Interventions for older adults with NCDs and depression should be relevant to the risk factors for NCDs in non-WEIRD populations. We conducted a single-group pilot study of the Ziba Ufa intervention, consisting of problem-solving therapy and health education over 6 weekly sessions delivered by lay counsellors; there was no control group. Participants were opportunistically sampled through outpatient NCD clinics in four sites in Kilimanjaro, Tanzania. We conducted exploratory analyses of the clinical relevance of the health education using self-report survey data, and perceived relevance using qualitative interviews. Thirty-two participants enrolled (88% with hypertension and 44% with type 2 diabetes). Of the 21 participants with height and weight data, 12 (57%) were obese. Advice on weight loss, a sleep routine, and increasing fruit and vegetable consumption may be clinically relevant, but alcohol and tobacco consumption, levels of physical activity and consumption of processed foods with added sugar or salt were self-reported as meeting recommendations; therefore, they may be less clinically relevant. Participants reported acting on the sleep advice more than on the dietary and physical activity advice. This may indicate that sleep advice was perceived as relevant, but dietary and physical activity advice was not.

Human milk is a dynamic, bioactive fluid that supports infant growth, development, and immune protection. Gestational diabetes mellitus (GDM), characterised by glucose intolerance with onset during pregnancy, is associated with altered maternal metabolism that may persist postpartum and affect lactation and milk composition. To systematically evaluate and meta-analyse evidence on associations between maternal GDM and human milk composition across lactation, five electronic databases were searched for studies comparing human milk composition between mothers with and without GDM. Data were extracted for milk macronutrients, lipids, oligosaccharides, hormones and metabolic regulatory factors, immune and inflammatory factors, micronutrients and antioxidants, and multiomics across colostrum, transitional, and mature milk. Meta-analyses were conducted where possible. Fifty-two studies with 3233 mothers were included. Macronutrient content, total fat, and fatty acids were found to be similar between GDM and non-GDM milk. However, lactose concentrations were lower in GDM colostrum. In addition, mothers with GDM who were not taking docosahexaenoic acid (DHA) supplements had lower DHA concentrations than mothers without GDM. Appetite- and metabolism-related peptides were lower in colostrum, whereas other regulatory peptides were higher. Mothers with GDM had lower colostrum concentrations of human milk oligosaccharides (HMOs), including 2′-fucosyllactose and 6′-sialyllactose, with partial normalisation in mature milk. Immune, metabolomic, and proteomic findings were heterogeneous but indicated stage-dependent remodelling. GDM is associated with selective, lactation-stage-specific alterations in the bioactive and functional components of human milk rather than the disruption of core nutritional composition. The stage-specific nature of these alterations suggests that human milk composition may adapt to maternal physiological changes during lactation.

Dietary acid load (DAL), which reflects diet’s overall acid–base balance, has been proposed to influence glucose metabolism; however, epidemiological findings on its relationship with diabetes risk remain inconsistent. While Western studies suggest that higher DAL is associated with higher diabetes risk, particularly among women, findings from East Asian populations have been inconsistent, particularly regarding sex-specific associations. The present prospective study examined the association between DAL and 5-year diabetes incidence among Japanese adults, focusing on sex-specific differences. Data were obtained from 19 040 participants (7037 men and 12 003 women) in the Japan Collaborative Cohort Study. DAL was estimated based on the potential renal acid load (PRAL) and net endogenous acid production (NEAP) derived from a validated food-frequency questionnaire. Odds ratios and 95 % confidence intervals for incident diabetes were estimated separately for men and women across PRAL and NEAP quartiles using multivariable logistic regression with multiple imputations for missing covariates. During follow-up, 490 new diabetes cases were identified (245 in each sex). Among women, higher DAL was significantly associated with a higher risk of diabetes; OR (95 % CI) from multivariable-adjusted model, including socio-demographic, lifestyle, health status and macronutrient covariates, comparing the highest with the lowest quartiles were 1·61 (1·09, 2·37) for PRAL and 1·72 (1·18, 2·52) for NEAP. No clear associations were observed among men. The findings provide a foundation for further studies in East Asian populations using more precise dietary assessment methods to clarify the association between DAL and incident diabetes and to inform dietary guidelines and preventive strategies.

This research sought to update understanding following improvements to treatment and deepen the understanding of the mortality risk associated with Type 1 or Type 2 diabetes, including relative risk in the presence of co-morbidities. Specifically, we developed a model to provide mortality predictions at a granular level for lives with and without diabetes. The model is tailored for use by the insurance industry to provide an updated source from which to appreciate the risk posed when underwriting people with diabetes. By providing an updated and deeper understanding of mortality risk, the research’s aim is to improve access to insurance for those individuals living with diabetes. The model combines industry standard underwriting risk factors, such as age, gender, deprivation index, body mass index (BMI), smoker status, blood pressure (BP) and cholesterol level, with various co-morbidities related to diabetes. A comprehensive analysis of mortality risk factors, between 2010 and 2019, for people with and without diabetes is undertaken on over 1.2 million records based on Clinical Practice Research Datalink (CPRD), Hospital Episode Statistics (HES) and Office for National Statistics (ONS) death registrations data. Cox proportional hazards models are used to estimate the probability of death, stratified by gender across three distinct populations: Type 1 diabetes, Type 2 diabetes and a general population sample. The model outputs produced are permutations of the following: gender; population split by general sample, Type 1 and Type 2 diabetes; and a time-dependent exponential model and a time-invariant homogeneous model. A Shiny model application allows interaction with the model outputs (https://0jv7e6-scott-reid.shinyapps.io/diabmdl/) and spreadsheets provide additional explanation. Useful insights were obtained through industry discussions on the variation of existing market practice against that implied by the results. Key rating factors were generally aligned with market practice, such as age, BMI, BP, cholesterol and years since a diabetes diagnosis. However, for a few significant mortality risks impacting co-morbidities, the results did not adhere to prior expectations. Exploratory work suggested that the order and sequencing of key co-morbidities for diabetes must be included in future model development.

Women with diabetes frequently experience ovarian dysfunction, which is a significant indication that diabetes adversely affects their reproductive health. This study investigates the efficacy of combined treatment with Pioglitazone and Cynara scolymus extract in improving ovarian function in streptozotocin-induced diabetic rats. A total of 35 female rats were divided into five groups: (1) Control (saline), (2) DM (diabetic control), (3) DM + Piog (30 mg/kg Pioglitazone), (4) DM + Cynara (400 mg/kg C. scolymus extract), and (5) DM + Piog + Cynara (combined treatment), and were administered orally for 30 consecutive days. Following treatment, histopathological and stereological analyses were performed to evaluate follicular development, corpus luteum volume, and oxidative stress markers. The results indicated that the combined treatment (DM + Piog + Cynara) led to significant improvements, including increased numbers of preantral, antral, and Graafian follicles, alongside an enhanced corpus luteum volume. Additionally, there was a notable reduction in atretic follicles and fasting blood glucose levels compared to the diabetic group. Diabetes resulted in elevated malondialdehyde (MDA) levels and decreased antioxidant enzyme activities. However, the combination therapy effectively modulated apoptotic pathways, enhancing Bcl-2 expression while reducing Caspase-9 activity. This study demonstrates that the combined therapy of C. scolymus extract and Pioglitazone mitigates diabetic-induced ovarian dysfunction by reducing oxidative stress, normalizing hormonal levels, and promoting healthy folliculogenesis. These findings suggest that this approach may serve as a promising complementary treatment for diabetes-related reproductive issues, potentially improving reproductive health.

Diabetes mellitus is a significant health burden, and recent reports indicate an increase in diabetes-related complications in the United States (U.S.). The mission of the National Institute of Diabetes and Digestive and Kidney Diseases Centers for Diabetes Translational Research (CDTR) is to improve the translation of research findings in diabetes prevention and treatment by supporting research across the translational science spectrum. To facilitate this mission, it is imperative to support multidisciplinary translational early-stage investigators (ESIs) to address the societal-, environmental-, and individual-level factors that impact diabetes outcomes. In this special communication article, we characterize the challenges, opportunities, and needs of ESIs transitioning to mid-careers whose goals are to develop a career in diabetes translational research. These challenges and opportunities were collected from 34 ESIs and 19 senior faculty members from 23 institutions across the U.S. who attended the inaugural CDTR National Enrichment Program Conference. Our findings aim to promote the engagement of ESIs in diabetes translational research and provide guidance in strengthening and sustaining their research careers.

Displaced persons with non-communicable diseases (NCD) face challenges in disease management and increased risk of mental health problems. This randomized controlled trial assessed the impact of psychotherapy treatment (Common Elements Treatment Approach [CETA]) on hypertension and diabetes mellitus medication adherence (primary) and mental and physical health outcomes (secondary) among displaced Myanmar adults with poor medication adherence in a Thai shelter community. Treatment participants received weekly CETA for 4–12 weeks; comparison participants had access to routine psychosocial support. Eligible participants were chronic disease patients with <70% medication adherence over prior month. Data were collected at baseline, 3 and 6 months. Of 650 adults screened, 283 (43.5%) met eligibility criteria and 224 consented (CETA n = 112, comparison n = 112) to participate; 73 (32.6%) reported elevated mental health symptoms. At 6-month follow-up, medication adherence improved in both arms, with greater improvements among CETA participants (MARS-5: 0.55, 95% CI: 0.07 to 1.02, p = 0.023). CETA significantly reduced mental health symptoms among those with elevated symptoms at baseline (−3.06, 95% CI: −5.19 to −0.93, p = 0.005). The high rate of mental health symptoms and the impact of CETA on NCD medication adherence supports integration of mental health services into NCD care systems.

Greater consumption of red meat has been linked to a higher risk of mortality and chronic diseases, including diabetes. We aim to examine the associations between total, processed and unprocessed red meat intake and diabetes and to evaluate the substitution effects of other protein sources for red meat on diabetes. This population-based cross-sectional study utilised data from the National Health and Nutrition Examination Survey (NHANES) 2003–2016. Diabetes was defined as a self-reported diagnosis by a physician or other health professional, having a fasting plasma glucose of 126 mg/dl or higher, an HbA1c level of 6·5 % or higher, or the use of antidiabetic drugs. Multivariable logistic regression models were conducted. The study included 34 737 adult participants (mean (sd) age of 45·8 (17·5) years) from NHANES 2003–2016. After adjusting for major confounders, compared with the first quintile, higher intakes of total, processed and unprocessed red meat were positively associated with higher odds of diabetes, with adjusted OR of 1·49 (95 % CI 1·22, 1·81), 1·47 (95 % CI 1·17, 1·84) and 1·24 (95 % CI 1·06, 1·44), respectively. The corresponding P-trend values were (< 0.001, 0.001, and 0.006). In this nationally representative sample of US adults, participants in the highest quintiles of total, processed and unprocessed red meat intake had higher odds of diabetes than those in the lowest quintile. Substituting 1 serving/d of dietary protein from foods of plant origin (including nuts, seeds, legumes and soya) for total, processed or unprocessed red meat was associated with 9 % to 14 % lower odds of diabetes.