Diabetology, Volume 6, Issue 4 (April 2025) – 10 articles

Background: Insulin resistance (IR) is a metabolic disorder linked to type 2 diabetes and cardiovascular diseases. Visceral fat is a better predictor of IR than BMI and waist circumference due to its metabolic and inflammatory impact. Methods such as DEXA and bioimpedance (BIA) estimate body fat, while scales such as METS-IR, SPISE, and TyG assess IR risk. This study analyzes the utility of visceral and body fat measured by BIA compared to other indicators. Methods: A cross-sectional study was conducted on 8590 workers in the Balearic Islands, analyzing anthropometric, clinical, and analytical variables. Body fat and visceral fat were measured by bioimpedance, and insulin resistance was assessed using METS-IR, SPISE, and TyG. ROC curves were used to evaluate the predictive value of BMI, WC, and body fat. Results: The areas under the curve (AUCs) were highest for high METS-IR, particularly in women (>0.97), indicating excellent performance. TyG showed the lowest AUC, especially in men. Body and visceral fat showed the highest AUC for all IR scales. Youden’s indices were highest for high METS-IR, with good predictive capacity, while TyG showed low values, limiting its utility in predicting insulin resistance. Conclusions: Measuring body and visceral fat by BIA is superior to BMI or WC for estimating IR risk. Full article

Background/Objective: Prevention of foot ulceration is critical to reduce the amputation rate in individuals with diabetes mellitus (DM). We investigated the knowledge of diabetic foot care management and prevention of diabetic foot ulcer (DFU) among categories of healthcare practitioners (HCPs). Methods: This descriptive cross-sectional observational study was conducted at public healthcare facilities within the Charlotte Maxeke Johannesburg Academic Hospital Cluster in Gauteng, South Africa. Participants included podiatrists, physiotherapists, occupational therapists, dieticians, medical orthotists and prosthetists, nurses, and medical doctors. Data were collected using a self-administered questionnaire that assessed knowledge of DFU risk factors, foot examination, foot care, and appropriate footwear. Knowledge level was classified as extremely poor if less than 50% of participants from a category of HCPs answered appropriately, reasonable for 50–59%, average at 60–69%, above average from 70–79%, and excellent when ≥80%. The questionnaire was completed by 449 HCPs and analyzed using STATA version 15, with statistical significance set at a p-value less than 0.05. Results: A total of 449 HCPs participated, which comprised the following: 48.1% (216) therapeutic health practitioners (THPs), 37.4% (168) nurses, and 14.5% (65) medical doctors. Only 36% (162) of participants had prior education on DFU. The overall knowledge levels among participants were risk factors of DFU (80%), foot examination (80%), identification of limb-threatening conditions (82%), foot care (77%), and footwear (65%). Medical doctors had the highest median scores for risk factors (85) and foot examination (80), followed by nurses (80 for risk factors and 78 for foot examination). THPs had the lowest median scores for risk factors (78) and foot examinations (70). Differences in knowledge levels across HCPs were statistically significant (p < 0.05). Conclusions: THPs have insufficient knowledge of diabetic foot care and prevention of DFUs. Comprehensive training and targeted educational programs are needed to fill these gaps and improve patient care. Full article

Background: Diabetic foot osteomyelitis (DFO) constitutes a severe and prevalent complication of diabetes mellitus (DM). Individuals afflicted with DM exhibit an elevated risk for DFO development, attributable to a confluence of factors, including peripheral neuropathy, compromised circulation, and impaired immune function. Timely diagnosis and appropriate therapeutic intervention are paramount. In recent years, alongside the ablative approach, the feasibility of substituting compromised bone with a bone substitute has emerged. Methods: We retrospectively analyzed resorbable bone grafting procedures performed at our third-level center for the care of people with diabetes between 2019 and 2024. Forty-nine patients were included in this. The median follow-up period was 13 months (Q1 7, Q3 20). Results: At follow-up, 34 patients (69%) had achieved healing, with a median healing time of 2.3 months (Q1 1.5, Q3 5). Lesion location significantly influenced healing outcomes, with forefoot and midfoot lesions demonstrating an 86% healing rate compared to 50% for hindfoot lesions. Eleven patients (22%) experienced infectious relapse after a median of 1 month (Q1 0.7, Q3 2.9). An analysis of different bone substitutes did not reveal significant differences in terms of healing among the various products and between the presence or absence of a local antibiotic. Conclusions: Bone substitute implantation offers an additional conservative strategy for managing DFO. Healing rates are significantly higher for forefoot and midfoot lesions, suggesting that further research is needed to improve outcomes in hindfoot osteomyelitis. Selection of the most effective bone substitute requires further studies. Full article

Background: This study examined differences in body composition, dietary intake, and exercise habits between people with type 1 diabetes (T1DM) and those without diabetes (NDM). We also sought to clarify the clinical and lifestyle characteristics of overweight people with T1DM. Methods: This controlled cross-sectional study was conducted at a single center, and included 45 people with T1DM and 50 NDM individuals. Body composition, nutrient intake, and exercise habits were evaluated, and exercise habits were compared between people with a T1DM onset before 20 years of age and those with an onset at or after 20 years of age, in relation to the NDM group. Overweight was defined using a BMI of 25.0 kg/m² as the cutoff. Results: The T1DM group had significantly higher BMI and body fat than the NDM group, but no significant difference in muscle mass, and consumed a higher percentage of carbohydrates and a lower percentage of fat. The early-onset T1DM group had significantly lower exercise habits during their school years and in their current life than the NDM group. Individuals in the overweight T1DM group had a lower time in range on a continuous glucose monitor and a higher carbohydrate intake than those in the non-overweight T1DM group. Conclusions: The study suggested that the T1DM group had a significantly higher body fat percentage and carbohydrate intake, and significantly reduced exercise habits as students, compared to the NDM group. Full article

Although digital platforms have gained popularity in the delivery of diabetes interventions, few models have focused on type 1 diabetes (T1D), offer different support delivery mechanisms, and involve peer and health professional-led support. TRIFECTA is a six-month multi-modal digital support intervention that includes a 24/7 peer texting group, an “ask-the-expert” web-based portal, and professional-led virtual group-based interactive sessions. This study examined diabetes-specific quality of life (DSQoL) changes following TRIFECTA. DSQoL was measured using Type 1 Diabetes and Life, a self-report survey that allows for subscale analysis in different age groups. Among 60 adults with type 1 diabetes, improvements were observed for overall diabetes-specific quality of life, primarily driven by the 26–45 years cohort. Subscale analysis found DSQoL improved for emotional experiences and daily activities for adults 26–45 years old, and social isolation improved for adults 46–60 years old. Full article

Objectives: Excessive fetal growth is the most common fetal complication associated with gestational diabetes (GDM), resulting in adverse short- and long-term outcomes. Our main objective was to evaluate the influence of excessive fetal growth on Doppler ultrasonographic measurements of the Umbilical Artery (UA) among women with GDM during the third trimester of pregnancy. Methods: A retrospective study among 472 women with GDM was conducted. UA-PI was measured by Doppler ultrasonography three different times during the third trimester of pregnancy at 28, 32, and 36 weeks. Pregnancies were grouped according to the fetal weight centile or birthweight in two groups: large for gestational age (LGA) group (>90th percentile or ≥4000 g at birth) and adequate for gestational age (AGA) group (<90th percentile or <4000 g at birth, not including the intrauterine growth restrictions). Results: In the LGA group (n = 57, 12.1%), women had higher BMI (p = 0.0001) and fasting blood glucose than the AGA group (97.08 ± 40.69 vs. 86.29 ± 39.58 mg/dL; p = 0.0550). They required insulin therapy more frequently to achieve glycemic control (63.2% vs. 34%, p = 0.0001). In LGA, UA-PI decreased progressively from 28 to 36 weeks (p = 0.0048). The most pronounced reduction occurred at 32 weeks (p = 0.0076). Conclusions: All fetuses from mothers with GDM had a significant and progressive decline in UA-PI during the third trimester of pregnancy. LGA fetuses showed lower UA-PI values compared with AGA fetuses. Since maternal hyperglycemia increases the risk of fetal overweight and GDM may represent a fetal vascular disorder, it therefore seems possible that in LGA fetuses, maternal hyperglycemia could influence the fetal vasculature. Full article

Background: Diabetic kidney disease (DKD) represents a chronic microvascular complication with diabetes, affecting around one-third of diabetic individuals. Despite current therapies, progression to end-stage kidney disease remains a challenge. Abnormal hyperphosphorylation of the Tau protein is implicated in various age-related diseases. This study aimed to explore the link between renal Tau protein hyperphosphorylation and kidney damage in type 2 diabetes mellitus (T2DM). Methods: Sprague Dawley rats were administered lithium chloride (LiCl), an inhibitor of a glycogen synthase kinase-3 (GSK3) inhibitor known to reduce Tau hyperphosphorylation. LiCl was administered either daily or every other day at a dosage of 1 mmol/kg. The effects of LiCl on kidney function were assessed through proteinuria, the kidney-to-bodyweight ratio, inflammation, fibrosis, and TGF-β1 expression levels. Results: Diabetic rats exhibited increased proteinuria, renal hypertrophy, inflammation, fibrosis, and elevated TGF-β1 expression. Lithium chloride treatment reduced kidney hypertrophy, inflammation, and fibrosis, indicating that Tau hyperphosphorylation contributes to the pathogenesis of DKD. LiCl also regulated TGF-β1 expression, which was associated with improved renal outcomes. Conclusions: The inhibition of Tau hyperphosphorylation by lithium chloride offers a potential therapeutic strategy for mitigating kidney damage in diabetic kidney disease. This study proposes LiCl as a novel treatment approach to attenuate DKD progression. Full article

Type 2 diabetes (T2D) is a rapidly growing global health concern, projected to affect 1.3 billion people by 2050, necessitating a multidisciplinary approach. This review examines the epidemiological disparities in T2D, focusing on modifiable and nonmodifiable risk factors, socioeconomic determinants, and healthcare inequities. While genetic predisposition, age, and ethnicity contribute to T2D risk, socioeconomic status (SES) significantly mediates modifiable factors such as diet, physical activity, and access to healthcare. Lower SES is associated with poorer lifestyle choices, limited access to resources, and increased exposure to risk factors, exacerbating T2D prevalence among vulnerable populations. Geographic variations in T2D prevalence are evident, with racial and ethnic minorities and lower-income individuals being disproportionately affected in regions like the United States and Europe. The economic burden of T2D is substantial, with global healthcare expenditures reaching USD 966 billion in 2021 and projected to rise significantly, albeit with variations across different countries and health systems. Despite advancements in treatment, inequities in healthcare access persist, particularly in low- and middle-income countries, hindering optimal glycemic control and consequently contributing to preventable complications and poor health outcomes. This review highlights the critical need for targeted interventions and policy reforms to address the intersection of demographic, economic, and healthcare-related variables influencing T2D disparities. By bridging gaps in prevention, management, and treatment and accounting for the effect of SES on both modifiable and nonmodifiable risk factors, the global disease burden of T2D could be reduced and health equity could be improved. Full article

Background: Microvascular disease (MVD) describes systemic changes in small vessels (~100 µm diameter or smaller) that impair tissue oxygenation and perfusion. MVD has been demonstrated to play an independent role in the risk of limb loss. Despite this relevance, MVD is not regularly assessed clinically because tools used to evaluate and quantify the severity of MVD of the foot remain limited. We sought to evaluate if the Semmes-Weinstein 10-g Monofilament (SWM) can be used to stratify clinical MVD severity. Methods: We evaluated a racially diverse cohort of 124 patients (with 248 limbs). SWM testing was performed on the plantar aspect of the feet at 1st, 3rd^, and 5th metatarsophalangeal joints. Clinical MVD was stratified in an ascending order of severity into: no diabetes; type 2 diabetes (DM); diabetes+ neuropathy (DM+N); diabetes + neuropathy + retinopathy (DM+N+R). Logistic regression models were used to examine the association between a patient’s clinical MVD severity and an abnormal SWM test. Results: Sixty-four patients (51.6%) tested had an abnormal sensation. The odds of an abnormal SWM test were significantly higher for patients with DM+N and DM+N+R compared to those with no DM respectively. (DM vs. No DM: OR: 3.58, [0.98–13.09], p = 0.05; DM+N vs. No DM: OR: 30.46, [10.33–105.17], p < 0.001; DM+N+R vs. No DM: OR: 43.00, [9.89–309.17], p < 0.001). Furthermore, we categorized SWM based on the degree of sensation loss and found that the proportion of people with a higher degree of sensation loss increased across the clinical MVD severity spectrum. Conclusions: Abnormal SWM sensation strongly correlates with the severity of clinical MVD. This suggests that a simple, non-invasive, 1-min SWM test that can be done in the clinic is a promising tool in assessing MVD in the feet, which is particularly significant considering MVD involvement in limb loss. Full article

Metabolic-associated steatotic liver disease (MASLD) and type 2 diabetes mellitus (T2DM) are interrelated metabolic disorders with significant global health impacts. MASLD, the hepatic manifestation of metabolic dysfunction, is driven by insulin resistance, ectopic lipid accumulation, and systematic inflammation. T2DM exacerbates the progression of MASLD, increasing the risk of advanced fibrosis, cardiovascular complications, and hepatocellular carcinoma (HCC). This bidirectional relationship highlights the need for integrated management strategies. The pathology of these conditions involves disrupted lipid and glucose metabolism, leading to a cycle of metabolic dysfunction which worsens both hepatic and systemic outcomes. Non-invasive diagnostic tools have improved early detection but lack precision in staging liver disease, emphasizing the need for more accurate biomarkers. Routine screening for MASLD in diabetic populations is critical for early intervention. Management focuses on weight reduction through lifestyle changes, although long-term adherence remains a challenge. Pharmacological advancements, including glucagon-like peptide-1 receptor agonists (GLP-1Ras) and sodium–glucose cotransporter-2 (SGLT2) inhibitors, show promise in reducing liver fat, improving glycemic control, and slowing fibrosis progression. However, these therapies are less effective in advanced stages of fibrosis and cirrhosis, underscoring the need for novel treatment options. In conclusion, the intertwined nature of MASLD and T2DM necessitates a multidisciplinary approach integrating early diagnosis, lifestyle interventions, and targeted therapies. Future research should prioritize refining diagnostic accuracy and developing innovative treatments for delivering personalized care strategies to mitigate the growing burden of these conditions. These efforts are crucial for improving outcomes in this vulnerable population. Full article