Journal of diabetes and its complications最新文献

{"title":"Clinical outcomes of patients with Polyvascular disease admitted with an acute diabetic foot ulcer","authors":"Nitzan Tal ,&nbsp;Isca Hershkowitz ,&nbsp;Kobi Gorin ,&nbsp;Michal Leibovitch ,&nbsp;Shahar Peled ,&nbsp;Karen Olshtain-Pops ,&nbsp;Jonathan Lorber ,&nbsp;Tamar Fisher-Negev ,&nbsp;Anat Tsur ,&nbsp;Amir Haze ,&nbsp;Yechiel N. Gellman ,&nbsp;Avivit Cahn","doi":"10.1016/j.jdiacomp.2025.109109","DOIUrl":"10.1016/j.jdiacomp.2025.109109","url":null,"abstract":"<div><h3>Aims</h3><div>Diabetic foot ulcer (DFU) is a common cause of admission in patients with diabetes. Diabetes increases the likelihood of inpatient Major Adverse Cardiovascular Events (MACE), and the presence of polyvascular disease (PD), defined by the presence of atherosclerosis in two or more arterial beds, further amplifies this risk. We assessed the impact of PD on outcomes in patients admitted due to a DFU.</div></div><div><h3>Methods</h3><div>In this retrospective single-center study, we enrolled adult patients admitted to the diabetic foot unit between 2014 and 2019. The primary outcome was a composite of inpatient MACE or death. Secondary outcomes included amputations, leg revascularization, duration of admission and 1-year mortality. We additionally collected survival data till the end of 2023.</div></div><div><h3>Results</h3><div>A total of 537 patients were enrolled in the study, 264 suffering of PD. The primary endpoint occurred in 12.5 % and 4.4 % of patients with vs. without PD (<em>p</em> = 0.001). Patients with PD had an increased incidence of vascular interventions (42 % vs. 19.4 %, <em>p</em> &lt; 0.001), any amputation (67.4 % vs. 48.4 %, <em>p</em> &lt; 0.001) and major amputation (35.6 % vs. 13.2 %, p &lt; 0.001). They had longer admissions (median 19 vs. 17 days, <em>p</em> = 0.002) and higher 1-year mortality rates (33.0 % vs. 12.1 %, <em>p</em> &lt; 0.001). During 10-year follow up (median 3.3 years) median survival was 2.0 vs. 5.9 years for patients with vs. without PD (p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>PD in patients admitted with a DFU is associated with poor inpatient and long-term outcomes. This highlights the need for comprehensive risk assessment, optimization of in-patient management and long-term control of cardiovascular risk factors.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 9","pages":"Article 109109"},"PeriodicalIF":2.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technosphere insulin in the treatment of Type 1 diabetes mellitus: A systematic review and meta-analysis","authors":"Vitória Karoline Justino Dos Santos ,&nbsp;Marcelo Lucas De Lima Prado ,&nbsp;Gabriela Simões Noel Da Silva ,&nbsp;Iapunira Catarina Sant'anna Aragão ,&nbsp;Felipe Matheus Sant'anna Aragão ,&nbsp;Vitor Henrique Justino Dos Santos ,&nbsp;Larissa Calixto Hespanhol ,&nbsp;Vanessa Lins De Menezes ,&nbsp;Francisco Prado Reis ,&nbsp;José Aderval Aragão","doi":"10.1016/j.jdiacomp.2025.109108","DOIUrl":"10.1016/j.jdiacomp.2025.109108","url":null,"abstract":"<div><h3>Aims</h3><div>Conduct a systematic review and meta-analysis comparing Technosphere Insulin and traditional ultra-rapid insulin in T1DM.</div></div><div><h3>Methods</h3><div>Researchers conducted a systematic search on databases to identify randomized controlled trials (RCTs) comparing two insulin regimens—TI and RAI —in patients with type 1 diabetes mellitus (T1DM). The outcomes of interest included changes in HbA1c levels, body weight, and rates of overall and severe hypoglycemia.</div></div><div><h3>Results</h3><div>Four RCTs were included. There was no significant difference between groups on change in HbA1c (MD 0.04; 95 % CI −0.19–0.27; <em>p</em> = 0.74; I² = 0 %). In terms of body weight change, the TI group exhibited significantly less (MD −1.05; 95 % CI −1.63 to −0.46; <em>p</em> = 0.0005; I² = 0 %) compared to the RAI group. Adverse events such as overall hypoglycemia (RR −0.97; 95 % CI 0.94–1.01; <em>p</em> = 0.24; I² = 26 %) and severe hypoglycemia (RR 0.63; 95 % CI 0.46–0.87; <em>p</em> = 0.005; I² = 0 %), were significantly more frequent in the RAI group.</div></div><div><h3>Conclusions</h3><div>The use of Technosphere Insulin (TI) in T1DM patients did not show a difference in HbA1c, suggesting that TI may offer advantages in weight stability and a lower incidence of hypoglycemic events compared to rapid-acting insulin (RAI).</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 9","pages":"Article 109108"},"PeriodicalIF":2.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144253490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NerveCheck master to screen patients with type 1 or type 2 diabetes for peripheral and cardiac autonomic neuropathy","authors":"Raffaele Galiero ,&nbsp;Amel Rezki ,&nbsp;Vittorio Simeon ,&nbsp;Domenico Beccia ,&nbsp;Maria Alfano ,&nbsp;Alfredo Caturano ,&nbsp;Ferdinando Carlo Sasso ,&nbsp;Paul Valensi","doi":"10.1016/j.jdiacomp.2025.109107","DOIUrl":"10.1016/j.jdiacomp.2025.109107","url":null,"abstract":"<div><h3>Aim</h3><div>NerveCheck Master (NCKM) is a portable device designed to assess vibration, warm, cold and heat pain perception thresholds. NCKM was shown to offer good diagnostic accuracy for diabetic peripheral neuropathy (DPN). Cardiac autonomic neuropathy (CAN) remains underdiagnosed. We assessed the role of NCKM against Michigan Neuropathy Screening Instrument (MNSI) to screen patients with diabetes for both DPN and CAN.</div></div><div><h3>Methods</h3><div>DPN was assessed using the 4 NCKM tests and MNSI, and CAN using standard tests, in 76 patients with type 1 (T1DM) and 65 with type 2 diabetes mellitus (T2DM).</div></div><div><h3>Results</h3><div>Among patients with T1DM and T2DM, DPN prevalence was 26.3 % and 35.4 %, respectively, according to MNSI score (≥2.5), and 61.8 % and 70.8 % according to NCKM (≥2 abnormal tests), and CAN prevalence was 22.4 % and 41.4 %, respectively. Among patients with T1DM, CAN prevalence was markedly higher in those with DPN according to NCKM than in those without (31.9 % <em>vs</em> 6.9 %, <em>p</em> = 0.011), with a far lesser difference among patients with T2DM. The cut-off of two abnormal tests offers good sensitivity and negative predictive value for the detection of patients with CAN, particularly among patients with T1DM (88.2 % and 93.1 %, respectively).</div></div><div><h3>Conclusion</h3><div>NCKM detects more patients with DPN and its positivity is associated with a higher likelihood of CAN. Using NCKM appears an attractive approach to identify patients to screen for CAN and to improve the yield of CAN tests.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 9","pages":"Article 109107"},"PeriodicalIF":2.9,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of gestational and type 2 diabetes on fetal endothelial cell miRNA expression","authors":"Samar Sultan ,&nbsp;Reham Sabeeh","doi":"10.1016/j.jdiacomp.2025.109106","DOIUrl":"10.1016/j.jdiacomp.2025.109106","url":null,"abstract":"<div><h3>Aims</h3><div>Fetal exposure to hyperglycemia <em>in utero</em> have been suggested to induce epigenetic changes through expression of various miRNAs, and cause dysfunctional endothelium connected with elevated risk of cardiovascular disease (CVD) in offspring during early adulthood. In this study, we investigated whether hyperglycemia-induced changes in the expression of 28 fetal endothelial microRNAs (miRNAs) are associated with endothelial dysfunction and CVD.</div></div><div><h3>Methods</h3><div>Differentially expressed miRNAs in TaqMan miRNA human arrays were quantified using qPCR.</div></div><div><h3>Results</h3><div>The expression of miR-140-3p, miR-1307-5p, miR-342-3p, and miR-16-5p was significantly reduced in human umbilical vein endothelial cells (HUVECs) from females with gestational diabetes (GDM-UVECs) compared with that of the control group. Meanwhile, in type 2 diabetes (T2D-HUVECs), miR-126-3p and miR-27a-5p were significantly reduced, while miR-27b-3p was significantly increased. Furthermore, miR-29b-3p expression was upregulated in both GDM– and T2D-HUVECs compared with that in the control. The expression of fibroblast growth factor 11 (<em>FGF11</em>) mRNA—a target of dysregulated miR-342-3p—was downregulated in GDMHUVECs compared with that in the control.</div></div><div><h3>Conclusions</h3><div>Altered miRNA and target <em>FGF11</em> mRNA expression may contribute mechanistically to endothelial dysfunction in diabetic HUVECs when maintained under normal glucose conditions for several passages.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 9","pages":"Article 109106"},"PeriodicalIF":2.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144221936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contents/Barcode","authors":"","doi":"10.1016/S1056-8727(25)00149-7","DOIUrl":"10.1016/S1056-8727(25)00149-7","url":null,"abstract":"","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 8","pages":"Article 109096"},"PeriodicalIF":2.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144194746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between body fat and cognitive function in individuals with diabetes mellitus","authors":"Micaela Rabelo Quadra ,&nbsp;Antônio Augusto Schäfer ,&nbsp;Fernanda Oliveira Meller ,&nbsp;Carla Damasio Martins ,&nbsp;Emilio Luiz Streck","doi":"10.1016/j.jdiacomp.2025.109105","DOIUrl":"10.1016/j.jdiacomp.2025.109105","url":null,"abstract":"<div><h3>Aim</h3><div>To investigate the relationship between body fat and cognitive function in individuals with Diabetes mellitus (DM).</div></div><div><h3>Methods</h3><div>Cross-sectional study conducted at a clinical school between March and August 2023. Individuals aged ≥18 years, with medical diagnosis of DM type 1 or 2, treated at the clinical school were included. The outcome was cognitive function, assessed using the Montreal Cognitive Assessment. The exposure was body fat, measured by skinfolds. Crude and adjusted analyses were conducted using Poisson regression, with results reported as prevalence ratios (PR) and their corresponding 95 % confidence intervals (95 % CI).</div></div><div><h3>Results</h3><div>A total of 365 individuals were studied. 67.9 % exhibited cognitive decline and 91.8 % had excess body fat. Although no association between excess body fat and cognitive decline was found in the crude analysis, an association emerged in the adjusted analyses. Individuals with DM and excess body fat had a 26 % lower prevalence of cognitive decline than those without excess body fat (PR = 0.74, 95%CI 0.62–0.88).</div></div><div><h3>Conclusion</h3><div>Excess body fat appears to be associated with a lower prevalence of cognitive decline, underscoring the complexity of this relationship and suggesting caution in interpreting these findings.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 9","pages":"Article 109105"},"PeriodicalIF":2.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incremental value of CT-based perirenal fat characteristics in the categorization and progression prediction of diabetic kidney disease","authors":"Jinlei Fan ,&nbsp;Liping Zuo ,&nbsp;Xiaoyun Liu ,&nbsp;Yuqing Tang ,&nbsp;Min He ,&nbsp;Qichao Cheng ,&nbsp;Chuanbin Yang ,&nbsp;Dexin Yu","doi":"10.1016/j.jdiacomp.2025.109104","DOIUrl":"10.1016/j.jdiacomp.2025.109104","url":null,"abstract":"<div><h3>Aims</h3><div>To explore the association between computed tomography (CT)-derived perirenal adipose tissue (PAT) characteristics and diabetic kidney disease (DKD) risk categories according to the Kidney Disease: Improving Global Outcomes (KDIGO) guideline, and to determine the incremental predictive value of PAT characteristics for DKD rapid progression in patients with type 2 diabetes mellitus (T2DM).</div></div><div><h3>Methods</h3><div>404 patients with T2DM who underwent plain abdominal CT were categorized into four KDIGO risk groups (low, moderate, high, and very-high). The area and CT attenuation values of different abdominal fat deposits were measured. Logistic and Cox regression analyses were performed to identify risk factors for high and very-high KDIGO risk categories and predictors of DKD rapid progression.</div></div><div><h3>Results</h3><div>In multivariate logistic regression analysis, the PAT index (PATI) (<em>P</em> &lt; 0.001), PAT attenuation value (<em>P</em> = 0.023) were independent risk factors for high- and very-high-risk KDIGO categories. In 125 patients with kidney function follow-up data, multivariate Cox regression analysis revealed that PAT attenuation value (<em>P</em> = 0.021) and haemoglobin (<em>P</em> = 0.031) were independent predictors of DKD rapid progression.</div></div><div><h3>Conclusions</h3><div>Patients with T2DM with higher PAT attenuation values and PATI exhibited an increased risk for higher DKD KDIGO risk categories. Baseline PAT attenuation values may have incremental value in DKD prognosis assessment.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 9","pages":"Article 109104"},"PeriodicalIF":2.9,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144213122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of biomarkers of innate and adaptive immunity in the early detection of diabetic nephropathy in children and adolescents with type 1 diabetes mellitus","authors":"Ayşen Türedi Yıldırım ,&nbsp;Nilay Tuğçe Işık Bayar ,&nbsp;Yeşim Yiğit ,&nbsp;Betül Ersoy","doi":"10.1016/j.jdiacomp.2025.109090","DOIUrl":"10.1016/j.jdiacomp.2025.109090","url":null,"abstract":"<div><h3>Aims</h3><div>Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are biomarkers linked to microvascular complications in adult diabetics. This study aimed to assess whether NLR and PLR, which increase in chronic inflammation, could aid in early detection of diabetic nephropathy (DN) in children and adolescents with Type 1 diabetes mellitus (T1DM).</div></div><div><h3>Methods</h3><div>The study included 90 children and adolescents with T1DM and 30 healthy controls. Microalbuminuria, defined as urine albumin &gt;20 μg/min, was used to indicate early DN. Participants were grouped by diabetes duration: 0–60 months, 61–120 months, and &gt;120 months.</div></div><div><h3>Results</h3><div>NLR was significantly higher in patients with microalbuminuria compared to controls and those without microalbuminuria (p10 years. Positive correlations were observed between urinary albumin and NLR (<em>r</em> = 0.274, <em>p</em> = 0.003) and between PLR and diabetes duration (<em>r</em> = 0.286, <em>p</em> = 0.006). For early DN diagnosis, an NLR threshold of 1.675 showed 60 % specificity and 84.2 % sensitivity.</div></div><div><h3>Conclusions</h3><div>NLR outperformed PLR in early DN detection and may prompt timely urine albumin testing in children with T1DM. Further studies are needed to confirm these results.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 9","pages":"Article 109090"},"PeriodicalIF":2.9,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144204285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impaired cerebral hemodynamics and oxygenation in type 2 diabetes: insights into insulin resistance and hyperglycemia effects","authors":"Islem Jlali ,&nbsp;Imen Touil ,&nbsp;Hassen Haj Amor ,&nbsp;Sémah Tagougui","doi":"10.1016/j.jdiacomp.2025.109102","DOIUrl":"10.1016/j.jdiacomp.2025.109102","url":null,"abstract":"<div><h3>Aims</h3><div>Emerging evidence suggests Type 2 diabetes (T2D) may adversely affect cerebral hemodynamics and oxygenation. This study aimed to explore the impact of uncomplicated T2D on cerebral hemodynamics and oxygenation during maximal exercise.</div></div><div><h3>Methods</h3><div>In a comparative clinical trial, 30 matched pairs of subjects with obesity, stratified by T2D status, were enrolled. Hemodynamic and oxygenation parameters were assessed during incremental maximal exercise. Additionally, physical activity levels, lipid profiles, and insulin resistance markers were evaluated.</div></div><div><h3>Results</h3><div>Participants with T2D exhibited significantly impaired cerebral blood volume (total hemoglobin) and oxygenation (oxygenated hemoglobin) compared to controls, especially at exercise intensities above 80 % of VO_2peak. This impairment was independent of differences in arterial carbon dioxide partial pressure (PaCO₂) levels between the groups at peak exercise (<em>P</em> &gt; 0.05, PaCO₂ 34.4 ± 3.2 vs 34.5 ± 1.3 mmHg). Moreover, individuals with T2D had a lower estimated glucose disposal rate (eGDR) compared to the control group (<em>P</em> = 0.02; 7.4 ± 2.4 vs 9.27 ± 0.97 mg/kg/min).</div></div><div><h3>Conclusions</h3><div>Our findings indicate that insulin resistance and hyperglycemia in T2D contribute to impaired cerebral hemodynamics and oxygenation, even before clinical signs of microangiopathy appear. These alterations could have significant implications for cognitive function and overall brain health in individuals with T2D.</div></div><div><h3>Trial registration</h3><div>PACTR202301667050563.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 9","pages":"Article 109102"},"PeriodicalIF":2.9,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144204286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A national quality survey of in-patient diabetic foot care calls for centralizing care and improving patient communication","authors":"Yaffa Ein-Gal ,&nbsp;Genya Aharon-Hananel ,&nbsp;Tal Sigawi ,&nbsp;Omer Hamtzany ,&nbsp;Itamar Raz ,&nbsp;Avivit Cahn","doi":"10.1016/j.jdiacomp.2025.109088","DOIUrl":"10.1016/j.jdiacomp.2025.109088","url":null,"abstract":"<div><h3>Aims</h3><div>To evaluate the quality of inpatient care for patients with diabetic foot ulcers (DFU) and examine the relationship between managerial awareness of quality indicators and the actual care provided, as documented in the electronic medical records (EMRs).</div></div><div><h3>Methods</h3><div>A peer-reviewed audit of inpatient DFU care based on interviews with hospital and department management, yielding a comprehensive management score for each hospital; review of electronic medical records (EMR); and patient interviews. Data regarding facilities and personnel were collected as well.</div></div><div><h3>Results</h3><div>Data was collected from 26 hospitals, 199 EMR and 86 patient interviews. Larger hospital size was correlated with higher comprehensive management scores (<em>p</em> = 0.008). Moreover, large hospitals were more likely to have dedicated DFU cohorts thus simplifying provision of multidisciplinary state-of-the-art care (<em>p</em> = 0.034). Committed managers were more likely to dedicate surgical sessions to DFU patients, mean (±SD) comprehensive management score of 95.9 ± 3.4 in hospitals with dedicated session vs. 79.7 ± 9.6 in those without (<em>p</em> &lt; 0.001). Hospitals with committed management had better documentation and more prevalent use of correct diagnostic codes (<em>r</em> = 0.542), while higher dedication of head nurses of the DFU departments was significantly correlated with higher scores in inpatient care and patient education (<em>r</em> = 0.509, 0.826 respectively). Overall, patient communication and shared decision-making scored relatively low with only 78.8 % of the patients interviewed noting satisfaction.</div></div><div><h3>Conclusions</h3><div>Large hospitals were more likely to deliver high-quality multidisciplinary care, pivotal to the care of DFU patients. Dedicated management teams strongly impact better delivery of care. Better communication and shared decision-making should be reinforced.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 9","pages":"Article 109088"},"PeriodicalIF":2.9,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144213121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}