Randomised controlled trials have demonstrated that treatment with glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduces body weight, waist circumference and haemoglobin A1c (HbA1c) levels in patients with schizophrenia. However, because of participant selection in clinical trials, it remains unclear whether the beneficial metabolic effects of GLP-1RAs for patients with schizophrenia extend to real-world clinical settings.

We investigated whether GLP-1RA treatment initiation was associated with reductions in HbA1c, low-density lipoprotein (LDL) and triglyceride levels (the latter two as proxies for weight loss) in individuals with schizophrenia.

We used the Danish nationwide registers to identify individuals with schizophrenia between 1996 and 2023. Among those, we identified individuals initiating GLP-1RA treatment. The main outcomes were changes in HbA1c, LDL and triglyceride levels following initiation of GLP-1RA treatment. Changes in HbA1c, LDL and triglyceride levels were visualised graphically and quantified with interrupted time-series analyses.

We identified 3042 individuals with schizophrenia who initiated a GLP-1RA. Initiation of GLP-1RA treatment for diabetes was followed by reductions in HbA1c, LDL and triglyceride levels of 11.4, 6.2 and 14.8%, respectively. Initiation of GLP-1RA treatment for overweight was followed by reductions in HbA1c, LDL and triglyceride levels of 3.4, 4.9 and 12.7%, respectively. All level changes were statistically significant (p < 0.001).

Initiation of GLP-1RA treatment was followed by clinically meaningful reductions in HbA1c, LDL and triglyceride levels among individuals with schizophrenia. These findings suggest that the metabolic benefits of GLP-1RA treatment found in randomised clinical trials in schizophrenia extend to real-world clinical settings.

This study aimed to examine the associations among complication risk perception, gender role stress, and symptom management self-efficacy in patients with Type 2 diabetes mellitus and to identify factors associated with these constructs.

This analytical cross-sectional study was performed at the endocrinology outpatient clinic of a hospital. The sample consisted of 500 Type 2 DM patients (250 women, 250 men). Study data were gathered through the Individual Information Form (IIF), Risk Perception Survey–Diabetes Mellitus Scale (RPS-DM), Symptom Management Scale for Self-Efficacy (SMSSE), Feminine Gender Role Stress Scale (FGRSS), and Masculine Gender Role Stress Scale (MGRSS). The data were analyzed using the Mann–Whitney test, Kruskal–Wallis H test, Spearman correlation coefficients, and binary logistic regression.

It was determined that both in women and men, it was found that as gender role stress increased, composite and environmental risk perceptions increased, and symptom management self-efficacy decreased (p < 0.001). According to logistic regression analysis, when risk knowledge increases in women, self-efficacy will increase (OR: 0.595), and composite risk perception will decrease (OR: 7.377). When composite risk perception increases in men, self-efficacy will decrease (OR: 16.933).

Complication risk perception and gender role stress were associated with symptom management self-efficacy among patients with Type 2 DM, with these associations differing by sex. Future interventional studies are needed to determine whether addressing these factors improves symptom management for self-efficacy. The findings may also help nurses recognize sex-specific differences when planning individualized patient care.

We aimed to examine changes in antidiabetic drug utilization associated with implementation and subsequent easing of pandemic-related restrictions.

The COVID-19 pandemic and associated restrictions disrupted healthcare access and glycemic regulation, affecting diabetes management.

We collected nationwide outpatient antidiabetic drug sales and projected prescribing data from IQVIA Turkey between 01.03.2018 and 31.12.2022. We assessed average monthly consumption, expenditure, and quarterly prescribing trends across ‘before restrictions’ (BfR, 01.03.2018–31.03.2020), ‘during restrictions’ (DuR, 01.04.2020–31.03.2022), and ‘after restrictions’ (AfR, 01.04.2022–31.12.2022) periods. Consumption and prescribing levels were expressed as ‘defined daily doses/1,000 inhabitants/day’ (DID).

Antidiabetic consumption increased from 123.6 ± 12.2 DID in BfR to 156.3 ± 25.4 DID in DuR and remained elevated in AfR (151.2 ± 28.9 DID), paralleled by expenditure (€63.6 m ± 8.4 m, €85.1 m ± 14.8 m, and €83.9 m ± 19.1 m, respectively). Prescribing levels declined from BfR to DuR (56.4 ± 3.5 to 29.9 ± 3.6 DID, p < 0.001) and slightly recovered in AfR (46.0 ± 10.9 DID, p > 0.05 vs. earlier periods). Oral antidiabetic consumption rose from 71.2 ± 6.8 DID in BfR to 90.6 ± 17.2 DID in DuR (p < 0.001) and further to 96.9 ± 19.4 DID in AfR (p < 0.001 vs. BfR), while sodium-glucose cotransporter-2 inhibitor use increased across periods (p < 0.001). Injectable antidiabetic consumption, mainly insulins, increased from BfR to DuR (p < 0.001), and decreased in AfR (p < 0.01 vs. DuR).

We demonstrated a sustained increase in antidiabetic consumption following implementation of COVID-19-related restrictions, persisting beyond easing of most measures. Medication-access policies, panic stockpiling, improved glycemic adherence, and newer therapies might have contributed. These findings may inform strategies to strengthen family physician-community pharmacist coordination while maintaining treatment continuity and optimizing medication access during future public health emergencies.

People with depressive disorder have increased premature mortality and higher rates of diabetes mellitus than general population. Evidence shows that diabetes may further increase their risk of premature death from diabetes-related complications, especially cardiovascular diseases (CVDs). Earlier studies examining depression-associated outcomes in diabetes patients have shown mixed results and were hindered by important limitations, especially the use of self-reported questionnaires to ascertain depression, causing misclassification bias by identifying subclinical symptoms or diabetes distress. Associations of depression with specific diabetes complications have not been systematically evaluated. This meta-analysis aimed to investigate the risk of mortality and complications among patients with depression and co-occurring diabetes (depression-diabetes group) relative to patients with diabetes-only (diabetes-only group), on their all-cause mortality rates, and if applicable cause-specific mortality rates, and occurrence of specific diabetes complications.

We systematically reviewed and quantitatively synthesized diabetes-related outcomes in patients with depression by searching Embase, MEDLINE, PsycInfo and Web-of-Science from inception to 20 December 2024, and included studies that examined mortality and complication outcomes in depression-diabetes group relative to diabetes-only group. Results were synthesized by random-effects meta-analytic models, with stratified-analyses (subgroup analyses and meta-regression) by study-level characteristics, including age, gender, study period, geographic region, follow-up duration and nature of diabetes sample. The study was registered with PROSPERO (CRD42024595145).

Twenty-six studies were identified from nine geographic regions. Regarding mortality risk, depression-diabetes group exhibited increased risks of all-cause mortality (RR = 1.30 [95% CI: 1.21–1.39]) and CVD-specific mortality (1.15 [1.02–1.29]) relative to diabetes-only group. Regarding complication risk, depression-diabetes group showed increased risk of complications (1.28 [1.18–1.40]) relative to diabetes-only group, especially in incident-diabetes sample signifying advanced disease stage upon presentation, with stratified-analyses showing higher risk of metabolic complications (1.63 [1.33–1.99]) and cardiovascular complications (1.20 [1.11–1.29]), and lower likelihood of retinopathy (0.84 [0.76–0.94]), albeit comparable rates of cerebrovascular complications (1.36 [0.99–1.87]), nephropathy (1.09 [0.93–1.27]) and peripheral-vascular complications (0.97 [0.79–1.18]). Both overall mortality and complication risks were present in various regions and persisted over time. Heterogeneities were noted and could not be entirely explained by stratified analyses.

Our study demonstrated that patients with depression and co-occurring diabetes were associated with elevated overall mortality risk and complication risk (particularly metabolic and cardiovascular-complications) than non-depressed counterparts, suggesting an overall poorer glycemic control that might eventually drive their earlier death. Comprehensive and multipronged interventions are needed for individualized risk estimation of diabetes-related outcomes, with consequent early interventions to minimize the avoidable physical morbidity and premature mortality in this vulnerable population.

Diabetes and mental health problems are closely linked, yet evidence examining this relationship among international labour migrants in the Gulf region is limited. Labour migrants are exposed to distinct occupational and psychosocial stressors that may increase vulnerability to depression and anxiety, particularly in the context of chronic diseases such as diabetes.

This study examined the prevalence and correlates of depressive and anxiety symptoms among male migrant workers with type 2 diabetes attending out-patient services in Qatar.

A clinic-based, cross-sectional study was conducted among adult male migrants receiving care at endocrinology out-patient clinics in Qatar. Symptoms of depression and anxiety were assessed using Patient Health Questionnaire 9 and Generalized Anxiety Disorder 7. Sociodemographic and clinical variables were collected using structured questionnaires and electronic medical records. Associations between clinical and sociodemographic factors and mental health outcomes were examined using chi-square tests and logistic regression analyses.

A total of 339 participants were included, predominantly of South Asian origin. Clinically significant depressive symptoms were identified in 21.3% of participants, with 14.8% reporting clinically significant anxiety symptoms. Depression severity was significantly associated with diabetes treatment modality and past psychiatric history. Anxiety severity was significantly associated with ethnicity and past psychiatric history. In multivariate analysis, past psychiatric illness independently predicted anxiety symptoms (odds ratio 6.24, 95% CI: 1.91–20.38, p = 0.002). No significant associations were observed between mental health outcomes and glycaemic control or duration of diabetes.

Lower-skilled male labour migrants with diabetes experience a substantial burden of depressive and anxiety symptoms, highlighting a clinically important but often overlooked dimension of diabetes care in this population. Past psychiatric illness and more complex diabetes treatment regimens were associated with poorer mental health outcomes. These findings support the need for integration of mental health assessment and targeted support within routine diabetes services for migrant worker populations.

Necrotising otitis externa is a severe, potentially life-threatening infection of the external auditory canal and skull base, first formally described by Chandler in 1968. However, historical literature suggests that its clinical features were recognised long before this, without conceptual unification.

A narrative historical review was undertaken using primary and secondary sources, including early otological texts, case reports and modern literature.

Descriptions consistent with necrotising otitis externa appear as early as the nineteenth century, with recurrent observations of severe otitis externa, temporal bone involvement and systemic vulnerability. These remained fragmented across diagnostic categories until the mid-twentieth century. Chandler’s work represents a transition from clinical observation to conceptual recognition, providing a unifying framework that enabled consistent diagnosis, comparison and subsequent study of the condition.

The evolution of necrotising otitis externa reflects a process of progressive recognition, offering insight into ongoing challenges in defining and studying the disease in contemporary clinical practice.

Diabetes distress, whereby people with diabetes experience distressing psychological symptoms associated with living with their condition, is an emerging problem in India. Diabetes distress leads to self-care deficits, suboptimal glycaemic control (which can lead to increasing risks of complications) and impaired quality of life.

To determine the burden of diabetes distress and its associated factors in an Indian tertiary care centre in Trichy, Tamil Nadu, India, covering a population of 1.25 million.

This prospective observational study involved a structured questionnaire covering demographic and clinical details, which was given to patients. The Diabetes Distress Scale 17 (DDS-17) was used to assess diabetes distress levels. The DDS-17 also measures four subdomains: emotional burden, physician-related distress, regimen-related distress and diabetes-related interpersonal distress. Patients were divided into two groups based on their DDS-17 score: no diabetes distress (DDS-17 score <2) versus diabetes distress (DDS-17 score ≥2) and compared. Correlation analysis, chi-squared tests and t-tests were used, with P < 0.05 considered statistically significant.

Of 1019 respondents (mean age 56 years; 59.6% male, 40.4% female), diabetes distress was reported in 24.4% (n = 249). Factors significantly associated with higher DDS-17 scores were younger age (<45 years) (P < 0.0001), long-standing diabetes (>10 years) (P < 0.0001), and smoking and alcohol (P < 0.05). Significant protective factors for diabetes distress included working, daily exercise, no comorbidities and medical insurance cover (P < 0.05). Significant positive correlation between DDS-17 score and all four subdomains was observed (P < 0.0001).

Our findings highlight the need for routine psychological screening and holistic management strategies in diabetes care, to improve patient outcomes and quality of life.

The dual burden of tuberculosis (TB) and diabetes mellitus (DM) presents a growing challenge for health systems in low- and middle-income countries (LMICs), including Pakistan. Despite global and national policies advocating for integrated care, evidence on health facility readiness to operationalize integration remains scarce. This study assessed the readiness of TB basic management units (BMUs) to deliver integrated TB-DM care and explored implementation barriers using the Consolidated Framework for Implementation Research (CFIR).

We conducted an explanatory sequential mixed-methods study from September 2024 to February 2025 across 13 TB BMUs in five districts of Pakistan. Quantitative readiness data were collected using a structured tool adapted from the WHO Service Availability and Readiness Assessment (SARA), generating a composite score across four domains. Subsequently, qualitative data were gathered through multi-stakeholder focus group discussions with healthcare providers, facility managers, patients, caregivers, and policymakers. Reflexive thematic analysis was conducted and mapped to CFIR Inner Setting constructs to contextualize quantitative findings.

Only one facility demonstrated high readiness, while 12 showed low readiness. Facilities lacked routine comorbidity screening, trained staff, diagnostic capacity, and essential medicines. Key barriers included inadequate infrastructure, workforce shortages, fragmented information systems, and low prioritisation of integrated care. Financial constraints and limited coordination further hindered implementation.

This study highlights critically low readiness among TB facilities in different districts of Pakistan to deliver integrated TB-DM care, reflecting systemic weaknesses across core domains. Strengthening systems, building capacity, and improving integration strategies are essential to bridge gaps between policy and practice.

This study aimed to determine the prevalence of undiagnosed diabetes and prediabetes in patients presenting with recurrent otomycosis and to evaluate associated risk factors, fungal profiles and cerumen pH variations.

This cross-sectional study included 213 adults with greater than or equal to two episodes of otomycosis. Glycaemic status was assessed using fasting blood sugar, post-prandial blood sugar and glycated haemoglobin. Fungal identification and cerumen pH measurement were performed. Multivariate analysis identified predictors of recurrence.

Undiagnosed diabetes and prediabetes were found in 30 per cent and 13 per cent of patients, respectively. Candida albicans predominated in diabetics, while Aspergillus niger was common in normoglycaemics. Cerumen pH was significantly higher in diabetics (6.6) compared to normoglycaemics (5.3). Glycated haemoglobin greater than or equal to 6.5 per cent, Candida infection and steroid ear drop use were independent predictors of recurrence.

A substantial proportion of patients with recurrent otomycosis harbour unrecognised glycaemic abnormalities. Routine diabetes screening in ENT clinics may aid in early metabolic disease detection and reduce recurrence rates.

Necrotising otitis externa is a serious infective condition with significant risk of complications and a profound impact on patients’ quality of life.

A quantitative descriptive study was undertaken using epidemiological data from the National Health Service Hospital Episode Statistics database and other national databases. Data correlating with reported cases 2002-2024 were compiled and analysed.

The national incidence of necrotising otitis externa has demonstrated a sustained increase 2002-2024. The 30 per cent incidence drop during the coronavirus disease 2019 pandemic may be attributable to reduced exposure to risk factors, reduced contact between susceptible patients and health professionals and pandemic-related deaths of at-risk populations. There remains a strong correlation between growths in necrotising otitis externa incidence, the ageing population and national incidence of diabetes mellitus. These are all projected to continue to rise. Antibiotic resistance is not a significant contributing factor.

This study demonstrates several significant trends, offering a strong foundation for deeper exploration in future studies.