Diabetology

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

Over 100 years after its commercialization, the insulin administration method still needs elementary education. Such observation contrasts with technological progress constantly elaborating new (e.g., weekly) insulin preparations, capable of mimicking the pharmacokinetics of insulin produced by the human pancreas and exploring alternatives to injection. However, insulin administration remains anchored to the subcutaneous route, thus creating the conditions for lipohypertrophies (LHs), a still too frequent and ubiquitously widespread skin complication that, despite being avoidable with an adequate educational path, affects up to 60% of patients and even more. Considering that there are approximately 580 million adult diabetic people in the world today, at least half of whom (290 million) self-inject insulin, should 50% of the latter have LH, approximately 145 million people and even more? Considering that there are approximately 580 million adult diabetic people in the world today, at least half of whom (290 million) self-inject insulin, should 50% of the latter have LH, approximately 145 million people would suffer from such a complication, thus causing a severe problem for the global health system. Indeed, besides being unsightly, LHs cause poor glycemic control, large glucose variability, and frequent unexplained hypoglycemia, and display a strong correlation with micro- and macrovascular complications, inevitably worsening the quality of life of diabetic people. In this narrative review, after a brief description of the alternative routes of administration to subcutaneous injections, we will recall the causes, consequences, and possible corrective actions of LHs, stigmatizing the fundamental role of therapeutic education and hoping that all this can interest all the actors who revolve around the management of insulin therapy, which is too often underestimated and hastily addressed by health professionals, who probably prefer to dedicate time to titration of therapy. Ultimately, our aim is to provide the reader with a practical review of injection errors resulting from incorrect insulin injection techniques, analyzing the leading causes of error and the consequences of these errors, while also providing advice and suggestions to overcome all this. Full article

Introduction/Aim: Type 1 diabetes (T1D) challenges glycemic control, with sleep disturbances affecting insulin sensitivity and glucose variability. This study aimed to observe sleep quality in T1D patients and glycemic outcomes, particularly at bedtime hours. Methods: This retrospective observational study, conducted at an Italian clinical center, included T1D patients using Medtronic devices. Sleep quality was assessed using the Italian version of the Pittsburgh Sleep Quality Index (PSQI), and glycemic outcomes were analyzed with CGM data. Descriptive statistics and non-parametric tests were applied for statistical comparisons. Results: Of 45 patients, four were excluded, leaving 41 for analysis. The mean PSQI score was 6.0 ± 4.1, with 36.6% showing poor sleep quality. No significant differences in age, sex, BMI, or diabetes duration were found. Poor sleepers had a higher time above range level 2 (TAR2) (6.3 ± 6.2%) compared to good sleepers (4.1 ± 5.0%). During bedtime hours, poor sleepers showed a significantly higher TAR2 (6.7 ± 7.2% vs. 3.3 ± 6.2%, p = 0.013). Conclusions: Poor sleep quality is associated with increased nocturnal hyperglycemia in T1D patients. Enhancing sleep quality may contribute to improved glycemic control, particularly during nighttime. Future research should explore targeted sleep interventions in diabetes care, and specific lifestyle-based healthcare programs are recommended to optimize glycemic outcomes. Full article

Background/Objectives: We evaluated the effects of glucagon-like peptide-1 receptor agonists (GLP1-RAs) on body weight and metabolic parameters in people with HIV and diabetes (PWHD) receiving maintenance therapy with integrase inhibitor, using a real-world study design. Methods: PWHD on integrase inhibitors-based antiretroviral therapies for at least 6 months, and treated with GLP1-RAs for at least 3 months, were included in this retrospective study. The primary study outcome was the absolute and relative change in body weight, as assessed during routine outpatient visits. Secondary analyses included evaluating the impact of GLP1-RAs on additional metabolic parameters, such as serum glucose, glycated hemoglobin, and LDL-cholesterol. Results: A total of 25 PWHD (74% males, mean age 65 ± 7 years, with 16% having a body mass index > 30 Kg/m²) receiving GLP1-RAs-based antihyperglycemic therapy were identified from our hospital database. No significant effects of GLP1-RAs on body weight were observed (absolute reduction −1.9 ± 3.0 Kg; relative reduction −2.2 ± 3.7%). Treatment with GLP1-RAs was associated with a progressive and significant reduction in serum glucose and glycated hemoglobin, with no observed impact on LDL cholesterol. Conclusions: Long-term GLP1-RA treatment significantly reduced serum glucose and glycated hemoglobin in overweight PWHD with no effects on body weight. Full article

Background: Diabetes-related distress (DD) significantly impacts self-management and quality of life (QoL) in individuals with type 1 diabetes (T1D). While previous research has established a strong link between DD and glycemic control in type 2 diabetes, the relationship remains less consistent in T1D. Additionally, continuous glucose monitoring (CGM) has been shown to improve glycemic outcomes, yet its effects on self-management and QoL are still debated. This study aimed to examine the relationship between DD, self-management efficacy (SME), and QoL in T1D, incorporating both physiological and behavioral indicators. Furthermore, differences between CGM-users and non-users were investigated. Methods: A cross-sectional study including 108 T1D patients was conducted. Participants completed several validated self-report measures, including the Diabetes Distress Scale (DDS), Diabetes Self-Management Questionnaire (DSMQ), and Audit of Diabetes-Dependent Quality of Life (ADDQoL-19). HbA1c levels and CGM usage were retrieved from medical records. Structural equation modeling (SEM) was used to examine the relationships between DD, self-management, and QoL. Results: Distress level (DDS) had a significant negative effect on SME (β = −0.47, p < 0.001), suggesting that higher distress levels are associated with lower self-management. In contrast, SME showed no significant impact on quality of life (β = 0.03, p = 0.779). However, the relationship between quality of life and distress was significant and negative (β = −0.37, p < 0.001), meaning that higher distress levels are linked to a lower quality of life. No significant differences in DD, SME, HbA1c, or QoL were found among CGM users and non-users. Conclusions: DD significantly impacts self-management and QoL in individuals with T1D. Therefore, incorporating PROs on DD and on behavioral aspects of self-management alongside HbA1c levels in clinical care is essential for optimizing treatment plans and improving physical health outcomes. While CGM technology facilitates glucose regulation, it does not inherently improve QoL, which is more closely linked to distress. Full article

Diabetes mellitus (DM) is a chronic metabolic disorder associated with late diagnosis due to the absence of early symptoms in patients. Cutaneous manifestations of DM often serve as indicators of insulin resistance and vary with disease progression, highlighting severity and systemic involvements. With an increasing global burden and rapidly rising prevalence, skin findings associated with DM have become more crucial for the rapid identification and treatment of underlying metabolic processes. However, current challenges in identification include inaccurate or missed detection in darker-skinned populations, which may be attributed to the lack of inclusion of diverse skin types in textbooks and research studies. This review provides clinicians with comprehensive updates on the diagnosis and treatment of cutaneous signs, complications, comorbidities, medication-associated side effects associated with DM, and the treatment of these manifestations. Full article

Continuous glucose monitoring (CGM) and flash glucose monitoring (FGM) systems have revolutionized diabetes management by delivering real-time, dynamic insights into blood glucose levels. This article provides a concise overview of the evolution of CGM technology, highlights emerging innovations in the field and explores current and potential future applications (including insulin management, early diagnostics, predictive modeling, diabetes education and integration into automated insulin delivery (AID) systems) of CGM in healthcare. Full article

Background/Objectives: The chronic metabolic condition of hyperglycemia in type-2 diabetics is known to cause various neurological disorders and compromise recovery from brain insults. Previously, we reported a delayed and reduced glial cell response and a greater neuronal cell death in different brain regions of diabetic, db/db, mice following cerebral hypoxic- ischemic injury. In this study, we explored the changes in baseline activation of astrocytes and microglia and its impact on vascular permeability in different brain regions. Methods: The numbers of activated astrocytes (GFAP-positive) and microglia/macrophage (Iba-1-positive) in the motor cortex, caudate and hippocampal regions of 12-week old, type-2 diabetic db/db and non-diabetic db/+ mice were quantitated. The leakage of serum IgG and loss of occludin, a tight junctional protein observed in the cortex and caudate of db/db mice, indicated a compromised blood brain barrier. Results: Results indicated significant differences in activation of glial cells in the cortex and caudate along with increased vessel permeability in diabetic mice. Conclusions: The study suggests that a constant activation of glial cells in the diabetic brain may be the cause of impaired inflammatory response and/or degenerating cerebral blood vessels which contribute to neuronal cell death upon CNS injury. Full article

Objectives: To describe the association of race with type 2 diabetes complications and determine if differences in rates of complications exist between racial/ethnic groups of adult type 2 diabetes patients in the United States. Additionally, we model the odds of in-hospital patient mortality across racial/ethnic groups. Methods: A retrospective cohort study was conducted using data from the 2018 National Inpatient Sample of Healthcare Cost and Utilization Project, including 97,314 unweighted and 486,500 weighted adults with type 2 diabetes. Chi-square analysis was used to determine the association of race with diabetes complications, along with z-tests to determine the differences in complication rates of 11 different complications between racial/ethnic groups and binary logistic regression to model in-hospital mortality. Results: Our analysis revealed significant racial/ethnic disparities in both complication rates and odds of in-hospital mortality. Whites had the lowest rate of complications overall, except for arthropathy/oral complications (18.8%) and foot/skin ulcers (18.2%), while Black/African Americans had the highest rates of hyperosmolarity (7.3%), ketoacidosis (21.2%), neurological complications (8.9%), and hyperglycemia (13.4%). Asian/Pacific Islanders had the highest rates of hypoglycemia (17.6%) as well as kidney (7.2%) and ophthalmic (0.3%) complications, and Hispanics the highest rates of circulatory complications (19.0%). Hispanic ethnicity was associated with 10.6% reduced odds of in-hospital mortality, and Asian/Pacific Islanders and Other races had increased odds of mortality by 25.2% and 27.0%, respectively. Notably, neurological (OR = 0.278, 95% CI: 0.111, 0.702) complications and hyperglycemia (OR = 0.304, 95% CI: 0.124, 0.749) were associated with a reduction in mortality odds by 62.2% and 69.6%, possibly reflecting the study’s focus on in-hospital rather than all-cause or 30-day mortality. Conclusions: We demonstrated disparities in both rates of type 2 diabetes complications and odds of mortality between different racial/ethnic groups. These results lay groundwork for future research into the root causes of these disparities and highlight the importance of targeting interventions and equitable case for those most at risk. Full article

Background: Dysglycemia, characterized by abnormal blood glucose levels, is a critical factor in the development of type 2 diabetes mellitus (T2DM) and its related complications. Among the traditional approaches to managing glucose homeostasis, supplementation with natural antidiabetic molecules stands out. Among these, abscisic acid (ABA), a naturally occurring compound abundant in unripe fruits, has shown potential for improving insulin sensitivity and glucose uptake. This study examines the effects of AbaComplex (ABAc), a nutraceutical derived from thinned nectarines, on glycemic control in individuals with dysglycemia, both alone and in combination with trivalent chromium, known for its role in increasing insulin signal. Methods: A three-arm, randomized, placebo-controlled trial was conducted over 3 months with 120 participants assigned to one of three groups: ABAc alone, ABAc with trivalent chromium (ABAc-Cr), or a placebo. Results: The results showed significant improvements in glycemic control in both the ABAc and ABAc-Cr groups compared to the placebo. Specifically, glycated hemoglobin decreased by 6.6% in the ABAc group and 11.3% in the ABAc-Cr group, while the placebo group showed a 4.3% increase. Both treatment groups also exhibited significant reductions in fasting glucose, insulin levels, and HOMA-IR. Nonetheless, the SF-12 questionnaire revealed marked improvements in physical and mental health, with the ABAc group alone demonstrating slightly greater improvements in certain quality-of-life measures. Conclusions: Overall, these findings underscore the effectiveness of ABAc supplementation as a valuable approach for managing dysglycemic conditions and early-stage T2D. Full article

Background/Objectives: Limited evidence is available regarding insulin total daily dose (TDD), or the factors associated with TDD, among adults with type 2 diabetes (T2D) using multiple daily injections of insulin (MDI). Our aim was to determine the percentage of adults in the United States (US) with T2D who are prescribed MDI, their prescribed insulin TDD, and potential factors associated with TDD. Methods: This retrospective cohort study used deidentified data from the US IQVIA ambulatory electronic medical record database to study adults (≥18 years) with T2D initiating MDI (≥3 daily basal-plus-prandial insulin injections) from 1 January 2017 to 1 July 2022. The TDD was calculated from first evidence of MDI (index date). We used a generalized linear model regression analysis to model the relationship between TDD and clinically relevant factors associated with TDD. Results: During the study period, of 3,339,663 adults with T2D, 451,769 (13.5%) had ≥1 basal insulin prescriptions, 206,000 (6.2%) had both basal and prandial insulin prescriptions, and 41,215 (1.2%) were prescribed MDI (mean age, 58 years; 52% women; 62% White/Caucasian, 14% African American; mean body mass index [BMI], 34 kg/m²). Mean TDD was 96 units (1.0 units/kg/day); median TDD was 80 units (interquartile range, 54–124). In the regression analysis (model R², 0.14), factors predicting lower TDD included female sex, African American race, and prior 6-month (pre-index) prescriptions of sulfonylurea, metformin, or 2–3 noninsulin glucose-lowering medications. Predictors of greater TDD included increasing BMI, age 30–64 years, and pre-index SGLT2 inhibitor or GLP-1 RA prescription. Conclusions: Among US adults with T2D, 1.2% were prescribed MDI, with a wide range of TDD and median TDD of 80 units. Further research in other populations and using other data sources is warranted to explore prescribed insulin TDD for T2D and to examine other potentially relevant predictors of TDD. Full article

Background: The prospective relationship between coffee and tea consumption and the risk of developing type 2 diabetes mellitus (T2DM) is seldom assessed in older adults. This study investigated the association between coffee and tea consumption and the 10-year incidence of T2DM in older Australian adults. Method: Data were collected from participants aged 49 years or above at baseline of the Blue Mountains Eye Study (n = 1668). Coffee and tea intakes were assessed using a validated food frequency questionnaire. T2DM was ascertained by the self-reported history, fasting blood glucose ≥ 7.0 mmol/L, or self-reported use of diabetes medication. Associations were assessed using discrete-time logistic regression, adjusting for lifestyle and demographic factors. Results: Compared to no consumption, coffee intake of 1 cup/day was associated with a lower risk of developing T2DM (multivariate-adjusted HR: 0.46, 95% CI: 0.23, 0.91) in the 10-year follow-up period. However, consumption of 2–3 cups/day (HR: 0.66, 95% CI: 0.37, 1.18) or ≥4 cups/day (HR: 1.04, 95% CI: 0.52, 2.08) showed no significant association. Tea consumption at any level was not significantly associated with T2DM incidence. Results were similar after excluding participants with implausible energy intake. Conclusions: In older adults, moderate coffee intake (1 cup/day) was associated with lower T2DM incidence, while higher coffee consumption and tea intake at any level were not. The lack of a dose-dependent effect in coffee consumption warrants further investigation. These findings should be verified in larger studies, considering different coffee and tea types and potential age-related and genetic factors. Full article

Type 2 diabetes (T2D) and metabolic syndrome (MetS) represent complex, multifactorial conditions that pose significant challenges to public health and healthcare costs worldwide. These two conditions share common risk factors such as obesity, dyslipidemia, and hypertension and, as a consequence, are frequently jointly diagnosed in an individual. More specifically, it is estimated that around 85% of T2D patients also have MetS, while patients diagnosed with MetS are five times as likely to develop T2D. While lifestyle and environmental factors, such as poor diet and physical inactivity, play a crucial role, genetic susceptibility also has a substantial influence on the overall risk. Recent advancements in genome-wide association studies (GWAS) have had a major impact on identifying numerous genetic loci associated with these conditions. This narrative review summarizes key findings from T2D and MetS genome-wide association studies, highlighting key genetic loci and pathways and their clinical implications. The objective of this review is to provide a comprehensive understanding of the known genetic underpinnings of T2D and MetS to inform future research and open potential therapeutic and preventive strategies. Full article

Background/Aim: Chronic kidney disease (CKD), primarily caused by diabetes, predisposes patients to a high risk of systemic complications, including vascular ulcers. This study aimed to evaluate the impact of arterial vascular ulcers in patients with CKD, with particular attention to predisposing factors including diabetes and prevention strategies. Methods: A narrative literature review was conducted, adopting the Scale for the Assessment of Narrative Review Articles (SANRA), using databases such as PubMed, CINAHL, Embase, and Cochrane Library, along with grey literature sources. Results: The literature review revealed a significant association between peripheral arterial disease (PAD) and CKD, highlighting the prevalence (41.5%) and associated risk factors, such as type 1 diabetes (OR, 2.993; 95% CI: 1.477–6.065, p = 0.002), type 2 diabetes (OR, 2.498; 95% CI: 1.466–4.256, p = 0.001), and hypertension (OR, 1.781; 95% CI: 1.293–2.450, p < 0.001) in hemodialysis patients. Preventive strategies were discussed, emphasizing the automation of ankle–brachial index (ABI) measurement. Conclusions: This review identifies risk factors and preventive strategies for PAD in CKD patients, emphasizing diabetes as a key contributor. Evidence supports current diagnostic approaches and guidelines but highlights the need for larger studies. Standardized protocols and targeted training are crucial for improved management. Full article

Background: Diabetic foot ulcers (DFUs) represent a significant cause of morbidity in diabetic patients, with surgical management frequently required in advanced cases. This study examines the association between preoperative vitamin C levels and wound-healing outcomes in patients with diabetic foot disease (DFD) requiring surgical debridement. Methods: A retrospective cohort study was conducted at a tertiary referral centre, with the study including diabetic patients who had undergone surgical debridement for forefoot and midfoot diabetic foot infections between January 2020 and July 2024. Patients with ISDA grades 3 and 4 ulcers and preoperative measurements of vitamin C, albumin, HbA1c, and BMI were included. The primary outcome was time to wound healing, defined as the duration from surgery to discharge from the orthopaedic diabetic foot clinic. Data were analysed using generalized linear models to assess the impact of preoperative vitamin C levels on healing time, controlling for confounding variables. Results: In the 61 patients included in the multivariable regression analysis, higher preoperative vitamin C levels were significantly associated with faster wound healing (p = 0.01). Other significant factors included albumin levels and ulcer location, with midfoot ulcers healing more slowly than forefoot ulcers. The mean time to healing was 3 months, with vitamin C levels showing a statistically significant effect on wound-healing outcomes. Conclusions: Our study demonstrates that higher preoperative vitamin C levels were associated with faster wound healing in surgically treated diabetic foot ulcers. Future prospective randomized controlled trials are needed to confirm these findings and assess the role of vitamin C supplementation in the management of surgically treated DFUs. Full article

Background: Choline (Ch) deprivation causes kidney injury and dysfunction, and diabetic nephropathy is also known to be a complication of diabetes; thus, this interplay could potentially aggravate diabetic kidney disease. Aim: This study aims to examine the effect of Ch-deprivation on the severity of kidney injury in streptozotocin (STZ)-induced diabetic rats. Methods: Twenty-four adult male Wistar rats were divided into four groups: control (C), nondiabetic Ch-deprived (CD), diabetic (DM), and diabetic Ch-deprived (DM + CD). Diabetes was induced by the intraperitoneal administration of 50 mg/kg body weight STZ; Ch-deprivation was induced through a choline-deficient diet. Rats were euthanized at week 5 of the study. Biochemical tests, renal histopathology, immunohistochemistry of the kidney injury molecule-1 (KIM-1), and vascular endothelial growth factor-A (VEGF-A) expression were assessed. Results: DM + CD and DM groups demonstrated significant increases in glucose levels and in the homeostasis model of insulin resistance (HOMA IR). Creatinine and blood urea nitrogen levels significantly increased in the DM + CD group compared to the control, and homocysteine levels were higher in the CD group. Kidney histopathology revealed that renal tubular necrosis, mesangial matrix expansion, and renal fibrosis substantially increased in the DM + CD group compared to all other groups, and KIM-1 and VEGF-A expressions were most pronounced in the DM + CD and DM groups, respectively. Conclusions: Ch deprivation affected kidney function and structure in STZ-induced diabetic rats. Choline deficiency and diabetes seem to have a synergistic effect, as evidenced by kidney biochemistry, histopathology, and immunohistochemistry. These findings could highlight the important role of choline in therapeutic strategies for the treatment and, potentially, prevention of chronic diabetic kidney disease. Full article

Background: Diabetes affects over 460 million people worldwide and represents a growing public health challenge driven largely by dietary and lifestyle factors. While Type 2 diabetes (T2D) is more prevalent, Type 1 diabetes (T1D) presents unique therapeutic challenges, particularly in younger individuals. Advances in diabetes management, such as continuous glucose monitoring (CGM), insulin pumps (IP), and, more recently, smart multiple dose injection (MDI) pens, have significantly enhanced glycemic control and improved patients’ quality of life. Aim: This study aims to evaluate the baseline characteristics of patients switching from MDI therapy to the Medtronic Smart MDI system [composed of a smart insulin pen (InPenTM) and a connected CGM Medtronic SimpleraTM sensor] and to assess its impact on glycemic outcomes over different time periods (14, 30, and 90 days). Methods: A retrospective observational study was conducted among adults with T1D who initiated Medtronic Smart MDI therapy. Participants were enrolled voluntarily at the Diabetes and Nutrition Clinic in Ast Fermo, Marche Region, Italy. Glycemic parameters were monitored using CGM data and analyzed with descriptive statistics, including mean, standard deviation (SD), and interquartile range (IQR). Comparisons across time periods were performed using the Wilcoxon signed-rank test, with statistical significance set at p < 0.05. Results: This study included 21 participants with a mean age of 51.5 years, a mean BMI of 24.7, and a mean duration of T1D of 21.9 years. The transition from a traditional MDI system to the Smart MDI system resulted in significant improvements in key glycemic parameters: mean Sensor Glucose (SG) decreased from 171.0 mg/dL to 153.5 mg/dL (p = 0.035), Time In Range (TIR) increased from 58.0% to 64.4% (p = 0.005), and time above range (TAR; >180 mg/dL) decreased from 39.0% to 34.2% (p = 0.015). No significant differences were observed in the time below range (TBR). Conclusions: The transition to the Medtronic Smart MDI system significantly enhanced glycemic control by lowering mean glucose levels and increasing TIR. These findings highlight its efficacy in improving hyperglycemia management while maintaining a stable risk of hypoglycemia. Full article

Background: It is well-known that persistent hyperglycaemia predisposes individuals with diabetes to oxidative stress. Bridelia ferruginea Benth., a tropical African plant, is known for its antioxidant activity. Methods: This comparative cross-sectional study assessed the oxidative status and associated parameters in 70 individuals living with type 2 diabetes (ILWT2D) who were receiving standard diabetes treatment and consistently drank Bridelia tea (Bridelia group) compared to 92 ILWT2D receiving standard diabetes treatment only (comparator group). Lipid peroxidation assessed using thiobarbituric acid reactive substances (TBARS) served as an indicator of oxidative stress. In addition, the total antioxidant capacity (TAC), glycated haemoglobin (HbA1c), and dietary intake of antioxidant-rich foods were assessed. Results: The comparator group had significantly better glycaemic control [median HbA1c—7.7% (IQR 6.7–9.4)] than the Bridelia group [9.2% (7.6–11.4)], p = 0.001. The comparator group had been on metformin treatment for a significantly longer period than the Bridelia group (p < 0.0001). Participants in the comparator group consumed antioxidant-rich fruits more frequently (monthly basis) than those in the Bridelia group who ate fruits seldomly (p < 0.0001). There was no significant difference (p = 0.11) observed in oxidative stress levels between the Bridelia group and the comparator group [TBARS: 323.0 ng/L (287.5–374.0) and 317.0 ng/L (272.5–342.0), respectively]. Nonetheless, the Bridelia group had significantly higher antioxidant capacity (p = 0.001) compared to the comparator group [TAC: 1.01 mmol/L (0.93–1.10) versus 0.92 mmol/L (0.84–1.03), respectively]. Participants in the comparator group, who did not drink Bridelia tea, had been on longer metformin treatment with better glycaemic control. However, those who drank the Bridelia tea showed comparable levels of oxidative stress and exhibited elevated antioxidant levels compared to those who did not. Conclusions: Bridelia tea consumption may serve as a sustainable source of antioxidants; however, its effect on mitigating oxidative stress in ILWT2D requires further investigation, particularly given that no significant improvement in TBARS was observed. Future studies are needed to clarify the potential role of Bridelia tea in oxidative stress management in resource-limited settings like Ghana. Full article

Background/Objectives: Diabetes mellitus (DM) is a prevalent disease with an increased risk of complications. Identifying risk factors for mortality in these patients is crucial, as early recognition can facilitate prompt therapeutic intervention. Machine learning (ML) models have proved to be valuable tools in different scenarios of healthcare decision making. We aimed to develop and test an ML model to predict all-cause mortality in a large cohort of subjects with DM. Methods: We included 1969 consecutive patients with DM type 1 (T1DM, n = 255) and type 2 (T2DM, n = 1714). eXtreme Gradient Boosting (XGBoost) was used for the prediction of all-cause mortality in this cohort and the Shapley additive explanation (SHAP) was used to assess the importance of each feature of the classifier. The missing values were imputed using the Missforest methodology. Results: The all-cause mortality rate was 21% during 5.5 ± 1.1 years of follow-up. The ML model achieved 90% sensitivity and 87% specificity with an AUC of 0.88 and an accuracy of 88% for predicting all-cause mortality. The SHAP analysis identified a lower glomerular filtration rate (eGFR), duration of insulin therapy, and a lower level of hemoglobin as the first three factors that contribute to the higher mortality rate. Conclusions: ML models can become valuable tools in clinical practice due to their unique ability to simultaneously assess the cumulative influence of multiple parameters and discover high-order interactions. The application of such models in clinical practice could improve the early identification of subjects at risk for complications and mortality and prompt early therapeutical interventions. Full article