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Postoperative endophthalmitis is a devastating complication of cataract surgery. Intracameral moxifloxacin has emerged as a promising prophylactic strategy due to its broad-spectrum properties and pre-formulated preparations. However, a robust synthesis of evidence from randomized controlled trials (RCTs) is needed to confirm its efficacy and safety. A systematic review and meta-analysis were conducted using evidence from PubMed, Scopus, Web of Science, and CENTRAL, including RCTs published up to August 2025. The primary outcome was the incidence of endophthalmitis, while secondary outcomes included endothelial cell count (ECC) and central corneal thickness (CCT). We pooled outcomes using risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) using Stata (version 18). A total of six RCTs involving 4,438 patients were included. Overall, one RCT demonstrated a low risk of bias, three RCTs raised some concerns, and two RCTs were assessed as having a high risk of bias. Intracameral moxifloxacin significantly reduced the incidence of postoperative endophthalmitis compared to the control group ( = 5 RCTs, RR: 0.22, 95% CI [0.07, 0.77], = 0.02). A sensitivity analysis excluding studies with a high risk of bias demonstrated that the effect remained statistically significant ( = 3 RCTs, RR: 0.183, 95% CI 0.038, 0.874, = 0.03), with no evidence of heterogeneity ( = 0%, = 0.65). There was no significant difference between the moxifloxacin and control groups regarding postoperative changes in ECC ( = 3 RCTs, MD: 22.17, 95% CI [-8.53, 52.88], = 0.16) or CCT ( = 3 RCTs, MD: -0.03, 95% CI [-0.36, 0.31], = 0.88). Prophylactic intracameral moxifloxacin significantly reduces the incidence of postoperative endophthalmitis following cataract surgery. This substantial protective benefit is achieved without evidence of compromised endothelial safety; however, safety conclusions are limited by the small number of patients assessed and should be interpreted with caution. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD420251144067), https://www.crd.york.ac.uk/PROSPERO/view/CRD420251144067.

This study aimed to investigate the association of physical activity and sleep metrics, measured via wrist-worn accelerometers, with depression in people with type 1 diabetes. People with type 1 diabetes were recruited from the Dasman Diabetes Institute in Kuwait and were invited to wear a wrist-worn accelerometer device for 7 days. Mean physical activity (overall acceleration), inactivity, light activity, moderate activity, vigorous activity, the distribution of physical activity intensity (intensity gradient), sleep duration and sleep efficiency were quantified from the accelerometer data. The associations of these metrics with depression were investigated using multiple linear regression. A total of 551 people with type 1 diabetes (age 33.1 (9.5) years) were included. Overall physical activity (B = -0.09, CI = -0.14 to -0.04), moderate intensity activity (B = -0.02, CI = -0.02 to -0.01), vigorous intensity activity (B = -0.16, CI = -0.27 to -0.05), and the intensity gradient (B = -2.11, CI = -3.51 to -0.72) were negatively associated with depression score (p < 0.01) and these associations remain significant even after adjustment for age, sex, diabetes duration, and BMI. However, sleep duration and efficiency were not associated with depression. After mutual adjustment overall physical activity (B = -0.07, CI = -0.12 to -0.01), but not the intensity gradient (B = -0.90, CI = -2.47 to 0.68), remained associated with depression. Overall, moderate and vigorous physical activity, and the intensity gradient were associated with lower symptoms of depression. Overall physical activity, rather than the distribution of activity intensity, appears more important in depression. This information can help guide physical activity interventions to improve depression in people with type 1 diabetes.

BackgroundDiabetes can be detected at the primary health-care level, and effective treatments lower the risk of complications. There are insufficient data on the coverage of treatment for diabetes and how it has changed. We estimated trends from 1990 to 2022 in diabetes prevalence and treatment for 200 countries and territories.MethodsWe used data from 1108 population-representative studies with 141 million participants aged 18 years and older with measurements of fasting glucose and glycated haemoglobin (HbA1c), and information on diabetes treatment. We defined diabetes as having a fasting plasma glucose (FPG) of 7·0 mmol/L or higher, having an HbA1c of 6·5% or higher, or taking medication for diabetes. We defined diabetes treatment as the proportion of people with diabetes who were taking medication for diabetes. We analysed the data in a Bayesian hierarchical meta-regression model to estimate diabetes prevalence and treatment.FindingsIn 2022, an estimated 828 million (95% credible interval [CrI] 757–908) adults (those aged 18 years and older) had diabetes, an increase of 630 million (554–713) from 1990. From 1990 to 2022, the age-standardised prevalence of diabetes increased in 131 countries for women and in 155 countries for men with a posterior probability of more than 0·80. The largest increases were in low-income and middle-income countries in southeast Asia (eg, Malaysia), south Asia (eg, Pakistan), the Middle East and north Africa (eg, Egypt), and Latin America and the Caribbean (eg, Jamaica, Trinidad and Tobago, and Costa Rica). Age-standardised prevalence neither increased nor decreased with a posterior probability of more than 0·80 in some countries in western and central Europe, sub-Saharan Africa, east Asia and the Pacific, Canada, and some Pacific island nations where prevalence was already high in 1990; it decreased with a posterior probability of more than 0·80 in women in Japan, Spain, and France, and in men in Nauru. The lowest prevalence in the world in 2022 was in western Europe and east Africa for both sexes, and in Japan and Canada for women, and the highest prevalence in the world in 2022 was in countries in Polynesia and Micronesia, some countries in the Caribbean and the Middle East and north Africa, as well as Pakistan and Malaysia. In 2022, 445 million (95% CrI 401–496) adults aged 30 years or older with diabetes did not receive treatment (59% of adults aged 30 years or older with diabetes), 3·5 times the number in 1990. From 1990 to 2022, diabetes treatment coverage increased in 118 countries for women and 98 countries for men with a posterior probability of more than 0·80. The largest improvement in treatment coverage was in some countries from central and western Europe and Latin America (Mexico, Colombia, Chile, and Costa Rica), Canada, South Korea, Russia, Seychelles, and Jordan. There was no increase in treatment coverage in most countries in sub-Saharan Africa; the Caribbean; Pacific island nations; and south, southeast, and central Asia. In 2022, age-standardised treatment coverage was lowest in countries in sub-Saharan Africa and south Asia, and treatment coverage was less than 10% in some African countries. Treatment coverage was 55% or higher in South Korea, many high-income western countries, and some countries in central and eastern Europe (eg, Poland, Czechia, and Russia), Latin America (eg, Costa Rica, Chile, and Mexico), and the Middle East and north Africa (eg, Jordan, Qatar, and Kuwait).InterpretationIn most countries, especially in low-income and middle-income countries, diabetes treatment has not increased at all or has not increased sufficiently in comparison with the rise in prevalence. The burden of diabetes and untreated diabetes is increasingly borne by low-income and middle-income countries. The expansion of health insurance and primary health care should be accompanied with diabetes programmes that realign and resource health services to enhance the early detection and effective treatment of diabetes.FundingUK Medical Research Council, UK Research and Innovation (Research England), and US Centers for Disease Control and Prevention.

Objective: To compare the effect of glucose-lowering drugs on peripheral nerve and kidney function in prediabetes. Methods: Multicenter, randomized, placebo-controlled trial in 658 adults with prediabetes treated for 1 year with metformin, linagliptin, their combination or placebo. Endpoints are small fiber peripheral neuropathy (SFPN) risk estimated by foot electrochemical skin conductance (FESC < 70 μSiemens) and estimated glomerular filtration rate (eGFR). Results: Compared to the placebo, the proportion of SFPN was reduced by 25.1% (95% CI:16.3–33.9) with metformin alone, by 17.3% (95% CI 7.4–27.2) with linagliptin alone, and by 19.5% (95% CI 10.1–29.0) with the combination linagliptin/metformin (p < 0.0001 for all comparisons). eGFR remained +3.3 mL/min (95% CI: 0.38–6.22) higher with the combination linagliptin/metformin than with the placebo (p = 0.03). Fasting plasma glucose (FPG) decreased more with metformin monotherapy −0.3 mmol/L (95%CI: −0.48; 0.12, p = 0.0009) and with the combination metformin/linagliptin −0.2 mmol/L (95% CI: −0.37; −0.03) than with the placebo (p = 0.0219). Body weight (BW) decreased by −2.0 kg (95% CI: −5.65; −1.65, p = 0.0006) with metformin monotherapy, and by −1.9 kg (95% CI: −3.02; −0.97) with the combination metformin/linagliptin as compared to the placebo (p = 0.0002). Conclusions: in people with prediabetes, a 1 year treatment with metformin and linagliptin, combined or in monotherapy, was associated with a lower risk of SFPN, and with a lower decrease in eGFR, than treatment with placebo.