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USA: A new long-term analysis published in Diabetes Care has highlighted the potential of continuous glucose monitoring (CGM) metrics to predict the risk of death among individuals with type 1 or type 2 diabetes. The study, led by Tomoki Okuno from the Department of Biostatistics at the University of California, Los Angeles, in collaboration with colleagues, suggests that CGM data may provide a more nuanced assessment of risk than traditional HbA1c measurements.
The research examined 2,752 adults aged 21 years or older with diabetes, 65% of whom had type 2 diabetes, from the Veterans Affairs Healthcare System. All participants had used Dexcom CGM devices between 2015 and 2020 and had at least 10 days of CGM data within landmark periods of 14 days, three months, or six months. These glucose readings were linked with electronic health records, and participants were followed for up to five years from the start of CGM use to assess all-cause mortality.
At the time of CGM initiation, the average age of participants was 64 years, and the median duration of CGM use was almost three years. Over the follow-up period, 407 participants died. The analysis evaluated multiple CGM-derived metrics—mean glucose (MG), time in range (TIR), time above range (TAR), coefficient of variation (CV), and glycemic risk index (GRI)—using multivariable Cox models adjusted for known mortality risk factors.
The study led to the following findings:
The researchers noted that while HbA1c remains a cornerstone in diabetes management, it provides an average glucose estimate and does not reflect fluctuations or the duration of hypo- and hyperglycemic episodes. CGM-derived data, on the other hand, offer a more dynamic picture of glycemic control, potentially enabling clinicians to identify high-risk individuals who might be missed using HbA1c alone.
Overall, the study emphasizes the importance of incorporating CGM metrics—particularly mean glucose, time in range, and measures of glucose variability—into clinical practice for long-term risk assessment. The authors suggest that this approach could pave the way for more targeted interventions aimed at reducing mortality in people with diabetes.
Reference:
Tomoki Okuno, Sharon A. Macwan, Gregory J. Norman, Donald R. Miller, Peter D. Reaven, Jin J. Zhou; Continuous Glucose Monitoring Metrics Predict All-Cause Mortality in Diabetes: A Real-world Long-term Study. Diabetes Care 2025; dc250716. https://doi.org/10.2337/dc25-0716
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Germany: A retrospective cohort study has found that prior use of SGLT2 inhibitors in type 2 diabetes mellitus (T2DM) patients did not reduce myocardial infarction (MI) size or decrease adverse events during hospitalization for MI treated with percutaneous coronary intervention (PCI).
The study, published in BMC Cardiovascular Disorders by Istvan Bojti and colleagues from the Department of Cardiology and Angiology, University Heart Center Freiburg – Bad Krozingen, examined whether ongoing SGLT2 inhibitor therapy influences infarct size and short-term outcomes in T2DM patients experiencing MI.
The research included 681 patients with T2DM who were admitted for MI and underwent PCI between November 2015 and December 2023. Among them, 105 were on SGLT2 inhibitors, while 576 were using other glucose-lowering medications at admission. The primary parameter assessed was infarct size, measured using peak high-sensitive troponin T (hs-TnT) normalized to the endangered myocardial area (EMA).
The analysis revealed the following findings:
The authors hypothesize that any potential protective effect of SGLT2 inhibitors may have been offset by more severe coexisting cardiovascular conditions and poorer glycemic control observed in the SGLT2 inhibitor group. They also noted that the evolving prescription patterns during the study period, especially following the positive outcomes of SGLT2 inhibitors in heart failure patients, may have resulted in a higher proportion of patients with advanced cardiovascular disease in the SGLT2 inhibitor cohort.
The study’s real-world design was highlighted as a strength, as it included patients with multiple comorbidities who are often excluded from randomized clinical trials, such as those with prior coronary artery bypass grafting, significant renal impairment, or those on insulin therapy. However, the authors acknowledged several limitations, including the study’s retrospective nature, the absence of data on therapy duration or adherence, and the lack of detailed diabetes-related complications that could influence outcomes. They also emphasized that the method used for estimating infarct size may not be as accurate as cardiac MRI, which is considered the gold standard.
The authors note that while the findings do not demonstrate a significant relationship between ongoing SGLT2 inhibitor therapy and reduced infarct size or adverse in-hospital outcomes, they recommend further prospective studies, ideally incorporating cardiac MRI and diverse patient populations.
“Such investigations are needed to clarify whether SGLT2 inhibitors exert any protective effects in the setting of myocardial infarction, both in patients with and without T2DM,” the researchers concluded.
Reference:
Bojti, I., Bojti, F., Hartikainen, T. et al. SGLT2-inhibition and myocardial infarction size in patients with type 2 diabetes mellitus– Insights from an acute cardiovascular care center. BMC Cardiovasc Disord 25, 566 (2025). https://doi.org/10.1186/s12872-025-04981-5
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South Korea: A large-scale study from South Korea has found that individuals living with both bronchiectasis and rheumatoid arthritis face more than double the risk of death compared to those with bronchiectasis alone. The research, published in Therapeutic Advances in Respiratory Disease, also indicates that RA seropositivity and the use of disease-modifying anti-rheumatic drugs may further heighten this risk.
The study, led by Dr. Hayoung Choi from the Division of Pulmonary, Allergy, and Critical Care Medicine at Hallym University Kangnam Sacred Heart Hospital, analysed data from the Korean National Health Insurance Service covering the years 2010 to 2017. It included 3,355 patients diagnosed with both bronchiectasis and RA — of whom 2,632 were seropositive and 723 were seronegative — and compared them with 16,240 age- and sex-matched individuals who had bronchiectasis but not RA. Participants were followed for a median period of 5.8 years, beginning one year after RA diagnosis or a corresponding index date for the control group.
The study revealed the following findings:
One of the major strengths of the study is its size, making it one of the most comprehensive investigations into the link between RA and bronchiectasis-related mortality. The authors also emphasise its novel exploration of both RA seropositivity and DMARD exposure. However, they acknowledge limitations, including the reliance on diagnostic codes, which may lead to over- or under-diagnosis, and the absence of detailed clinical data such as lung infection rates, hospitalisation history, microbiological findings, RA disease activity measures, or the presence of RA-associated interstitial lung disease. Additionally, the number of patients on DMARDs was relatively small, which restricted the analysis of drug-related outcomes.
The findings emphasize the need for careful monitoring and tailored treatment approaches for patients with both bronchiectasis and RA, particularly those who are seropositive. The study’s authors call for further research to clarify the role of DMARDs in this context and to develop strategies that can help reduce mortality and improve long-term outcomes for this high-risk group.
Reference:
Choi, H., Han, K., Jung, J. H., Soyza, A. D., Kim, H., Shin, D. W., & Lee, H. (2025). Impact of rheumatoid arthritis, seropositivity and disease-modifying anti-rheumatic drugs on mortality risk in bronchiectasis. Therapeutic Advances in Respiratory Disease. https://doi.org/10.1177_17534666251360071
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A new study published in the Journal of Pediatric Urology found that children who have low or borderline vitamin B12 levels are more prone to experience primary monosymptomatic nocturnal enuresis (PMNE).
Urinary control systems may be impacted by micronutrient deficits, especially those involving vitamin B12. The most prevalent voiding issue in the pediatric population is PMNE, which is defined as involuntary nighttime urination in children past the age at which bladder control would typically be expected. Over the past few decades, nocturnal enuresis has continued to be the subject of substantial scientific inquiry due to its high incidence. Despite much discussion, the etiology of PNE is still not fully known.
Although their precise functions in both healthy and diseased settings are not entirely understood, vitamin B12 and folate are crucial for the metabolism, growth, and maturation of the nervous system. Despite a great deal of study on PNE, there are still a lot of concerns about its precise pathogenesis. Thus, this study wanted to determine whether vitamin B12 insufficiency is a possible risk factor for the development of enuresis and to examine the association between children’s blood vitamin B12 levels and PMNE.
A total of 167 age- and sex-matched healthy controls and 184 children with enuresis, ages 5 to 15, were included in this prospective case-control research. Vitamin B12 levels, age, gender, and family history of enuresis were noted for each participant. Serum B12 levels were classified as “normal” (>300 pg/mL), “deficiency” (<200 pg/mL), and “borderline deficiency” (200-300 pg/mL).
Almost, 12.5% of the enuresis group had a B12 shortage, 41.3% had a borderline deficiency, and 46.2% had normal levels. These rates were 9.6%, 29.3%, and 61.1% in the control group, respectively (p<0.05). Multivariate analysis revealed that PMNE was strongly correlated with B12 deficiency (OR: 2.05; 95% CI: 1.01-4.08; p=0.049) and family history of enuresis (OR: 8.62; 95% CI: 4.61-16.13; p<0.001).
Overall, these findings suggest a statistically significant correlation between PMNE and vitamin B12 levels. When compared to healthy controls, B12 deficiency or borderline B12 levels were more prevalent. In addition to a family history of enuresis, a B12 deficiency quadrupled the risk of PMNE. The inclusion of vitamin B12 evaluation in clinical judgment for kids with enuresis is supported by this data.
Reference:
Gülyüz, A. (2025). Relationship between serum vitamin B12 levels and primary monosymptomatic nocturnal enuresis: A prospective case-control study. Journal of Pediatric Urology. https://doi.org/10.1016/j.jpurol.2025.07.032
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Chronic pain frequently coexists with anxiety and depression, complicating treatment outcomes and exacerbating patients’ suffering. Dexmedetomidine (DEX), a selective α2-adrenoreceptor agonist used primarily in perioperative settings, has shown promise in alleviating these co-occurring symptoms due to its analgesic and anxiolytic properties. However, its application in chronic pain patients who also suffer from anxiety and depression remains under-researched. To investigate this, a recent retrospective cohort study evaluated patients who received intravenous DEX during interventional pain management procedures.
The study enrolled 306 chronic pain patients who exhibited no less than mild symptoms of anxiety and depression, as assessed by the GAD-7 and PHQ-9 questionnaires. Participants were divided into two groups: those receiving DEX (n=106) and those undergoing local analgesia (LA) (n=184). Propensity score matching ensured balanced characteristics between the DEX and LA groups, facilitating a robust comparison of outcomes.
Results
The findings demonstrated that at one-month follow-up, DEX administration was associated with significantly greater reductions in anxiety (GAD-7 score reduced by -4.43 for DEX vs. -2.42 for LA) and depressive symptoms (PHQ-9 score reduced by -6.19 for DEX vs. -3.92 for LA). Pain relief was also greater in the DEX cohort (-3.32 vs. -2.62 based on the NRS), indicating DEX’s effectiveness in managing both physical and psychological distress. Patient satisfaction scores were notably higher in the DEX group, reflecting improvements in anxiety management and overall procedural experiences. Sensitivity analyses reinforced these findings, particularly among patients exhibiting both anxiety and depression, and indicated that approximately 18-32% of anxiety and depression improvements could be directly attributed to pain alleviation. Despite these promising results, limitations included the retrospective design, single-center scope, and short follow-up duration, which may affect generalizability and long-term efficacy assessment. The research suggests DEX may serve as a dual-purpose treatment for chronic pain patients with anxiety and depressive symptoms, acting independently on mood regulation beyond analgesic effects. However, further randomized controlled trials are necessary to confirm DEX’s effectiveness, explore neurobiological mechanisms, and determine optimal dosing strategies to enhance outcomes in varied patient populations. Such efforts could lead to integrated approaches in managing chronic pain alongside psychological comorbidities, optimizing therapeutic strategies for multifaceted patient needs.
Key Points
– A retrospective cohort study evaluated the effects of intravenous dexmedetomidine (DEX) in 306 chronic pain patients with mild to moderate symptoms of anxiety and depression, assessing its potential benefits beyond standard local analgesia (LA).
– Participants were divided into two groups: those receiving DEX (n=106) and those receiving LA (n=184), with propensity score matching applied to ensure comparability in demographics and clinical characteristics between the groups.
– Results at one-month follow-up indicated that DEX treatment produced significantly greater reductions in anxiety (GAD-7 score: -4.43 for DEX vs. -2.42 for LA) and depressive symptoms (PHQ-9 score: -6.19 for DEX vs. -3.92 for LA), highlighting DEX’s multifaceted role in managing pain and psychological distress.
– The DEX cohort reported greater pain relief measured by the Numeric Rating Scale (NRS) (-3.32 for DEX vs. -2.62 for LA), along with higher patient satisfaction scores, which emphasized the therapeutic value of DEX in enhancing patient experiences during procedural interventions.
– Sensitivity analyses confirmed the robustness of these findings, especially among patients with concomitant anxiety and depression, revealing that 18-32% of the improvements in anxiety and depression could be attributed to pain relief obtained from DEX treatment.
– Limitations of the study include its retrospective design, the single-center nature of the research, and the relatively short follow-up period, which may restrict the generalizability of the results and necessitate further randomized controlled trials to validate DEX’s efficacy and explore underlying mechanisms in diverse patient populations.
Reference –
Yiting Ren et al. (2025). Dexmedetomidine For Chronic Pain Patients With Anxiety And Depression: A Propensity Score Matching Cohort Study. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03087-x.
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Regulator-approved AI models used in eye care vary widely in providing evidence for clinical performance and lack transparency about training data, including details of gender, age and ethnicity, according to a new review led by researchers at UCL (University College London) and Moorfields Eye Hospital.
The analysis, published in the journal npj Digital Medicine, examined 36 regulator-approved “artificial intelligence as a medical device” (AIaMD) tools in Europe, Australia and the US, and found concerning trends.
Of the devices reviewed, 19% had no published peer-reviewed data on accuracy or outcomes. In evaluating the available evidence for the remainder, the researchers found that across 131 clinical evaluations, only 52% of studies reported patient age, 51% reported sex, and only 21% reported ethnicity. The review also highlights that most validation used archival image sets, with limited diversity or inadequate reporting of basic demographic characteristics and uneven geographical distributions.
Very few studies compared the AI tools head-to-head with each other (8%) or with the standard of care of human doctors (22%). Strikingly, only 11 of the 131 studies (8%) were interventional – the kind that test devices in real-life clinical settings and affect clinical care. This means real-world validation is still scarce.
More than two-thirds of the AI tools target diabetic retinopathy in a screening context, either singly or together with glaucoma and macular degeneration, while other common sight-threatening conditions and settings remain largely unaddressed.
Almost all the devices examined (97%) are approved in the European Union, but only 22% have Australian clearance with just 8% are authorised in the U.S. This uneven regulatory landscape means devices cleared on one continent may not meet standards elsewhere.
The authors argue these shortcomings must be addressed. They call for rigorous, transparent evidence and data that meets the FAIR principles of Findability, Accessibility, Interoperability, and Reusability, since lack of transparency can hide biases.
Lead author Dr Ariel Ong (UCL Institute of Ophthalmology and Moorfields Eye Hospital NHS Foundation Trust) said: “AI has the potential to help fill the global gap in eye care. In many parts of the world, there simply aren’t enough eye specialists, leading to delayed diagnoses and preventable vision loss. AI screening could help identify disease earlier and support clinical management, but only if the AI is built on solid foundations.
“We must hold AI tools to the same high standards of evidence as any medical test or drug. Facilitating greater transparency from manufacturers, validation across diverse populations, and high-quality interventional studies with implementation-focused outcomes are key steps towards building user confidence and supporting clinical integration.”
Senior author Jeffry Hogg, from the University of Birmingham, said: “Our review found that the evidence available to evaluate the effectiveness of individual AIaMDs is extremely variable, with limited data on how these devices work in the real world. Greater emphasis should be placed on accurate and transparent reporting of datasets. This is critical to ensuring devices work equally well for all people, as some populations may be underrepresented in the training data.”
In practical terms, the study suggests several next steps. The authors encourage manufacturers and regulators to adopt standardised reporting – for example, publishing detailed “model cards” or trial results at each stage of development. They note that regulatory frameworks for AIaMDs may benefit from a more standardised approach to evidence reporting, which would give clarity to both device developers and end users. The review also highlights new guidance, such as the EU AI Act, that could raise the bar for data diversity and real-world trials.
The researchers hope their work will inform policymakers and industry leaders to ensure that AI in eye care is both equitable and effective. Robust oversight, they argue, will help deliver on the promise of faster, more accurate eye disease detection—without leaving any patient group behind.
Reference:
Ong, A.Y., Taribagil, P., Sevgi, M. et al. A scoping review of artificial intelligence as a medical device for ophthalmic image analysis in Europe, Australia and America. npj Digit. Med. 8, 323 (2025). https://doi.org/10.1038/s41746-025-01726-8
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A new international study led by researchers at McMaster University has identified the most effective and safest treatments for people suffering from chronic urticaria, more commonly known as chronic hives.
Published in The Journal of Allergy and Clinical Immunology on July 15, 2025, the study is the first comprehensive network meta-analysis to compare more than 40 treatment options for chronic hives, a condition that affects about one per cent of people and can severely impact quality of life, sleep, and productivity. The study examined 93 randomized controlled trials involving over 11,000 participants.
Prior to now, patients and clinicians had to consult a growing list of treatment options without up-to-date evidence.
The research identified the following treatments as most effective:
“This first comprehensive analysis of all advanced treatment options for chronic urticaria provides a clear and evidence-based ‘menu of treatment options’ for patients and their clinicians to choose from,” says Derek Chu, senior author and assistant professor with McMaster’s Department of Medicine.
Chu says the study makes clear which treatment options were the most effective and safe.
Reference:
Chu, Alexandro W.L. et al., Comparative efficacy and safety of biologics and systemic immunomodulatory treatments for chronic urticaria: Systematic review and network meta-analysis, Journal of Allergy and Clinical Immunology.
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The American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) published the Clinical Practice Guideline (CPG): Adult Sinusitis Update today in Otolaryngology–Head and Neck Surgery. The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing adult sinusitis and to provide explicit and actionable guidance that can be implemented across all clinical practices.
“With sinusitis affecting about one in eight adults in the United States each year, this CPG update empowers both patients and their healthcare providers with evidence-based recommendations that can lead to better outcomes,” said Spencer C. Payne, MD, Chair of the Guideline Update Group.
“Key changes from the 2015 guideline include expanding ‘watchful waiting’ as the preferred initial approach for most bacterial sinus infections, since most people get better on their own. We’ve also provided clearer guidance on when antibiotics are truly needed, what the first-choice antibiotic should be, and new information about advanced treatments like biologics for chronic sinusitis with nasal polyps. Most importantly, we’ve emphasized that not all sinus symptoms require antibiotics, and there are effective symptomatic treatments like nasal saline rinses and steroid sprays that can provide relief. We encourage patients to have open conversations with their healthcare providers about these options to find the right treatment approach for their specific situation.”
Sinusitis affects approximately 12% of adults in the United States resulting in over 30 million annual diagnoses. The direct cost of managing acute and chronic sinusitis exceeds $11 billion per year, with additional expense from lost productivity, reduced job effectiveness, and impaired quality of life ranging from $12 to 20 billion. One in five antibiotics prescribed in adults are for sinusitis, making it the fifth most common diagnosis responsible for antibiotic therapy. Despite the high prevalence and economic impact of sinusitis, considerable practice variations exist across and within the multiple disciplines involved in managing the condition.
This CPG update provides 14 research-based key action statements that address such areas as unnecessary antibiotic use, conservative-treatment first approaches, objective confirmation for chronic cases, and targeted therapy options based on specific patient characteristics.
In the development of this CPG update, the guideline update group considered new evidence from 14 guidelines, 194 systematic reviews, and 133 randomized controlled trials. The group, which was led by AAO-HNSF, included representatives from the fields of otolaryngology, infectious disease, family medicine, allergy and immunology, advanced practice nursing, a patient advocate, and staff. Before the guideline was published, it went through public and peer review for comments.
Reference:
Spencer C. Payne, Margo McKenna, Jennifer Buckley, Clinical Practice Guideline: Adult Sinusitis Update, Otolaryngology–Head and Neck Surgery, https://doi.org/10.1002/ohn.1344.
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Premature menopause has been described as a life-changing diagnosis with profound physical, psychological, and social consequences. Affected women not only experience the effects of estrogen deficiency, but they also experience the unanticipated loss of reproductive function. However, some women are more adversely affected by these changes than others. A new study helps explore reasons for these differences. Results are published online today in Menopause, the journal of The Menopause Society.
Premature menopause, medically known as premature or primary ovarian insufficiency (POI), is a condition in which the ovaries cease to function normally before the age of 40. It has been linked to an elevated lifetime risk for depression and anxiety. A recent meta-analysis revealed an odds ratio of 3.3 for depression and 4.9 for anxiety in women with POI compared with those without the condition. The increased risk is understandable given the combined experience of infertility and the additional burdens resulting from estrogen deficiency, such as hot flashes, vaginal dryness, reduced bone mineral density, and an increased risk of cardiovascular disease, among others. For some women, infertility means altered life goals, loss of sense of control, social stigma, and disrupted social roles.
However, not all women experience depression or the same level of depression when presented with the same diagnosis. In this new study, researchers gathered data from nearly 350 women with POI to try to identify the specific variables that contribute to the likelihood of depressive symptoms. Their first observation was the high prevalence of depression among participants. Nearly one-third (29.9%) of the women with POI suffered from depressive symptoms.
The researchers additionally found that a younger age at POI diagnosis, severe menopause symptoms, fertility-related grief, and lack of emotional support were risk factors. No significant difference was found in depressive symptoms between women using estrogen plus progestogen therapy and those not using hormone therapy, underscoring the role of psychosocial factors. Interestingly, a genetic cause for POI was associated with lower depressive symptoms. Another unexpected result was that, even though a higher burden of menopause symptoms was independently associated with depressive symptoms, hot flashes (specifically night sweats) were not.
This is the first known large-scale study to investigate specific variables that are associated with depressive symptoms in women with POI. The researchers believe its results highlight the importance of comprehensive care addressing both physical and psychological aspects of menopause at an early age.
Survey results are published in the article “Depressive symptoms in women with premature ovarian insufficiency (POI): a cross-sectional observational study.”
“The high prevalence of depressive symptoms in those with POI highlights the importance of routine screening in this vulnerable population. Although hormone therapy is recognized as the standard of care for those with POI for management of some menopause-related symptoms and preventive care, it is not first-line treatment for mood disorders. This was evident in this study in which there was no difference in depressive symptoms between those using hormones and those not using hormone therapy. Addressing behavioral-health concerns with evidence-based interventions should be part of any comprehensive POI care plan,” says Dr. Monica Christmas, associate medical director for The Menopause Society.
Reference:
van Zwol‐Janssens, Charissa MD; Louwers, Yvonne V. MD, PhD; Laven, Joop S.E. MD, PhD; Schipper, Jits MD, PhD; Jiskoot, Geranne PhD. Depressive symptoms in women with premature ovarian insufficiency (POI): a cross-sectional observational study. Menopause ():10.1097/GME.0000000000002614, July 15, 2025. | DOI: 10.1097/GME.0000000000002614
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