services was slower than anticipated, resulting in a limited number of patients on the care pathway. Securing local funding for existing services, once national pilot funding ended, was identified as a significant challenge. In order to ensure services are sustainable and commissioned at a local level, consideration may need to be given to alternative service delivery models.

To evaluate whether type 2 diabetes mellitus (T2DM) presence and severity are associated with differences in global and domain-specific cognitive function among US adults, using standardised Montreal Cognitive Assessment (MoCA) testing.

Cross-sectional study

Three U.S academic medical centres participating in the Artificial Intelligence–Ready and Equitable Atlas for Diabetes Insights (AI-READI) study.

Adults aged ≥40 years enrolled in the AI-READI cross-sectional study at three US academic medical centres were eligible. The study excluded individuals with type 1 diabetes, pregnancy or inability to speak, read and understand English. For this secondary analysis, 1067 participants from the first publicly released AI-READI data set who had MoCA data and assigned glycaemic status were included. Participants were classified into four prespecified glycaemic groups: controls without diabetes (n=371), pre-diabetes (n=239), medication-controlled type 2 diabetes (n=323), and insulin-dependent type 2 diabetes (n=129).

The primary outcome was global cognitive function measured by the MoCA total score. Secondary outcomes included MoCA domain scores and the prevalence of cognitive impairment, defined as MoCA

Significant differences in MoCA total scores were observed across glycaemic groups (p

Individuals with more advanced T2DM, particularly those on insulin, had significantly higher risk of cognitive impairment. These findings support routine cognitive screening in patients with T2DM, especially those on insulin therapy. Early identification of cognitive impairment may improve diabetes management and cognitive outcomes.

To investigate associations between body composition indices and metabolic status among normal-weight adults.

Cross-sectional study using data from the Tehran Lipid and Glucose Study (phaseVII: 2019–2021).

Primary care and community health services in an urban Tehran population.

1298 adults (40.5% men, 59.5% women), aged 18–80years, body mass index (BMI) 18.5–24.9 kg/m². Exclusions: known diabetes, cardiovascular disease, kidney failure, malignancy, pregnancy or lactation, diuretic or glucocorticoid use. Participants were classified as metabolically healthy normal weight (MHNW) or unhealthy (MUHNW).

The primary outcome was the association between body composition and anthropometric indices with metabolic status. The secondary outcome was identification of the strongest predictors of MUHNW. Body composition was assessed by bioelectrical impedance analysis to obtain fat mass (FM), body fat percentage (BFP), skeletal muscle mass percentage (SMM%), fat mass index (FMI), fat-free mass index, skeletal muscle indices and the fat-to-muscle mass ratio (FMR). Anthropometric measures included waist circumference (WC) and waist-to-hip ratio (WHR). Associations were examined using logistic regression adjusted for age, smoking and physical activity.

Mean age: 37.5±12.8 y; MUHNW participants were older than MHNW (44.5±13.2 vs 35.8±12.1 years, p

BMI, WC, WHR and body fat indices were positively associated with metabolically unhealthy status among normal-weight adults of both sexes. WHR was the strongest predictor, highlighting its value for identifying at-risk individuals where advanced body composition tools are unavailable.

Osteoporosis (OP) is a systemic skeletal disorder that increases fragility and susceptibility to fractures. Despite the availability of teriparatide for the treatment of patients with acute fractures with better efficacy, its long-term daily injection and high cost limit its broader use among a wider patient population, especially for those living in low- and middle-income countries. This study aims to evaluate the efficacy of a novel sequential treatment with teriparatide daily for 6 months followed by denosumab every 6 months for another 18 months, in comparison with denosumab monotherapy every 6 months for 24 months, in reducing the risk of fractures in patients with newly diagnosed osteoporotic fractures. The study will also explore the possible difference between two sequential treatments (shifting to denosumab treatment at 6 or 12 months) in their effect on increasing bone mineral density (BMD).

This study is designed as a multicentre, open-label, randomised controlled trial among 2478 patients with newly diagnosed osteoporotic fractures from 58 hospitals across China. Participants will be randomly assigned in a 10:10:1 ratio to three treatment groups: 24 months of denosumab monotherapy, early sequential treatment (teriparatide for 6 months followed by denosumab for 18 months) and late sequential treatment (teriparatide for 12 months followed by denosumab for 12 months). The primary outcome is the incidence of vertebral fractures over 24 months of treatment. Secondary outcomes include changes in BMD at the lumbar spine, total hip and femoral neck, changes in bone turnover markers (β-carboxy-terminal telopeptide of type 1 collagen and procollagen type 1 N-terminal propeptide), treatment adherence and cost-effectiveness. Follow-up assessments are scheduled at 3, 6, 9, 12, 18 and 24 months post-randomisation for primary and secondary outcomes, and biannually afterwards for the primary outcome.

The study protocol has been registered on ClinicalTrials.gov and has received ethical approval from the Peking Union Medical College Hospital Medical Science Research Ethics Committee (1-22PJ939). The findings will be disseminated through peer-reviewed scientific journals.

NCT05866029.