Background: An antidiabetic medication regimen is crucial for maintaining glycemic control. Type 2 diabetes mellitus (T2DM) and cognitive dysfunction have a bidirectional relationship. This study aims to explore the impact that adjusting antidiabetic medication regimens has on medication adherence, glycemic control, and cognitive function in patients with T2DM and mild cognitive impairment (MCI). Methods: This is an observational cross-sectional analysis that includes 364 consecutive inpatients with T2DM. Clinical data were collected, medication adherence was assessed using the Medication Adherence Report Scale (MARS-5), and cognitive status was evaluated using the Chinese version of the Montreal Cognitive Assessment (MoCA) and Mini-mental State Examination (MMSE). These data were obtained both during hospitalization and at a three-month follow-up. Multivariable logistic regression analysis was applied to determine the association between changes in medication regimens and medication adherence, glycemic control, and cognitive function. Results: Baseline medication adherence was high across all three different cognitive status groups, with no significant difference in MARS-5 scores. At the 3-month follow-up, the group with a high adjustment ratio of antidiabetic medication regimens showed an increase in their hemoglobin A1c (HbA1c) level compared to the baseline, while the group with a low adjustment ratio showed a decrease in this level. In addition, the MoCA, MMSE, and MARS-5 scores of the high-adjustment group were significantly lower than those of the low-adjustment group. Conclusions: A high ratio of medication adjustment was significantly associated with worse medication adherence and glycemic control in T2DM patients with MCI. Patients with a low ratio of medication adjustment had good adherence and better glycemic control. Clinicians should take cognitive status into account when adjusting antidiabetic regimens for T2DM patients and may need to provide additional guidance to patients with cognitive impairment to improve adherence and glycemic outcomes.

Background: Cognitive impairment is a prevalent complication of type 2 diabetes, influenced significantly by various dietary patterns. High-carbohydrate diets (HCDs) are commonly consumed nowadays; however, the specific impact of HCDs on cognitive function in diabetes remains unclear. Methods: The objective of this study was to investigate whether an HCD has effects on cognition in diabetes. Eight-week-old diabetic (db/db) mice and wild-type (WT) mice underwent a twelve-week dietary intervention, including a normal diet (ND), an HCD, or a high-fat diet (HFD). Following this, behavioral tests were conducted, and related hippocampal pathology was evaluated. Results: Our results demonstrated that an HCD exacerbated cognitive decline in db/db mice compared to an ND. Additionally, an HCD increased amyloid-β burden and expression of β-site APP cleaving enzyme-1. An HCD was also found to promote the phosphorylation of tau protein via the PI3K/Akt/GSK-3β pathway. Furthermore, an HCD markedly induced neuroinflammation and increased the quantity of microglia and astrocytes. However, these damages induced by an HCD were less severe than those caused by an HFD. Conclusions: Collectively, our findings indicate that a high intake of carbohydrates can have an adverse impact on cognitive function in diabetes.

Background: Evidence supports the effectiveness and safety of open-source automated insulin delivery (AID) in patients with type 1 diabetes. However, evidence regarding the clinical application of open-source AID in perioperative patients with type 2 diabetes remains limited. Methods: This was an open-label, single-center, exploratory pilot randomized controlled trial (RCT) with parallel groups. Patients with diabetes (excluding type 1 diabetes mellitus) scheduled for elective surgery were randomly assigned to the closed-loop group (open-source hybrid closed-loop AID system) or the control group (conventional insulin pump). The primary outcome was the percentage of time in the target glucose range (TIR, 3.9–10.0 mmol/L). Other efficacy and safety outcomes were also compared between the groups. Results: A total of 49 participants were included and randomized to the closed-loop group (n = 25) or the control group (n = 24). Participants underwent abdominal, orthopedic, thoracic surgery, or neurosurgery during hospitalization. Patients in the closed-loop group had significantly higher TIR than patients in the control group (76.4 ± 14.1% vs. 61.2 ± 20.0%, p = 0.005). Compared with the control group, the closed-loop group also exhibited a 15.6 percentage point reduction in time above range (TAR, >10 mmol/L) without increasing time below range (TBR, <3.9 mmol/L). There were no episodes of severe hypoglycemia (<2.2 mmol/L) or diabetic ketoacidosis in either group. Conclusions: This study demonstrates that in patients with diabetes undergoing elective surgery, the open-source hybrid closed-loop AID system provides better glycemic control than conventional insulin pump therapy.

Background/Objectives: Prosaposin (PSAP) is a multifunctional protein involved in sphingolipid metabolism and neuroprotection. This study investigated the association between serum PSAP levels and type 2 diabetes mellitus (T2DM) and explored the association between PSAP and lower-limb motor nerve conduction abnormalities in patients with T2DM. Methods: This single-center cross-sectional study included 172 participants (48 normal controls and 124 patients with T2DM). Serum PSAP was measured by ELISA. Among patients with T2DM, 112 underwent nerve conduction studies to assess lower-limb motor nerve conduction abnormalities. Logistic regression, Firth penalized logistic regression, and RCS analyses were performed. Exploratory mediation analysis with 5000 bootstrap resamples evaluated the indirect effect involving glycated hemoglobin A1c (HbA1c) in the association between PSAP and T2DM. Results: Serum PSAP levels were higher in patients with T2DM than in normal controls (p < 0.001). The association between lnPSAP and T2DM remained significant after adjustment for age, sex, systolic blood pressure, BMI, and total cholesterol (p = 0.008), but was attenuated and no longer significant after further adjustment for HbA1c. Exploratory mediation analysis identified a significant indirect-effect estimate involving HbA1c (p < 0.001), warranting cautious interpretation given the cross-sectional design and the role of HbA1c in T2DM diagnosis. For lower-limb motor nerve conduction abnormalities, lnPSAP was significantly associated in univariable analysis (p = 0.044), but not after multivariable adjustment (p = 0.157), consistent with the Firth penalized logistic regression and RCS analyses. Conclusions: Serum PSAP levels were elevated in patients with T2DM, although the association was substantially attenuated after further adjustment for HbA1c. The exploratory mediation findings do not establish a causal pathway. The association between PSAP and lower-limb motor nerve conduction abnormalities remained inconclusive after multivariable adjustment. Further longitudinal studies are needed to clarify these associations.