{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:29:48Z","timestamp":1786627788329,"version":"build-2736575974"},"reference-count":61,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Type 2 diabetes mellitus (T2DM) is a global health concern associated with complications that significantly impact patients\u2019 quality of life and place significant burdens on healthcare systems. While the prevalence of T2DM is rising in Ethiopia, the scope and factors contributing to its complications remain understudied. Hence, this study aimed to assess the burden and identify associated factors of chronic complications among Type 2 diabetes mellitus patients attending Wolaita Sodo University Comprehensive Specialized Hospital in Southern Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A facility-based cross-sectional quantitative study was conducted from July 1 to August 30, 2024, involving 404 systematically sampled T2DM patients. Data on sociodemographic characteristics, clinical profiles, self-care practices, and chronic complications were collected through structured interviews and medical record reviews. Descriptive statistics summarized patient characteristics, while multivariable logistic regression identified factors associated with chronic complications. Results were reported as Adjusted Odds Ratios (AORs) with 95% Confidence Intervals (CIs), and a p-value\u2009&lt;\u20090.05 was considered statistically significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 404 type 2 Diabetes mellitus patients participated in the study, with a response rate of 97.58%. The mean age of participants was 44.80\u2009\u00b1\u200914.10 years, 41.09% had diabetes for more than 5 years, and 64.85% had suboptimal glycemic control. Among participants, 45.54% (95% CI: 40.61\u201350.54) had at least one chronic complication, and one in five had multimorbidity. The most common microvascular complications were peripheral neuropathy (14.85%) and nephropathy (9.65%), while macrovascular complications included congestive heart failure (14.11%) and cerebrovascular disorders (11.39%). Multivariable logistic regression identified older age (AOR\u2009=\u20092.74; 95% CI: 1.73, 4.37; p\u2009&lt;\u20090.000), female sex (AOR\u2009=\u20092.14; 95% CI: 1.12, 4.16; p\u2009=\u20090.039), longer diabetes duration (AOR\u2009=\u20092.98; 95% CI: 1.41, 6.54; p\u2009=\u20090.007), poor glycemic control (AOR\u2009=\u20092.02; 95% CI: 1.33, 3.09; p\u2009=\u20090.001), hypertriglyceridemia (AOR\u2009=\u20092.00; 95% CI: 1.06, 3.80; p\u2009=\u20090.038), high salt intake (AOR\u2009=\u20091.57; 95% CI: 1.06, 2.32; p\u2009=\u20090.024), and physical inactivity (AOR\u2009=\u20091.75; 95% CI: 1.16, 2.64; p\u2009=\u20090.008) as significant factors associated with chronic complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Nearly half of patients with Type 2 diabetes in Southern Ethiopia experienced chronic complications, emphasizing the need for improved prevention and management strategies. Strengthening diabetes care should include routine lipid and blood pressure screening, HbA1c testing where feasible, and nurse-led foot assessment. Community-based interventions promoting physical activity and dietary modification, along with patient education on glycemic control, should be scaled up. Implementing these feasible, low-cost measures within Ethiopia\u2019s existing chronic care framework can help reduce the burden and improve health outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0336666","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T18:26:36Z","timestamp":1762885596000},"page":"e0336666","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Chronic complications among patients with type 2 diabetes in Southern Ethiopia"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6870-9193","authenticated-orcid":true,"given":"Biniyam Demisse","family":"Andarge","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3158-9500","authenticated-orcid":true,"given":"Desta Haftu","family":"Hayelom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayih Mehari","family":"Degualem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Habtamu Esubalew","family":"Bezie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Habtamu","family":"Wondmagegn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohannes","family":"Habtegiorgis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muluken Bekele","family":"Sorrie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yilma","family":"Chisha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"pone.0336666.ref001","doi-asserted-by":"crossref","DOI":"10.2337\/dc14-S081","article-title":"Diagnosis and classification of diabetes mellitus","volume":"37","author":"American Diabetes Association","year":"2014","journal-title":"Diabetes Care"},{"key":"pone.0336666.ref002","article-title":"Introduction: Standards of medical care in diabetes\u20142018","volume":"41","author":"American Diabetes Association","year":"2018","journal-title":"Diabetes Care"},{"key":"pone.0336666.ref003","first-page":"223","article-title":"Type 2 diabetes","volume-title":"Exercise management for referred medical conditions","author":"J Henson","year":"2023"},{"issue":"19","key":"pone.0336666.ref004","doi-asserted-by":"crossref","first-page":"5939","DOI":"10.3390\/jcm11195939","article-title":"Non-communicable diseases: the invisible epidemic","volume":"11","author":"D Piovani","year":"2022","journal-title":"J Clin Med"},{"key":"pone.0336666.ref005","first-page":"1","volume-title":"IDF Diabetes Atlas","author":"International Diabetes Federation","year":"2025","edition":"11"},{"key":"pone.0336666.ref006","author":"Institute for Health Metrics and Evaluation (IHME)","year":"2024"},{"issue":"10397","key":"pone.0336666.ref007","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/S0140-6736(23)01301-6","article-title":"Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021","volume":"402","author":"GBD 2021 Diabetes Collaborators","year":"2023","journal-title":"Lancet"},{"key":"pone.0336666.ref008","doi-asserted-by":"crossref","first-page":"100132","DOI":"10.1016\/j.obmed.2019.100132","article-title":"Diabetes in Ethiopia: A systematic review of prevalence, risk factors, complications, and cost","volume":"15","author":"KG Bishu","year":"2019","journal-title":"Obes Med"},{"issue":"9131","key":"pone.0336666.ref009","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1016\/S0140-6736(98)07019-6","article-title":"Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group","volume":"352","author":"R Turner","year":"1998","journal-title":"Lancet"},{"issue":"37","key":"pone.0336666.ref010","doi-asserted-by":"crossref","first-page":"16009","DOI":"10.1073\/pnas.1006639107","article-title":"Paracrinology of islets and the paracrinopathy of diabetes","volume":"107","author":"RH Unger","year":"2010","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"7258","key":"pone.0336666.ref011","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1136\/bmj.321.7258.405","article-title":"Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study","volume":"321","author":"IM Stratton","year":"2000","journal-title":"BMJ"},{"issue":"9833","key":"pone.0336666.ref012","doi-asserted-by":"crossref","first-page":"2243","DOI":"10.1016\/S0140-6736(12)60525-X","article-title":"Effect of regression from prediabetes to normal glucose regulation on long-term reduction in diabetes risk: results from the Diabetes Prevention Program Outcomes Study","volume":"379","author":"L Perreault","year":"2012","journal-title":"Lancet"},{"key":"pone.0336666.ref013","article-title":"Complications of diabetes","volume":"2018","author":"K Papatheodorou","year":"2018","journal-title":"J Diabetes Res"},{"issue":"5","key":"pone.0336666.ref014","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1001\/archinternmed.2011.2","article-title":"Impact of diabetes on cardiovascular disease risk and all-cause mortality in older men: influence of age at onset, diabetes duration, and established and novel risk factors","volume":"171","author":"SG Wannamethee","year":"2011","journal-title":"Arch Intern Med"},{"issue":"11","key":"pone.0336666.ref015","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.2522\/ptj.20080020","article-title":"Epidemiology of diabetes and diabetes-related complications","volume":"88","author":"AD Deshpande","year":"2008","journal-title":"Phys Ther"},{"issue":"1","key":"pone.0336666.ref016","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1152\/physrev.00045.2011","article-title":"Mechanisms of diabetic complications","volume":"93","author":"JM Forbes","year":"2013","journal-title":"Physiol Rev"},{"key":"pone.0336666.ref017","doi-asserted-by":"crossref","first-page":"121","DOI":"10.2147\/IJGM.S226010","article-title":"Demographic and Clinical Factors Associated with Development of Type 2 Diabetes: A Review of the Literature","volume":"13","author":"Y Pinchevsky","year":"2020","journal-title":"Int J Gen Med"},{"key":"pone.0336666.ref018","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1186\/s12902-019-0463-3","article-title":"Sociodemographic and lifestyle-related risk factors for identifying vulnerable groups for type 2 diabetes: a narrative review with emphasis on data from Europe","volume":"20","author":"I Kyrou","year":"2020","journal-title":"BMC Endocr Disord"},{"issue":"1","key":"pone.0336666.ref019","first-page":"1","article-title":"Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025","volume":"10","author":"X Lin","year":"2020","journal-title":"Scient Rep"},{"issue":"11","key":"pone.0336666.ref020","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2023-013994","article-title":"Strengthening evidence to inform health systems: opportunities for the WHO and partners to accelerate progress on non-communicable diseases","volume":"8","author":"AA Hyder","year":"2023","journal-title":"BMJ Glob Health"},{"issue":"8","key":"pone.0336666.ref021","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1096\/fba.2020-00117","article-title":"Progress and challenges in achieving noncommunicable diseases targets for the sustainable development goals","volume":"3","author":"J Singh Thakur","year":"2021","journal-title":"FASEB Bioadv"},{"issue":"2","key":"pone.0336666.ref022","article-title":"The Burden of Non-Communicable Diseases and Its Implications for Sustainable Development Goals Across Regions in Ethiopia","volume":"37","author":"Awedew AF, Tezera, Berheto M, Dheresa M, Tadesse S, Hailemariam A, et al","year":"2023","journal-title":"Ethiop J Health Dev"},{"issue":"12","key":"pone.0336666.ref023","article-title":"Mapping national, regional and local prevalence of hypertension and diabetes in Ethiopia using geospatial analysis","volume":"12","author":"DN Koye","year":"2022","journal-title":"BMJ Open"},{"key":"pone.0336666.ref024","doi-asserted-by":"crossref","first-page":"2095","DOI":"10.2147\/DMSO.S368165","article-title":"Poor self-care practices and being urban resident strongly predict chronic complications among patients with type 2 diabetes in eastern Ethiopia: A hospital-based cross-sectional study","volume":"15","author":"S Letta","year":"2022","journal-title":"Diabetes Metab Syndr Obes"},{"key":"pone.0336666.ref025","volume-title":"WHO STEPS Surveillance Manual: The WHO STEPwise approach to noncommunicable disease risk factor surveillance","author":"World Health Organization","year":"2017"},{"key":"pone.0336666.ref026","volume-title":"Diagnosis and management of type 2 diabetes (HEARTS-D)","year":"2020"},{"key":"pone.0336666.ref027","volume-title":"National Noncommunicable Diseases Management Protocols","author":"Ethiopian Ministry of Health","year":"2021"},{"issue":"1","key":"pone.0336666.ref028","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1186\/s12933-018-0787-8","article-title":"Vascular complications in patients with type 2 diabetes: prevalence and associated factors in 38 countries (the DISCOVER study program)","volume":"17","author":"M Kosiborod","year":"2018","journal-title":"Cardiovasc Diabetol"},{"key":"pone.0336666.ref029","article-title":"Glycemic targets: standards of medical care in diabetes\u20142022","volume":"45","author":"American Diabetes Association Professional Practice Committee","year":"2022","journal-title":"Diabetes Care"},{"issue":"5","key":"pone.0336666.ref030","doi-asserted-by":"crossref","first-page":"667","DOI":"10.4093\/dmj.2022.0215","article-title":"Blood Pressure Target in Type 2 Diabetes Mellitus","volume":"46","author":"H-J Kim","year":"2022","journal-title":"Diabetes Metab J"},{"key":"pone.0336666.ref031","doi-asserted-by":"crossref","DOI":"10.2337\/dc20-S005","article-title":"Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2020","volume":"43","author":"American Diabetes Association","year":"2020","journal-title":"Diabetes Care"},{"key":"pone.0336666.ref032","volume-title":"Clinical Practice Recommendation on the Diabetic Foot: A Guide for Health Care Professionals","author":"International Diabetes Federation","year":"2017"},{"key":"pone.0336666.ref033","doi-asserted-by":"crossref","first-page":"1028342","DOI":"10.3389\/fpsyt.2022.1028342","article-title":"Medical outcomes study social support survey (MOS-SSS) in patients with chronic disease: A psychometric assessment","volume":"13","author":"C Merino-Soto","year":"2023","journal-title":"Front Psychiatry"},{"key":"pone.0336666.ref034","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.2147\/DMSO.S227664","article-title":"Glycemic Control, Diabetes Complications and Their Determinants Among Ambulatory Diabetes Mellitus Patients in Southwest Ethiopia: A Prospective Cross-Sectional Study","volume":"13","author":"M YimamAhmed","year":"2020","journal-title":"Diabetes Metab Syndr Obes"},{"issue":"8","key":"pone.0336666.ref035","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0290240","article-title":"The magnitude of chronic diabetes complications and its associated factors among diabetic patients attending the general hospitals in Tigray region, Northern Ethiopia","volume":"18","author":"KK Berhe","year":"2023","journal-title":"PLoS One"},{"key":"pone.0336666.ref036","doi-asserted-by":"crossref","first-page":"4909","DOI":"10.2147\/DMSO.S281992","article-title":"Prevalence, Patterns and Predictors of Chronic Complications of Diabetes Mellitus at a Large Referral Hospital in Ethiopia: A Prospective Observational Study","volume":"13","author":"T Sheleme","year":"2020","journal-title":"Diabetes Metab Syndr Obes"},{"issue":"4","key":"pone.0336666.ref037","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.18203\/2394-6040.ijcmph20191049","article-title":"Prevalence of complications of diabetes among patients with diabetes mellitus attending a tertiary care centre in Tamil Nadu","volume":"6","author":"MS Praythiesh Bruce","year":"2019","journal-title":"Int J Community Med Public Health"},{"issue":"6","key":"pone.0336666.ref038","article-title":"Prevalence and associated factors of vascular complications among inpatients with type 2 diabetes: A retrospective database study at a tertiary care department, Ningbo, China","volume":"15","author":"J Li","year":"2020","journal-title":"PLoS One"},{"issue":"2","key":"pone.0336666.ref039","doi-asserted-by":"crossref","first-page":"195","DOI":"10.3402\/ijch.v69i2.17442","article-title":"Micro- and macrovascular complications among Greenlanders and Danes with type 2 diabetes mellitus in Nuuk, Greenland","volume":"69","author":"ML Pedersen","year":"2010","journal-title":"Int J Circumpolar Health"},{"issue":"2","key":"pone.0336666.ref040","doi-asserted-by":"crossref","first-page":"117","DOI":"10.2174\/1570161117666190502103733","article-title":"Microvascular Complications of Type 2 Diabetes Mellitus","volume":"18","author":"C Faselis","year":"2020","journal-title":"Curr Vasc Pharmacol"},{"issue":"1","key":"pone.0336666.ref041","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1186\/s13098-021-00704-w","article-title":"Microvascular complications and its predictors among type 2 diabetes mellitus patients at Dessie town hospitals, Ethiopia","volume":"13","author":"MA Seid","year":"2021","journal-title":"Diabetol Metab Syndr"},{"issue":"2","key":"pone.0336666.ref042","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1001\/jamainternmed.2013.12956","article-title":"Rates of complications and mortality in older patients with diabetes mellitus: the diabetes and aging study","volume":"174","author":"ES Huang","year":"2014","journal-title":"JAMA Intern Med"},{"key":"pone.0336666.ref043","doi-asserted-by":"crossref","first-page":"9367483","DOI":"10.1155\/2023\/9367483","article-title":"In-Hospital Mortality and Its Predictors among Hospitalized Diabetes Patients: A Prospective Observational Study","volume":"2023","author":"D Eyob Tediso","year":"2023","journal-title":"Int J Clin Pract"},{"issue":"3","key":"pone.0336666.ref044","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1007\/s12020-024-03772-w","article-title":"Early onset type 2 diabetes mellitus: an update","volume":"85","author":"M Strati","year":"2024","journal-title":"Endocrine"},{"issue":"9","key":"pone.0336666.ref045","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/S2213-8587(15)00236-3","article-title":"The challenge of diabetes in sub-Saharan Africa","volume":"3","author":"R Atun","year":"2015","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"7","key":"pone.0336666.ref046","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1007\/s12170-015-0462-5","article-title":"Sex Differences in the Excess Risk of Cardiovascular Diseases Associated with Type 2 Diabetes: Potential Explanations and Clinical Implications","volume":"9","author":"SAE Peters","year":"2015","journal-title":"Curr Cardiovasc Risk Rep"},{"issue":"6","key":"pone.0336666.ref047","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s11892-018-1005-5","article-title":"Sex Differences in the Burden and Complications of Diabetes","volume":"18","author":"SAE Peters","year":"2018","journal-title":"Curr Diab Rep"},{"issue":"3","key":"pone.0336666.ref048","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1210\/er.2015-1137","article-title":"Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus","volume":"37","author":"A Kautzky-Willer","year":"2016","journal-title":"Endocr Rev"},{"issue":"7","key":"pone.0336666.ref049","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.2337\/dc08-0194","article-title":"Sex disparities in the treatment and control of cardiovascular risk factors in type 2 diabetes","volume":"31","author":"I Gouni-Berthold","year":"2008","journal-title":"Diabetes Care"},{"issue":"4","key":"pone.0336666.ref050","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0035515","article-title":"Self care behavior among patients with diabetes in Harari, Eastern Ethiopia: the health belief model perspective","volume":"7","author":"K Ayele","year":"2012","journal-title":"PLoS One"},{"issue":"1","key":"pone.0336666.ref051","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1186\/s12944-017-0625-0","article-title":"Hypertriglyceridemia and atherosclerosis","volume":"16","author":"J Peng","year":"2017","journal-title":"Lipids Health Dis"},{"issue":"5","key":"pone.0336666.ref052","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/j.bbalip.2011.10.003","article-title":"Hypertriglyceridemia secondary to obesity and diabetes","volume":"1821","author":"S Subramanian","year":"2012","journal-title":"Biochim Biophys Acta"},{"issue":"24","key":"pone.0336666.ref053","doi-asserted-by":"crossref","first-page":"2313","DOI":"10.1093\/eurheartj\/ehz962","article-title":"Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel","volume":"41","author":"J Bor\u00e9n","year":"2020","journal-title":"Eur Heart J"},{"issue":"2","key":"pone.0336666.ref054","doi-asserted-by":"crossref","first-page":"135","DOI":"10.4070\/kcj.2016.46.2.135","article-title":"Hypertriglyceridemia and cardiovascular diseases: revisited","volume":"46","author":"SH Han","year":"2016","journal-title":"Korean Circ J"},{"key":"pone.0336666.ref055","doi-asserted-by":"crossref","first-page":"111315","DOI":"10.1016\/j.biopha.2021.111315","article-title":"Adipose tissue and insulin resistance in obese","volume":"137","author":"B Ahmed","year":"2021","journal-title":"Biomed Pharmacother"},{"issue":"5","key":"pone.0336666.ref056","first-page":"575","article-title":"Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms","volume":"34","author":"JR Petrie","year":"2018","journal-title":"Can J Cardiol"},{"issue":"1","key":"pone.0336666.ref057","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1002\/jgf2.10","article-title":"Dietary salt intake and diabetes complications in patients with diabetes: An overview","volume":"18","author":"C Horikawa","year":"2017","journal-title":"J Gen Fam Med"},{"issue":"4","key":"pone.0336666.ref058","doi-asserted-by":"crossref","first-page":"280","DOI":"10.4093\/dmj.2016.40.4.280","article-title":"Dietary Sodium Intake in Patients with Type 2 Diabetes Mellitus","volume":"40","author":"MK Kim","year":"2016","journal-title":"Diabetes Metab J"},{"key":"pone.0336666.ref059","doi-asserted-by":"crossref","DOI":"10.3949\/ccjm.84.s1.03","article-title":"The essential role of exercise in the management of type 2 diabetes","volume":"84","author":"JP Kirwan","year":"2017","journal-title":"Cleve Clin J Med"},{"issue":"2","key":"pone.0336666.ref060","doi-asserted-by":"crossref","first-page":"471","DOI":"10.2337\/dc12-0783","article-title":"Association between physical activity and risk of all-cause mortality and cardiovascular disease in patients with diabetes: a meta-analysis","volume":"36","author":"S Kodama","year":"2013","journal-title":"Diabetes Care"},{"issue":"12","key":"pone.0336666.ref061","doi-asserted-by":"crossref","DOI":"10.2337\/dc10-1548","article-title":"Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement","volume":"33","author":"SR Colberg","year":"2010","journal-title":"Diabetes Care"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0336666","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T18:26:48Z","timestamp":1762885608000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0336666"}},"subtitle":[],"editor":[{"given":"Mirna Alejandra","family":"Gonzalez-Gonzalez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,11,11]]},"references-count":61,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0336666","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,11]]}}}