ABSTRACTIntroductionThe use of metformin among children and adolescents has risen in the past decade; however, its effect on vitamin B12 has been unclear. To address this gap, we conducted this first systematic review and single‐arm meta‐analysis.ObjectiveTo investigate the effect of metformin on vitamin B12 levels.MethodsPubMed, Scopus and Web of Science were systematically searched until April 2025. The primary outcomes were the effect of metformin on vitamin B12 levels after 6 and 12 months of duration, and vitamin B12 deficiency after at least 12 months of usage. We conducted the risk‐of‐bias assessment using the NOS and Cochrane ROB2 tool. The mean difference (MD) and standard error (SE) were calculated and used for analysis. We assessed the heterogeneity of the studies using the chi‐squared test and measured it with the I2 statistic. A fixed effects model was applied to calculate the pooled MD in the absence of significant heterogeneity. The registration number in PROSPERO 2025 is CRD420251045023.ResultsA total of five articles were included in this systematic review and meta‐analysis. The pooled rate of vitamin B12 deficiency in RCT studies after at least 12 months of use was 1.4% [95% CI: −0.012, 0.040] with mild heterogeneity (I2 = 30.87%, p = 0.235). While in observational studies the pooled rate was 18.7% [95% CI: −0.212, 0.586] with substantial heterogeneity (I2 = 87.93%, p = 0.004). Vitamin B12 levels decreased after 6 and 12 months of using metformin; however, it was neither statistically nor clinically significant (p > 0.05).ConclusionMore trials with larger sample sizes and longer durations of follow‐up are needed to better understand the risk of vitamin B12 deficiency among the paediatric population.Trial Registration: PROSPERO (CRD420251045023).

Selenium supplementation has been suggested as a therapeutic option for Hashimoto's thyroiditis, but its effects on thyroid function and other patient-related outcomes remain unclear. This retrospective cohort study utilised a global federated health research network to compare patients with Hashimoto's thyroiditis who received selenium supplementation after diagnosis to those who did not. Propensity score matching was performed to balance baseline characteristics. Primary outcomes included longitudinal thyroid function measures, while secondary outcomes included development of autoimmune diseases, thyroid cancer, need for thyroidectomy and all-cause mortality. All outcomes were followed for 5 years. After matching, 2347 patients were included in each cohort. Selenium supplementation was associated with persistently higher mean TSH, free T4 and TPOAb levels, as well as greater proportions of elevated TPOAb (> 35 IU/mL) at 3 years (6.9% vs. 5.0%, p = 0.01) and 5 years (7.9% vs. 5.3%, p < 0.01). The incidence of autoimmune disorders was higher in the selenium group (RR 1.33, 95% CI 1.14-1.56), particularly Sjögren's syndrome (RR 1.61, 95% CI 1.03-2.52) and psoriasis (RR 2.69, 95% CI 1.52-4.76). The rates of thyroid cancer and need for thyroidectomy were similar between groups. However, selenium use was associated with increased all-cause mortality (RR 1.38, 95% CI 1.09-2.03). Selenium supplementation in Hashimoto's thyroiditis was associated with worsened biochemical autoimmunity, increased autoimmune comorbidity and higher mortality. These findings should be interpreted cautiously given the absence of baseline selenium measurements, which limits assessment of deficiency status. Nevertheless, they highlight the need for further research to confirm these results.

Diabetes mellitus remains a major public health concern in East Africa, and poor glycaemic control continues to drive avoidable complications, deaths and pressure on already stretched health systems. To estimate the prevalence of poor glycemic control and describe the main factors associated with it among people living with diabetes in East Africa. This review synthesized evidence from observational studies, cross-sectional surveys and regional health databases identified through PubMed, Scopus and Web of Science, following PRISMA guidance. Sociodemographic, clinical and behavioural indicators were examined to identify common patterns and predictors of poor glycaemic control. The review also considered how measurement approaches shaped reported estimates. Fifty records were identified across PubMed (10), Scopus (23) and Web of Science (17). After screening, 37 records were eligible for full-text review, and 15 studies met the inclusion criteria for evidence synthesis. Across the region, poor glycemic control was consistently high, ranging from 60% to 85%. Most studies were facility-based and cross-sectional. Glycemic control was assessed mainly using HbA1c, commonly defined as ≥ 7% or > 7.5%, and less frequently by fasting blood glucose, typically ≥ 7.2 mmol/L or > 130 mg/dL. Type 2 diabetes was the dominant population studied, with fewer mixed cohorts and only one study focused on type 1 diabetes. Factors repeatedly linked to poor control included older age, longer duration of diabetes, poor medication adherence, limited access to care, low health literacy, inadequate diabetes education, insulin use, comorbidities, diabetic complications, unhealthy diet, physical inactivity, sedentary behaviour, substance use and limited self-management support. Poor glycemic control is alarmingly common among people with diabetes in East Africa and reflects intertwined clinical, behavioural and health-system challenges. Region-specific strategies are needed to strengthen primary care, improve diabetes education, expand affordable monitoring and treatment and enhance surveillance to guide policy and resource allocation.

The growing number of hypoglycaemia risk prediction models for Type 2 diabetes mellitus (T2DM) underscores the need for systematic evaluation of their risk of bias and applicability. This study summarises and critically assesses their characteristics and predictive performance using established guidelines for prediction model development. The review protocol was registered on PROSPERO (CRD420251031980). We searched nine main English and Chinese databases from inception to May 2025. The CHARMS checklist and PROBAST tool were used to assess the risk of bias and applicability. A meta-analysis of AUC values from models was conducted using MedCalc software. We included 25 studies (45 models), with reported AUCs ranging from 0.630 to 0.996. The pooled AUC value of 16 models was 0.815 (95% CI 0.765-0.861), indicating excellent discrimination. 24 (96%) studies were overall at high risk of bias and 22 (88%) studies had low-risk applicability, primarily due to small sample size, improper handling of missing data, failure to report calibration, screening of predictors by univariate analysis and lack of external validation. Current hypoglycaemia prediction models for T2DM show substantial methodological limitations and high bias risk. While machine learning models have advanced rapidly in recent years, their methodology remains opaque and validation is limited. Future research should focus on optimising existing models, enhancing methodological rigour and conducting external validation.

Type 2 diabetes mellitus (T2DM) is a growing public health concern among older adults worldwide including in Iran. Despite extensive research on the metabolic effects of dairy products, their association with T2DM remains inconsistent, particularly in non-Western populations. This study examined the relationship between dairy consumption including specific types, and T2DM among older adults in eastern Iran. This cross-sectional study utilised baseline data from the Birjand Longitudinal Aging Study (BLAS), which included community-dwelling adults aged 60 years and older. Dietary intake was assessed using structured questionnaires, and participants were categorised into tertiles based on dairy consumption (low, moderate, high). T2DM status was determined by FBS ≥ 126 mg/dL or a previous physician diagnosis. Logistic regression models estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for T2DM across different levels of dairy intake, adjusting for potential confounders. Data from 1348 participants were analysed, with an overall T2DM prevalence of 27.15%. Individuals in the highest tertiles of yogurt and cheese intake had significantly increased odds of T2DM (OR = 1.454, 95% CI = 1.08-2.20, p = 0.08; OR = 1.44, 95% CI = 1.04-2.00, p = 0.029). No significant association was found between milk consumption and T2DM risk. Total dairy consumption showed no significant association with T2DM in the fully adjusted model (OR = 1.42, 95% CI = 1.00-2.403, p = 0.05). This study reveals a complex association between dairy intake and the risk of T2DM in Iran, in which high consumption of yogurt and cheese was paradoxically associated with increased odds of disease. This finding may be explained by the high fat content of these products, residual confounding from unmeasured dietary patterns, or biological pathways related to diabetes pathology and gut microbiota modulation that were not captured in our analysis.

Metabolic dysfunction-associated steatotic liver disease (MASLD) and Type 2 Diabetes (T2D) are components of insulin resistance, but the prevalence of MASLD at the diagnosis of youth-onset T2D is unknown. We aimed to describe the prevalence of alanine aminotransferase (ALT) elevation, a biomarker for MASLD, in youth-onset T2D at diagnosis and after one year and investigate factors associated with ALT elevation. A single-centre retrospective cohort study was conducted of patients (age ≤ 21 years) diagnosed with T2D between 1/1/2010 and 31/12/2021, with ALT available at diagnosis. ALT elevation was defined as being greater than 1.5 times the upper range of normal based on patient sex. In the cohort (n = 438), 58% of patients had ALT elevation at T2D diagnosis. Hispanic patients had higher odds of ALT elevation than non-Hispanic Black patients (p < 0.001), and lower HbA1c at diagnosis was associated with higher odds of ALT elevation (p < 0.001). Among patients followed for one year (n = 141), the prevalence of ALT elevation decreased from 65% to 47%. ALT at diagnosis was not associated with a change in Haemoglobin A1C (HbA1c) from diagnosis to one year of follow-up, nor was HbA1c at diagnosis associated with a change in ALT. ALT elevation is common at T2D diagnosis in youth. HbA1c is negatively associated with ALT elevation at diagnosis, but ALT and HbA1c at diagnosis did not impact the change in the corresponding marker at one year. The prevalence of elevated ALT varies between groups, and analysis of disease course within subpopulations is pertinent.

Insoluble fibre (IF) may reduce the risk factors of type 2 diabetes development, but evidence on its short-term effects is limited. The influence of IF on oxidative stress markers, including reduced glutathione (GSH) and antioxidant enzymes, as well as on leukocyte telomere length (LTL), remains poorly studied. Coronavirus disease (COVID-19) occurring before or during IF interventions may influence study outcomes. The study included 29 adults with impaired fasting glucose (IFG) who received 15 g/day of IF for 3 months. Seven participants had a recent history of COVID-19, defined as PCR-confirmed infection within 6 months before the intervention or COVID-19-like symptoms during the study. Fasting plasma glucose, 2-h plasma glucose (2hPG) during a WHO oral glucose tolerance test, glycated haemoglobin (HbA1c) and GSH were assessed at baseline and after 3 months. Fat mass (FM), blood pressure (BP), LTL, superoxide dismutase and catalase (CAT) were also measured. In participants without COVID-19 (n = 22), IF intake was associated with reductions in 2hPG, HbA1c, FM and GSH, along with an increase in systolic BP. In the COVID-19 group (n = 7), HbA1c decreased, while both systolic and diastolic BP increased. No significant changes in LTL, superoxide dismutase or CAT levels were observed in either group. Short-term IF supplementation in individuals with IFG improved selected glycaemic parameters but was accompanied by unexpected reductions in GSH and increases in blood pressure. These findings indicate complex physiological responses to IF that warrant further investigation. ClinicalTrials.gov identifier: NCT04283201.

ABSTRACTIntroductionThyroglobulin (Tg) is a sensitive and specific marker for differentiated thyroid carcinoma (DTC). The presence of thyroglobulin autoantibodies (TgAb) can interfere with Tg measurement in commonly used immunoassays, often resulting in falsely low or undetectable Tg levels. However, data on the prognostic significance of TgAb or its potential utility as a surrogate marker for DTC are limited, leaving its role in the clinical management of DTC uncertain. The aim of this study was the evaluation of the prognostic significance of TgAb in a clinical cohort of patients with DTC.MethodsWe included n = 289 patients with DTC who presented to our clinic for radioiodine treatment. Clinical data and follow‐up outcomes were retrospectively analysed. The TgAb status at initial treatment and during follow‐up was assessed, and its association with disease remission, persistence or recurrence was evaluated.ResultsRoughly 25% of DTC patients in our cohort showed positive TgAb post‐surgery. There were no significant differences between TgAb‐positive and TgAb‐negative patients in histology, tumour size, metastasis, therapeutic regimen or risk stratification.ConclusionThe presence of TgAb did not influence the outcome regarding overall and disease‐free survival. Results implicate that the initial appearance of TgAb does not influence the outcome of patients with DTC. Patients with positive TgAb should be monitored closely during follow‐up as Tg measurement is unreliable, while overtreatment should be avoided.

Type 2 diabetes mellitus (T2DM) has emerged as one of the most critical public health challenges worldwide, with its prevalence continuing to rise steadily. Current projections estimate that the global number of individuals affected by T2DM will reach approximately 783 million by 2045, imposing an increasingly severe burden on healthcare systems globally. In recent years, growing attention has been directed toward the relationship between telomere biology and metabolic disorders. Telomeres, the protective structures at the ends of chromosomes, serve as key markers of cellular aging, with their length and integrity reflecting biological age. Telomerase, a specialised enzyme complex, plays a central role in maintaining telomere stability. Accumulating evidence suggests that telomere shortening and dysfunction not only accelerate organismal aging but may also contribute to the pathogenesis of T2DM through multiple molecular pathways. This review aims to systematically synthesise recent research advances regarding the association between telomeres and T2DM, and to explore the clinical translational potential of telomere length and telomerase activity as biomarkers of disease risk or as potential therapeutic targets. A systematic search of relevant articles was conducted across databases including PubMed, Web of Science, and CNKI. Search terms comprised 'Telomere', 'Telomerase', 'T2DM' and 'Treatment'. Through screening and integration of evidence from cellular experiments, animal model studies, population-based epidemiological investigations and clinical observational research, this review systematically synthesises the mechanistic evidence and current research landscape regarding the association between telomeres and T2DM. Accumulating evidence consistently indicates a significant association between telomere biology and the development and progression of T2DM. Key mechanisms primarily involve oxidative stress and cellular apoptosis, while telomere dysfunction may also contribute to glucose metabolism disorders by impairing pancreatic β-cell function and peripheral tissue insulin sensitivity. Dynamic changes in telomeres hold promise as novel biomarkers for assessing T2DM risk and disease progression. A close and bidirectional relationship exists between telomere biology and T2DM. Deeper insights into this association not only enhance our understanding of T2DM pathogenesis but also offer potential therapeutic targets for anti-aging-based interventions, highlighting important clinical translation prospects. Future research should further clarify the causal relationships involved and explore strategies aimed at preserving telomeres or modulating telomerase activity to delay diabetes progression and prevent its complications, thereby advancing novel approaches for early risk assessment and precision management of T2DM.

A main challenge identified by youth during exercise and sport is the lack of knowledge and awareness around type 1 diabetes (T1D) particularly in community sport settings. Working with youth living with T1D, parents and community sport coaches, our team has developed resources for the T1D and sporting community. This study was to evaluate the acceptability and usability of the resources. Participants completed an online evaluation survey consisting of a T1D quiz and ratings of subjective knowledge and confidence perception. The quiz on exercise and T1D management knowledge consisted of questions developed from the content of the resources and included: an understanding of T1D; signs and symptoms associated with T1D; identification and management of hypoglycaemic episodes. Participants were then provided access to the resources over a 4-week exposure period. After 4 weeks, participants completed the same online survey. Participants were interviewed to collect qualitative information relating to the usability and acceptability of the resources, which included concepts around confidence, trust, and frequency of use. 24 coaches, mean age of 38 years, participated in the study. After the 4-week exposure period, coaches' scores significantly better (p < 0.001) on the standardised T1D quiz from 67.3% to 81.8%. Similarly, coaches' self-perceived ratings of knowledge and confidence increased significantly (p < 0.001) after the 4-week period by an average of 1.6 Likert-scale rating points across all four components. In interviews, coaches indicated high trust and perceived usefulness of the resources, and provided recommendations regarding further tailoring of information, language, and design of resources to enable wide community engagement. The resources developed were found to be informative, trustworthy, acceptable, and easy to use. Following minor amendments, the resources will be implemented into community sport settings through a nationwide launch.