Editor’s Choice Articles

Hospitalizations for diabetes and dementia can impose a significant health and economic toll on older adults in the United States. This study sought to examine differences in hospitalization characteristics and outcomes associated with diabetes and dementia, separately and together, using 2019–2021 discharge record data from the California Department of Health Care Access and Information. The sampled group were residents of Los Angeles County who were aged 50+ at the time of the study. The multivariable linear regression analysis showed that compared to those with no diabetes or dementia, patients with diabetes alone exhibited the highest total charges, while those with comorbid diabetes and dementia exhibited lower charges (p < 0.05). The multinomial logistic regression found that patients with comorbid diabetes and dementia had the highest odds of having a length of stay of 7+ days (Adjusted Odds Ratio = 1.49; 95% Confidence Interval (CI) = 1.44–1.53). A matched case–control analysis revealed that comorbid diabetes and dementia were associated with significantly lower odds of hypertensive disease than diabetes alone (Matched Odds Ratio = 0.81; 95% CI = 0.67–0.97). Collectively, these results highlight the complex factors that may influence the variable hospitalization outcomes that are common occurrences in these three distinct disease profiles. Study findings suggest a need to consider these complexities when developing policies or strategies to improve hospitalization outcomes for these conditions. Full article

The Centers for Disease Control and Prevention (CDC) indicates that individuals with prediabetes are significantly less likely to develop type 2 diabetes if they participate in a lifestyle change program that results in at least 5% weight loss and 150 min of physical activity per week. The CDC recognizes distance learning as an effective delivery mode for lifestyle change programs to prevent type 2 diabetes. The purpose of this study was to assess enrollment, engagement, and effectiveness of a type 2 diabetes prevention program (DPP) using synchronous distance technology. Eat Smart, Move More, Prevent Diabetes (ESMMPD) is an intensive 12-month DPP delivered using synchronous distance technology. Throughout 26 lessons, participants focused on healthy eating, physical activity, and mindfulness behaviors. Study findings showed a significant decrease in A1C (−0.24 p < 0.0001). Weight loss averaged 5.66% for those who completed the program. Based on the Wilcoxon signed-rank test, participants demonstrated statistically significant changes in self-reported confidence in their ability to perform all 18 health-promoting behaviors assessed (p < 0.0001). Participation in the program also resulted in the adoption of health promoting behaviors. A DPP using synchronous distance technology is an effective delivery mode to help participants adopt healthy behaviors, increase physical activity, and achieve the weight loss necessary to prevent or delay the onset of type 2 diabetes. Full article

This study presents a comprehensive analysis of 898 clinical trials conducted between 1999 and 2023, focusing on the interplay of metabolic syndrome, cardiovascular diseases (CVDs), and type 2 diabetes mellitus (T2D). This study draws upon data sourced from the International Clinical Trials Registry Platform (ICTRP) until August 2023. The trials were predominantly interventional (67%) or observational (33%). A geographical distribution reveals that while the United States registered approximately 18% of the trials, other regions like Australia, the United Kingdom, and multicounty trials made substantial contributions. Most studies (84%) included both male and female participants, with adults aged 18 to 65 years predominantly represented. The trials aimed at treatment (21%) and prevention (21%), emphasizing the dual focus on addressing existing CVD risk and preventing its development. Notably, CVDs (29%), T2D (8%), and the coexistence of both (21%) constituted the primary conditions of interest. Key interventions encompassed lifestyle and behavioral modifications, dietary supplementation, and drug therapies, with metformin and statins leading in pharmacological treatments. Interestingly, additional interventions such as glucagon-like peptide-1 agonists and dipeptidyl peptidase IV inhibitors are gaining recognition for their potential in managing metabolic syndrome-related conditions. Moreover, the report highlights a growing focus on inflammation, body mass index, blood pressure, body weight, and major adverse cardiovascular events as primary outcomes. Overall, the study highlights the importance of ICTRP as the source of data for clinical trials targeting metabolic syndrome, CVDs, and T2D and the growing recognition of diverse intervention strategies to address this critical global health concern. Full article

Similar microorganisms, via similar mechanisms, play a role in the development of both pancreatic cancer (PC) and type 2 diabetes (T2D). Since the new onset of T2D is potentially one of the earliest signs of PC, it is highly plausible that a common denominator might be responsible for both, as the growth of the cancer will take a longer time to manifest compared to the insulin resistance. Although a variety of host-dependent factors and susceptibility play a role, and the mechanisms connecting the two diseases remain poorly understood, future well-designed trials should hypothesize whether a microbial intervention (modification and/or transplantation) results in a lower incidence and the better treatment of both diseases since the T2D–PC–gut microbiome interconnection seems scientifically logical. Full article

Type 2 diabetes mellitus (T2DM) is a common metabolic disease characterised by insulin resistance and elevated blood glucose levels, affecting millions of people worldwide. T2DM individuals with dyslipidaemia have an increased risk of cardiovascular disease (CVD). A complex interplay of risk factors such as hyperglycaemia, dyslipidaemia, hypertension, obesity, inflammation, and oxidative stress favour the development of atherosclerosis, a central mechanism in the pathogenesis of cardiovascular disease. Dyslipidaemia, a hallmark of T2DM, is characterised by elevated triglycerides, decreased high-density lipoprotein (HDL) cholesterol and the presence of small, dense low-density lipoprotein (LDL) particles, all of which promote atherosclerosis. In this article, we have attempted to present various treatment strategies that include pharmacological interventions such as statins, ezetimibe, PCSK9 inhibitors, fibrates, and omega-3 fatty acids. We have also tried to highlight the pivotal role of lifestyle modifications, including physical activity and dietary changes, in improving lipid profiles and overall cardiovascular health in T2DM individuals. We have also tried to present the latest clinical guidelines for the management of dyslipidaemia in T2DM individuals. In conclusion, the treatment of dyslipidaemia in T2DM individuals is of great importance as it lowers lipid particle levels, slows the progression of atherosclerosis, and ultimately reduces susceptibility to cardiovascular disease. Full article

Type 2 diabetes mellitus (T2DM) is a multisystemic disease with a high global burden and chronic complications. Sexual dysfunction (SD) in patients with T2DM is an often-overlooked complication, despite its high impact on quality of life (QoL). Female sexual disorders can affect women of reproductive age as well as menopausal women. Proposed mechanisms are intertwining a variety of physiological, neurological, vascular, hormonal, and psychological variables. The impairment of sexual function has been linked to hyperglycemia, insulin resistance, chronic low-grade inflammation, endothelial dysfunction, neuropathy, and hormonal abnormalities. There are many different manifestations of female sexual dysfunction, such as insufficient sexual desire, diminished arousal, difficulty in eliciting orgasm, and pain during sexual engagement. Numerous studies have shown that the QoL of patients living with diabetes mellitus (DM) is lower than that of those without DM. SD in women with T2DM leads to deteriorated QoL. Treatment must be individualized based on the diagnosis and the sexual dysfunction as well as underlying medical, psychological, and interpersonal issues. The goal of modern medical care for patients living with diabetes is not to delay death but to improve their health and QoL. The present review article aimed to raise awareness about female sexual dysfunction in patients with T2DM and to provide an overview of its impact on QoL. Full article

An ever-growing body of evidence suggests that sex and gender influence the pathophysiology, incidence, prevalence, clinical manifestations, course, and response to therapy of diabetes. Sex and gender differences are particularly evident in type 1 diabetes, especially in patients using advanced technologies (CGM and AHCL), as they are factors that interact with each other and have an impact on adherence to therapy, which affects not only metabolic compensation, but also, therefore, the prevention of complications and quality of life. Full article

Despite the progress in treatment options and improved understanding of pathophysiology, type 2 diabetes remains one of the costliest and most harmful global chronic diseases. The current guidelines encourage physicians to fight an uphill battle and react to an incubated disease state that has been propelled forward by clinical inertia. The authors completed a literature search of PubMed, ScienceDirect, and NIH, searching with the terms intermittent fasting, type 2 diabetes, and prediabetes, and excluded studies related to religion-based fasting. There is emerging evidence that intermittent fasting could be an option to aid in weight loss, reduce hepatic steatosis, and lower the level of biomarkers such as fasting glucose while improving insulin resistance. If incorporated into the lives of patients with risk factors for type 2 diabetes, intermittent fasting could prove to be a cost-effective and efficient tool for preventing this insidious disease. This clinical review examines current evidence supporting the implementation of this lifestyle to prevent the onset or exacerbation of type 2 diabetes and the hurdles that must still be overcome for physicians to confidently prescribe this to their patients. Full article

In the light of the rapidly increasing global incidence of, and therapeutic arsenal for, diabetes type 2, this brief report underscores the need for advancements in clinical pharmacology and therapeutics (CPT) education with regard to diabetes type 2. We advocate for the comprehensive training of medical students and junior doctors in line with current guidelines, and emphasize the importance of teaching how to draw up individualized treatment plans based on patients’ specific risk factors and conditions, such as cardiovascular risks, weight, and risk of hypoglycaemia. Within the curriculum, traditional teaching approaches should be replaced by innovative methods such as problem-based learning, which has been shown to be more effective in developing prescribing knowledge and skills. The inclusion of real-world experience and interprofessional learning via so-called student-run clinics is also recommended. Subsequently, innovative assessment methods like the European Prescribing Exam and objective structured clinical examinations (OSCE) are highlighted as essential for evaluating knowledge and practical skills. By adopting these educational advances, medical education can better equip future practitioners to adequately manage the complex pharmacological treatment of diabetes. Full article

Aims: To determine the prevalence and predictors of diabetic retinopathy (DR) in Saudi males and females with diabetes. Methods: This cross-sectional study enrolled 507 patients with diabetes between May and August 2018. The data extracted from patients’ records included demographic and clinical information and laboratory investigations. The retinopathy data were based on fundus photography graded into five categories: no DR, NPDR, MNPDR, SNPDR, and PDR. Results: The patients’ mean age was 47.3 years, the majority (59.3%) being female and T2DM being the most common type (52.4%). The prevalence of no DR was 51.4%; NPDR, 4.4%; MNPDR, 7.7%; SNPDR, 3.7%; and PDR, 5.1%. The duration of DM, as well as the severity of hypertension and neuropathy values rose significantly as DR progressed, underlining the pivotal role of hyperglycemia as the primary driver of diabetic complications. The odds ratio for the presence of hypertension was 1.8 (95% CI 0.9–3.5); hypertension showed the highest risk of DR. Stratification according to gender showed a significantly higher DR risk in females than males. Interestingly, nephropathy played a significant role in the DR risk in T1DM. Conclusions: Among T1DM and T2DM patients, the severity of DR is associated with risk factors including the DM duration, hyperglycemia, hypertension, and neuropathy. The impact of these factors varies with gender and diabetes type. Therefore, the severity of DR could define patients at a high risk of macro/microvascular complications and enable earlier interventions to reduce morbidity and mortality among T1DM and T2DM patients. Full article

Alexithymia is the inability to describe one’s own feelings and is being increasingly researched. According to contemporary psychodynamic theories, negative emotions cannot be adequately named and externalized, but remain trapped in the body. Recent research shows the connection of alexithymia with numerous somatic diseases. Diabetes mellitus type 2 and obesity represent great challenges in treatment, and the psychological profiles in these diseases are being studied more and more often. Therefore, alexithymia enters the focus of some research as a factor that could play a significant role in these diseases, namely as the one that makes a difference. The aim of this paper is a review of the literature with the purpose of understanding the current knowledge about the interconnection between alexithymia, obesity and type 2 diabetes mellitus. Full article

Medication adherence (MA) is a major problem. On average 50% of chronic disease management medications are not taken as prescribed While digital healthcare tools like mobile apps offer benefits such as informative messages and prescription management, they must be personalized and offer support across all medication phases to effectively address individual patient factors and optimize adherence, with room for further improvements. This scoping review examined the impact of digital health technologies on MA in adults with diabetes as well as their benefits and barriers. Using PubMed and Scopus databases, 11 out of 385 studies (2.86%) from January 2017 to August 2023 met the criteria for digital health interventions in diabetes MA, assessed through the Chronic Care Model. The Chronic Care Model (CCM) is a patient-centered, evidence-based framework designed to improve the care and outcomes for chronic illness patients, consisting of six core elements and enhanced by eHealth tools that facilitate self-management and support through digital innovations. The results demonstrate the effectiveness of digital health technology in improving medication adherence among adults with diabetes. Specific digital interventions, including mobile apps like Gather and Medisafe, SMS text messaging, telemonitoring, and tailored care management have demonstrated effectiveness in enhancing MA. These interventions have shown positive outcomes, including enhanced glycemic control and increased patient engagement. Some of the limitations, which these technologies face, are the poor usability, digital illiteracy among the patients, low rates of sustainability and low accessibility among the elderly population. Digital health technology shows promise in enhancing medication adherence among adults with diabetes, as revealed in this scoping review. However, ongoing research is necessary to fine-tune these interventions for improved outcomes and the overall well-being of individuals with diabetes. Additional improvement of the technologies and adaptation to the diverse population might be a good field for exploration. Full article

Diabetes is the leading cause of chronic kidney disease (CKD), with nearly half of all cases of kidney failure requiring kidney replacement therapy. While attention is often focused on the profound effects kidney failure has on the quality of life, the principal cause of complications and death among patients with diabetes and CKD is cardiovascular disease (CVD). These risks are often underappreciated by both healthcare professionals and patients. Sodium–glucose cotransporter 2 (SGLT-2) inhibitors were originally developed and approved as glucose-lowering agents for treating type 2 diabetes (T2D). However, agents within the SGLT-2 inhibitor class have since demonstrated robust benefits for CKD, atherosclerotic cardiovascular disease (ASCVD), and heart failure (HF) outcomes. Specifically, dedicated kidney disease and HF outcome trials have shown markedly reduced rates of kidney failure, CVD and HF events, and death among people (with and without diabetes) with CKD. SGLT-2 inhibitors will be used by primary care clinicians, nephrologists, and cardiologists across a range of cardiovascular and kidney conditions and diabetes. Knowledge and awareness of the benefits and key safety considerations, and risk mitigation strategies for these medications is imperative for clinicians to optimize the use of these life-saving therapies. Full article

Diabetes is a chronic, metabolic disease characterized by hyperglycemia, which occurs as a result of inadequate production or utilization of insulin. Type 2 diabetes (T2D) is the most common type of diabetes with estimates projecting a prevalence of more than 1 billion people living with T2DM by 2050. Hence, it was decided to conduct a systematic literature review of health economic evaluations of insulin, the most common medication used for the treatment of the disease, to inform policy. Pharmacoeconomic analyses, written in English and published after 2016, were considered for inclusion. PubMed/Medline, Global Health, Embase and Health Management Consortium were searched separately between 5 July 2023 and 17 July 2023. Grey literature articles were searched on ISPOR and the Cost-Effectiveness Analysis Registry during the same period. After the exclusion criteria were applied, 21 studies were included. Using the BMJ checklist, a quality appraisal was performed on all included studies. Data extraction was performed manually. Regarding evidence synthesis, data were heterogenous and are presented based on study type. The results showed a variety of treatment combinations being available for the treatment of diabetes, with insulin degludec/DegLira and semaglutide being cost-effective despite their high cost, due to the effectiveness of managing the disease. Research around the cost-effectiveness or cost-utility of insulin has potential to progress further, to ensure informed policy-making in the future. Full article

Type 2 diabetes (T2D) poses a growing global health challenge, impacting patients’ and their caregivers’ well-being. This study investigates the influence of T2D complications on caregivers’ quality of life (QoL) using the WHOQOL-BREF questionnaire, accounting for factors like age, disease duration, and control. The research involved 382 T2D patients and 300 caregivers from Vuk Vrhovac University Clinic for Diabetes, Endocrinology, and Metabolic Diseases. The WHOQOL-BREF questionnaire assessed caregivers’ QoL across physical, psychological, social, and environmental domains. Complications, including retinopathy, neuropathy, and kidney disease, were examined for their effects on QoL. Patients’ age impact, gender differences, and disease duration were analyzed. T2D complications had varying impacts on different QoL domains. Caregivers of patients with multiple complications showed significant social functioning impairment. Those without complications reported lower psychological health. Age correlated with poorer physical health scores. Female caregivers rated higher in psychological and environmental health. Disease duration and T2D control had no significant impact on caregiver QoL. Caregivers’ concerns included medication adherence and worry about their partner’s health. This study illustrates the delicate interplay between T2D patients and caregivers, highlighting the multifaceted effects of chronic illness. Comprehensive healthcare techniques that address emotional and social components in addition to medical care are critical for improving the well-being of both patients and their caregivers. The findings contribute to a broader understanding of T2D care dynamics, advocating for empathetic and all-encompassing healthcare practices. Full article

Background and Objectives: Prediabetes is associated with a high risk of developing diabetes and cardiovascular disease. Early treatment with exercise and dietary interventions can reduce the progression of prediabetes to diabetes or even lead to a return of glucose levels to normal. The aim of the study was to evaluate the effect of a dietary supplement with Portulaca oleracea and titrated Cistus creticus extract on the glycemic profile of people with prediabetes. Materials and Methods: Participants were assigned to a dietary supplement with Portulaca oleracea and titrated Cistus creticus extract, along with vitamins and minerals, received once daily for 90 days. Demographics and medical history were obtained, and a complete clinical examination, measurement of somatometric characteristics, and laboratory parameters were performed at baseline. The measurement of somatometric characteristics and laboratory tests were repeated at the end of the study. Results: A total of 26 people with prediabetes participated, 11 females and 15 males. There was a tendency for a decrease in HbA1c after intervention [baseline: 5.9 (5.7–6.1)%; at the end of the study: 5.7 (5.7–6.0)%, p = 0.062] and a significant decrease in fasting glucose levels (from 110.8 ± 7.0 mg/dL to 103.9 ± 10.3, p = 0.005). Fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) decreased significantly [baseline fasting insulin: 20.7 (9.3–34.20) μU/mL; at the end of the study: 15.1 (8.6–19.0) μU/mL, p = 0.028; baseline HOMA-IR: 3.6 (2.5–8.9); at the end of the study: 3.5 (2.0–4.6), p = 0.035]. Significant reductions were observed in alkaline phosphatase and uric acid levels. No significant change was observed in body weight, body mass index, or waist circumference after the intervention. No treatment-emergent adverse events were observed, and all participants completed the study. Conclusions: The dietary supplement from Portulaca oleracea and titrated Cistus creticus extract, along with vitamins and minerals, may improve the metabolic profile of people with prediabetes. Full article

There is a correlation between the existence of type 2 diabetes mellitus (T2DM) and the development of thyroid disorders. Prediabetes is a progressive state of moderate insulin resistance that often precedes the onset of T2DM. However, the association between prediabetes and thyroid function is unknown. This study assessed changes in markers of thyroid function in diet-induced prediabetes. Twelve male Sprague Dawley rats (n = 12) were randomly assigned into two groups. Rats in the non-prediabetic (NPD) group were fed a standard rat diet, while rats in the prediabetic (PD) were fed a high-fat high-carbohydrate diet for 20 weeks to induce prediabetes. Thereafter, fasting blood glucose levels were measured. Plasma samples were assessed for triiodothyronine (T3), thyroxine (T4), thyroxine peroxidase (TPO) antibody, insulin, and glycated hemoglobin (HbA1c) concentrations. The elevated blood glucose, HbA1c, and plasma insulin levels coincided with increased T3 and reduced T4 levels in the PD group when compared to the NPD group. There was also an increase in the concentration of TPO antibodies in the PD group. Additionally, there was a significant correlation between the thyroid hormone concentrations and HbA1c levels. In conclusion, these results indicated that there is a positive association between thyroid dysfunction and diet-induced prediabetes in rats. Full article

This study was conducted to determine the barriers to the utilization of diabetic retinopathy (DR) screening in Papua New Guinea (PNG). A list of patients booked for DR screening at Madang Provincial Hospital Eye Clinic (MPHEC) between January 2017 and December 2021 who had not been screened was retrieved, and the patients were invited to participate in the study. The data were collected using a structured questionnaire, and IBM Statistical Package for Social Sciences version 26 was used for the analysis. p < 0.05 was considered statistically significant. One hundred and twenty-nine patients (37.4%) did not attend DR screening for the period under study. The study response rate was 80.6%. The mean ± SD age of the respondents was 51.5 ± 10.9 years. The majority of the study respondents were female (62.5%), people living in rural settings (53.8%), and farmers (22.1%). Time constraints, poor knowledge about DR, and long waiting periods at the DR screening center were the main barriers to the uptake of DR screening. Compared to respondents in urban communities, those in rural settings were significantly concerned about cost (p < 0.001), travel distance to the MPHEC (p < 0.001), and poor information about DR screening (p = 0.002). More than half of the respondents (63.5%) had discontinued using pharmacotherapy for DM. There is a high rate of nonadherence to diabetes (DM) and DR treatment in PNG. There is a need for public health campaigns about DM and strategic DR screening at the community level in PNG and similar countries. Full article

Type 2 diabetes mellitus (T2DM) is a debilitating, lifelong condition with a rising incidence. A wide variety of antihyperglycemic agents are available on the market to treat diabetes. However, the number of patients living with diabetes under suboptimal control remains relatively high. This calls into question whether the application of the current treatment standards is effective and durable to truly manage the disease well. This paper aims to highlight the various classes of antihyperglycemic agents from a pathophysiologic perspective and explore the best possible combination that can have a durable effect on diabetes management. To determine this, an eight-piece pathophysiologic puzzle was created, each piece representing an organ system affected by the disease—liver, pancreas (alpha and beta cells), muscle, adipose tissue, gut, brain, and kidneys. Choosing a combination therapy that is both durable and can effectively address all eight pieces of the puzzle can theoretically create sustainable ameliorating effects. This combination can potentially lead to reduced microvascular and macrovascular complications, as well as work towards creating an ideal long-term, affordable diabetes care plan. Full article

Diabetes is a leading non-communicable disease with a huge and predictably increasing burden on individuals, societies and governments. Interprofessional education (IPE) aims to enhance healthcare providers’ competence and patient care by providing well-organised, coordinated interprofessional care (IPC) within teams of healthcare professionals of different disciplines. Interprofessional practices are crucial in diabetes care. However, evidence on the effect of diabetes-specific IPE on diabetes outcomes is limited. This study aims to survey and report recent findings on the impact of interprofessional approaches on the outcomes of diabetes management. A systematic search of PubMed and Google Scholar from 2008 was adopted to identify relevant studies. After screening for relevance, the studies used in this review were thematically analysed, and two main categories of the findings were isolated: the impact of IPE and IPC on enhanced care provision and on improved diabetes self-management. The results indicate that healthcare professionals and students and people with diabetes benefit from IPE/IPC to improve diabetes outcomes and quality of care. However, improving diabetes care is achieved when inhibitors are addressed to incorporate IPE in health professions curricula and to support IPC in clinical settings. Full article

3D-printed insoles are increasingly used for the management of foot pathologies, and the recent literature reports on various experimental studies dealing with either whole foot orthoses or pads fabricated through 3D-printing processes. In the case of diabetic foot disease, the main aim is to deliver more effective solutions with respect to the consolidated processes to reduce compressive risk forces at specific plantar foot sites. Clinical studies are, however, still limited, at least in peer-review journals. Additionally, in Italy, the manufacturing process of these medical devices has not been formally integrated yet into the list of care processes approved for reimbursement by the public healthcare service. Within the Italian DIAPASON project (DIAbetic PAtients Safe ambulatiON), a feasibility pilot study has been conducted in the territory on 21 patients with diabetic foot complications to assess the pros and cons of an innovative process. The process, which relies on in-shoe pressure measurements and on a patented 3D modeling and printing procedure, includes the prescription, design, manufacturing and testing of 3D-printed personalized insoles. The process has been tested in an ambulatory setting and showed the potential to be also implemented in community settings. In this paper, we report a case study on a single volunteer, and we describe and comment on how the whole process has been proven safe and suitable for the purpose. Full article

Diabetes is an independent risk factor for cognitive impairment, with the latter presenting challenges for diabetes self-management and glycemic control in individuals with type 2 diabetes. Predicated on the theory of unpleasant symptoms, the purpose of the current narrative review of the literature was to identify etiologic factors that influence cognitive impairment as a precursor to dementia in individuals with diabetes. Physiological, psychological, and situational factors were recognized as important life course components of cognitive impairment in later adulthood. Developing interventions targeting modifiable factors is warranted in preventing cognitive impairment in adults with diabetes. Full article

Background: There is limited evidence on the association between chronic kidney disease (CKD) and frailty in older people in Vietnam. This study aimed to investigate the prevalence of frailty and its impact on mortality in older patients with end-stage renal disease. Method: This is a prospective, observational study performed at two large Dialysis Centres in Vietnam from November 2020 to June 2021. Consecutive older patients diagnosed with end-stage renal disease and on haemodialysis were recruited. Participants’ frailty status was defined by the Clinical Frailty Scale (CFS). The study outcome was all-cause mortality at the sixth month. Results: A total of 175 participants were recruited (mean age 72.4 years, 58.9% female). Using the cut point of CFS ≥ 4, 87.4% of the participants were frail. Mortality at the sixth month was 14.9%, 31.9% in participants with CFS ≥ 7, 12.8% in participants with CFS = 6, 7.5% in participants with CFS from 4 to 5, and 4.5% in participants with CFS ≤ 3 (p = 0.001). Cox regression analysis showed that, compared with the non-frail participants, the probability of death over 6 months was nearly two-fold higher in the mildly frail, three-fold higher in the moderately frail, and nine-fold higher in the severely frail participants. Conclusions: This study demonstrated a very high prevalence of frailty in older patients with end-stage renal disease and dialysis and the significant impact of frailty severity on mortality. Healthcare providers should consider incorporating frailty screening into routine care for older patients with end-stage renal disease and dialysis. Full article

Background: Tissue healing consists of four main phases: coagulation, inflammation, proliferation, and remodeling. In diabetic patients, this process is stagnant in the inflammatory stage, leading to chronic wounds. The aim of this study is to evaluate in an animal model the biological evidence related to the use of the Rigenera^® technology (Turin Italy), an innovative mechanical procedure to isolate autologous micrografts (AMG). Methods: Fifty male Wistar rats were divided into four groups: control (C), control treated with micrografts (CM), diabetic (DB), and diabetic treated with micrografts (DBM). The experimental setup involved: the quantification of the total collagen and elastic fibers; histopathological analysis; immunohistochemical analysis for collagen type I (COL1), collagen type III (COL3), vascular endothelial growth factor (VEGF-A), and interleukin 4 (IL4) and 10 (IL10); evaluation of the oxidative stress; measurement of gluthatione (GSH); and, finally, an enzyme-linked immunosorbent assay (ELISA) on tumor necrosis factor-α (TNF-α). Results: The AMG technology induces a faster healing process: VEGF-A, IL4, IL10, and GSH increased, while TNF-α and oxidative stress decreased. Conclusions: Animals treated with micrografts showed more favorable results for healing compared to those that did not receive treatment, demonstrating a positive participation of the micrografts in the treatment of difficult-to-heal wounds. Full article

Through a partnership with three Federally Qualified Health Centers (FQHCs), the local health department in Los Angeles County implemented a produce prescription program (PPR) to increase fresh fruit and vegetable purchases among patients with diabetes or prediabetes. The PPR, which began in 2020, provided eligible patients with a USD 40 voucher every month for 6 months to promote the purchase of fresh produce at large-chain grocery stores. To address gaps in current practice and program delivery, this qualitative assessment describes staff experiences with the PPR, documenting the facilitators and barriers they encountered while implementing the program. Fifteen clinic staff (i.e., PPR implementers) were interviewed for this assessment. Thematic analysis and coding were conducted using the ATLAS.ti software; the coding was carried out by two separate coders. Interviewees discussed the importance of having preexisting partnerships and programs to support the PPR at their clinic site. Hidden costs related to implementing the program included a large and unexpected amount of staff time devoted to enrolling patients into the program. Collecting quality data and having limited expertise to rigorously evaluate the program were other challenges. Because patients often share their food with their family, the monthly USD 40 incentive was generally not enough to support their needs; interviewees suggested giving a higher inventive amount to those with a larger household. Future PPR efforts and similar food incentive programs should consider these and other facilitators and barriers to implementation and sustainability, especially when making adjustments to these programs to improve services and access to food resources. Full article

Type 2 diabetes (T2D) is a growing global health problem that requires new and effective prevention and management strategies. Recent research has highlighted the role of epigenetic changes in the development and progression of T2D, and the potential of functional foods as a complementary therapy for the disease. This review aims to provide an overview of the current state of knowledge on the preventive epigenetic mechanisms of functional foods in T2D. We provide background information on T2D and its current treatment approaches, an explanation of the concept of epigenetics, and an overview of the different functional foods with demonstrated preventive epigenetic effects in T2D. We also discuss the epigenetic mechanisms by which these functional foods prevent or manage T2D, and the studies that have investigated their preventive epigenetic effects. In addition, we revisit works on the beneficial influence of functional foods against the programming and complications of parentally-triggered offspring diabetes. We also suggest, albeit based on scarce data, that epigenetic inheritance mechanistically mediates the impacts of functional nutrition against the metabolic risk of diabetes in offspring. Finally, our review highlights the importance of considering the preventive epigenetic mechanisms of functional foods as a potential avenue for the development of new prevention and management strategies for T2D. Full article

Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been linked to beneficial effects on cardiovascular risk factors, blood pressure, body weight, and lipid profile, according to a substantial body of literature. Significant cardiac and renal benefits with the use of SGLT2 inhibitors have been shown in patients with type 2 diabetes, as well as in those with heart failure and/or chronic kidney disease (CKD), regardless of diabetes status, in subsequent large cardiovascular outcome trials. Thus, SGLT2 inhibitors have become a mainstay of therapy for type 2 diabetes in patients with established cardiovascular disease and CKD due to their benefits for the heart and kidneys. Based on data from randomized controlled trials and meta-analyses, this article attempts to present a thorough review of the mechanism of action, as well as the benefits of SGLT2 inhibitors for cardiac and renal protection. On the basis of a growing body of literature on diabetes and other conditions, clinical practice guidelines have been updated to suggest the use of SGLT2 inhibitors in specific patient populations. These modifications will also be concisely described, based on evidence-based medicine principles. Full article

Obesity and the intake of high-sugar diets have dramatically increased in recent decades. However, it is still uncertain how sugar intake during the critical development phase affects the long-term health of children. In this context, the Developmental Origins of Health and Disease (DOHaD) concept established a correlation between early life environment and the development of cardiometabolic diseases in adulthood. This review summarizes the current knowledge about the consequences of sugar intake during the critical development phase for the onset of non-communicable diseases (NCDs). We found evidence that increased sugar intake during pregnancy contributes to maternal obesity and many cardiometabolic dysfunctions in the offspring. Furthermore, dietary sugar during the suckling period provokes the obese phenotype in adulthood. Finally, high-sugar diet intake during childhood induces metabolic syndrome and depressive-like behavior. Full article

There is a need for a modified Global Physical Activity Questionnaire (GPAQ) to estimate physical activity levels more accurately in populations. We aimed to develop a modified GPAQ and examine its construct validity among adults in Kerala, India. We incorporated locality-specific, metabolic equivalent task (MET)-based activities into the original GPAQ and administered this modified GPAQ among randomly selected 451 individuals (age ≥ 20 years) residing in the Trivandrum district of Kerala. Construct validity of the modified GPAQ was assessed using generalized linear models by examining the association of total moderate-to-vigorous physical activity (MVPA) MET-minutes per week with clinical measures. The mean age of participants was 45.4 (SD: 14.1) years, and 52.6% were female. Increasing total MVPA MET-minutes per week was associated with decreasing weight (β = −0.011 kg, 95% CI: −0.020, −0.002), waist circumference (β = −0.013 cm, 95% CI: −0.023, −0.004), and systolic blood pressure (β = −0.009 mmHg, 95% CI: −0.015, −0.002), independent of age, sex, education, occupation, current smoking, current alcohol use, and fruit and vegetable intake. The validity coefficients and associations between total MVPA MET-minutes per week and theoretical constructs of physical activity agreed with those predicted, providing evidence of construct validity for the modified GPAQ. Full article

Plants have been used as sources of medicine since ancient times. Natural products have been used extensively in Chinese, ayurvedic and folk medicine. In addition, a significant portion of the world’s population still utilizes herbal medicine. Diabetes is a common ailment affecting almost 463 million people in the world. However, current medications exert harmful after-effects on patients, while herbal medicines have fewer adverse effects. Plants possess secondary metabolites, such as alkaloids, flavonoids, tannins, steroids, etc., which exert numerous beneficial effects on health. Extensive research has been conducted over the years investigating and proving the hypoglycemic potential of various plants. The present paper reviews 37 such plants that are rich in phytoconstituents that possess a variety of pharmacological activities and have been experimentally proven to possess potentially hypoglycemic properties in animal models: Ficus racemosa, Agremone mexicana, Bombax ceiba, Cajanus cajan, Coccinia cordifolia, Momordica charantia, Syzygium cumini, Neolamarckia cadamba, Mangifera indica, Cocos nucifera, Tamarindus indica, Punica granatum, Azadirachta indica, Costus speciosus, Moringa oleifera, Andrographis paniculata, Ficus benghalensis, Anacardium occidentale, Annona squamosa, Boerhaavia diffusa, Catharanthus roseus, Cocculus hirsutus, Ficus hispida, Terminalia chebula, Terminalia catappa, Amaranthus tricolor, Blumea lacera, Piper betle leaves, Achyranthes aspera, Kalanchoe pinnata, Nelumbo nucifera, Mikania cordata, Wedelia chinensis, Murraya koenigii, Aloe barbadensis, Bryophyllum pinnatum and Asparagus racemosus. These 37 plant extracts exhibit antidiabetic activities through different mechanisms, including α-amylase and α-glucosidase inhibition, increases in glucose uptake and the stimulation of insulin secretion. Full article

Regular consumption of dietary sugars can cause significant damage to the β-cells. Almost a century after the discovery of insulin, it has been suggested that the frequent consumption of certain carbohydrates can damage pancreatic β-cells, causing disturbances in the regulation of insulin secretion. Most noncommunicable diseases, such as diabetes, obesity, and hypertension have a common origin, metabolic dysfunction, which is partly due to β-cell malfunction. In this article, we believed that sugars can lead to an imbalance in cellular metabolism, causing insulin exocytosis to dangerously increase or decrease blood insulin concentrations. In this study, we describe the major mechanism of insulin secretion and discuss the effects of sugar on pancreatic β-cells. Although many environmental factors strongly influence β-cells, occidental diet, including excess sugar, has been found to be the predominant factor that kills or disrupts the functioning of the unique cells that produce, store, and secrete insulin. Full article

Individuals with type 2 diabetes mellitus (T2DM) are at an increased risk of cognitive dysfunction. Growing evidence supports the use of cognitive training to target cognitive dysfunction in T2DM, but only limited evidence exists surrounding its feasibility and acceptability. The primary aim of this research is to determine the feasibility and acceptability of a cognitive training study in T2DM. Adults diagnosed with T2DM were randomly allocated to either a 6-week cognitive training group or a usual care control group. Feasibility outcomes (recruitment, adherence, retention, motivation, data collection, and intervention design) were evaluated using a traffic light progression criterion. Qualitative interviews were conducted to explore study acceptability. Cognition was measured at baseline and post-intervention. Forty-one participants completed the study (age 66 ± 9.8 years; HbA1c 54.0 ± 13.3 mmol.mol). Feasibility was shown in the adherence, retention, and motivation of participants, whilst minor amendments were proposed to the study design, recruitment, and data collection. Participants described cognitive training as highly enjoyable, with study components broadly reported as acceptable. Data signalled improvements in cognition, with large improvements observed in executive function. This study provides evidence for the potential feasibility, acceptability, and efficacy for cognitive training in T2DM. Recommendations for future studies are provided. Full article

The metabolic syndrome (MetS), first introduced by Haller in 1975, was sometimes also known as insulin resistance syndrome, syndrome X, and plurimetabolic syndrome. In 1989, it was rechristened by Kaplan as the “Deadly Quartet” based on a consolidation of central obesity, impaired glucose tolerance, dyslipidemia, and systemic hypertension. MetS is positively associated with a pro-inflammatory and pro-thrombotic state, attributed to increased pro-thrombotic and inflammatory marker activity. Moreover, MetS is frequently associated with increased atherosclerotic cardiovascular disease, impaired glucose tolerance, hyperuricemia, obstructive sleep apnea, and chronic kidney disease. Despite concerted endeavors worldwide, the complexity of the pathophysiology of metabolic syndrome still needs to be clearly understood. Currently, therapeutic possibilities are confined to individual therapy for hyperglycemia, hypertension, hypertriglyceridemia, hyperuricemia, regular physical exercise, and a restricted diet. In this review, progress regarding the understanding and pathophysiology of MetS; recent emerging technologies, such as metabolomics and proteomics; the relation of MetS with obesity, diabetes, and cardiovascular diseases; and the association of MetS with COVID-19 are discussed. Full article

Approximately half of all people with diabetes are women; however, the inclusion of women at all levels of research on diabetes is lacking. Clinical and pre-clinical trials do not have gender equity despite the differing progression of diabetes complications in women, and fewer women sit in academic or clinical leadership positions in diabetes than men. Whilst this scenario is not unique to diabetes, the purpose of this opinion article is to evaluate women’s position in diabetology and focus on why the drive for gender equity at all levels is important. This article serves as a preface to the upcoming Diabetology Women’s Special Issue Series, which aims to highlight and celebrate the achievements of women and people who identify as women in the hope of raising female voices in diabetes research and practice. Full article

The causes and metabolic consequences of lipohypertrophy (LH) from incorrect insulin injection techniques have been well-known for a long time and are the subject of countless publications. However, only some researchers propose structured research modalities for LH and programs to teach patients how to prevent them and minimize their effects, thus contributing to complete rehabilitation. Experts and scientific societies have produced consensus documents and recommendations to spread the culture of LH and its complications among clinicians. However, they should go deeper into LH detection methods. This short article analyzes the recent literature on the best way to explore and find more or less evident LH lesions by using a structured and validated clinical methodology to benefit the many clinicians without access to technological equipment such as ultrasonography. This text also aims to bring awareness that since the last published recommendations on injection techniques, new needles for insulin injection, more technologically advanced and suitable for specific populations, have come to market but still need a thorough evaluation. Full article

Supporting diabetes self-care in school is important for optimal glycemic control and mental health. The aim of this study was to investigate parental experiences of diabetes management in Danish schools, with an emphasis on the importance of school staff support in self-care. This cross-sectional study surveyed parents of schoolchildren with type 1 diabetes aged 6 to 16 years in Denmark. The parents were identified among members of the Danish Diabetes Association and were invited to complete an online questionnaire. A total of 252 parents of schoolchildren with type 1 diabetes answered the questionnaire. Only 28% of the children had a designated staff member responsible for support in diabetes self-care during school hours. Having a designated staff member responsible for support in self-care was positively associated with parental experiences of better school–parent cooperation (p < 0.001), better experience of diabetes management in school (p < 0.001), and larger proportions of children and parents feeling comfortable in school (p = 0.022 and p = 0.049, respectively). School staff support was positively associated with better parental experience of diabetes management and with some parameters of mental health in schoolchildren with type 1 diabetes and their parents in Denmark. Full article

Despite evolution in treatment options and improved understanding of pathophysiology, the treatment of type 2 diabetes remains unsatisfactory. Current management guidelines complicated by clinical inertia have resulted in over half of patients failing to meet glycemic targets. Expert consensus has defined a state of diabetes remission whereby treatment can induce sustained normalization of glucose levels. Evidence suggests that metabolic surgery, intensive lifestyle modification, and pharmacologic approaches are each viable options for achieving remission when implemented early in the disease course. The authors review each of these strategies and include practical considerations to aid in the pursuit of remission. Full article

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are emerging as an important therapy not only for type 2 diabetes (T2DM), but also for heart disease and kidney disease. As these medicines gain acceptance, the number of hospitalized patients receiving them is likely to rise. During clinical trials, SGLT2 inhibitors were noted to have a potential risk for diabetic ketoacidosis (DKA), particularly DKA with relatively normal blood glucose levels, ‘euglycemic DKA’. Similar to DKA that is not associated with SGLT2 inhibitors, most of these events seem to be related to acute illnesses or other changes in a patient’s medications or self-management circumstances. This creates a need among hospital providers to create strategies to prevent DKA in their hospitalized patient and guidance on monitoring and treating euglycemic DKA. Our combined experience concerning this phenomenon has given a great deal of insight into this problem and the knowledge needed to improve patient care, by augmenting patient education, inpatient surveillance, and early treatment for euglycemic DKA. Full article

We aimed to study the knowledge of diabetes among individuals with a high risk for developing type 2 diabetes in the Trivandrum district of the Indian state of Kerala. The baseline data collected from 1007 participants of the Kerala Diabetes Prevention Program were analyzed. Diabetes knowledge was assessed using a scale adapted from a large nationwide study conducted in India. The composite score of the scale ranged from 0 to 8. The mean age of the participants was 46.0 (SD: 7.5) years, and 47.2% were women. The mean diabetes knowledge score was 6.9 (SD: 2.1), with 59.5% having the maximum possible score of 8. Of the 1007 participants, 968 (96.1%) had heard the term diabetes, and of them, 87.2% knew that the prevalence of diabetes is increasing, 92.9% knew at least one risk factor for diabetes, 79.6% knew that diabetes can cause complications in organs, and 75.9% knew that diabetes can be prevented. While the overall level of knowledge of diabetes about its risk factors, complications, and prevention was generally high, an alarmingly low proportion of participants knew that diabetes can affect key organs such as the eyes (24.0%), heart (20.1%), feet (10.2%), and nerves (2.9%), and nearly a quarter (24.1%) were not aware that diabetes can be prevented. It is essential to educate high-risk individuals about diabetes complications and the importance of and strategies for diabetes prevention in the Trivandrum district of Kerala. Full article

Obesity is one of the most important factors responsible for the marked increase in both the incidence and prevalence of type 2 diabetes mellitus (T2DM) in recent decades. Addressing the lifestyle factors associated with the progression to T2DM would present a potential rational early prevention strategy. The current evidence suggests that excessive energy intake is mediated via dietary fat. Biochemical signals released in response to the ingestion of food require supportive signalling from the presence of food in the stomach. The degree of supportive volume signalling emanating from the stomach influences both the satiation and satiety phases. The Lipids and Volume in Satiation and Satiety (LIVES) Hypothesis proposes that the biological feedback from fat intake appears to be influenced by the other macronutrients with which it is consumed. By identifying the various possible macronutrient combinations with fat, it is possible to construct a matrix of food composition/volume scenarios, which may help elucidate dysfunction in the human food energy regulation system within the context of the modern food environment. Full article

The onset of the COVID-19 pandemic in March 2020 accelerated the efforts of several organizations providing the National Diabetes Prevention Program (National DPP) and the Diabetes Self-Management Education and Support (DSMES) program to rapidly transition from in-person service delivery to program administration via telehealth. Semi-structured interviews were conducted with 35 National DPP and DSMES experts and providers in Los Angeles County to gain a better understanding of the challenges and benefits associated with this transition. Interviews were completed during June to October 2021. Thematic analyses were performed using the Social-Ecological Model as a guiding framework. The analyses revealed several factors that influenced the transition, including at the individual (e.g., technology and health behaviors), interpersonal (e.g., social connections and support), organizational (e.g., provider workload and program enrollment and retention), community (e.g., recruitment), and policy (e.g., government support and reimbursement for telehealth services) levels. Findings suggest that the transition to telehealth was challenging for most National DPP and DSMES providers. However, because of its lower cost, ability to reach long distances virtually, and potential efficiency when employed as part of a hybrid approach, this delivery modality remains viable, offering benefits beyond the traditional program models. Full article

Glucose, fructose, and galactose are widely used in the food industry as sweeteners and food additives. The over-consumption of these carbohydrates has been identified as a possible trigger of non-communicable diseases. These include insulin resistance, obesity, and type 2 diabetes. These sugars induce an energy overload with consequent adipose tissue (AT) expansion, contributing to the development of obesity. Furthermore, a common feature of these non-communicable diseases is the detrimental, chronic, low-grade inflammation contributing to their onset. In the present review, we identify the most widely used dietary free sugars and their direct impacts on AT metabolism and inflammation, as well as their involvement in systemic inflammation and effects on the immune cell phenotype and function. Additionally, we discuss the capacity of the free sugars to induce immune modulation, enhancing inflammation, an underlying hallmark of insulin resistance, obesity, and T2DM. Dietary sugars have an important and deleterious metabolic impact on AT and also on immune cells. More research is needed to effectively understand the impact of chronic exposure to high levels of individual or combined sugars on metabolism, with the impact on immunomodulation being especially important. Full article

Studies have shown that COVID-19 patients with prediabetes frequently present with high plasma glucose levels on hospital admission. However, whether the glycemic abnormalities are temporary or persist after recovery from the illness is unclear. We conducted a follow-up study of the case series of 69 COVID-19 patients with prediabetes (HbA1c 5.7–6.4%) who were admitted to a tertiary care hospital in Chennai, India, from May to October 2020 and were discharged alive. Over a mean follow-up of 146.6 (SD: 72.5) days, the mean fasting plasma glucose rose significantly by 16.8 mg/dL (from 119.3–136.1 mg/dL), 2-hr post-prandial glucose by 61.0 mg/dL (from 176.2–237.2 mg/dL), and HbA1c by 0.6% (5.9–6.5%). Of the 49 (84.5%) patients who were discharged with glucose-lowering medications, 40 (81.6%) continued taking them at the first follow-up visit (mean of 50.1 days from admission), and 39 (79.6%) continued taking them at the second follow-up visit (mean of 114.3 days from the first follow-up visit). In addition, 12.1% of patients developed new-onset diabetes after recovery from the illness. These findings underscore the importance of regular monitoring of glycemic parameters in COVID-19 patients with prediabetes after recovery. Full article

Type 2 diabetes mellitus (T2DM) is a growing global health issue that is closely linked to the epidemic of obesity. In addition to genetic factors, environmental and health-risk behaviours (i.e., high-carbohydrate diet and physical inactivity) contribute to a variety of pathophysiological disorders. Advanced exercise protocols, such as Moderate-to-intensity (MIT) and High Intensity Interval Training (HIIT), revealed a strategy for mitigating and/or attenuating the DTMII’s harmful effects by controlling glycated haemoglobin (HbA1c) levels. The goals of this review were to summarize the most recent evidence on the impact of HIIT on HbA1c levels. A mini-review protocol was performed through the PubMed/Medline database. The search comprised experimental and randomized controlled trial studies published in English between 2016 and 2021. The terms HbA1c, T2DM, MIT and HIIT, and their analogues were used. A total of seven studies were finally included. Our findings showed that the HIIT protocol is an effective strategy to induce HbA1c balance and improve glycaemic control than moderate training. The HIIT conducted in the laboratory and involving aerobic exercise on a cycle ergometer appears to be more efficient that MIT. Additional findings include improved beta-cell function, decreased low-grade inflammation, and the induction of cardiovascular benefits. More research is required to investigate the feasibility and safety of HIIT protocols in T2DM patients. Full article

Food behaviour is a complex and multifaceted cooperation between physiologic, psychological, social, and genetic factors, influencing meal timing, amount of food intake, food preferences, and food selections. Deregulation of the neurobiological mechanisms controlling food behaviour underlies the development of obesity and type 2 diabetes, two epidemics of the present century. Several brain nuclei are involved in the regulation of the different components of food behaviours; the hypothalamus is the key in controlling appetite and energy homeostasis. In this review, we will explain the role of the hypothalamus in the control of food intake and its interplay with other brain nuclei important in food behaviour. We will also highlight the deregulation of satiety pathways in type 2 diabetes and obesity and the mechanisms behind this deregulation. Finally, knowing that there are different categories of sugars and that they differently impact food behaviours, we will review in a concise manner the studies referring to the effects of sugars in satiety and reward pathways and their impacts on metabolic diseases. Full article

A high consumption of sugar leads to an increase in caloric intake, which in turn will lead to a higher risk of developing health issues. Foods contain both naturally occurring sugars and added sugars. The World Health Organization recommends that the daily intake of free sugars be below 10% of the total daily energy intake. Food performs a key role in maintaining an adequate glycaemic control in people with diabetes. However, there is a low compliance to dietary recommendations, namely in the amount of sugar intake. This review article aims to assess and compare the intake of various types of sugars in the general population and among individuals with and without a diabetes diagnosis, identify the food sources that contribute to the intake of free and added sugars, and understand their impact on health. Studies performed on the general population found that the consumption of sugar was high, and that children and teens are more likely to exceed the recommended amounts. It was found that diabetics consume less total and added sugar than non-diabetics, as well as a less sugary drinks. Guidelines and public health policy measures aimed at limiting the intake of free and added sugars are needed in order to minimize the consumption of foods high in empty calories. Full article

Nocturia is a common disease in patients with type 2 diabetes mellitus that can reduce the quality of life. Sodium glucose co-transporter 2 (SGLT2) inhibitors increase the urine volume and are often discontinued when polyuria occurs, although tofogliflozin, which has a short half-life in the blood, may improve nocturia by managing hyperglycemia and hypertension, without aggravating nocturia. As excessive sodium intake worsens nocturia and increases urine volume, sodium restriction is also effective in managing nocturia. This multicenter, open-label, randomized parallel-group trial will examine 80 patients with type 2 diabetes who experienced nocturia. After the baseline examination, the patients are randomly stratified into two groups and receive tofogliflozin treatment with or without sodium restriction for 12 weeks. The primary outcome is nocturia frequency at 12 weeks. The secondary outcomes are the frequency of daytime urine, changes in urine volume, and changes in home blood pressure. Full article

The number of adult individuals with insulin-treated diabetes mellitus (DM) is steadily increasing worldwide. The main local complications of insulin injection are lipohypertrophies (LHs), i.e., subcutaneous nodules consisting of aggregates of macro-adipocytes and fibrin. These nodules result from errors repeatedly made by patients while injecting insulin. Despite being very common, LH lesions/nodules due to incorrect insulin injection techniques are often flat and hardly visible and thus require thorough deep palpation examination and ultrasonography (US) for detection. Identifying LHs is crucial, especially in elderly and frail subjects, because they may eventually result in poor diabetes control due to associated unpredictable insulin release patterns. Raising awareness of the adequate detection of LHs and their clinical consequences is crucial and urgent. A call to action is required on this topic at all levels of undergraduate and postgraduate education. Full article

The circadian rhythm is essential in order to maintain metabolic homeostasis and insulin sensitivity. Disruption of circadian mechanisms is associated with the development of metabolic diseases, such as diabetes. Lifestyle changes such as an equilibrated diet and physical activity are known to improve glycaemic control in diabetic patients. One of the mechanisms possibly involved in such an improvement is the restoration of insulin circadian rhythms. There are several available dietary schemes based on circadian rhythms. Some of them are associated with better regulation of daily insulin fluctuations and the improvement of Type 2 Diabetes and metabolic syndrome. In the current review, we aim to explore how the different types of diet can impact glucose metabolism and insulin sensitivity in patients with diabetes, highlighting the interactions with the mechanisms of circadian insulin rhythm and the prevention of hyperinsulinemia. Full article

Glycotoxins include the group of advanced glycation end-products (AGEs) and their precursors, most of them highly reactive intermediary compounds of sugar metabolism. Glycotoxins and products of the Maillard reaction are present in high concentrations in foods rich in sugars and processed at high temperatures and are often associated with the flavour of the food. Proteins undergoing this type of molecular modification are targets for gut peptidases and may be absorbed into circulation. AGEs are associated with the toxic effects of glucose in diabetic patients, and some studies have shown that they also contribute to metabolically unhealthy obesity and prediabetes development. Restriction of dietary glycotoxins was shown to improve insulin resistance in humans. However, the real contribution of dietary AGEs to such mechanisms is still not understood. This review summarizes the current knowledge about glycotoxin formation from dietary sugars, their digestion throughout the gastrointestinal system, and the mechanisms of their intestinal absorption. Full article