Aims: To develop and validate a risk prediction model for Chinese patients with type 2 diabetes with the recurrence of diabetic foot ulcers (DFUs) based on a systematic review and meta‐analysis.Methods: A prospective analysis was performed with 1333 participants and followed up for 60 months. Three models were analysed using a derived cohort. The risk factors were screened using meta‐analysis and logistic regression, and the missing variables were interpolated by multiple imputation. The internal validation was performed using the bootstrap procedure, and the validation cohort was applied to the external validation. The performance of the model was evaluated in the area under the discrimination Receiver Operating Characteristic Curve (ROC). Calibration and discrimination methods were used for the validation cohort. The variables were selected according to their clinical and statistical importance to construct the nomograms.Results: Three models were developed and validated. Model 1 included seven social and clinical indicators like sex, diabetes mellitus duration, previous DFU, location of ulcer, smoking, history of amputation, and foot deformity. Model 2 included four more indicators besides those in Model 1, which were statin agents used, antiplatelet agents used, systolic blood pressure, and body mass index. Model 3 added further laboratory indicators to Model 2, such as LDL‐C, HbA1C, fibrinogen, and blood urea nitrogen. In the derivation cohort, 20.1% (206/1027) participants with DFU recurred as compared to the validation cohort, which was 38.2% (117/306). The areas under the curve in the derivation cohort for Models 1–3 were 0.781 (0.744–0.817), 0.843 (0.813–0.873), and 0.899 (0.876–0.922), respectively. The Youden indexes for Models 1–3 were 0.430, 0.559, and 0.653, respectively. Model 3 showed the highest sensitivity and specificity. All models performed well for both discrimination and calibration.Conclusions: Models 1–2 were non‐invasive, which indicate their role in general screening for patients at a high risk of recurrence of DFU. However, Model 3 offers a more specific screening due to its best performance in predicting the risk of DFU recurrence amongst the three models.

Websites are rich resources for the public to access health information, and readability ensures whether the information can be comprehended. Apart from the linguistic features originated in traditional readability formulas, the reading ability of an individual is also influenced by other factors such as age, morbidities, cultural and linguistic background. This paper presents a reader-oriented readability assessment by combining readability formula scores with machine learning techniques, while considering reader background. Machine learning algorithms are trained by a dataset of 7 readability formula scores for 160 health articles in official health websites. Results show that the proposed assessment tool can provide a reader-oriented assessment to be more effective in proxy the health information readability. The key significance of the study includes its reader centeredness, which incorporates the diverse backgrounds of readers, and its clarification of the relative effectiveness and compatibility of different medical readability tools via machine learning.

This review is to systematically explore the relationship between muscle dysfunction and diabetes in adults, and to examine the impact of glycemic variability on muscle health and the development of diabetes-related complications. The review was conducted using three databases: MEDLINE, Scopus, and EMBASE, targeting peer-reviewed journal articles written in English and published from January 2014 to September 2024. The methodological quality assessment of the eligible studies was conducted using Joanna Briggs Institute Critical Appraisal Checklists. A total of 17 studies were included. Most studies were undertaken in Asian countries (n = 11) and focused on adults with type 2 diabetes (n = 12). There were 8,392 adults with diabetes, and their mean age ranged from 52 to 75 years old. The measurements for muscle function and glycemic variability varied across studies. The research findings regarding the relationship between muscle dysfunction and glycemic variability metrics among adults with diabetes, both with and without complications were inconsistent. For adults with diabetes and sarcopenic obesity, poor glycemic control was identified as an independent risk factor for sarcopenic obesity. Additionally, all included studies were rated as moderate or high quality in relation to their methodology. In conclusion, this review underscores the complex and inconsistent relationship between glycemic variability and muscle dysfunction in older adults with diabetes. Poor glycemic management is a significant risk factor for sarcopenic obesity, highlighting the need for tailored interventions to improve glycemic control and muscle health in this population.

Improving organisational health literacy ensures people can navigate, understand and use essential health information and services. However, systematic reviews have identified limited evidence for practical approaches to implementing such organisational change, particularly at a national level. This study aimed to (a) investigate the approach taken by an Australian national diabetes organisation—Diabetes Australia, as the administrator of the National Diabetes Services Scheme (NDSS)—to improve organisational health literacy over a 15-year-period and (b) examine the impact of organisational changes on the health literacy demands of health information. We performed an environmental scan, examining the websites of the NDSS, Diabetes Australia and the Australian government for reports and position statements describing organisational health literacy policies and practices between 2006 and 2021. The Patient Education Materials Assessment Tool (PEMAT) was applied to consecutively published NDSS diabetes self-care fact sheets (n = 20) to assess changes in the health literacy demands (understandability and actionability) of these fact sheets over the same period. We identified nine policies resulting in 24 health literacy practice changes or projects between 2006 and 2021, applied using a streamlined incremental approach and group reflexivity. The incremental approach focused on (1) increasing audience reach, (2) consistency and branding, (3) person-centred language and (4) the understandability and actionability of health information. The PEMAT scores of fact sheets improved between 2006 and 2021 for understandability (53% to 79%) and actionability (43% to 82%). Diabetes Australia’s information development process leveraging national policies, employing an incremental approach and group reflexivity has improved the health literacy demands of diabetes information and serves as a template for other organisations seeking to improve their organisational health literacy.

Background: Developmental challenges of adolescence, such as puberty and social pressures, exacerbate the complexity of managing type 1 diabetes (T1D) as they transition from pediatric to adult care. However, there is a paucity of codesigned, evidence‐based diabetes education and support programs and services to guide adolescents through this transition. Objective: This study aimed to explore the experiences, perspectives, facilitators, and barriers faced by adolescents with T1D in diabetes education and program services and to identify feasible approaches to support them as they transition from pediatric to adult care. Methods: Semistructured interviews were conducted with 13 adolescents aged 13–19 years with T1D. Thematic analysis was used to understand participants’ past experiences, facilitators, barriers, and preferences regarding diabetes education programs and services. Results: Participants highly valued the opportunity to meet with peers living with T1D and the emotional support from those interactions. Participants also highlighted the need for age‐appropriate content and interactive learning experiences. Suggested gamification features were well‐received, with participants emphasizing the importance of interactivity. While there was not a strong preference between virtual or in‐person game formats, it was suggested that online options offered flexibility and inclusiveness regardless of physical abilities. Participants were not as enthusiastic for a one‐on‐one live chat compared to an online community chat, again, for the opportunity for peer support. Conclusion: The study highlights the value that adolescents with T1D place on peer support that arises from opportunities to meet others through in‐person events. It was evident that codesigning diabetes education programs and services with adolescents with T1D is key to develop tailored offerings for this population.

Type 2 diabetes (T2D) has emerged as a significant catalyst for various health conditions. The availability and cost of health professionals pose challenges, limiting access to personalised lifestyle support. To address this issue, utilising Conversational Agents (CAs) presents an opportunity to improve scalability and adoption by improving efficiency and engagement. Thus, this study focuses on the potential impact and response to T2D. This paper aims to develop a framework for designing CA functions that support individuals at risk of T2D to be more active and raise their awareness. The study involves a mixed methods approach, including a survey conducted among 30 participants in Sydney and Jeddah, followed by semi-structured interviews conducted with 10 participants. While descriptive statistics were used to analyse the survey, the interviews were analysed using thematic analysis. Drawing upon the interviews and relevant literature, this study proposes developing a preliminary framework to help design CAs that support individuals with prediabetes to adopt a more active lifestyle.