Despite the frequent co-occurrence of depression and diabetes, gender differences in their relationship remain unclear.

This exploratory study examined if gender modifies the association between depressive symptoms, prediabetes and diabetes with cognitive-affective and somatic depressive symptom clusters.

Cross-sectional analyses were conducted on 29 619 participants from the 2007–2018 National Health and Nutrition Examination Survey. Depressive symptoms were measured by the nine-item Patient Health Questionnaire. Multiple logistic regression was used to analyse the relationship between depressive symptoms and diabetes. Multiple linear regression was used to analyse the relationship between depressive symptom clusters and diabetes.

The odds of having depressive symptoms were greater in those with diabetes compared to those without. Similarly, total symptom cluster scores were higher in participants with diabetes. Statistically significant diabetes–gender interactions were found in the cognitive-affective symptom cluster model. Mean cognitive-affective symptom scores were higher for females with diabetes (coefficient = 0.23, CI: 0.10, 0.36, P = 0.001) than males with diabetes (coefficient = −0.05, CI: −0.16, 0.07, P = 0.434) when compared to the non-diabetic groups.

Diabetes was associated with higher cognitive-affective symptom scores in females than in males. Future studies should examine gender differences in causal pathways and how diabetic states interact with gender and influence symptom profiles.

West Virginia is a rural state with high rates of type 2 diabetes (T2DM) and prediabetes. The Diabetes Prevention and Management (DPM) program was a health coach (HC)-led, 12-month community-based lifestyle intervention.

The study examined the impact of the DPM program on changes in glycosylated hemoglobin (A1C) and weight over twelve months among rural adults with diabetes and prediabetes. Program feasibility and acceptability were also explored.

An explanatory sequential quantitative and qualitative one-group study design was used to gain insight into the pre- and 12-month changes to health behavior and clinical outcomes. Trained HCs delivered the educational sessions and provided weekly health coaching feedback. Assessments included demographics, clinical, anthropometric, and qualitative focus groups. Participants included 94 obese adults with diabetes (63%) and prediabetes (37%). Twenty-two participated in three focus groups.

Average attendance was 13.7 ± 6.1 out of 22 sessions. Mean weight loss was 4.4 ± 11.5 lbs at twelve months and clinical improvement in A1C (0.4%) was noted among T2DM adults. Program retention (82%) was higher among older participants and those with poor glycemic control. While all participants connected to a trained HC, only 72% had regular weekly health coaching. Participants reported overall acceptability and satisfaction with the program and limited barriers to program engagement.

Our findings suggest that it is feasible to implement an HC-led DPM program in rural communities and improve A1C in T2DM adults. Trained HCs have the potential to be integrated with healthcare teams in rural regions of the United States.

This study aimed to assess the association between emotional attitudes towards diabetes, eating behaviour styles and glycaemic control in outpatients with type 2 diabetes.

Observational study.

Endocrinology Division of Hospital de Clínicas de Porto Alegre, Brazil.

Ninety-one outpatients diagnosed with type 2 diabetes. Baseline assessments included data on clinical parameters, lifestyle factors, laboratory results, eating behaviour styles and emotional attitudes. All patients received nutritional counseling following diabetes recommendations. A follow-up visit was scheduled approximately 90 days later to evaluate changes in weight, medication dosages and glycated Hb (HbA1c) values. Patients were categorised based on their emotional attitude scores towards diabetes (positive or negative), and their characteristics were compared using appropriate statistical tests.

At baseline, no differences were observed in the proportion of patients with good glycaemic control, eating behaviour styles and emotional attitudes. However, patients with a positive attitude towards the disease exhibited a significantly better response in glycaemic control compared with the reference group (OR = 3·47; 95 % CI = 1·12, 10·75), after adjusting for diabetes duration, sex and medication effect score. However, when BMI was included in the model, the association did not reach statistical significance. Therefore, these results should be interpreted with caution.

Patients with a positive attitude towards diabetes showed a greater reduction in HbA1c levels following nutritional counseling. However, baseline BMI could be a potential confounding factor.

To characterise the association between risk of poor glycaemic control and self-reported and area-level food insecurity among adult patients with type 2 diabetes.

We performed a retrospective, observational analysis of cross-sectional data routinely collected within a health system. Logistic regressions estimated the association between glycaemic control and the dual effect of self-reported and area-level measures of food insecurity.

The health system included a network of ambulatory primary and speciality care sites and hospitals in Bronx County, NY.

Patients diagnosed with type 2 diabetes who completed a health-related social need (HRSN) assessment between April 2018 and December 2019.

5500 patients with type 2 diabetes were assessed for HRSN with 7·1 % reporting an unmet food need. Patients with self-reported food needs demonstrated higher odds of having poor glycaemic control compared with those without food needs (adjusted OR (aOR): 1·59, 95 % CI: 1·26, 2·00). However, there was no conclusive evidence that area-level food insecurity alone was a significant predictor of glycaemic control (aOR: 1·15, 95 % CI: 0·96, 1·39). Patients with self-reported food needs residing in food-secure (aOR: 1·83, 95 % CI: 1·22, 2·74) and food-insecure (aOR: 1·72, 95 % CI: 1·25, 2·37) areas showed higher odds of poor glycaemic control than those without self-reported food needs residing in food-secure areas.

These findings highlight the importance of utilising patient- and area-level social needs data to identify individuals for targeted interventions with increased risk of adverse health outcomes.

To examine the psychosocial impact of the COVID-19 pandemic on patients with a diagnosis of diabetes mellitus (DM).

Semi-structured interviews were conducted with 31 individuals with DM attending a diabetes clinic to determine the impact of the COVID-19 restrictions on anxiety and depressive symptoms, social and occupational functioning and quality of life. Anxiety symptoms were correlated with functioning, quality of life and diabetes self-management.

Likert data demonstrated that social functioning (mean = 5.5, SD = 3.7) and quality of life (mean = 4.1, SD = 3.1) were most impacted by the COVID-19 pandemic. Anxiety symptoms were prevalent with 13 individuals (41.9%) scoring above cut-off scores for the presence of anxiety symptoms based on the Beck Anxiety Inventory. Diabetes self-management was significantly correlated with functioning (r = 0.51, p = 0.006) and inversely correlated with anxiety symptoms (r = −0.51, p = 0.007). A prior history of a depressive or anxiety disorder was associated with significantly increased anxiety symptoms, as well as impaired global functioning (p < 0.01), poorer self-care of diabetes (p = 0.014) and satisfaction with diabetes treatment (p = 0.03).

The psychological and social impact of COVID-19 restrictions on individuals with DM was significant, with poorer management of diabetes correlated with anxiety symptom severity.

Evidence for necrotising otitis externa (NOE) diagnosis and management is limited, and outcome reporting is heterogeneous. International best practice guidelines were used to develop consensus diagnostic criteria and a core outcome set (COS).

The study was pre-registered on the Core Outcome Measures in Effectiveness Trials (COMET) database. Systematic literature review identified candidate items. Patient-centred items were identified via a qualitative study. Items and their definitions were refined by multidisciplinary stakeholders in a two-round Delphi exercise and subsequent consensus meeting.

The final COS incorporates 36 items within 12 themes: Signs and symptoms; Pain; Advanced Disease Indicators; Complications; Survival; Antibiotic regimes and side effects; Patient comorbidities; Non-antibiotic treatments; Patient compliance; Duration and cessation of treatment; Relapse and readmission; Multidisciplinary team management.

Consensus diagnostic criteria include 12 items within 6 themes: Signs and symptoms (oedema, otorrhoea, granulation); Pain (otalgia, nocturnal otalgia); Investigations (microbiology [does not have to be positive], histology [malignancy excluded], positive CT and MRI); Persistent symptoms despite local and/or systemic treatment for at least two weeks; At least one risk factor for impaired immune response; Indicators of advanced disease (not obligatory but mut be reported when present at diagnosis). Stakeholders were unanimous that there is no role for secondary, graded, or optional diagnostic items. The consensus meeting identified themes for future research.

The adoption of consensus-defined diagnostic criteria and COS facilitates standardised research reporting and robust data synthesis. Inclusion of patient and professional perspectives ensures best practice stakeholder engagement.

This study aimed to identify unmet and unperceived needs for T2D self-management among those residing in Tabriz slums, Iran, in 2022.

Type 2 diabetes (T2D) and its complications are more common among slum dwellers. T2D is a lifelong disease that requires continuous care. By contrast, slum dwellers are less likely to adhere to standard health care.

This study is cross-sectional. We included 400 patients using a systematic random sampling method. Unmet and unperceived needs were assessed through a researcher-made questionnaire. The questionnaire was developed based on Iran’s Package of Essential Non-Communicable Diseases (IraPEN) instructions and an expert panel. Data were analyzed using SPSS version 22.

Need for more healthcare cost coverage by insurance organizations (85.5%), financial support to provide medicine (68%), free and accessible sports equipment in the area (48.5%), continuous access to blood sugar test instruments (47.8%), know how to test blood sugar and interpret the results (47.7%), more communication with healthcare providers (42.3%), and detailed education from health professionals (41.2%) were the most common unmet needs. The least perceived need was to know how to care for feet (16%).

Comorbid depression substantially affects the management of glycemia and diabetes-related complications among patients with type 2 diabetes mellitus. In this study, we sought to determine the association between weight change over 4 years and depression risk among patients with type 2 diabetes mellitus.

This population-based retrospective cohort study from the National Health Insurance Services of Korea included 1 111 345 patients with type 2 diabetes who were divided into groups according to body weight change over 4 years. Body weight changes were compared with the preceding 4-year period (2005–2008). Depression was defined according to the International Classification of Diseases 10th revision code for depression (F32 and F33) on one or more inpatient or outpatient claims.

During a median follow-up of 7.4 years, 244 081 cases of depression were identified. We observed a U-shaped association between body weight change and depression risk with a higher risk among both groups of weight loss (hazard ratio (HR) 1.17, 95% CI 1.15–1.19 for ⩾ −10%; HR 1.07, 95% CI 1.06–1.08 for −10 to −5%) and weight gain (HR 1.06, 95% CI 1.04–1.08 for ⩾10%; HR 1.02, 95% CI 1.01–1.04 for 5–10%) compared with the stable weight group (−5 to 5%).

A U-shaped association between body weight change and depression risk was observed in this large nationwide cohort study. Our study suggests that patients with type 2 diabetes and weight change, either gain or loss, could be considered a high-risk group for depression.

Recurrent respiratory papillomatosis is a benign manifestation of human papillomavirus types 6 and 11 in the respiratory tract. Disease is recurrent, and factors predicting these recurrences and severity of disease are incompletely characterised. This retrospective cohort study examined the relationship of immunosuppression with recurrent respiratory papillomatosis morbidity.

A retrospective cohort of 97 adult patients with recurrent respiratory papillomatosis treated at a tertiary referral centre from 2005 to 2020 was conducted. Measures assessed included inter-surgical interval, Voice Handicap Index (‘VHI-10’) and anatomical Derkay scores.

Bivariate analyses comparing average inter-surgical interval, Voice Handicap Index and Derkay scores in immunosuppressed and healthy patients were insignificant. When controlling for diabetes mellitus and comparing immunosuppressed to healthy patients, inter-surgical interval and Voice Handicap Index change were insignificant (p = 0.458 and p = 0.465, respectively).

Recurrent respiratory papillomatosis morbidity for immunosuppressed patients did not significantly differ from that of immunocompetent patients.

Necrotising otitis externa is a serious infection with minimal evidence underpinning its management. This review aims to synthesise published evidence of antimicrobial therapies and their outcomes in necrotising otitis externa.

The review was PROSPERO registered (CRD42022353244) and conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses (‘PRISMA’) guidelines. A robust search strategy filtered 28 manuscripts into the final review. Antimicrobial therapy and clinical outcome data were extracted and analysed.

Published studies are heterogeneous, with high risk of bias and low certainty. Reporting of outcomes is poor and extremely variable. First-line therapy is most commonly in-patient (95 per cent) empiric fluoroquinolone (68 per cent) delivered intravenously (82 per cent). The lack of granular data and poor outcome reporting mean it is impossible to correlate treatment strategies with clinical outcomes.

Robust, consistent outcome reporting with reference to treatments administered is mandatory, to inform clinical management and optimise future research. Optimal antimicrobial choices and treatment strategies require clarification through prospective clinical trials.

Based on previous qualitative studies, it was hypothesised that dissimilarities in beliefs about illness, which influence healthcare-seeking behaviour, exist between foreign- and native-born persons diagnosed with type 2 diabetes living in Sweden (in the following termed ‘Swedish-born’).

Beliefs about illness are individual, culturally related, based on knowledge, and guide health-related behaviour, and thus have an impact on health. The question is whether beliefs differ between foreign- and native-born persons diagnosed with type 2 diabetes. No previous comparative studies have been found on this. Based on previous qualitative studies, it was hypothesised that dissimilarities in beliefs about illness, which influence healthcare-seeking behaviour, exist between foreign- and native-born (Swedish) persons diagnosed with type 2 diabetes living in Sweden.

Cross-sectional survey, 138 participants, comprising 69 foreign- and 69 Swedish-born persons aged 33–90 vs 48–91 years. Data were analysed with descriptive and analytic statistics.

Beliefs about illness differed between foreign- and Swedish-born persons concerning causes of diabetes and healthcare-seeking behaviour. Foreign-born persons more often than Swedish-born persons reported uncertainty or lack of knowledge about whether heredity (67% vs 90%, P = 0.002) and pancreatic disease (40% vs 62%, P = 0.037) could cause diabetes. To a higher extent than Swedish-born persons, they reported that emotional stress and anxiety could cause the disease. Furthermore, they claimed they had sought care due to diabetes during the last 6 months to a higher extent than Swedish-born persons (30% vs 4%, P = 0.000).

The findings confirmed that dissimilarities in beliefs about illness, including the causes of diabetes and healthcare-seeking behaviour, exist between foreign- and Swedish-born persons with type 2 diabetes.

A key clinical feature of necrotising otitis externa is granulation tissue arising from the ear canal, representing epidermal compromise. The aim of this work was to explore the role of epidermal compromise in the aetiology of necrotising otitis externa.

A structured risk factor history was taken from 54 patients diagnosed with necrotising otitis externa between 2017 and 2022. Primary care records were also reviewed.

A total of 94 per cent of patients reported incidents of potential epidermal compromise preceding severe pain onset, including a 35 per cent incidence of ear syringing. A total of 94 per cent of patients were immunosuppressed, including 78 per cent with diabetes. All patients had medical co-morbidities.

This study proposed an aetiological triad for necrotising otitis externa: immunosuppression, infection and epidermal compromise. Epidermal compromise is a potentially modifiable risk factor for necrotising otitis externa. Meticulous primary ear care for older adult, diabetic and immunosuppressed patients is recommended. These populations should never undergo ear syringing and should avoid ear canal trauma and prolonged exposure to moisture.