Background: Ankle-brachial index (ABI) is a simple method for diagnosing peripheral artery disease (PAD) but has limited reliability in patients with diabetes mellitus (DM) because of medial artery calcification. Our study aims to investigate whether the toe brachial index (TBI) or the cardio-ankle vascular index (CAVI) has a better detection over the ABI for diagnosing PAD in diabetic kidney disease (DKD). Materials and Methods: A cohort of 368 patients (mean age 68.59 ± 13.14 years, 190 males and 178 females) with type 2 DM underwent ABI, TBI, and CAVI measurements at our outpatient clinic. Results: Of all enrolled patients, the TBI is significant in evaluating PAD, especially in patients whose chronic kidney disease (CKD) stage 3a with adjusted odds ratio (AOR) = 6.50, 95% confidence interval (CI) 1.63–25.97, p = 0.0080, stage 3b AOR = 7.47, 95% CI 1.52–36.81, p = 0.0135, and stage 4–5 AOR = 20.13, 95% CI 1.34–94.24, p = 0.0116. CAVI is also significant in CKD stage 1 with AOR = 0.16, 95% CI 0.03–0.77, p = 0.0223, stage 2 with AOR = 0.18, 95% CI 0.04–0.74, p = 0.0180, and stage 3a AOR = 0.31, 95% CI 0.10–0.93, p = 0.0375. Conclusion: TBI has a better yield of detection of PAD compared to ABI among Taiwanese patients with DKD. CAVI may play a role in the early stage of DKD.

Background/Objectives: Dementia associated with diabetes mellitus (DM) has been well documented in the literature, but studies utilizing early screening tools to target populations with mild cognitive dysfunction remain limited. This study aimed to investigate early cognitive decline by studying the relationships between “Ascertain Dementia 8” (AD8) questionnaire scores and glycemic control, lipid profiles, estimated glomerular filtration rate (eGFR), and the complications of diabetes. Methods: This case–control, cross-sectional, observational study was conducted at a medical center and an affiliated regional hospital in southern Taiwan from 30 June 2021 to 30 June 2023. Patients diagnosed with type 2 diabetes mellitus aged ≥40 years were recruited. Their past medical history, biochemical data, and AD8 score were collected at the same time. Results: The patients with glycated hemoglobin (HbA1c) levels of ≥7% had a higher risk of cognitive impairment than those with HbA1c levels of <7% (p < 0.001). The participants whose eGFR was <60 mL/min/1.73 m² had a higher mean AD8 score compared to those with an eGFR of ≥60 mL/min/1.73 m² (p = 0.008). The patients with a medical history of peripheral artery disease and diabetic neuropathy were also associated with a higher mean AD8 score (p < 0.001 and p = 0.017, respectively). Conclusions: By employing the AD8 questionnaire as a sensitive screening tool, our study suggests that early cognitive decline is significantly associated with poorer glycemic control, a lower glomerular filtration rate, peripheral artery disease, and diabetic neuropathy. Early detection of these risk factors may facilitate timely interventions and tailored treatment strategies to treat or prevent cognitive dysfunction.

Background: Medication adherence is a critical component of effective management in type 2 diabetes mellitus (T2DM). Although previous studies have explored the relationship between adherence and clinical outcomes, the strength and consistency of these associations have not been fully elucidated and remain unclear. In particular, evidence derived from patient-reported measures of adherence is limited, and the prognostic significance of adherence as assessed from the patient perspective is not clearly defined. Methods: We conducted a prospective observational cohort study consisting of adult patients with T2DM who received regular outpatient follow-up. Medication adherence was assessed at the time of enrollment using the eight-item Morisky Medication Adherence Scale (MMAS-8) and was categorized as good, moderate, or poor. Participants were subsequently followed for five years to ascertain clinical outcomes. Primary outcomes were assessed longitudinally and included the occurrence of nonfatal myocardial infarction, heart failure, nonfatal stroke, and progression to end-stage kidney disease (ESKD), as well as all-cause mortality. Secondary outcomes included changes in glycated hemoglobin (HbA1c), estimated glomerular filtration rate (eGFR), and low-density lipoprotein (LDL) levels. Results: No statistically significant differences were observed in the incidence of nonfatal myocardial infarction, heart failure, nonfatal stroke, or progression to ESKD across adherence groups. In contrast, all-cause mortality was significantly higher among patients with poor adherence. With respect to metabolic outcomes, HbA1c and eGFR at five years were comparable across adherence groups, whereas LDL levels were significantly higher in patients with poor adherence. Conclusions: Poor medication adherence as assessed at baseline may be related to a higher risk of all-cause mortality and poorer lipid control, while no statistically significant differences were observed for nonfatal cardiovascular or renal outcomes.

Background/Objectives: Erectile dysfunction (ED) affects up to 50% of men with type 2 diabetes mellitus (T2DM), yet the independent effects of oral antihyperglycemic medications on erectile function remain controversial. This study investigated associations between commonly prescribed antihyperglycemic medications and erectile function in Taiwanese men with T2DM. Methods: This cross-sectional study enrolled 242 Taiwanese men aged 18–80 years with T2DM. Erectile function was assessed using the International Index of Erectile Function–5 (IIEF-5). Participants were categorized by 12-month HbA1c patterns into well-controlled, variably controlled, and poorly controlled groups. Multiple linear regression models adjusted for demographics, metabolic parameters, and comorbidities examined medication–IIEF-5 associations. Results: The mean IIEF-5 score was 18.16 ± 5.68. None of the seven oral antihyperglycemic medication classes showed significant independent associations with IIEF-5 scores. However, glycemic control demonstrated a significant association with erectile function (F(2,192) = 3.390, p = 0.036), with well-controlled patients showing higher scores than poorly controlled patients (mean difference = 2.488, p = 0.032). Conclusions: In this cross-sectional study, better glycemic control was associated with improved erectile function in men with T2DM. No significant independent associations were observed between individual oral antihyperglycemic medication classes and erectile function after adjustment for glycemic control and other confounders. These findings suggest that glycemic management, rather than the independent effect of medication class, may be the primary determinant of erectile function in this population; however, causal inferences cannot be drawn from this cross-sectional design.