{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T11:10:33Z","timestamp":1767179433563,"version":"build-2238731810"},"update-to":[{"DOI":"10.1371\/journal.pntd.0013486","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000}}],"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research","doi-asserted-by":"publisher","award":["IRIS ID No. 2020-1428; No.6\/9(257)2020\/ECD-II"],"award-info":[{"award-number":["IRIS ID No. 2020-1428; No.6\/9(257)2020\/ECD-II"]}],"id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008064","name":"Georgetown University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008064","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Filarial lymphedema, caused by lymphatic filariasis, is characterized by chronic swelling and recurrent skin infections. Acute adenolymphangitis (ADL) episodes significantly exacerbate morbidity. Diabetes mellitus (DM) increases susceptibility to infections; however, the relationship between diabetes and ADL frequency and severity in filarial lymphedema patients remains unclear. This study investigated the influence of diabetes on ADL attacks and identified predictors influencing ADL episodes in patients with filarial lymphedema.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methodology\/Principal findings<\/jats:title>\n                    <jats:p>This case-control study analyzed data from 166 patients (79 diabetic, 87 non-diabetic) attending a filariasis management clinic in Puducherry, India. Sociodemographic data, clinical characteristics, ADL frequency, severity, and adherence to morbidity management and disability prevention (MMDP) practices were collected. Univariate and multivariate logistic regression analyses examined the association between diabetes mellitus and ADL episodes. Diabetes status did not significantly influence ADL frequency or severity. However, lymphedema severity and intertrigo presence emerged as significant predictors of increased ADL attack risk. Home-based care was associated with increased ADL frequency, suggesting potential inadequacies in current self-care practices.<\/jats:p>\n                    <jats:p>Integration of filarial lymphedema care into existing non-communicable disease (NCD) clinics at primary healthcare centers (PHCs) and subcenters could streamline care delivery, enhance patient management, and optimize healthcare resource utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study emphasizes the importance of integrated care approaches addressing both diabetes and lymphedema management. Lymphedema severity and intertrigo management should be prioritized in patient care to mitigate ADL risks. Strengthening home-care education and protocols is essential for improving ADL outcomes. Future research should explore structured community-based and prospective studies to clarify diabetes management\u2019s potential protective role and further enhance the quality of care for affected individuals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0013486","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T17:54:02Z","timestamp":1757354042000},"page":"e0013486","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of diabetes mellitus on adenolymphangitis episodes in patients with filarial lymphedema\u2014Towards an integrated care approach"],"prefix":"10.1371","volume":"19","author":[{"given":"Nikita","family":"Kubal","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sowmiya","family":"Manavalan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vijayakumar","family":"Balakrishnan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nileshkumar","family":"Elangovan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danapriyaa","family":"Dharmalingam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8435-218X","authenticated-orcid":true,"given":"Vijesh Sreedhar","family":"Kuttiatt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"issue":"2","key":"pntd.0013486.ref001","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/s00436-020-06991-y","article-title":"Lymphatic filariasis in Asia: a systematic review and meta-analysis","volume":"120","author":"N Bizhani","year":"2021","journal-title":"Parasitol Res"},{"key":"pntd.0013486.ref002","volume-title":"Lymphatic filariasis","author":"World Health Organization","year":"2023"},{"issue":"9747","key":"pntd.0013486.ref003","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1016\/S0140-6736(10)60586-7","article-title":"Lymphatic filariasis and onchocerciasis","volume":"376","author":"MJ Taylor","year":"2010","journal-title":"Lancet"},{"issue":"3","key":"pntd.0013486.ref004","doi-asserted-by":"crossref","first-page":"119","DOI":"10.3347\/kjp.2008.46.3.119","article-title":"Clinical and pathological aspects of filarial lymphedema and its management","volume":"46","author":"RK Shenoy","year":"2008","journal-title":"Korean J Parasitol"},{"key":"pntd.0013486.ref005","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1475-2883-6-2","article-title":"Morbidity management in the Global Programme to Eliminate Lymphatic Filariasis: a review of the scientific literature","volume":"6","author":"DG Addiss","year":"2007","journal-title":"Filaria J"},{"issue":"1","key":"pntd.0013486.ref006","doi-asserted-by":"crossref","first-page":"316","DOI":"10.3390\/ijerph19010316","article-title":"Lymphatic Filariasis: A Systematic Review on Morbidity and Its Repercussions in Countries in the Americas","volume":"19","author":"ZM Medeiros","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"3","key":"pntd.0013486.ref007","doi-asserted-by":"crossref","first-page":"227","DOI":"10.4103\/0974-777X.83527","article-title":"Impact of basic lymphedema management and antifilarial treatment on acute dermatolymphangioadenitis episodes and filarial antigenaemia","volume":"3","author":"H El-Nahas","year":"2011","journal-title":"J Glob Infect Dis"},{"key":"pntd.0013486.ref008","unstructured":"Lymphatic filariasis: managing morbidity and preventing disability. 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