Diabetology

Diabetes mellitus (DM) and osteoporosis are among the most common non-communicable diseases worldwide. Beyond their considerable socio-economic burden, both conditions significantly impair quality of life and reduce life expectancy, representing major causes of disability. DM-induced osteoporosis has recently emerged as a notable and frequent complication. Patients with type 2 DM have a twofold increased risk of fragility fractures, while those with longstanding type 1 DM exhibit a fivefold higher risk of hip, vertebral, and non-vertebral fractures. Bone mineral density (BMD) assessed by Dual Energy X-ray Absorptiometry (DXA) often fails to predict fracture risk in this population, as bone mass tends to be normal, slightly reduced, or even elevated. However, DXA-derived indices can offer additional clinical value. The Trabecular Bone Score (TBS), which reflects bone microarchitecture, is frequently reduced in patients with DM and is associated with increased fracture risk, particularly in postmenopausal women. TBS is also linked to glycemic control and microvascular complications and can improve with bone-active medications, thus aiding follow-up assessments. Another useful DXA-based tool is the Bone Strain Index (BSI), which evaluates load resistance and has been shown to be degraded in diabetic patients, offering further predictive value for fractures. Additionally, Hip Structural Analysis (HSA) provides information on the mechanical integrity of the proximal femur, which may be compromised in DM. Based on the available evidence, this review aims to highlight the clinical utility of DXA-derived tools in DM-induced osteoporosis, emphasizing their ability to provide quantitative and qualitative information on bone health and to predict the risk of fragility fractures. Full article

Background: The global surge in obesity has reignited the need for larger cuff sizes to avoid inaccurate blood pressure (BP) readings and inappropriate antihypertensive treatment. More precise methods are essential. Forearm BP measurement has emerged as a promising alternative, showing strong correlation with noninvasive beat-to-beat monitoring. This study aimed to validate the digital oscillometric method on the forearm, comparing results to brachial artery readings in hypertensive patients with prediabetes and obesity. Methods: A non-randomized, open, cross-sectional observational study was conducted with 72 hypertensive individuals presenting with obesity and prediabetes. BP was measured using oscillometric devices on both the arm and forearm, following standardized protocols. Data were analyzed using Pearson correlation and Bland–Altman agreement tests. Results: Arm and forearm BP readings showed high agreement: r = 0.86 for systolic BP (SBP), r = 0.93 for diastolic BP (DBP), and r = 0.90 for mean arterial pressure (MAP). Bland–Altman analysis confirmed equivalence (SBP: p = 0.8, DBP: p = 0.3, MAP: p = 0.2). Conclusions: Forearm BP measurement is a reliable and effective alternative, particularly for hypertensive patients with prediabetes and obesity. It offers accurate readings, reduces treatment risks, and supports better clinical decisions. Broader studies are needed for generalization. Full article

Background: Abscisic acid (ABA), a phytohormone widely distributed in nature, has recently emerged as an endogenous regulator of glucose homeostasis in humans. Specifically, scientific studies have demonstrated that exogenous ABA supplementation improves glycemic control and reduces insulin requirements, with significant advantages in prediabetic subjects. Beyond its metabolic role, growing evidence suggests that ABA is also involved in immune responses, including those associated with pulmonary diseases. Despite these promising results, the evaluation of plasma ABA levels remains largely unexplored in clinical practice. Methods: This study aimed to evaluate whether plasma ABA concentrations differ among healthy individuals, patients with type 2 diabetes, and smokers, in order to clarify the role of ABA as a potential biomarker of both metabolic imbalance and smoking-related inflammatory stress. Results: Our findings show that ABA levels were significantly higher in healthy subjects (10.9 ± 3.8 ng/mL) compared to diabetic patients (6.8 ± 4.2 ng/mL, p < 0.01 vs. healthy subjects), with the lowest levels observed in smokers (3.5 ± 2.5 ng/mL, p < 0.0001 vs. healthy subjects and p < 0.0001 vs. diabetic patients). Moreover, a significant correlation was observed between ABA plasma concentration and number of cigarettes smoked (R² = −0.6776, p = 0.0001). Conclusions: Overall, these results highlight the relevance of measuring ABA plasma levels in both metabolic and inflammatory conditions, confirming its role as a biomarker for identifying individuals who can benefit from exogenous supplementation. Full article

Background/Objectives: Obesity-related insulin resistance leads to the development of type 2 diabetes mellitus (T2DM); however, the pathophysiology of these metabolic alterations remains incompletely understood. This study aimed to characterize the lipidomic alterations during obesity–insulin resistance–T2DM progression in a high-sugar diet (HSD) model. Methods: Fruit flies were fed either a standard diet (SD) or an HSD and monitored across a 14-day period. Metabolic phenotyping and lipidomic profiling were conducted during the experiment. Results: After two days of HSD, fruit flies exhibited an obesity phenotype (50% increase in triglyceride content) and insulin resistance (hyperglycemia and insulin overexpression), progressing to an early T2DM-like state (increased triglycerides, hyperglycemia, and normal insulin expression) from days 4 to 6, and finally to a late T2DM-like phenotype (increased triglycerides, hyperglycemia, and insulin down-regulation) from days 8 to 14. Multivariate analyses indicated an altered lipidome profile in HSD-fed fruit flies from day 2 until the end of the experiment. Fatty acids and phosphatidylethanolamines (PEs) containing 16:0, 16:1, and 18:1 acyl chains were significantly altered during the development of obesity-related insulin resistance and early T2DM-like state (days 2 to 6); whereas palmitic acid and oleic acid-LysoPE alterations were associated with the onset and progression of obesity-related T2DM-like state (days 4 to 14). Conclusions: The progression from obesity-related insulin resistance to a T2DM-like state in an HSD-fed D. melanogaster model is accompanied by distinct lipidomic signatures involving 16- and 18-carbon fatty acid derivatives. These findings provide insight into potential biomarkers and mechanistic pathways in the early pathogenesis of T2DM. Full article

Background/Objectives: There is a ubiquitous presence of plastics worldwide, and recent data highlight the continuous growth in their production and usage—a trend paralleled by the rise in chronic diseases like diabetes. The multifactorial nature of these diseases suggests that environmental exposure, notably to bisphenol A (BPA), could be a contributing factor. This study investigates the potential correlation between emerging BPA substitutes, bisphenol S and F (BPS and BPF), and diabetes in a cohort of the general adult population. Methods: A retrospective cohort study was conducted using data from the U.S. National Health and Nutrition Examination Survey (NHANES) 2013–2014 and 2015–2016 cycles. Basic comparative analyses and Pearson correlation tests were performed, followed by logistic regression models. Advanced statistical approaches, including Weighted Quantile Sum (WQS) regression and quantile g-computation, were subsequently applied to evaluate the combined effects of bisphenol exposures. Results: Findings reveal a positive association between combined bisphenols (BPs) and glycated hemoglobin (HbA1c), with binomial logistic regression demonstrating an odds ratio (OR) of 1.103 (1.002–1.214) between BP levels corrected for creatinine (crucial due to glomerular filtration variations) and diabetes. weighted quantile sum (WQS) and quantile G-computation analyses showed a combined positive effect on diabetes, glucose levels, and HbA1c. Individual effect analysis identifies BPS as a significant monomer warranting attention in future diabetes-related research. Conclusions: Replacing BPA with new molecules like BPS or BPF may pose a greater risk in the context of diabetes. Full article

Youth-onset type 2 diabetes (T2D) is a growing public health challenge. This narrative review aims to provide a comprehensive overview of epidemiology, pathophysiology, diagnosis, complications, and therapeutic strategies in children and adolescents with T2D, highlighting the most recent evidence and the distinctive features that differentiate youth-onset from adult-onset disease. Over recent decades, its incidence has increased worldwide, closely linked to rising rates of childhood obesity, sedentary behavior, and socioeconomic disparities. The disease typically emerges around puberty, a period marked by physiological insulin resistance, and is influenced by a complex interplay of genetic, environmental, and developmental factors. Diagnosis can be delayed or missed due to overlapping features with type 1 diabetes and limitations in current screening tools. The clinical course is often aggressive, with early onset of microvascular and macrovascular complications. Management is particularly challenging due to the limited number of pharmacologic agents approved for pediatric use and the psychological and behavioral complexities of adolescence. While metformin remains the first-line treatment, newer therapies such as GLP-1 receptor agonists and SGLT2 inhibitors show promise in improving metabolic outcomes. In conclusion, early diagnosis, multidisciplinary management, and equitable access to effective therapies are essential to improve long-term outcomes in this vulnerable population. Full article

The clinical case presented demonstrates how a person living with type 2 diabetes and treated with insulin reuses the same pen needle several times to save money and performs an incorrect maneuver while screwing the needle, which breaks, remains stuck at the end of the pen, and causes loss of insulin during subsequent use. The findings in this case study are observed in many others in clinical practice but have only been sporadically published. Who is responsible for incorrect injections? Indeed, health workers, diabetic patients, and all the other actors involved in diabetes care and insulin utilization share responsibility. Recommendations and guidelines are not enough to fill this gap. Moreover, not all healthcare providers (HCPs) know or adhere to them. It is observed daily that more than half of insulin users make mistakes that affect glycemic control, increase the risk of complications, and reduce the quality of life of people living with diabetes, who, by a rough estimate, make up a population of over 100 million in the world. This case study offers us the opportunity to briefly review the literature on the most common errors made during insulin injection technique and, therefore, consider how necessary it is to promote structured and coordinated actions among various actors to promote the culture of therapeutic education. Full article

Background/Objectives: Multimorbidity, where patients have ≥2 comorbidities, is recognized as a major challenge for health systems worldwide, driving up morbidity and cost. The differences in multimorbidity burden between those with and without type-2 diabetes mellitus (T2DM) in the Veteran population are not well studied. This large retrospective cohort study fills the existing gap. Methods: Using a retrospective cohort of adult Veterans with and without T2DM, we examined 29 comorbidities defined by Elixhauser criteria for 10,499,394 Veterans from 1 January 2008 to 31 December 2009. We then ascertained diabetes status for 10 years of follow-up from 1 January 2010 to 31 December 2019. Multimorbidity status was categorized using the Elixhauser comorbidity index (0, 1, ≥2) and logistic regression was used to estimate the odds ratio (OR) for its association with risk of diabetes, adjusting for covariates. Results: Compared to those with zero comorbidities, the odds of having diabetes were more than doubled (2.53, CI: 2.51–2.54) for those with ≥2 comorbidities. Conclusions: The doubling of the odds of T2DM among those with more than one comorbidity is typical of Veterans with T2DM. In addition, the odds were significantly higher for Hispanics compared to other groups when adjusting for covariates. This calls for more attention to reduce the risk of T2DM through improved management and effective use of treatments informed by disparities that exist in the VHA. Full article

Background. Type 2 diabetes mellitus (T2D) and moderate-to-severe obstructive sleep apnea (OSA) commonly coexist and exacerbate poor glycemic control, systemic inflammation, and diminished quality of life (QoL). Although continuous positive airway pressure (CPAP) therapy has demonstrated metabolic and anti-inflammatory benefits, its real-world impact in Bulgarian outpatient settings—where CPAP costs are borne entirely by patients—has not been characterized. Objectives. To evaluate the effects of six months of CPAP therapy on glycemic control (hemoglobin A₁c [HbA₁c]), systemic inflammation (high-sensitivity C-reactive protein [hsCRP]), body mass index (BMI), lipid profile (low-density lipoprotein [LDL]), QoL (Short Form 36 Physical Component Summary [SF-36 PCS] and Mental Component Summary [SF-36 MCS]), and survival among Bulgarian outpatients with T2D and moderate-to-severe OSA. Methods. In this prospective, multicenter cohort study conducted from January 2022 to July 2023, 142 adults with established T2D and OSA (apnea–hypopnea index [AHI] ≥ 15) were enrolled at three outpatient centers in Bulgaria. Fifty-five patients elected to purchase and use home-based CPAP (intervention group), while 87 declined CPAP—either because of cost or personal preference—and continued standard medical care without CPAP (control group). All participants underwent thorough outpatient evaluations at baseline (month 0) and at six months, including measurement of HbA₁c, hsCRP, BMI, fasting lipid profile (LDL), and patient-reported QoL, via the SF-36 Health Survey. Survival was tracked throughout follow-up. Results. After six months, the CPAP group experienced a significant reduction in HbA₁c from a median of 8.2% (IQR 7.5–9.5%) to 7.7% (6.7–8.7%), p < 0.001, whereas the control group’s HbA₁c decreased modestly from a median of 8.6% (IQR 7.9–9.4%) to 8.3% (7.6–9.1%); p < 0.001), with a significant between-group difference at follow-up (p = 0.005). High-sensitivity CRP in the CPAP arm fell from a median of 2.34 mg/L (IQR 1.81–3.41) to 1.45 mg/L (IQR 1.25–2.20), p < 0.001, while remaining unchanged in controls (p = 0.847). BMI in the CPAP group declined significantly from 28.6 kg/m², IQR 26.6–30.6 to 28 kg/m², IQR 25.6–29.2 (p < 0.001), compared to no significant change in controls (median 28.9 kg/m²), p = 0.599. LDL decreased in the CPAP group from a median of 3.60 mmol/L (IQR 3.03–3.89) to 3.22 mmol/L (IQR 2.68–3.48), p < 0.001, with no significant reduction in controls (p = 0.843). Within the CPAP arm, both SF-36 PCS and SF-36 MCS scores improved significantly from baseline (p < 0.001 for each), although between-group differences at six months did not reach statistical significance (PCS: 48 ± 10 vs. 46 ± 9, p = 0.098; MCS: 46, IQR 40–54 vs. 46, IQR 39–53, p = 0.291). All-cause mortality during follow-up included 2 events in the CPAP group and 11 events in the control group (log-rank p = 0.071). Conclusions. In Bulgarian outpatients with T2D and moderate-to-severe OSA, six months of CPAP therapy significantly improved glycemic control, reduced systemic inflammation, lowered BMI and LDL, and enhanced QoL, with a non-significant trend toward reduced mortality. These findings underscore the importance of integrating CPAP into multidisciplinary management despite financial barriers. Full article

Background: COVID-19 has been associated with multisystemic sequelae, including persistent neurocognitive impairment and emerging metabolic alterations. Growing evidence suggests that glial dysfunction and inflammation may play a pivotal role in both cognitive decline and new-onset diabetes following SARS-CoV-2 infection. Objectives: This study aimed to assess the prevalence and characteristics of cognitive impairments in post-COVID-19 patients and to explore their correlation with new-onset diabetes, neuroanatomical changes, and psychological symptoms, with a specific focus on gender differences. Methods: A total of 245 patients (mean age 56.8 ± 12 years), previously diagnosed with COVID-19, were enrolled between April 2021 and August 2023. Participants underwent a comprehensive neuropsychological assessment (MMSE, Rey-Osterrieth Figure, FAB, Hamilton, STAI, IES-R), structured interviews, and, in a subset, brain MRI. Individuals with pre-existing neurological disorders were excluded. Data were analyzed for cognitive performance, neuroimaging abnormalities, and metabolic outcomes, including new-onset diabetes. Results: Cognitive dysfunction was identified in 87% of participants: mild in 47%, moderate in 21.6%, and severe in 10.8%. Glial alterations on MRI were observed in 51%, hippocampal atrophy in 9%, and temporal lobe reduction in 4%. Notably, 12% of patients developed new-onset diabetes post-COVID, of whom 80% exhibited mild to moderate cognitive deficits. Depressive symptoms were present in 80.9%, and anxiety in 93.5%, with significantly higher incidence in female patients. PTSD symptoms correlated with greater cognitive impairment. Ongoing research into the mechanisms underlying these persistent cognitive impairments in subjects with and without types 1 and 2 diabetes. This paper presents the final data of the research published in the previous article referenced in the bibliography. Conclusions: This study highlights a significant association between cognitive decline and new-onset diabetes in post-COVID patients, likely mediated by systemic inflammation and glial dysfunction. Particularly noteworthy are the findings of neuroanatomical alterations, including nonspecific glial signal changes, hippocampal atrophy, and temporal lobe volume reductions, suggesting post-infectious cerebral vulnerability with potential long-term consequences. These results support the need for integrating cognitive screening, brain neuroimaging, and metabolic monitoring into post-COVID care pathways—especially for women and individuals presenting with anxiety or depressive symptoms. An early and interdisciplinary approach is essential to address the neuro-metabolic and cerebral sequelae of long COVID. Full article

Background: The present study aims to evaluate the effectiveness of ESYSTA^® (Emperra GmbH E-Health Technologies, Germany), a CE-certified digital health application made to support insulin-treated diabetes patients to improve their disease management through better self-empowerment. Methods: To evaluate the effectiveness of ESYSTA^®, data from patients who used ESYSTA^® for at least 12 months and participated in an originally prospective one-arm study were evaluated. This study was conducted in cooperation with the German health insurance company AOK Nordost (2012–2015). From a real-world data pool of insured AOK Nordost patients, a control group was matched to mimic a controlled trial that allows the use of ESYSTA^® to be compared with standard care in the context of a disease management program (DMP). Results: The study results show significant and clinically relevant reductions in HbA1c values of at least 0.4% in ESYSTA^® users after 6 months. After 12 months, users achieved, on average, an HbA1c reduction of approximately 0.7%. These reductions are more pronounced compared to the matched control group. Conclusions: The present study shows the effectiveness of the digital health application ESYSTA^®. Using a matched control group further increased the internal and external validity of the study results. Full article

Background/Objectives: Civic engagement may be a critical determinant of prognostic outcomes in persons with diabetes. Persons with diabetes are at increased risk for mobility impairment. Little research has explored the role of mobility difficulties in voting participation among persons with diabetes. Methods: To examine whether mobility difficulties influence voting participation in U.S. local elections among persons with diabetes, data was obtained from the 2022 National Health Interview Survey for persons with diabetes (n = 1398). The independent variable was mobility difficulties, defined as difficulty walking or climbing stairs. The dependent variable, voting participation, was assessed by an indication as to whether respondents voted in the last local elections. Weighted logistic regression assessed the influence of mobility difficulties on voting participation adjusting for potentially influential covariates among persons with diabetes. Results: Among persons with diabetes, less than one fifth (18.8%) voted in the last local election and half (48.9%) reported difficulties walking or climbing stairs. In models adjusting for covariates, persons with diabetes who indicated they had difficulties in walking or climbing stairs were significantly less likely to indicate they had voted in the last local election in comparison with those without mobility difficulties (adjusted odds ratio (AOR) = 0.638, 95% confidence interval (CI) = (0.443, 0.918)). Persons with diabetes who were female, married, had graduated from college or technical school, or rated their health as good/very good were significantly more likely to report having voted in a local election. Conclusions: Initiatives are needed to foster voting participation among persons with diabetes and mobility difficulties. Full article

Background: Artocarpus heterophyllus, familiar as jackfruit, is a tropical fruit highly valued not only for its nutritional content but also for its medicinal properties, including potential antidiabetic effects. Objectives: This study aimed to evaluate the insulinotropic, β-cell proliferative and anti-hyperlipidaemic properties of the ethanol extract of unripe Artocarpus heterophyllus (EEAH) in high-fat-fed (HFF) diet-induced obese mice. Method: We evaluated acute insulin secretion and β-cell proliferation in BRIN-BD11 cells, and assessed in vitro glucose diffusion and starch digestion. In vivo, acute and chronic studies in HFF induced obese mice measured glucose tolerance, body weight, food and fluid intake, and lipid profiles. A preliminary phytochemical screening was also performed. Results: In this study, EEAH exhibited significant antidiabetic activity through multiple mechanisms. EEAH enhanced glucose-stimulated insulin secretion in BRIN-BD11 β-cells via K_ATP channel modulation and cAMP-mediated pathways, with partial dependence on extracellular calcium, and it also promoted β-cell proliferation. In vitro assays revealed its ability to inhibit starch digestion and glucose diffusion, indicating delayed carbohydrate digestion and absorption. In high-fat-fed (HFF) obese mice, the acute and chronic oral administration of EEAH improved oral glucose tolerance, reduced fasting blood glucose, decreased body weight, and normalized food and fluid intake. Lipid profile analysis showed increased HDL and reduced total cholesterol, LDL, and triglycerides, while higher doses of EEAH also enhanced gut motility. Phytochemical screening revealed the presence of bioactive compounds such as alkaloids, tannins, flavonoids, saponins, steroids, and terpenoids, which are likely responsible for these therapeutic effects. Conclusion: These findings highlight EEAH as a promising natural candidate for adjunctive therapy in managing type 2 diabetes and associated metabolic disorders and emphasize the importance of future multi-omics studies to elucidate its molecular targets and pathways. Full article

Metabolic syndrome comprises a constellation of comorbidities, including obesity, hypertension, and disorders in carbohydrate and lipid metabolism, associated with an elevated risk of cardiovascular mortality. Obesity is regarded as the principal cause of metabolic syndrome (both collectively and in relation to its components), frequently linked in previous scientific studies with a deficiency of magnesium, one of the most important cations found in the human body. Objectives: The objective of this study was to assess the prevalence of hypomagnesemia in patients with metabolic syndrome and to determine the most significant risk factor among its components for this nutritional deficiency. Methods: Retrospective medical data from 403 patients admitted to the hospital for conditions unrelated to magnesium levels from 2015 to 2019 were evaluated, encompassing serum magnesemia and specific data about components of metabolic syndrome. Data underwent statistical analysis, including linear and logistic regression, to assess the principal risk variables of hypomagnesemia. Results: Hypomagnesemia was observed in 14.89% of the patients with metabolic syndrome, exhibiting a 2.42-fold greater risk of this deficiency (95%CI: 1.40–3.40). Among the components of metabolic syndrome, hyperglycemia emerged as the most significant determinant affecting both the incidence and severity of hypomagnesemia, elevating the risk by a ratio of 2.72 (95%CI: 1.52–4.87). In the multivariate regression model, hyperglycemia was the sole factor independently influencing magnesium concentration (β = −0.145; p < 0.001). Conclusions: Patients presenting signs of metabolic syndrome are at heightened risk for hypomagnesemia. Hyperglycemia appears to be the most important variable affecting the risk of magnesium insufficiency; however, additional research is needed in this area. Full article

Objectives: Diabetes Mellitus involves demanding challenges that interfere with family functioning and routines. In turn, family and social context impacts individual glycemic control. This study aims to identify this recursive interplay, the mutual influences of family systems and diabetes management. Design: Data was collected through a cross-sectional design comparing patients, aged 22–55, with and without metabolic control. Methods: Participants filled out a set of self-report measures of sociodemographic, clinical and family systems assessment. Patients (91) were also invited to describe their perception about disease management interference regarding family functioning. We first examined the extent to which family variables grouped dataset to determine if there were similarities and dissimilarities that fit with our initial diabetic groups’ classification. Results: Cluster analysis results identify a two-cluster solution validating initial classification of two groups of patients: 49 with metabolic control (MC) and 42 without metabolic control (NoMC). Independent sample tests suggested statistically significant differences between groups in family subscales- family difficulties and family communication (p < 0.05). Binary logistic regression shed light on predictors of explained variance to no metabolic control, in four models: Sociodemographic, Clinical data, SCORE-15/Congruence Scale and Eating Behavior. Furthermore, groups differ on family support, level and sources of family conflict caused by diabetes management issues. Considering only patients who co-habit with a partner for more than one year (N = 44), NoMC patients score lower on marital functioning in all categories (p < 0.05). Discussion: Family-Chronic illness interaction plays a significant role in a patient’s adherence to treatment. This study highlights the Standards of Medical Care for Diabetes, considering caregivers and family members on diabetes care. Full article

Background and Aim: Type 2 diabetes (T2D) continues to pose a significant public health challenge worldwide. Among therapeutic options, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have proven effective in optimizing glycemic control and improving cardiometabolic profiles. Semaglutide, now available in an oral formulation, represents a modern strategy to improve patient adherence while supporting glucose and weight regulation. This study primarily investigated the effects of oral semaglutide on key metabolic indicators and secondary endpoints included cardiovascular risk markers (blood pressure and lipid profile) and patient-reported quality of life (QoL). Study Design and Methods: A longitudinal, prospective observational study was conducted involving patients with T2D across two Italian healthcare facilities. Participants were assessed at baseline (T0) and at three subsequent intervals—6 months (T1), 12 months (T2), and 18 months (T3)—following the initiation of oral semaglutide use. Key Findings: Out of 116 participants enrolled, 97 had complete and analyzable data. Across the 18-month follow-up, significant improvements were observed in glycemic parameters, with a notable reduction in HbA1c levels (T0 vs. T3, p = 0.0028; p ≤ 0.05, statistically significant). Self-reported outcomes showed enhanced quality of life, especially in treatment satisfaction and perceived flexibility (T0 vs. T3, p < 0.001). Conclusions: Daily administration of 14 mg oral semaglutide in individuals with T2D resulted in substantial benefits in glycemic regulation, weight reduction, cardiovascular risk management, and overall patient satisfaction. These findings reinforce its potential role as a sustainable and effective option in long-term diabetes care from both a clinical and public health perspective. Full article

Background/Objectives: Primary liver cancer (PLC), encompassing hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), constitutes a growing global health concern. Metabolic dysfunction-associated Steatotic Liver Disease (MASLD) and Type 2 diabetes mellitus (T2DM) represent a recurrent epidemiological overlap. Individuals with MASLD and T2DM (MASLD-T2DM) are at a higher risk of PLC. This scoping review highlights the epidemiological burden, the classic and novel pathogenetic frontiers, and the potential strategies optimizing the management of PLC in MASLD-T2DM. Methods: A systematic search of the PubMed, Medline, and SCOPUS electronic databases was conducted to identify evidence investigating the pathogenetic mechanisms linking MASLD and T2DM to hepatic carcinogenesis, highlighting the most relevant targets and the relatively emerging therapeutic strategies. The search algorithm included in sequence the filter words: “MASLD”, “liver steatosis”, “obesity”, “metabolic syndrome”, “body composition”, “insulin resistance”, “inflammation”, “oxidative stress”, “metabolic dysfunction”, “microbiota”, “glucose”, “immunometabolism”, “trained immunity”. Results: In the MASD-T2DM setting, insulin resistance (IR) and IR-induced mechanisms (including chronic inflammation, insulin/IGF-1 axis dysregulation, and autophagy), simultaneously with the alterations of gut microbiota composition and functioning, represent crucial pathogenetic factors in hepatocarcinogenesis. Besides, the glucose-related metabolic reprogramming emerged as a crucial pathogenetic moment contributing to cancer progression and immune evasion. In this scenario, lifestyle changes, simultaneously with antidiabetic drugs targeting IR-related effects and gut-liver axis, in parallel with novel approaches modulating immunometabolic pathways, represent promising strategies. Conclusions: Metabolic dysfunction, classically featuring MASLD-T2DM, constitutes a continuously expanding global issue, as well as a critical driver in PLC progression, demanding integrated and personalized interventions to reduce the future burden of disease. Full article

Background: Diabetes mellitus is associated with worse outcomes after cardiac arrest. Hyperglycemia, diabetes treatments and other long-term sequalae may contribute to this association. We sought to determine the acute effect of diabetes on the return of spontaneous circulation (ROSC) and post-arrest cardiac function in a rat cardiac arrest model. Methods: Eighteen male Wistar rats were utilized, and 12 underwent the induction of type II diabetes for 10 weeks through a high-fat diet and the injection of streptozotocin. The carotid artery flow and femoral arterial pressure were measured. Seven minutes of asphyxial cardiac arrest was induced. An external cardiac compression was performed via an automated piston. Post-ROSC, epinephrine was titrated to a mean arterial pressure (MAP) of 70 mmHg. Data was analyzed using the Mann–Whitney test. The significance was set at p ≤ 0.05. Results: The rate of the ROSC was significantly lower in animals with diabetes, 50% compared to 100% in non-diabetics. Additionally, it took significantly longer to achieve the ROSC in diabetics, p = 0.034. In animals who survived, the cardiac function was reduced, as indicated by an increased epinephrine requirement, p = 0.041, and a decreased cardiac output at the end of the experiment, p = 0.017. The lactate, venous and arterial pressures, heart rate and carotid flow did not differ between groups at 2 h. Conclusions: Diabetes negatively affects the survival from cardiac arrest. Here, the critical difference was the rate of the conversion to a life-sustaining rhythm and the achievement of the ROSC. The post-ROSC cardiac function was depressed in diabetic animals. Interventions targeted at improving defibrillation success may be important in diabetics. Full article

Background/Objectives: Physical activity is a cornerstone of diabetes mellitus (DM) management and is strongly recommended in the American Diabetes Association (ADA)’s guidelines. This study aims to investigate the self-reported physical activity levels of individuals with DM in Germany, as well as the barriers and facilitators they encounter. Methods: Individuals with type 1 DM (T1DM) and type 2 DM (T2DM) were asked to fill out an online questionnaire that was partly based on the International Physical Activity Questionnaire (IPAQ). Results: The questionnaire was completed by 338 persons with either T1DM (57.1%) or T2DM (42.9%) (females: 56.2%, males: 42.0%, gender diverse persons: 1.8%) of all age groups (at least 18 years). In total, 80.5% of respondents were aware of the current physical activity recommendations. Among the respondents, 58% reported meeting the recommendations for endurance-type physical activity, while only 30.5% reported meeting those for strength training. The three most frequently cited barriers to physical activity were lack of time, lack of motivation and current state of health. Supporting factors included coverage of costs, availability of exercise programs in close proximity to the patient’s home and target group specific exercise programs. Conclusions: The results imply that many individuals with DM in Germany do not meet ADA’s physical activity recommendations, especially considering that self-reports often overestimate actual behavior. In particular, the actual number of individuals who regularly engage in strength training may be too low. There is a clear need to better communicate the benefits of different forms of physical training and to provide physical activity programs aligned with patients’ individual needs. Full article