Diabetology

Objectives: To assess the impact of peripheral artery disease (PAD) on the outcomes of patients admitted for infected diabetic foot attack (DFA). Methods: Retrospective observational study of consecutive patients admitted to a third-level multidisciplinary diabetic foot service in 2024 for diabetic foot ulcers (DFUs) complicated by moderate or severe infection. Based on the presence of PAD, patients were divided into two groups: those with neuro-ischemic DFA (PAD+), treated with prompt revascularization, and those with neuropathic DFA (PAD-). The following in-hospital outcomes were evaluated: minor and major amputations; length of stay (LOS); mortality. Once discharged, patients were regularly followed as outpatients, and their six-month outcomes (healing, major amputation, and mortality) were analyzed. Results: Overall, 119 patients were included (70% PAD+ vs. 30% PAD-). The mean age was 67 ± 13 years, most patients were male (75%) and had type 2 diabetes (92%) with a mean duration of 20 ± 12 years. In-hospital outcomes for the two groups (PAD+ vs. PAD-) were as follows: minor amputation (41.7 vs. 25.7%, p = 0.09); major amputation (2.4 vs. 2.9%, p = 0.8); LOS (21 ± 11 vs. 14 ± 11 days, p = 0.004); mortality (3.6 vs. 0%, p = 0.1). The six-month follow-up outcomes (PAD+ vs. PAD-) were as follows: healing (40.5 vs. 90.6%, p < 0.0001); major amputation (8.1 vs. 3.1%, p = 0.1); mortality (8.1 vs. 0%, p = 0.01). Additionally, PAD (OR 3.6, CI: 1.4–12.1, p = 0.001) was independently related to non-healing. Conclusions: In the context of infected DFA, PAD appeared to play a significant role only in hospitalization length, while having greater influence on mid-term outcomes at the six-month follow-up, particularly in reducing healing chances. Full article

Purpose: Hyperglycemia frequently occurs in critically ill patients with COVID-19 and may worsen outcomes. This study evaluated the prevalence, predictors, and clinical impact of poor glycemic control in severe and critical cases. Methods: We conducted a retrospective observational study of 338 ICU patients with COVID-19 and hyperglycemia at a tertiary center in Vietnam (August 2021–February 2022). Nearly 15,000 bedside glucose measurements were analyzed. Patients were classified into well-controlled or poorly controlled groups based on mean glucose levels (140–180 mg.dL⁻¹ target). Logistic regression identified predictors of poor control. The primary outcome was in-hospital mortality. Propensity score matching (PSM) and multivariable Cox regression were performed to adjust for confounders. Results: Poor glycemic control occurred in 79% of patients. Independent predictors included invasive mechanical ventilation, elevated admission glucose, pre-existing diabetes, HbA1c > 7.0%, and prolonged corticosteroid exposure. After PSM, mortality was higher in the poorly controlled group compared to the well-controlled group (54.8% vs. 35.5%, p = 0.047). Cox regression confirmed poor glycemic control as an independent predictor of death (adjusted hazard ratio [HR] 1.61, 95% confidence interval [CI] 1.01–2.55, p = 0.045). Conclusions: Poor glycemic control is common and strongly associated with excess mortality in critically ill COVID-19 patients. Prolonged corticosteroid use emerged as a modifiable risk factor. Careful glucose monitoring and tailored steroid management are warranted to improve outcomes. Full article

Background: Type 2 diabetes mellitus (T2DM) is a chronic condition that has been attributed to social factors; however, the cumulative effect of social determinants of health (SDOH) on T2DM incidence is not known. Objective: The aim of the present study was to examine the association between T2DM and the cumulative burden of multiple SDOH. Design: The study is a retrospective cohort study with a baseline between 2008 and 2009 and a ten-year follow-up between 2010 and 2019. Setting: The study was conducted using data from the United States Veterans Health Administration (VHA). Participants: Out of 10,537,027 patients treated in the VHA between 2010 and 2019, 6,518,102 patients were selected who had no evidence of T2DM or Elixhauser comorbidities at baseline (2008–2009). Measurements: Over 10 years following baseline, the exposure consisted of seven types of SDOH occurring in structured data: social isolation, financial stress, employment issues, food insecurity, transportation insecurity, unstably housed, and psychosocial need. Incidence of T2DM in the ten-year follow-up window was the primary outcome. Results: Veterans with ≥3 SDOH doubled their adjusted odds of T2DM (2.07; CI: 2.05–2.09). There were significant racial differences in cumulative SDOH, with 8.8% of Black individuals having the highest burden of ≥3 SDOH compared with 3.8% of White individuals. Transportation insecurity, psychosocial need, and financial stress significantly increased the odds of T2DM across all racial and ethnic groups. Black individuals had the highest T2DM odds ratio for psychosocial need (OR = 1.58; CI: 1.56, 1.60). Limitations: The Veteran population is predominantly male, limiting generalization to the wider population. Conclusions: With each additional SDOH burden, the odds of T2DM increased, and ≥3 SDOH doubled the odds. The cumulative SDOH burden and associated disparities warrant investigation to reduce T2DM incidence. Full article

Background/Objectives: Gestational diabetes mellitus (GDM) affects approximately 12.7% of pregnant women in South Korea. While breastfeeding provides critical health benefits for mothers with GDM and their infants, including improved insulin resistance and reduced Type 2 diabetes risk, no validated GDM-specific breastfeeding knowledge instrument exists. This study aimed to develop and validate a breastfeeding knowledge instrument for women with GDM. Methods: This methodological study employed systematic procedures for the development and validation of knowledge test. Initial item generation yielded 30 items across three domains: postpartum physical characteristics, breastfeeding barriers, and breastfeeding benefits. Content validity was evaluated by six clinical experts and ten experiential experts (women with GDM). An online survey was conducted in October 2022 with 220 women diagnosed with GDM who were either pregnant or within six months postpartum. Item analysis, exploratory factor analysis, and reliability testing were performed. Convergent validity was assessed by calculating the Pearson correlation coefficient with an established breastfeeding knowledge scale. Results: Following expert review and psychometric analysis, the final instrument comprised 14 items across three factors: postpartum physical characteristics (3 items), breastfeeding barriers (2 items), and breastfeeding benefits (9 items). The Kaiser–Meyer–Olkin measure was 0.884, Bartlett’s test was significant (χ² = 838.835, p < 0.001), and factor loadings were satisfactory. The KR-20 reliability coefficient was 0.826, and criterion validity was confirmed. Conclusions: This first validated GDM-specific breastfeeding knowledge instrument enables the identification of knowledge gaps and the development of targeted educational interventions to improve maternal-child health outcomes. Full article

Diabetic foot ulcers (DFUs) are among the most severe and costly complications of diabetes, affecting millions of individuals worldwide. This narrative review summarizes major advances in regenerative medicine relevant to the management of DFUs and discusses how these approaches contribute to faster and more effective wound healing. Stem cell-based therapies, particularly those using adipose-derived mesenchymal stem cells (AD-MSCs), have demonstrated promising clinical outcomes through their ability to modulate inflammation, promote angiogenesis, and support skin and soft tissue regeneration. Platelet-rich plasma (PRP), an accessible autologous therapy, delivers concentrated growth factors that accelerate wound closure, enhance neovascularization, and shorten healing time compared with standard care. In addition, decellularized extracellular matrix (dECM) scaffolds provide a biologically active structural framework that supports cell adhesion, tissue remodeling, and granulation tissue formation. Collectively, these regenerative strategies offer new perspectives for improving functional recovery and quality of life in patients with DFUs, transforming chronic non-healing wounds into opportunities for effective tissue repair. Full article

Background/Objectives: There is an invisibility of the diabetes epidemic among Vietnamese Americans. Not only is there limited availability of culturally and linguistically tailored national Diabetes Prevention Program (DPP) and Diabetes Self-Management Education and Support (DSMES) programs, but there are enrollment and retention challenges that hinder these programs’ sustainability and expansion. The purpose of this study was to explore the cultural beliefs, perceived barriers, and motivating factors that influence Vietnamese Americans’ willingness to engage in existing diabetes prevention and self-management programs. Methods: A qualitative descriptive study design was used. A total of 26 participants were recruited through snowball sampling. Bilingual Vietnamese American researchers conducted semi-structured interviews. Content analysis was used to analyze data. Results: Most participants were in the earlier stages of readiness for engagement in a national diabetes program. Major barriers to engagement were related to financial and time constraints, notable among middle-aged participants. Key motivators for engagement included increasing health awareness and family and other social support. Despite their hesitation regarding diabetes program engagement, most participants were further along in the stages of readiness for self-directed lifestyle management. Conclusions: These results will guide the development of a linguistically and culturally adapted diabetes prevention and management program that will support individuals at various stages of their behavior change journey. The program should align with cultural values, address structural barriers, and emphasize the integration of social and familial motivators. Full article

Metabolic inflammation, a state of chronic low-grade inflammation linked to insulin resistance, plays a central role in the development of obesity-related conditions such as type 2 diabetes, non-alcoholic fatty liver disease (NAFLD), and cardiovascular disorders. In recent years, two molecules have gained significant prominence in this field, owing to their mechanistic involvement in metabolic inflammation and insulin resistance: fetuin-A (FetA), aliver-derived hepatokine, and chymase, a serine protease released from mast cells. Although they arise from distinct biological sources, they converge on overlapping inflammatory and metabolic pathways. FetA acts as an endogenous ligand for Toll-like receptor 4 (TLR4), activating nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling, driving proinflammatory cytokine release, and impairing insulin signaling. Chymase, on the other hand, generates angiotensin II and activates transforming growth factor-β (TGF-β), thereby promoting oxidative stress, fibrosis, and secondary metabolic dysfunction. This review proposes a conceptual dual-target framework in which FetA and chymase are considered complementary, rather than independent, mediators of metabolic inflammation. Importantly, this framework is not intended to supersede other established pathways implicated in metabolic inflammation, but rather to provide an integrative perspective that complements existing hepatokine and immune-centered models. Their convergence on NF-κB and TGF-β signaling pathways highlights shared mechanistic nodes within metabolic inflammation. Accordingly, the emphasis of this review is on mechanistic integration within metabolic inflammation, rather than on immediate therapeutic innovation or clinical translation. Full article

Background: Type 2 diabetes (T2D) increases cardiovascular disease (CVD) risk and predisposes individuals to heart failure with preserved ejection fraction. Metabolic dysfunction-associated steatotic liver disease (MASLD), prevalent in T2D, may worsen cardiac remodelling and haemodynamics. This secondary analysis of the DIASTOLIC trial examined the relationship of liver fat to cardiac remodelling in T2D at baseline and after a 12-week intervention or standard care. Methods: Adults with obesity and T2D and matched controls underwent hepatic MRI, cardiac MRI, echocardiography, and adipokine profiling as part of the DIASTOLIC study (NCT02590822). Participants with T2D were randomised to supervised exercise, a low-calorie meal-replacement plan (MRP), or routine care for 12 weeks. A baseline case–control and then pre- and post-analyses in those with T2D were performed. Associations between changes in liver fat and cardiovascular measures were assessed using correlation and adjusted generalised linear models. Results: At baseline, 81 T2D and 35 healthy controls were compared, and 76 subjects with T2D completed the trial. Participants with T2D had ~4× higher hepatic fat and adverse haemodynamics. The MRP arm achieved the greatest reductions in BMI, blood pressure, dysglycaemia, insulin resistance, and hepatic fat (−8.9%), with favourable adipokine changes. Overall, hepatic fat loss was associated with reductions in cardiac index and stroke volume and with additional reductions in end-diastolic volume in the MRP arm, independent of BMI. Conclusions: In T2D, hepatic fat is strongly linked to pathological haemodynamic profiles. Intensive caloric restriction achieves substantial hepatic fat loss and normalisation of hyperdynamic cardiovascular physiology independent of weight loss, identifying hepatic steatosis as a potential therapeutic target for early cardiovascular risk reduction. Full article

Background: This work aimed to determine whether curcumin influences the development of type 1 diabetes mellitus (DM) in a murine model. Methodology: Four groups of six non-obese diabetic (NOD) mice (A, B, C, and D) and one CD1 control group (E) were included. Groups A, B, and C received different doses of turmeric curcumin (50 mg/kg body weight (bw), 100 mg/kg bw, and 200 mg/kg bw, respectively) for six weeks, while groups D and E received only the vehicle simultaneously. Glycemia, body weight, and inflammatory infiltrate in the pancreatic islets were determined in all cases. Also, insulin and vitamin D receptor (VDR) expression in pancreatic cells was evaluated relative to the basal expression in the control (group E). Results: Glycemia in all the animals treated with curcumin remained stable from weeks 1 to 6, while the control group showed hyperglycemia (≥500 mg/dL) and weight loss (16.7 g ± 1 g). Treated animals had less inflammatory infiltrate, while maintaining insulin and VDR expression in the pancreas, compared with the control group. Finally, the serum concentrations of proinflammatory cytokines in treated animals were statistically lower than in the control group without curcumin. Conclusions: Curcumin delays the onset of T1DM and reduces pancreatic inflammatory infiltrate. Full article

Background: The pancreatic beta-cell hormone insulin regulates the metabolism of carbohydrates, as well as fats and protein. While the insulin response to a carbohydrate challenge is well defined in normoglycaemic as well as dysglycaemic (prediabetes and type 2 diabetes (T2DM)) individuals, the response of co-secreted beta-cell products (C-peptide, proinsulin and proinsulin intermediates) is less well defined. This analysis aimed to establish the expected glycaemic and pancreatic beta-cell responses to a standardised mixed meal in individuals with impaired glucose tolerance (IGT) and T2DM alongside reference ranges established in normoglycaemic individuals (NGT). Methods: A total of 743 adults (104 NGT, 85 IGT and 554 T2DM) were included, none of whom were on any anti-diabetic medication at the time of initial testing. All attended following a 10 h fast, before consuming a 500 kcal solid mixed meal (calorie contribution: 58% carbohydrates, 22% fat and 20% protein). Blood samples were collected every 30 min for the 4.5 h duration of the test for the determination of plasma glucose, insulin, C-peptide and intact and total proinsulin. Median profiles with corresponding 2.5th and 97.5th percentile lines to display the expected range were calculated and plotted for the three participant groups. Results: Median profiles with ranges over a 4.5 h meal period have been created for glucose, insulin, C-peptide and intact and total proinsulin, along with respective fasting and post-meal intervals in the three participant groups with differing glycaemic status. Conclusions: The resulting profiles and ranges allow for comparison in responses to a carbohydrate challenge in individuals across the glycaemic spectrum. Full article

Diabetes mellitus remains a major global health burden, and many patients do not achieve durable glycemic control despite modern pharmacotherapy. This narrative review synthesizes evidence on plant-derived strategies that may complement standard care, focusing on two clinically aligned domains: glucose-lowering medicinal plants and plant-based sugar substitutes that reduce dietary glycemic load. We summarize key mechanistic pathways, including inhibition of α-amylase/α-glucosidase, reduced intestinal glucose entry and absorption kinetics, glucose-dependent insulinotropic effects, improved insulin signaling, suppression of hepatic gluconeogenesis, and microbiota-linked effects. We critically appraise human evidence for selected botanicals (cinnamon, fenugreek, mulberry, gymnema, gynura, rosehip, and Jerusalem artichoke) and plant sweeteners (stevia and monk fruit). Overall, clinical effects are modest and heterogeneous; the most reproducible signals are observed for mulberry leaf in blunting postprandial glucose excursions, and for cinnamon, fenugreek, and gymnema, where meta-analyses suggest modest improvements in glycemic markers. Stevia and monk fruit are best supported as glycemically neutral sucrose substitutes, while inulin-type fructans show small-to-moderate benefits with sustained intake, limited by gastrointestinal tolerability at higher doses. Key gaps include a shortage of long-term randomized trials using standardized preparations and durable endpoints such as glycated hemoglobin. Plant-derived interventions are therefore best positioned as adjuncts within individualized, evidence-based glycemic management. Full article

Diabetic ketoacidosis (DKA) remains a life-threatening complication of diabetes mellitus with suboptimal outcomes despite standard management. Emerging evidence suggests that thiamine (vitamin B1) deficiency may play an under-recognized role in DKA pathophysiology and clinical course. This narrative review synthesizes current evidence regarding thiamine deficiency in diabetes and DKA, examining molecular mechanisms, clinical implications, and the rationale for thiamine supplementation as adjunctive therapy. Thiamine deficiency is highly prevalent in diabetes, with plasma concentrations reduced by approximately 75% compared to healthy controls. In DKA specifically, 25–35% of patients present with thiamine deficiency, which often worsens during insulin therapy. The primary mechanism involves hyperglycemia-induced downregulation of renal thiamine transporters (THTR-1 and THTR-2), resulting in 16–24-fold increased renal clearance and massive urinary losses. Thiamine pyrophosphate serves as an essential cofactor for three critical enzymes in glucose metabolism: pyruvate dehydrogenase, α-ketoglutarate dehydrogenase, and transketolase. Deficiency impairs these pathways, causing pyruvate accumulation with conversion to lactate (resulting in lactic acidosis), compromised TCA cycle function (reducing ATP production by 40–48%), and decreased NADPH generation (increasing oxidative stress). Clinical manifestations include persistent metabolic acidosis despite standard therapy, myocardial dysfunction with elevated cardiac biomarkers, neurological impairment, and prolonged recovery times. Cellular studies demonstrate that thiamine supplementation significantly improves mitochondrial oxygen consumption in DKA patients. The high prevalence of thiamine deficiency in DKA, compelling biochemical rationale, excellent safety profile, and preliminary mechanistic evidence support the urgent need for large-scale randomized controlled trials examining thiamine supplementation to definitively establish efficacy, optimal dosing, and patient selection criteria. Full article

Background: Diabetes mellitus is known to affect the prognosis of critically ill patients; however, its impact on independence in activities of daily living (ADL) at hospital dis-charge remains unclear. This study aimed to investigate whether preexisting diabetes is associated with reduced ADL independence at hospital discharge among critically ill patients. Methods: In this prospective cohort study, 423 adult intensive care unit (ICU) patients who were admit-ted for ≥48 h were enrolled and categorized by the presence or absence of diabetes. Primary outcomes included time to achieve walking independence (unassisted walking over 50 m) and the Barthel Index at discharge. Secondary outcomes were handgrip strength, ICU length of stay, and highest ICU Mobility Scale (IMS) scores. Multivariable analyses adjusted for age, illness severity, and other confounders. Results: Among the 101 patients with diabetes, time to achieve walking independence at discharge was significantly longer compared to those without diabetes (p = 0.013). The diabetes group also had a lower Barthel Index (p = 0.020), longer ICU stays (p = 0.003), weaker handgrip strength (p = 0.041), and lower maximum IMS scores (p = 0.002). Multivariable analysis confirmed that diabetes was independently associated with reduced ADL independence and poorer physical function at discharge. Conclusions: Preexisting diabetes is an independent predictor of impaired ADL independence in critically ill patients. These findings highlight the importance of early and individualized rehabilitation strategies for patients with diabetes in the ICU. Full article

Background/Objectives: Postprandial hyperglycemia and sleep quality can influence arterial stiffness; however, the interaction between sleep quality and postprandial hyperglycemia-induced changes in arterial stiffness remains poorly elucidated. Therefore, the purpose of this study was to investigate whether sleep quality modifies postprandial changes in blood glucose levels and arterial stiffness following a 75 g oral glucose tolerance test in healthy middle-aged and older adults. Methods: In this study on 104 healthy middle-aged and older adults (50–83 years old), arterial stiffness was assessed using carotid–femoral pulse wave velocity (cfPWV) and brachial–ankle pulse wave velocity (baPWV) before and 60 min after a 75 g oral glucose tolerance test (OGTT). Poor sleep quality was defined as a Pittsburgh Sleep Quality Index score > 5.5. Results: In the 51 participants with poor sleep quality, baPWV increased significantly from baseline to 60 min after the 75 g OGTT (p < 0.01), whereas no such change was observed in the 53 subjects with good sleep quality. baPWV was significantly higher in the poor-sleep-quality group than in the good-sleep-quality group 60 min after the 75 g OGTT (p < 0.01). Moreover, baPWV and blood glucose levels 60 min after the 75 g OGTT had a positive correlation (p < 0.01, r = 0.64). Conclusions: These findings suggest that a poor sleep quality may enhance postprandial hyperglycemia-induced arterial stiffness, whereas a good sleep quality may help protect vascular function. Full article

Background: Diabetes is a known risk factor of acute coronary syndrome (ACS). However, diabetes de novo and prediabetes are also common in ACS patients. This study explored the prevalence of prediabetes and diabetes de novo in ACS patients, glucose-mediating therapy at discharge, and compared the prevalence of 30-day major adverse cardiac and cerebrovascular events (MACCE) in patients with prediabetes and diabetes de novo with known diabetes. Methods: ACS patients with measured haemoglobin A1c (HbA1c) from the South-East Netherlands Heart Registry, a prospective, multicentre registry of patients undergoing percutaneous coronary intervention (PCI), were analysed. Patients were stratified into two groups: known diabetes, and prediabetes (HbA1c 39–47 mmol/mol) or diabetes de novo (HbA1c ≥ 48 mmol/mol). Outcomes were analysed at 30 days post-PCI. Results: HbA1c was available in 34.1% of ACS patients (n = 1836), of whom 526 (28.7%) had known diabetes, 619 (33.7%) prediabetes, and 180 (9.8%) diabetes de novo. Compared with patients with known diabetes, patients with prediabetes and diabetes de novo had a significantly higher risk of MACCE (HR = 1.81, 95% CI 1.12–2.93, p = 0.016) after multivariable adjustment. At discharge, 59% of patients with diabetes de novo received no insulin, metformin, nor sodium-glucose co-transporter-2 inhibitor, compared with 16% of patients with known diabetes (p < 0.001). Conclusions: Impaired glucose metabolism without known diabetes was observed in nearly 45% of ACS patients and they demonstrated a significantly higher risk of 30-day MACCE compared with patients with known diabetes. Despite clear guideline recommendations, routine screening for hyperglycaemia and the appropriate initiation of glucose-mediating therapy remain underutilised in clinical practice. Full article

Background/Objectives: Achieving a balanced wholefood diet while stabilising glycaemic management is challenging for many people with type 2 diabetes (T2D) due to barriers such as food preparation skills, time, and medication effects. Diabetes-specific nutritional formulas (DSNFs) are nutritionally complete products designed to support glycaemic management and overall nutritional adequacy and may complement wholefood dietary approaches when these are not feasible or are insufficient. Despite growing clinical evidence of efficacy, practical guidance for routine use is limited. Methods: A multidisciplinary expert working group developed a Clinical Practice Guide (CPG) for integrating DSNFs into diabetes care. Development was informed by a literature review and iterative consensus among experts, including representatives of the Australian Diabetes Society, Australian Diabetes Educators Association, and the Royal Australian College of General Practitioners. Results: The CPG outlines a three-step pathway: (1) assess suitability (clinical indications, contraindications, preferences, cultural context); (2) tailor the approach (individual goals, dose/timing relative to weight and body composition goals and observed glycaemic patterns, integration with lifestyle care); and (3) monitor progress (baseline, 2–4 weeks to assess initial response, then 3, 6, and 12 months for glycaemic indices, weight/body composition where available, and medication review). Conclusions: This CPG provides practical, multidisciplinary guidance for the person-centred use of DSNFs as an adjunct to standard care, supporting translation of current evidence into clinical practice and promoting consistent, multidisciplinary implementation. Full article

Background: Irisin, a recently discovered muscle-originating hormone, has been found to act as a biomarker of several ailments, while no guideline clearly indicates its testing so far in any particular population category or pathological condition. Objective: We analyzed blood (circulating) irisin in relation to the potential correlations with the evaluation of glucose and bone profile. Methods: This was a prospective, pilot, exploratory study (between December 2024 and August 2025). The enrolled patients were menopausal women aged ≥50. Exclusion criteria: Endocrine tumors, thyroid dysfunction, malignancies, or chronic kidney disease. Baseline (fasting) testing was followed by 75 g oral glucose tolerance test (OGTT). Enzyme-linked immunosorbent assay (ELISA)-based irisin assay (MyBioSource) was performed. The subjects underwent central Dual-Energy X-Ray Absorptiometry (DXA), which provided lumbar, femoral neck and total hip bone mineral density (BMD)/T-score (GE Lunar Prodigy), and lumbar DXA-based trabecular bone score (TBS iNsight). Results: We enrolled 89 females [mean age of 62.84 ± 9.33 years, average years since menopause (YSM) of 15.94 ± 9.23]. Irisin (102.69 ± 98.14 ng/mL) did not correlate with age, YSM, but with body mass index (r = 0.36, p < 0.001). Bone formation marker osteocalcin (r = −0.25, p = 0.018) was negatively associated with irisin, amidst multiple other mineral metabolism assays (including PTH and 25-hydroxyvitamin D). Irisin positively correlated with insulin (r = 0.385, p = 0.0008), HbA1c (r = 0.243, p = 0.022), and HOMA-IR (r = 0.313, p = 0.007). Additional endocrine assays pointed a statistically significant association between irisin and TSH, respectively, ACTH (r = 0.267, p = 0.01, and r = 0.309, p = 0.041, respectively). No correlation irisin-BMD/T-score/TBS was confirmed. Conclusions: Irisin correlates with markers of glucose status (insulin, HOMA-IR, and HbA1c), as well as body mass index and, to a lesser extent, bone metabolism markers. Interestingly, TSH and ACTH correlations open a new (hypothesis-generating) perspective in the endocrine frame of approaching this exerkine. To the best of our knowledge, no distinct study has so far addressed the TBS–irisin relationship or pinpointed the glucose effects on TBS, particularly in menopausal women. Full article

Background/Objectives: Inflammation may play a critical role in the pathogenesis of gestational diabetes mellitus (GDM). However, evidence linking early-pregnancy cytokines to subsequent GDM risk remains inconsistent, with most prior research focusing only on CRP, IL6, and TNFα. In this study, we expand on prior work by evaluating a broader range of immune markers and assessing sociodemographic factors as potential moderators. Methods: Data from a prospective U.S. pregnancy cohort (n = 308) were analyzed. Twenty cytokines were quantified in maternal first-trimester plasma using the MILLIPLEX High-Sensitivity Human Cytokine Magnetic Bead Panel. One-hour oral glucose (50 g) tolerance test (OGTT) values assessed at an average gestational age of 27.7 weeks (SD = 2.9) and GDM diagnosis were abstracted from medical records. Multivariable linear and logistic regression models were used to examine associations between cytokines and 1 h 50 g OGTT levels or GDM diagnosis, adjusting for key sociodemographic factors. Interactions terms were included to evaluate whether sociodemographic factors moderated cytokine–GDM relationships. Results: Sixteen women (5.1%) were diagnosed with GDM. Higher first-trimester high-sensitivity-IL6 levels were significantly associated with increased 1 h 50 g OGTT values (b = 3.76; 95% CI: 0.21, 7.32; p = 0.04) and greater odds of GDM (OR = 2.36; 95% CI: 1.17, 4.77; p = 0.02). These associations were more pronounced among Non-Hispanic White women compared to Non-Hispanic Black women (p for interaction = 0.03) and potentially those with normal weight or underweight during early pregnancy compared to overweight or obese women (p for interaction = 0.08). Conclusions: Elevated inflammatory markers, particularly high-sensitivity IL6, in early pregnancy are linked to impaired glucose metabolism and increased GDM risk later in pregnancy. These relationships appeared stronger in Non-Hispanic White women and women with normal weight or underweight during early pregnancy, underscoring the potential to develop serology-based early identification and prevention strategies. Full article

Background/Objectives: Youth with type 1 diabetes (T1DM) face unique challenges in balancing dietary choices, physical health outcomes, and social–emotional well-being in school settings. This cross-sectional exploratory pilot study examined the associations of diet with physical health and teacher-reported social–emotional functioning in students with T1DM. Methods: Students with T1DM (mean age = 13.42; 47 female, 50 male; 50% White, Non-Hispanic, 50% minority) self-reported their nutritional habits using the KBlock Dietary Screener for Children when school was in session. Teacher-rated school-related behaviors were assessed through the Behavior Assessment Scale for Children-2nd Edition (BASC-2). Canonical correlation analysis was conducted to determine whether the variable sets (diet with physical health and school-related behavioral health) shared a significant multivariate relationship. Results: Youth with lower glycemic loads and consuming more sugar, dairy, and meat/poultry/fish but fewer legumes, fruit, and less saturated fat exhibited fewer externalizing symptoms and higher BMI. Diet uniquely accounted for modest variance in combined social–emotional and physical health, controlling for demographics and T1DM duration. Findings support increasing the availability of whole, nutrient-rich foods, integrating comprehensive nutrition education into curricula, and ensuring access for all students, regardless of socioeconomic status. Conclusions: Comprehensive dietary assessments and school-based randomized control trials are needed to enact more evidence-based dietary recommendations or interventions for youth, aiming for a balanced approach that addresses both mental and physical health outcomes. Full article