Correlates and Covariates of Type 2 Diabetes in an African American Population in the Washington DC Area

In the United States, type 2 diabetes mellitus (T2DM) disproportionately affects the African American (AA) community, which has not been systematically included in molecular studies of underlying mechanisms. As part of a gene expression study, we recruited cases with T2DM and matched, unaffected controls at an urban hospital in Washington, DC, with a majority AA population. Here we describe the profile of socio-demographic, behavioral, and health-related associations of the study population. Self-reported data were collected from cases with T2DM (N = 77) and age- and gender-matched controls (N = 80), ages 45 - 65 years. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). As expected, obesity, hypertension, and cardiovascular disease were more prevalent in cases than in controls. Tobacco smoking and working alongside other tobacco smokers were also associated with T2DM. After adjusting for covariates, current tobacco smoking remained statistically associated with the disease (OR per half pack of cigarettes 1.43, 95% CI 1.04 - 1.95;p-value 0.027). HbA1c levels were elevated in T2DM cases who smoked more than a pack of cigarettes daily. These associations highlight the comorbid burdens of T2DM in an AA urban community setting and identify tobacco control as an unmet need for future prevention and control efforts.

短吻三线舌鳎、褐斑三线舌鳎和紫斑舌鳎种类的有效性厘定

舌鳎属有些种类形态特征高度相似,导致了鉴定困难和种类的混乱,例如短吻三线舌鳎(Cynoglossus abbreviatus,Gray,1834)、褐斑三线舌鳎(C.trigrammus,Günther,1862)和紫斑舌鳎(C.purpureomaculatus,Regan,1905)的种类有效性和种间关系就存在三种观点:仅短吻三线舌鳎为有效种;短吻三线舌鳎和褐斑三线舌鳎均为有效种,而紫斑舌鳎是褐斑三线舌鳎的次同物异名;三个名义种均为有效种。为了解决这一分类混乱,本研究对三种舌鳎的原始描述、自测的模式标本和中国内地沿海采集标本的28个形态特征和分子条形码进行了比较分析。结果显示,8个可数和16个可量特征的比例值以及2个描述性状在三个种之间为一致、包含、大部分重叠的关系;只有2个描述特征存在差异,一个是在吻长较上眼上缘距背鳍基部的长度特征上,短吻三线舌鳎和紫斑舌鳎为略长、等长或略短于的连续特征值,而褐斑三线舌鳎为明显大于;另一个差异是体表的花色差异,紫斑舌鳎体长一般小于200 mm,且具有明显的斑纹,短吻三线舌鳎体长一般大于200 mm,且随着体长增加,斑点逐渐淡化或者无斑,而不同体长的褐斑三线舌鳎在头后和身体前3/4均具有明显的零星褐色斑纹。COⅠ分子条形码结果显示,短吻三线舌鳎和紫斑舌鳎的遗传距离为0.000~0.002,为种内差异;褐斑三线舌与其他两种舌鳎之间的遗传距离为0.141~0.145,为种间差异。研究表明,短吻三线舌鳎和褐斑三线舌鳎是有效种,紫斑舌鳎是短吻三线舌鳎的次同物异名。本研究结果为鲽形目鱼类的正确分类提供了科学依据。

RNAi抑制结肠癌细胞系DcR3的表达及对癌细胞生长的影响

目的:观察抑制DcR3基因表达的人SW480结肠癌细胞其恶性表型的改变.方法:应用RNA干扰(RNAi)技术,构建小双链DNA,克隆入表达载体,转染进入SW480结肠癌细胞系(DcR3高表达细胞),在细胞内形成小干扰双链RNA;识别并降解DcR3 mRNA.筛选DcR3低表达转染癌细胞,观测其体外DcR3-SW480-RNAi转染细胞的增长率及凋亡表达.结果:与对照组相比,转染DcR3-RNAi(F1R1)的WS480细胞,DcR3 mRNA的表达明显降低,各组相比,加入DcR3-RNAi(F1R1)组的SW480细胞数量明显减少,而仅加入DcR3及对照组细胞数量明显增加.统计学处理差异显著(P<0.001).与对照组相比,经DcR3-RNAi处理组凋亡抗体Caspase3及PARP产物表达增加.结论:经转染的DcR3-RNAi-SW480结肠癌细胞其DcR3 mRNA表达降低.肿瘤细胞的生长数量减少,凋亡增加,有一定可探索性抗癌前景.

Finding the magnetopause location using soft X-ray observations and a statistical inverse method

Variability in the location and shape of the dayside magnetopause is attributed to magnetic reconnection,a fundamental process that enables the transfer of mass,energy,and momentum from the solar wind into the magnetosphere.The spatial and temporal properties of the magnetopause,under varying solar and magnetospheric conditions,remain largely unknown because empirical studies using in-situ observations are challenging to interpret.Global wide field-of-view(FOV)imaging is the only means to simultaneously observe the spatial distribution of the plasma properties over the vast dayside magnetospheric region and,subsequently,quantify the energy transport from the interplanetary medium into the terrestrial magnetosphere.Two upcoming missions,ESA/CAS SMILE and NASA’s LEXI will provide wide-field imagery of the dayside magnetosheath in soft X-rays,an emission generated by charge exchange interactions between high charge-state heavy ions of solar wind origin and exospheric neutral atoms.High-cadence two-dimensional observations of the magnetosheath will allow the estimation of dynamic properties of its inner boundary,the magnetopause,and enable studies of its response to changes in the solar wind dynamic pressure and interplanetary magnetic field orientation.This work introduces a statistically-based estimation approach based on inverse theory to estimate the spatial distribution of magnetosheath soft X-ray emissivities and,with this,identify the location of the magnetopause over the Sun−Earth line.To do so,we simulate the magnetosheath structure using the MHD-based OpenGGCM model and generate synthetic soft X-ray images using LEXI’s orbit and attitude information.Our results show that 3-D estimations using the described statistically-based technique are robust against Poisson-distributed shot noise inherent to soft X-ray images.Also,our proposed methodology shows that the accuracy of both three-dimensional(3-D)estimation and the magnetopause standoff distance calculation highly depends on the observational point.

Estimating the subsolar magnetopause position from soft X-ray images using a low-pass image filter

The Lunar Environment heliospheric X-ray Imager(LEXI)and Solar wind Magnetosphere Ionosphere Link Explorer(SMILE)missions will image the Earth’s dayside magneto pause and cusps in soft X-rays after their respective launches in the near future,to specify glo bal magnetic reconnection modes for varying solar wind conditions.To suppo rt the success of these scientific missions,it is critical to develop techniques that extract the magnetopause locations from the observed soft X-ray images.In this research,we introduce a new geometric equation that calculates the subsolar magnetopause position(RS)from a satellite position,the look direction of the instrument,and the angle at which the X-ray emission is maximized.Two assumptions are used in this method:(1)The look direction where soft X-ray emissions are maximized lies tangent to the magnetopause,and(2)the magnetopause surface near the subsolar point is almost spherical and thus RSis nea rly equal to the radius of the magneto pause curvature.We create synthetic soft X-ray images by using the Open Geospace General Circulation Model(OpenGGCM)global magnetohydrodynamic model,the galactic background,the instrument point spread function,and Poisson noise.We then apply the fast Fourier transform and Gaussian low-pass filte rs to the synthetic images to re move noise and obtain accurate look angles for the soft X-ray pea ks.From the filte red images,we calculate RS and its accuracy for different LEXI locations,look directions,and solar wind densities by using the OpenGGCM subsolar magnetopause location as ground truth.Our method estimates RS with an accuracy of<0.3 RE when the solar wind density exceeds>10 cm-3.The accuracy improves for greater solar wind densities and during southward interplanetary magnetic fields.The method ca ptures the magnetopause motion during southwa rd interplaneta ry magnetic field turnings.Consequently,the technique will enable quantitative analysis of the magnetopause motion and help reveal the dayside reconnection modes for dynamic solar wind conditions.This technique will suppo rt the LEXI and SMILE missions in achieving their scientific o bjectives.

Approach to traumatic cardiac arrest in the emergency department: a narrative literature review for emergency providers

BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modalities,survival rates for TCA patients remain low.This narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating TCA.METHODS:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,2022.The search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English language.Following the search,943 articles were retrieved,and two independent reviewers conducted a screening process.RESULTS:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm.There were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital epinephrine.Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma.Resuscitative endovascular balloon occlusion of the aorta(REBOA)provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock.When implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality rates.Veno-venous extracorporeal life support(V-V ECLS)and veno-arterial extracorporeal life support(V-A ECLS)are viable options for treating respiratory failure and cardiogenic shock,respectively.In the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS.CONCLUSION:TCA remains a signifi cant challenge for emergency medical services due to its high morbidity and mortality rates.Pre-and intra-arrest prognostic factors can help identify patients who are likely to benefit from aggressive and resource-intensive resuscitation measures.Further research is needed to enhance guidelines for the clinical use of established and emerging therapeutic approaches that can help optimize treatment effi cacy and ameliorate survival outcomes.

Molecular Docking Studies on Streptomycin Antileishmanial Activity

Resistance to pentavalent antimonial drugs and the lack of vaccines make it urgent to find novel therapeutic options to treat Leishmaniasis, a tropical disease caused by the Leishmania protozoan parasite. The study reported here is to investigate if Streptomycin, an aminoglycoside, and Amphotericin B, the second-line treatment drug, exhibit antileishmanial activity through a similar mechanism. By using MOE (Molecular Operating Environment), we performed molecular docking studies on these drugs binding to a range of targets including ribosome targets in Leishmania and H. sapiens. Our study shows that the two drugs do not bind to the same pockets in Leishmania targets but to the same pockets in the human ribosome, with some differences in interactions. Moreover, our 2D maps indicated that Amphotericin B binds to the A-site in the human cytoplasmic ribosome, whereas streptomycin does not.

Advanced Computing for Cardiovascular Disease Prediction

Developing a predictive model for detecting cardiovascular diseases (CVDs) is crucial due to its high global fatality rate. With the advancements in artificial intelligence, the availability of large-scale data, and increased access to computational capability, it is feasible to create robust models that can detect CVDs with high precision. This study aims to provide a promising method for early diagnosis by employing various machine learning and deep learning techniques, including logistic regression, decision trees, random forest classifier, extreme gradient boosting (XGBoost), and a sequential model from Keras. Our evaluation identifies the random forest classifier as the most effective model, achieving an accuracy of 0.91, surpassing other machine learning and deep learning approaches. Close behind are XGBoost (accuracy: 0.90), decision tree (accuracy: 0.86), and logistic regression (accuracy: 0.70). Additionally, our deep learning sequential model demonstrates promising classification performance, with an accuracy of 0.80 and a loss of 0.425 on the validation set. These findings underscore the potential of machine learning and deep learning methodologies in advancing cardiovascular disease prediction and management strategies.

促进糖尿病患者足溃疡愈合的干预措施指南(2023年更新版)——《国际糖尿病足工作组:糖尿病相关的足病预防与管理指南(2023)》的一部分

创面处理的原则,包括清创、创面准备和使用涉及改变创面生理以促进愈合的新技术,在试图治愈慢性糖尿病相关的足溃疡时是至关重要的。此外,糖尿病相关的足溃疡的发病率和治疗成本不断上升,这就需要结合作为金标准的多学科治疗已有共识,运用高质量的疗效和成本效益证据来支持和加强慢性糖尿病相关的足溃疡创面愈合的干预措施。本指南是2023年国际糖尿病足工作组(IWGDF)针对促进糖尿病患者足溃疡愈合的干预措施的循证指南。它是对2019年IWGDF指南的更新。我们遵循推荐、评估、发展、评价分级(GRADE)方法,以患者-干预-对照-结果(PICO)形式设计临床问题从而得出重要结果,进行系统综述,制定评判表汇总,并为每个问题撰写推荐和理由。每条推荐的形式都是基于系统综述中发现的证据,并使用GRADE评判汇总项目,包括理想和不理想的效果、证据的可信度、对患者的价值、所需的资源、成本效益、公平性、可行性和可接受性;我们制定的推荐由作者同意并由独立专家和利益相关者审查。根据系统综述和从证据到决策过程的结果,我们提出29条推荐。我们对使用干预措施改善糖尿病患者足溃疡的愈合提出了一些有条件的支持性推荐。这些推荐包括蔗糖八硫酸盐敷料的使用,对手术后的创面使用负压疗法,使用胎盘衍生产品,使用自体白细胞、血小板、纤维蛋白贴剂,使用局部氧疗,以及使用高压氧,但我们强调在任何情况下这些推荐应在单独应用最佳标准治疗无法治愈伤口且有资源可用于干预的情况下使用。这些关于创面愈合的推荐应该有助于提高糖尿病伴足溃疡患者的疗效,我们希望这些推荐能得到广泛的实施。然而,尽管作为推荐基础的许多证据的准确性正在提高,但总体上仍然很差,我们鼓励在这一领域进行更多、质量更好的试验,包括那些有关卫生经济学分析的试验。

Integration of traditional,complementary,and alternative medicine with modern biomedicine:the scientization,evidence,and challenges for integration of traditional Chinese medicine

Traditional medicine has garnered significant global recognition,with an estimated 80%of the global population using it.Therefore,it is essential to fully understand the integration of traditional medicines into current healthcare systems.This review aims to provide a comprehensive overview of the standard process to modernize traditional medicine scientifically in the context of modern biomedicine,further termed here as“scientization”.Specifically,we aim to summarize the advancements made in understanding the efficacy,effectiveness,and underlying mechanisms of herbal medicine.We also examined the transition from experience-to evidence-based medicine during acupuncture.Furthermore,we explore the development of universal safety and quality control standards.Finally,we discuss international trade and export markets for Chinese medical products.The development and integration of traditional medicine have allowed it to further improve human health,resulting in a more comprehensive health solution for the global population.

Mitigating the Prevalence of Diabetic Retinopathy in the United States: Utilization of the Chronic Care Model as a Public Health Framework

As the prevalence of diabetic retinopathy continues to be on the rise, the Chronic Care Model (CCM) offers a transformative, patient-focused approach for efficient diabetic retinopathy care, emphasizing the need for urgent and innovative strategies in the United States. The model integrates community resources, healthcare organizations, self-management support, delivery system design, decision support, and clinical information systems. Addressing challenges and solutions, the model emphasizes proactive and preventive measures, collaborative multidisciplinary care, technological integration, and overcoming resistance to change. This paper proposes the utilization of the Chronic Care Model (CCM) as a possible public health framework for comprehensive management of diabetic retinopathy in the United States. Implementing the CCM offers a comprehensive approach to diabetic retinopathy care, addressing both individual and systemic factors, essential for improving public health outcomes.

Universal newborn hearing screening program in Saudi Arabia: Current insight

Newborn hearing screening(NHS) programs are essential to identify hearing loss early in life and to improve outcomes in children. In Saudi Arabia, the national NHS program has been operational since 2016;however, few studies have evaluated its status, and none have covered all provinces across the country. This cross-sectional retrospective study provides an overview of the program's status across all provinces, focusing on screening coverage rates, referral/fail rates, and follow-up procedures. In 2021, 199,034 newborns were screened, with a coverage rate of 92.6% and an overall referral/fail rate of 1.87%. These performance measures provide a foundation for future progress and improvements. This study highlights the importance of ongoing efforts to enhance the program's effectiveness and sustainability.

Non-linear dynamic state-space network modeling for decoding neurodegeneration

Neurodegenerative disorders represent a pervasive global health challenge,yet therapeutic options remain conspicuously limited.These disorders are inherently dynamic processes within the central nervous system,unfolding across distinct sub-stages:initial structural neuronal alterations(sub-stage 1),functional impairment(sub-stage 2),and culminating in neuronal death(sub-stage 3).

Fusion: It’s Time to Color outside the Lines

There has been some good news, and some bad news in the controlled fusion community recently. The good news is that the Lawrence Livermore National Laboratory (LLNL) has recently produced a burning plasma. It succeeded on several of its shots where ~1.5 - 2 megajoules from its laser (National Ignition Facility, or NIF) has generated ~1.3 - 3 megajoules of fusion products. The highest ratio of fusion energy to laser energy it achieved, defined as its Q, was 1.5 at the time of this writing. While LLNL is sponsored by nuclear stockpile stewardship, this author sees a likely path from their result to fusion for energy for the world, a path using a very different laser and a very different target configuration. The bad news is that the International Tokamak Experimental Reactor (ITER) has continued to stumble on more and more delays and cost overruns, as its capital cost has mushroomed from ~$5 billion to ~ $25 B. This paper argues that the American fusion effort, for energy for the civilian economy, should switch its emphasis not only from magnetic fusion to inertial fusion but should also take much more seriously fusion breeding. Over the next few decades, the world might well be setting up more and more thermal nuclear reactors, and these might need fuel which only fusion breeders can supply. In other words, fusion should begin to color outside the lines.

Effects of Chlorine and Chlorine Monoxide on Stratospheric Ozone Depletion

This paper presents a system approach of mass balance calculations of ozone and other species under diffusion-convection-reaction processes to study the impacts of major ozone-depleting chemicals, chlorine (Cl) and chlorine monoxide (ClO), and the effect of photolysis on ozone concentrations, ozone depletion, total ozone abundance, and ozone layer along the altitude in the stratosphere. The calculated ozone concentrations and profile of the layer followed a similar trend and were generally in good agreement with the measurements above the tropical area. The calculated peak of the layer was at the same mid-stratosphere at Z = 30 km with a peak concentration and total ozone abundance about 20% higher than the measured peak concentration of 8.0 ppm and total abundance of 399 DU. In the presence of Cl and ClO, the calculated ozone concentrations and total abundance were substantially reduced. Cl generally depleted more uniformly of ozone across the altitude, while ClO reduced substantially the ozone in the upper stratosphere and thus shifted the peak of the layer to a much lower elevation at Z = 14 km. Although both ClO and Cl are active ozone-depleting chemicals, ClO was found to have a more pronounced impact on ozone depletion and distribution than Cl. The possible explanations of these interesting phenomena were discussed and elaborated. The approach and calculations in this paper were shown to be useful in providing an initial insight into the structure and behavior of the complex ozone layer.

2-D Modeling and Calculations of Stratospheric Ozone and Influences of Convection, Diffusion, and Time

An engineering system approach of 2-D cylindrical model of transient mass balance calculations of ozone and other concerned chemicals along with fourteen photolysis, ozone-generating and ozone-depleting chemical reaction equations was developed, validated, and used for studying the ozone concentrations, distribution and peak of the layer, ozone depletion and total ozone abundance in the stratosphere. The calculated ozone concentrations and profile at both the Equator and a 60˚N location were found to follow closely with the measured data. The calculated average ozone concentration was within 1% of the measured average, and the deviation of ozone profiles was within 14%. The monthly evolution of stratospheric ozone concentrations and distribution above the Equator was studied with results discussed in details. The influences of slow air movement in both altitudinal and radial directions on ozone concentrations and profile in the stratosphere were explored and discussed. Parametric studies of the influences of gas diffusivities of ozone DO3 and active atomic oxygen DO on ozone concentrations and distributions were also studied and delineated. Having both influences through physical diffusion and chemical reactions, the diffusivity (and diffusion) of atomic oxygen DO was found to be more sensitive and important than that of ozone DO3 on ozone concentrations and distribution. The 2-D ozone model present in this paper for stratospheric ozone and its layer and depletion is shown to be robust, convenient, efficient, and executable for analyzing the complex ozone phenomena in the stratosphere. .

Bifurcation Analysis Reveals Solution Structures of Phase Field Models

The phase field method is playing an increasingly important role in understanding and predicting morphological evolution in materials and biological systems.Here,we develop a new analytical approach based on the bifurcation analysis to explore the mathematical solution structure of phase field models.Revealing such solution structures not only is of great mathematical interest but also may provide guidance to experimentally or computationally uncover new morphological evolution phenomena in materials undergoing electronic and structural phase transitions.To elucidate the idea,we apply this analytical approach to three representative phase field equations:the Allen-Cahn equation,the Cahn-Hilliard equation,and the Allen-Cahn-Ohta-Kawasaki system.The solution structures of these three phase field equations are also verified numerically by the homotopy continuation method.

The effect of alcohol and eligibility for liver transplant:a critical review

Background:Alcohol-related liver disease(ALRD)has emerged as a significant global health concern,primarily attributed to the overconsumption of alcohol.While alcoholism has the potential to impact various organs,it is the liver that is especially vulnerable.Methods:This review comprehensively examines the challenges encountered during the pre-transplant,intra-transplant,and post-transplant phases,a significant number of which are attributable to alcohol misuse.Historically,liver transplant(LT)programmes have excluded patients with alcohol-related liver disease(ARLD)due to mandatory abstinence requirements and apprehensions regarding potential graft shortages for other hepatic diseases.This review counters these concerns by highlighting the minimal usage of grafts for early liver transplantation.It strongly advocates for the incorporation of severe alcoholic hepatitis into the model for end-stage liver disease allocation,devoid of any stigmatization.The selection of ARLD individuals for LT necessitates the critical involvement of a multidisciplinary team,inclusive of addiction specialists.Results:Despite the complexities associated with LT for patients with ARLD,this review underscores its therapeutic advantages,particularly for those anticipated to experience severe adverse effects.This review accentuates the necessity of ensuring equitable access to medical interventions for all patients,irrespective of their lifestyle choices.Conclusion:The examination of genetic and epigenetic variables that play a role in the onset and advancement of ALD.The identification of potential therapy strategies is also an important area of study.The formulation of intricate eligibility rules for LT in patients with a past of alcohol abuse needs essential interactions between medical practitioners and researchers.The use of new technologies such as genomics and epigenomics could boost the accuracy of ALD diagnostic and prognostic approaches.These targeted investigations could potentially lead to major improvements in the management and treatment results of ALD.

Adherence to Advisory Committee on Immunization Practices in diabetes mellitus patients in Saudi Arabia:A multicenter retrospective study

BACKGROUND Patients with diabetes mellitus(DM)are predisposed to an increased risk of infection signifying the importance of vaccination to protect against its potentially severe complications.The Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices(CDC/ACIP)issued immunization recommendations to protect this patient population.AIM To assess the adherence of patients with DM to the CDC/ACIP immunization recommendations in Saudi Arabia and to identify the factors associated with the vaccine adherence rate.METHODS An observational retrospective study conducted in 2023 was used to collect data on the vaccination records from 13 diabetes care centers in Saudi Arabia with 1000 eligible patients in phase I with data collected through chart review and 709 patients in phase II through online survey.RESULTS Among participants,10.01%(n=71)had never received any vaccine,while 85.89%(n=609)received at least one dose of the coronavirus disease 2019(COVID-19)vaccine,and 34.83%(n=247)had received the annual influenza vaccine.Only 2.96%(n=21),2.11%(n=15),and 1.12%(n=8)received herpes zoster,tetanus,diphtheria,and pertussis(Tdap),and human papillomavirus(HPV)vaccines,respectively.For patients with DM in Saudi Arabia,the rate of vaccination for annual influenza and COVID-19 vaccines was higher compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,site of care,income level,DM-related hospitalization history,residency site,hemoglobin A1c(HbA1c)level,and health sector type can significantly influence the vaccination rate in patients with DM.Among non-vaccinated patients with DM,the most reported barriers were lack of knowledge and fear of side effects.This signifies the need for large-scale research in this area to identify additional factors that might facilitate adherence to CDC/ACIP vaccine recommendations in patients with DM.CONCLUSION In Saudi Arabia,patients with DM showed higher vaccination rates for annual influenza and COVID-19 vaccines compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,the site of care,income level,DM-related hospitalization history,residency site,HbA1c level,and health sector type can significantly influence the vaccination rate in patients with DM.

Practical guide:Glucagon-like peptide-1 and dual glucosedependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonists in diabetes mellitus

Practical guide:Glucagon-like peptide-1 and dual glucosedependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonists in diabetes mellitus common second-line choice after metformin for treating T2DM.Various considerations can make selecting and switching between different GLP-1 RAs challenging.Our study aims to provide a comprehensive guide for the usage of GLP-1 RAs and dual GIP and GLP-1 RAs for the management of T2DM.