Journal of Clinical Medicine

Research

11 pages, 1055 KB

Open AccessArticle

Association of BMI Change with New-Onset or Progressive Diabetic Kidney Disease in People with Normal-Weight Type 2 Diabetes

by Lina Mao, Eisha Adnan, Zhuo Chen, Yan Pan, Xiangjun Chen, Tinghua Zan, Shichun Huang, Yujie Wu, Lingjun Sun, Wenyuan Lv, Tingting Luo, Jinbo Hu, Shumin Yang, Qifu Li, Lilin Gong and Zhihong Wang

J. Clin. Med. 2026, 15(8), 3125; https://doi.org/10.3390/jcm15083125 - 20 Apr 2026

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Abstract

Aims: This study aimed to examine the association between three-year changes in body mass index (BMI) and the risk of new-onset or progressive diabetic kidney disease (DKD) among people with type 2 diabetes and a normal BMI at baseline. Methods: A total of [...] Read more.

Aims: This study aimed to examine the association between three-year changes in body mass index (BMI) and the risk of new-onset or progressive diabetic kidney disease (DKD) among people with type 2 diabetes and a normal BMI at baseline. Methods: A total of 416 people with type 2 diabetes (T2DM) and a normal BMI were enrolled from the Chongqing Diabetes Registry (CDR, NCT03692884) cohort and were followed for incident DKD until 2025. The change in BMI at the three-year follow-up was classified as follows: stable BMI (<5% change), decreased BMI (≥5% reduction), and increased BMI (≥5% gain). Cox proportional hazards models were used to analyze the association between BMI change categories and DKD risk. Results: During a mean follow-up of 3.4 years, people with an increased BMI exhibited a significantly higher risk of DKD onset or progression compared with people with a stable BMI [HR = 1.67, 95%CI: 1.15–2.43, p = 0.007]. Each 1% increase in BMI was significantly associated with an increased risk of DKD onset or progression [HR = 1.05, 95%CI: 1.02–1.07, p < 0.001]. This association remained significant after multivariable adjustment. Time-dependent receiver operating characteristic (ROC) curves showed that the area under the curve (AUC) of this indicator reached 0.683–0.729 for the prediction of new-onset or progressive DKD risk over 3–5 years. In subgroup analyses, decreased BMI was associated with a lower risk of DKD among people aged <60 years [HR = 0.21; 95% CI: 0.04–0.96; p = 0.044]. Conclusions: A ≥5% increase in BMI in three years may be a risk factor for new-onset or progressive DKD among people with T2DM and normal BMI. Conversely, a ≥5% decrease in BMI may be associated with renal protection in non-elderly individuals within the population. Full article

(This article belongs to the Special Issue Chronic Complications of Type 2 Diabetes: Prevalence, Prevention, and Management)

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18 pages, 2000 KB

Open AccessArticle

Estimating the Clinical, Quality-of-Life and Economic Impact of Optimized Management of Type 2 Diabetes Patients in Spain

by Óscar Martínez-Pérez, Seila Lorenzo-Herrero, Ester Amado-Guirado, Fernando Gómez-Peralta, Jesús Balea-Filgueiras, Joan Barrot, Alberto Cordero, Carlos Crespo, Virginia Pascual and Mónica Cerezales

J. Clin. Med. 2026, 15(4), 1628; https://doi.org/10.3390/jcm15041628 - 20 Feb 2026

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Abstract

Background: Type 2 diabetes (T2D) is associated with acute and chronic complications, entailing significant use of healthcare resources. Clinical guidelines recommend holistic management and recognize the critical role of obesity and cardio-renal protection in T2D. This study aims to estimate the clinical, [...] Read more.

Background: Type 2 diabetes (T2D) is associated with acute and chronic complications, entailing significant use of healthcare resources. Clinical guidelines recommend holistic management and recognize the critical role of obesity and cardio-renal protection in T2D. This study aims to estimate the clinical, quality of life, and economic benefits of optimized weight, metabolic, and cardiovascular management of T2D-related complications in Spain. Methods: An estimation model was built incorporating the risk of complications associated with changes in glycated hemoglobin (HbA1c), weight and high-sensitivity C-reactive protein (hs-CRP), considering incidence of complications and healthcare costs in Spain. A literature review was performed to identify these clinical inputs. The potential reduction in the annual number of complications and their associated disability-adjusted life years (DALYs) and costs were estimated for reductions of 1% HbA1c, 5% weight and 0.5 mg/L hs-CRP in three T2D patient subgroup scenarios. Probabilistic sensitivity analyses were conducted to validate the results and determine their potential range. Results: Combined reduction of HbA1c, weight and hs-CRP was estimated to prevent 19.16–20.80% T2D complications per year. This led to an estimated range of 1317–6568 avoided DALYs, and potential annual savings between €242.77M and €821.68M depending on the T2D patient subgroup. Savings per patient and year ranged from €196.86 to €296.75 for the three scenarios analyzed. Sensitivity analysis validated these results. Conclusions: Integrated management of patients with T2D, controlling HbA1c levels, weight, and cardiovascular benefit, can improve patient outcomes, reduce incidence of complications, prevent quality of life worsening, and result in cost savings for the Spanish national healthcare system. Full article

(This article belongs to the Special Issue Chronic Complications of Type 2 Diabetes: Prevalence, Prevention, and Management)

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13 pages, 443 KB

Open AccessArticle

Predictors of One-Year Renal Function Decline in Type 2 Diabetes: Implications for Metabolic Target Management

by Anudari Batbold, Narangerel Bayarmagnai, Oyumaa Davaasuren, Dorjzodov Dashdorj, Ankhlan Boldbaatar, Azzaya Sodnomjamts, Narkhajid Galsanjigmed, Altaisaikhan Khasag and Oyuntugs Byambasukh

J. Clin. Med. 2026, 15(2), 499; https://doi.org/10.3390/jcm15020499 - 8 Jan 2026

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Abstract

Background: Early decline in kidney function is a major complication of type 2 diabetes mellitus (T2DM). The extent to which achievement of glycemic, blood pressure, lipid, and weight targets influences short-term renal trajectories remains insufficiently characterized. Methods: We conducted a retrospective [...] Read more.

Background: Early decline in kidney function is a major complication of type 2 diabetes mellitus (T2DM). The extent to which achievement of glycemic, blood pressure, lipid, and weight targets influences short-term renal trajectories remains insufficiently characterized. Methods: We conducted a retrospective analysis of 125 T2DM patients who had baseline and 1-year follow-up eGFR measurements at the Mongolia Japan Hospital of the MNUMS during 2023–2024. Clinical and metabolic control was categorized using standard thresholds. Renal outcomes were assessed using absolute 1-year eGFR change and the occurrence of ≥30% decline. Results: Mean eGFR declined from 91.2 ± 24.1 to 88.4 ± 25.5 mL/min/1.73 m² over one year (mean change −3.77 ± 11.3 mL/min/1.73 m²); 7.2% experienced ≥30% decline. Individuals with pre-existing CKD showed significantly greater deterioration than those without (interaction p < 0.001). Poor glycemic control was consistently associated with greater decline: participants with HbA1c > 7.5% had a significant reduction and regression analyses showed an additional adjusted decline of −4.7 mL/min/1.73 m² (p = 0.029) compared with those at target. Elevated blood pressure (>130/80 mmHg) was also associated with greater annual decline (adjusted β = −6.40, p = 0.024). Lower BMI (<25 kg/m²) predicted larger decreases in eGFR in both CKD and non-CKD groups. Lipid target achievement demonstrated small, inconsistent associations with renal outcomes. Conclusions: In this clinical cohort, poor glycemic control and elevated blood pressure were the strongest modifiable predictors of short-term kidney function decline, particularly among individuals without pre-existing CKD. Full article

(This article belongs to the Special Issue Chronic Complications of Type 2 Diabetes: Prevalence, Prevention, and Management)

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15 pages, 1968 KB

Open AccessArticle

Risk Factors Associated with Corneal Nerve Fiber Length Reduction in Patients with Type 2 Diabetes

by Lidia Ladea, Christiana M. D. Dragosloveanu, Ruxandra Coroleuca, Iulian Brezean, Eduard L. Catrina, Dana E. Nedelcu, Mihaela E. Vilcu, Cristian V. Toma, Adrian I. Georgevici and Valentin Dinu

J. Clin. Med. 2025, 14(23), 8411; https://doi.org/10.3390/jcm14238411 - 27 Nov 2025

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Abstract

Background: Diabetic neuropathy affects almost half of diabetic patients, yet the relative contributions of metabolic, vascular and clinical factors remain controversial. We aimed to investigate which risk factors are more associated with reduced corneal nerve fiber length (CNFL). Methods: This is [...] Read more.

Background: Diabetic neuropathy affects almost half of diabetic patients, yet the relative contributions of metabolic, vascular and clinical factors remain controversial. We aimed to investigate which risk factors are more associated with reduced corneal nerve fiber length (CNFL). Methods: This is a cross-sectional study of 30 patients with type 2 diabetes. We assessed metabolic parameters (HbA1c, lipids), vascular measurements (Doppler ultrasonography of carotid and ophthalmic arteries, central vessel density measured by optical coherence tomography angiography), and corneal epithelial thickness. We explored the data using network analysis, then applied penalized mixed-effect regression (in which

β

represents the standardized coefficients with mean 0 and unit standard deviation), followed by generalized additive models and polynomial transformations. Results: Penalized regression identified vascular parameters as dominant predictors: carotid plaques (

β

= −0.609) and intima-media thickness (

β

= −0.574) showed the strongest associations with CNFL. Traditional metabolic markers including HbA1c failed to meet selection thresholds. Bifurcation velocity (

β

= −0.313) and corneal sensitivity measures (

β

= 0.278–0.135) were also significant. The non-linear modeling showed complex vascular–structural interactions. Conclusions: Vascular compromise, particularly carotid disease, had the highest association with CNFL in our cohort. Thus, our study reports a higher effect of vascular parameters than HbA1c in patients with a longer history of diabetes. This may reflect the progression of diabetic complications, where initial metabolic insults are followed by vascular pathology as the primary driver of end-organ damage. Our findings highlight the need for carotid artery screening in diabetic patients for a better estimation of the neuropathy risk. Full article

(This article belongs to the Special Issue Chronic Complications of Type 2 Diabetes: Prevalence, Prevention, and Management)

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14 pages, 357 KB

Open AccessArticle

A Nationwide Study on the Prevalence of Peripheral Neuropathy in Patients with Type 2 Diabetes Mellitus in Greece—The PRENEDIG Study

by Ilias N. Migdalis, Nikolaos K. Tentolouris, Triantafyllos P. Didangelos, Nikolaos Papanas, Magdalini X. Bristianou, Anastasia N. Mavrogiannaki and on behalf of the PRENEDIG Study

J. Clin. Med. 2025, 14(19), 6723; https://doi.org/10.3390/jcm14196723 - 23 Sep 2025

Cited by 1 | Viewed by 3925

Abstract

Background/Objectives: Peripheral neuropathy (PN) is a common complication of diabetes mellitus (DM) with prevalence estimates showing considerable variation across studies. This study aimed to assess the prevalence and risk factors of PN in adult Greek subjects with type 2 diabetes mellitus (T2DM). Methods: [...] Read more.

Background/Objectives: Peripheral neuropathy (PN) is a common complication of diabetes mellitus (DM) with prevalence estimates showing considerable variation across studies. This study aimed to assess the prevalence and risk factors of PN in adult Greek subjects with type 2 diabetes mellitus (T2DM). Methods: Τhe PRENEDIG (PREvalence of peripheral NEuropathy in type 2 DIabetes in Greece) study was a nationwide, cross-sectional multicenter study based on data collected from hospital-based diabetes clinics and primary care practices from January 2024 to June 2024 in Greece. Diabetic peripheral neuropathy (DPN) prevalence and severity were evaluated using the Neuropathy Symptom Score (NSS) and the Neuropathy Disability Score (NDS). Additional sensory assessment tools were considered to support clinical evaluation. Multivariate regression analysis examined the association between DPN and potential risk factors. Results: Among the study population (n = 1807), the overall DPN prevalence was 18.87% and increased with longer diabetes duration. DPN prevalence among participants with over 10 years of T2DM reached 26.49%. Logistic regression analysis identified several independent predictors of DPN including diabetes duration > 10 years (p < 0.001), arterial hypertension in participants with diabetes duration < 10 years (OR = 2.69, CI: 1.68–4.30, p < 0.001), HbA1c levels (OR = 1.20, CI: 1.10–1.31, p < 0.001), and age (OR = 1.02, CI: 1.00–1.03, p = 0.024). An interaction-related association was observed, with arterial hypertension not increasing the risk of DPN any further in participants with disease duration > 10 years (OR: 3.73 vs. 3.80 with or without arterial hypertension, respectively). Sensory assessment tools further validated DPN diagnosis. Conclusions: In Greece, DPN is a common complication, affecting nearly one in five T2DM patients. The results of the study reinforce the importance of routine screening, particularly among older patients and those with longer diabetes duration to facilitate early detection and timely management of DPN and its associated complications. Full article

(This article belongs to the Special Issue Chronic Complications of Type 2 Diabetes: Prevalence, Prevention, and Management)

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16 pages, 522 KB

Open AccessArticle

Sex Differences in Cardiovascular Risk and Diabetic Polyneuropathy: A Single-Center Retrospective Study in North-Eastern Hungary

by Ferenc Sztanek, Attila Pető, László Imre Tóth, Hajnalka Lőrincz, Ágnes Molnár, Miklós Lukács, Adrienn Menyhárt, Péter Kempler, György Paragh, Mariann Harangi and Attila Csaba Nagy

J. Clin. Med. 2025, 14(16), 5780; https://doi.org/10.3390/jcm14165780 - 15 Aug 2025

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Abstract

Background/Objectives: Diabetic sensorimotor polyneuropathy (DSPN) is a frequent microvascular complication of diabetes mellitus, associated with increased morbidity and reduced quality of life. The existing literature offers a limited understanding of sex-specific cardiovascular risk profiles and their association with DSPN, particularly within Central [...] Read more.

Background/Objectives: Diabetic sensorimotor polyneuropathy (DSPN) is a frequent microvascular complication of diabetes mellitus, associated with increased morbidity and reduced quality of life. The existing literature offers a limited understanding of sex-specific cardiovascular risk profiles and their association with DSPN, particularly within Central and Eastern European populations. Methods: A retrospective analysis was conducted using data from 621 individuals with type 1 or type 2 diabetes mellitus who underwent comprehensive neuropathy screening at the University of Debrecen between 2017 and 2021. The diagnosis of DSPN was made in accordance with international criteria, incorporating symptom scores, and electrophysiological measurements. Multivariate logistic regression was applied in order to identify independent predictors. Results: The diagnosis of DSPN was made in 444 individuals (71.5%), of whom 58.2% were female. Despite similar glycemic control (HbA1c: 7.81% in men vs. 7.65% in women, p = 0.297), men had significantly more frequent occurrences of previous myocardial infarction (11.8% vs. 5.0%, p = 0.008), peripheral vascular disease (19.9% vs. 12.7%, p = 0.041) and atherosclerosis (31.7% vs. 22.0%, p = 0.021). Multivariate analysis showed that female gender was independently associated with a lower incidence of DSPN (odds ratio [OR] = 0.592, 95% confidence interval [CI]: 0.369–0.950, p = 0.030), while diabetic retinopathy was a significant predictor (OR = 2.728, 95% CI: 1.300–5.725, p = 0.008). Electrophysiological testing revealed lower nerve conduction amplitudes in females for selected nerves. Conclusions: Our findings highlight sex-specific differences in neuropathy risk and support the implementation of individualized screening strategies in diabetic populations with region-specific risk factors. Full article

(This article belongs to the Special Issue Chronic Complications of Type 2 Diabetes: Prevalence, Prevention, and Management)

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11 pages, 768 KB

Open AccessArticle

Effect of Diabetes Mellitus on Survival and Complication Rates of Tooth-Supported Fixed Dental Prostheses (FDPs): Long-Term Clinical Evaluation

by Ali Alenezi

J. Clin. Med. 2025, 14(16), 5673; https://doi.org/10.3390/jcm14165673 - 11 Aug 2025

Cited by 2 | Viewed by 1953

Abstract

Background/Objectives: Diabetes mellitus (DM) can adversely affect oral health by compromising immune function and promoting chronic inflammation. This effect can significantly impact the outcomes of fixed dental prostheses (FDPs). This study aimed to evaluate the rates of complications in FDPs in diabetes [...] Read more.

Background/Objectives: Diabetes mellitus (DM) can adversely affect oral health by compromising immune function and promoting chronic inflammation. This effect can significantly impact the outcomes of fixed dental prostheses (FDPs). This study aimed to evaluate the rates of complications in FDPs in diabetes patients. Methods: The study investigated various clinical factors, including technical complications and biological complications. The investigation included diabetic patients (test group) and non-diabetic patients (control group), who were evaluated during their follow-up visits. Clinical and radiographic assessments were performed to determine the cumulative survival rate, and life table survival analyses of FDPs in the presence of complications were performed. Results: This study evaluated 1125 FDPs (66.1% in women), with 27.1% in diabetics, over a mean of 9.3 ± 7.7 years. The overall complication rates analysis, using the Mann–Whitney U test, showed a significant difference between diabetic and non-diabetic patients (p = 0.002). Diabetic patients had higher biological complications (58.4% vs. 51.1%, p = 0.03) and more technical complications (7.5% vs. 6.1%, p = 0.382). Poor oral hygiene strongly correlated with failure (72.1% vs. 12.9%, p < 0.001). Survival analysis revealed a decline in FDP survival probability to 0.23 for diabetics and 0.33 for non-diabetics at 15 years (p = 0.012). Conclusions: DM may reduce the durability of fixed dental prostheses, with diabetic patients showing noticeably higher rates of technical and biological complications compared to non-diabetics. Full article

(This article belongs to the Special Issue Chronic Complications of Type 2 Diabetes: Prevalence, Prevention, and Management)

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15 pages, 878 KB

Open AccessArticle

Intrahospital Prevalence of Diabetes and Prediabetes in Medical Departments in Upper Austria

by Matthias W. Heinzl, Michael Resl, Jörg Kellermair, Clemens Steinwender, Bernhard Mayr, Jana Obereder, Renate Fellner-Färber, Carmen Klammer, Stefanie Hartl, Julia Brandner, Andreas Zierer, David Bernhard, Gersina Rega-Kaun, Julia K. Mader, Michaela Riedl, Harald Stingl, Lars Stechemesser, Claudia Ress, Elke Fröhlich-Reiterer, Johanna M. Brix, Thomas C. Wascher, Harald Sourij, Peter Fasching and Martin Clodi Show full author list Hide full author list

J. Clin. Med. 2025, 14(11), 3668; https://doi.org/10.3390/jcm14113668 - 23 May 2025

Cited by 2 | Viewed by 1990

Abstract

Background: The intrahospital prevalence of diabetes and prediabetes is not well known in Austria and worldwide. Screening for diabetes in hospitalised patients requires systematic glycaemic assessment via HbA1c measurement, which is not routinely performed in all patients in most hospitals. This study is [...] Read more.

Background: The intrahospital prevalence of diabetes and prediabetes is not well known in Austria and worldwide. Screening for diabetes in hospitalised patients requires systematic glycaemic assessment via HbA1c measurement, which is not routinely performed in all patients in most hospitals. This study is the first multicentre investigation to conduct structured HbA1c screening in hospitalised adult medical patients of all ages. Methods: In this exploratory multicentre analysis, HbA1c screening was performed in 3025 consecutive patients hospitalised at three different medical departments in Upper Austria. HbA1c screening was conducted over a period of three months between October 2023 and March 2024. Patients were diagnosed with diabetes (HbA1c ≥6.5% (≥48 mmol/mol)) or prediabetes (HbA1c 5.7–6.4% (39–47 mmol/mol)) based on HbA1c values or a previous diagnosis. Results: Dysglycaemia (diabetes or prediabetes) was identified in 1557 patients (51.5%). Diabetes was present in 840 patients (27.8%) and prediabetes in 717 patients (23.7%). A first-time diagnosis of diabetes was made in 73 patients (2.4%). The prevalence of diabetes was highest among patients aged 70–79 years (36.8% diabetes; 24.8% prediabetes). Conclusions: Structured HbA1c screening in 3025 consecutive hospitalised patients across three medical departments in Upper Austria revealed a diabetes prevalence of 27.8% and a prediabetes prevalence of 23.7%. Overall, dysglycaemia was present in 51.5% of hospitalised patients. Full article

(This article belongs to the Special Issue Chronic Complications of Type 2 Diabetes: Prevalence, Prevention, and Management)

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17 pages, 2073 KB

Open AccessArticle

Dynamics of Glycemic Status and Glucose Metabolism Markers 12 Months After Coronary Artery Bypass Grafting and Their Relationship with the Annual Prognosis of Patients

by Alexey N. Sumin, Natalia A. Bezdenezhnykh, Ekaterina V. Belik, Yulia A. Dyleva, Andrey V. Bezdenezhnykh, Olga V. Gruzdeva and Olga L. Barbarash

J. Clin. Med. 2025, 14(2), 351; https://doi.org/10.3390/jcm14020351 - 8 Jan 2025

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Abstract

Background and Objectives: We aim to evaluate the dynamics of glycemic status and markers of carbohydrate metabolism 12 months after coronary artery bypass grafting (CABG) and their relationship with the one-year prognosis. Materials and Methods: The analysis of outcomes of 653 patients during [...] Read more.

Background and Objectives: We aim to evaluate the dynamics of glycemic status and markers of carbohydrate metabolism 12 months after coronary artery bypass grafting (CABG) and their relationship with the one-year prognosis. Materials and Methods: The analysis of outcomes of 653 patients during 1 year after coronary artery bypass grafting is presented. In those patients who visited the study center after 1 year, markers of carbohydrate metabolism (glucose, glycated hemoglobin, fructosamine, 1.5 anhydroglucitol) were assessed; in 371 of them, they were studied at three points—before surgery, before discharge from the hospital, and one year after surgery. The influence of these indicators on the incidence of cardiovascular events (death from any cause, myocardial infarction, stroke, repeat myocardial revascularization, surgical interventions on non-coronary arteries, amputations due to peripheral atherosclerosis, emergency hospitalizations due to cardiovascular disease, or combined endpoint [CEP]) was assessed during the year after CABG. Groups with (n = 59)/absence (n = 594) of the combined endpoint were formed and compared based on the dynamics of carbohydrate metabolism markers over the course of a year. Additionally, factors associated with the development of major adverse cardiovascular events (MACE) after CABG were assessed. Results: After 1 year, the number of patients with type 2 diabetes increased from 23.9% to 25.6% and prediabetes from 17.2% to 26.6% (p < 0.001). Among patients with diabetes mellitus, the following dynamics of carbohydrate metabolism markers were noted: a decrease in glucose levels in both groups (with or without CEP), glycated hemoglobin in the group without CEP, and fructosamine in the group with CEP. There were no differences in the intergroup comparison of all the described markers (glucose, fructosamine, glycated hemoglobin) and carbohydrate metabolism at all points. The following factors were associated with the development of MACE within a year after CABG: the presence of peripheral arterial disease, preoperative fibrinogen level, the risk of surgery according to the EuroSCORE scale, and off-pump CABG. Conclusions: In patients with diabetes mellitus one year after coronary artery bypass grafting, a decrease in glucose and glycated hemoglobin levels was noted. No differences in the dynamics of carbohydrate metabolism markers were found in the groups of patients with and without cardiovascular complications. The impact of glycated hemoglobin dynamics one year after CABG on long-term prognosis requires further research. Full article

(This article belongs to the Special Issue Chronic Complications of Type 2 Diabetes: Prevalence, Prevention, and Management)

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15 pages, 1808 KB

Open AccessArticle

Risk Factors for Cataracts in Patients with Diabetes Mellitus

by Adriana Ivanescu, Simona Popescu, Laura Gaita, Oana Albai, Adina Braha and Romulus Timar

J. Clin. Med. 2024, 13(23), 7005; https://doi.org/10.3390/jcm13237005 - 21 Nov 2024

Cited by 9 | Viewed by 7327

Abstract

Background: Diabetes mellitus (DM) is one of the most impactful health problems worldwide. It affects ocular health in multiple ways and is one of the leading causes of vision loss. Our study aimed to evaluate the most important systemic risk factors related to [...] Read more.

Background: Diabetes mellitus (DM) is one of the most impactful health problems worldwide. It affects ocular health in multiple ways and is one of the leading causes of vision loss. Our study aimed to evaluate the most important systemic risk factors related to the occurrence of cataracts in patients with DM. Method: This study evaluated a final number of 319 participants who were previously diagnosed with DM. For all patients, we retrieved data regarding DM status, metabolic control, demographic and anthropometric indices, and generally associated comorbidities from their medical charts. A comprehensive eye examination was performed on all patients. Results: The main studied risk factors were hypertension, cardiovascular disease (CVD), chronic kidney disease (CKD), diabetic polyneuropathy (DPN), dyslipidemia, and hepatic steatosis, which were present among the entire population. Hypertension (67.6%), DPN (53.3%), and dyslipidemia (46.6%) were highly prevalent in the cataract subgroup, and CKD (p < 0.001) and DPN (p = 0.019) were found to be predictive factors for the probability of cataract occurrence. Ophthalmologic evaluation was used to assess the presence of ocular complications, such as diabetic retinopathy (DR) and diabetic maculopathy. DR reached statistically significant values in the occurence of cataracts. Patients’ age and DM-related factors, such as disease duration (p < 0.001) and HbA1c values (p = 0.029), significantly increased the risk of cataracts. Smoking was self-reported by 24.8% of the patients, with a significant impact on the occurrence of cataracts (p = 0.04). Conclusions: Patients with DM who exhibit a longer disease duration and poor glycemic control in conjunction with systemic comorbidities present a higher risk of developing cataracts; consequently, a strict therapeutic approach regarding these risk factors is needed. Full article

(This article belongs to the Special Issue Chronic Complications of Type 2 Diabetes: Prevalence, Prevention, and Management)

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Review

Jump to: Research, Other

15 pages, 1274 KB

Open AccessReview

Dietary and Nutritional Strategies to Prevent Uremic Toxin Formation and Slow the Progression of Diabetic Kidney Disease

by Karolina Kędzierska-Kapuza, Anna Grudniewska, Anna Durma, Robert Małecki, Edward Franek and Małgorzata Szczuko

J. Clin. Med. 2025, 14(13), 4701; https://doi.org/10.3390/jcm14134701 - 3 Jul 2025

Cited by 3 | Viewed by 2995

Abstract

Background: Type 2 diabetes (T2D) is the leading cause of chronic kidney disease (CKD), responsible for approximately 60% of cases. Diabetic kidney disease (DKD) affects 20–50% of individuals with diabetes, with diabetes-related ESKD cases rising steadily worldwide from 22.1% in 2000 to 31.3% [...] Read more.

Background: Type 2 diabetes (T2D) is the leading cause of chronic kidney disease (CKD), responsible for approximately 60% of cases. Diabetic kidney disease (DKD) affects 20–50% of individuals with diabetes, with diabetes-related ESKD cases rising steadily worldwide from 22.1% in 2000 to 31.3% in 2015. Methods: This review examines the literature published up to 25 February 2025, using a systematic search in PubMed and Scopus. Keywords included uremic toxins and diabetic kidney disease and/or gut microbiota, or dysbiosis or gut–kidney axis. Studies were independently assessed by a minimum of three authors, with discrepancies resolved through consensus. Results: Gut microbiota dysbiosis is a key driver of DKD progression, making the gut–kidney axis a promising therapeutic target. A “nuts and fruits” dietary pattern reduces the DKD risk by 43.3%, while an animal protein intake lowers the diabetic peripheral neuropathy risk by 42.8%. High-fiber diets and supplements like resistant starch may reduce uremic toxins through microbiota modulation. Conclusions: Microbiota-targeted interventions, including probiotics, synbiotic, and dietary modifications, show potential in reducing uremic toxin production and inflammation, though DKD-specific evidence remains limited. Lactobacillus and Bifidobacterium strains may help lower urea and creatinine levels, but outcomes vary by disease stage. Further research is needed to confirm the efficacy of dietary and probiotic approaches in DKD management. Full article

(This article belongs to the Special Issue Chronic Complications of Type 2 Diabetes: Prevalence, Prevention, and Management)

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Other

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25 pages, 1844 KB

Open AccessSystematic Review

Metformin’s Overall Effectiveness and Combined Action with Lifestyle Interventions in Preventing Type-2 Diabetes Mellitus in High-Risk Metformin-Naïve Patients: An Updated Systematic Review and Meta-Analysis of Published RCTs

by Georgios I. Tsironikos, Vasiliki Tsolaki, George E. Zakynthinos, Vasiliki Rammou, Despoina Kyprianidou, Thomas Antonogiannis, Epaminondas Zakynthinos and Alexandra Bargiota

J. Clin. Med. 2025, 14(14), 4947; https://doi.org/10.3390/jcm14144947 - 12 Jul 2025

Cited by 8 | Viewed by 11424

Abstract

Background: The effectiveness of metformin in preventing Type-2 Diabetes Mellitus (T2DM) is examined. There are new available data. Currently, there are no available analyses classifying its effectiveness compared to placebo, standard care, or lifestyle interventions, and there is limited evidence on the combined [...] Read more.

Background: The effectiveness of metformin in preventing Type-2 Diabetes Mellitus (T2DM) is examined. There are new available data. Currently, there are no available analyses classifying its effectiveness compared to placebo, standard care, or lifestyle interventions, and there is limited evidence on the combined action of metformin and lifestyle interventions in preventing T2DM. Objective: To calculate the updated overall effectiveness of metformin in preventing T2DM using all available and most recent data, and to explore the effectiveness of metformin and lifestyle interventions in preventing T2DM. Materials and Methods: A search was performed in PubMed and the Cochrane Library Central Register of Controlled Trials (CENTRAL) (from inception to 24 May 2025). A systematic review (SR) and meta-analysis (MA) of randomized controlled trials (RCTs) was carried out, including metformin-naïve adults with any identified diabetes risk factors. The overall effectiveness of metformin was estimated by combining studies that compare metformin against placebo, metformin and standard care against standard care, and metformin plus lifestyle interventions and the same lifestyle interventions. The combined action of metformin and lifestyle interventions was evaluated against standard care. We performed a GRADE assessment of the overall evidence. Results: Overall, metformin may reduce the incidence of T2DM by 23% in high-risk adults (OR 0.77, 95% CI 0.67, 0.88, p-value 0.0001) and 25% in patients with prediabetes (OR 0.75, 95%CI 0.66, 0.86, p-value < 0.0001). It is also effective in both obese and normal-weight patients, in Caucasians, in studies with female predominance, in studies with a mean age over 60 years, at 1700 mg daily, and after 18 months of administration. Effectiveness weakens after interruption of administration. Metformin is more effective compared to placebo and when combined with standard care than standard care alone, but not when combined with lifestyle interventions against lifestyle interventions alone. Metformin and lifestyle interventions reduce the incidence of diabetes in patients with prediabetes by 52% compared to standard care (OR 0.48, 95% CI 0.30, 0.77; p-value 0.002). There are effectiveness concerns in studies with more men than women, Asian Indians and Pakistanis, a mean age below 60 years, 500 mg of metformin daily, and after six months. The effect is reduced during post-intervention. Finally, metformin alone is more effective than standard care (OR 0.56, 95% CI 0.34, 0.90, p-value 0.02). The quality of evidence was moderate for the overall effectiveness of metformin and metformin combined with lifestyle interventions, and low for metformin against standard care. Conclusions: A 1700 mg dose of metformin daily is effective in preventing T2DM, especially in Caucasians, in women over 60 years, in prediabetes, and independent of obesity. Lifestyle interventions and 500 mg of metformin daily may prevent T2DM in patients with prediabetes, especially in men and Asian Indians or Pakistanis under 60 years. The effectiveness of complex interventions is more pronounced than that of metformin alone in patients with prediabetes. Further research is needed for post-intervention effectiveness, patients with any diabetes risk factors, patients from different regions, and women in complex interventions. Full article

(This article belongs to the Special Issue Chronic Complications of Type 2 Diabetes: Prevalence, Prevention, and Management)

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Open AccessCase Report

Unexpectedly High and Difficult-to-Explain Regenerative Capacity in an 82-Year-Old Patient with Insulin-Requiring Type 2 Diabetes and End-Stage Renal Disease

by Mihaela Gheorghiu, Maria-Florina Trandafir, Octavian Savu, Daniela Pasarica and Coralia Bleotu

J. Clin. Med. 2025, 14(8), 2556; https://doi.org/10.3390/jcm14082556 - 8 Apr 2025

Cited by 1 | Viewed by 1615

Abstract

Background/Objectives: The case we present is part of a large study that we conducted on hemodialysis patients with type 2 diabetes mellitus (T2DM) and which set the following objectives: studying changes in the intestinal microbiota, innate and acquired immune response capacity, and tissue [...] Read more.

Background/Objectives: The case we present is part of a large study that we conducted on hemodialysis patients with type 2 diabetes mellitus (T2DM) and which set the following objectives: studying changes in the intestinal microbiota, innate and acquired immune response capacity, and tissue regeneration. Methods: (1) For the genetic study of the gut microbiota, special techniques that are not based on cultivation were used since most of the species in the intestinal flora are not cultivable. (2) The immunological study had two targets: innate immunity (inflammation) and adaptive immunity (we chose to address the cellular immune response because, unlike the humoral one, it is insufficiently studied in this category of associated pathologies). As markers for innate immunity (inflammation), the following were determined: IL-6, sIL-6R, IL-1β, TNFα, IL-10, and NGAL. TNFβ/LTα was determined as a marker for adaptive immunity (the cellular immune response). (3) The study of tissue regeneration capacity was performed using NT-3 (this is the first study to do so) and VEGFβ (another marker that is scarce in this category of patients) as markers. All the aforementioned compounds were determined from serum samples, utilizing Merck Millipore ELISA kits for IL-6, IL-1β, IL-10, NT-3, and VEGF β, and Elabscience ELISA kits for IL-6R, TNFα, TNFβ, and NGAL. Results: We were very surprised to find unexpected immunological changes and tissue regenerative capacity in one of the patients studied, an 82-year-old female patient diagnosed with insulin-dependent T2DM with multiple complications, including end-stage renal disease (ESRD). The patient showed a huge capacity for tissue regeneration, combined with amplification of immunological capacity, in comparison to patients in the same group (T2DM and ESRD) and to those in the control group (ESRD). Thus, extremely elevated serum concentrations of IL-1β, IL-6, IL-10, and TNF-β, as well as the tissue regeneration indicators NT-3 and VEGFβ, were obtained in comparison to all other members of the patient group. At the same time, serum levels of the soluble IL-6 receptor (sIL6-R) and TNFα were greatly reduced compared to the test group’s mean. Conclusions: All the data obtained during our research were corroborated with those from the specialized literature and entitle us to support the hypothesis that the cause of these unexpected behaviors is the genetically conditioned overproduction (possibly acquired post-infection) of IL-6, along with its predominant anti-inflammatory and pro-regenerative signaling through the membrane-bound receptor IL-6R. Full article

(This article belongs to the Special Issue Chronic Complications of Type 2 Diabetes: Prevalence, Prevention, and Management)

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