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Chronic Complications of Type 2 Diabetes: Prevalence, Prevention, and Management
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Chronic Complications of Type 2 Diabetes: Prevalence, Prevention, and Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Endocrinology & Metabolism".

Deadline for manuscript submissions: 25 July 2025 | Viewed by 3578

Special Issue Editor

Dr. Ilias Migdalis

E-Mail Website
Guest Editor
Director of Diabetes Centre, Lefkos Stavros Hospital, 115 28 Athens, Greece
Interests: chronic complications of diabetes; prevention of diabetes
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The prevalence of type 2 diabetes is increasing rapidly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. Chronic complications of type 2 diabetes are due to myriad disorders and numerous metabolic pathways that are responsible for most of the morbidity and mortality associated with the disease. These are, in general, divided into micro- and macrovascular complications. Microvascular complications in diabetes result from the impairment of small blood arteries, leading to a large increase in morbidity. Retinopathy, nephropathy, and neuropathy are prevalent microvascular consequences. The development of microvascular problems in diabetes is closely associated with the combined impact of long-term high blood sugar levels, abnormal lipid levels, and high blood pressure. The major forms of macrovascular disease are coronary heart disease, stroke, and peripheral vascular disease, which share both an atherosclerotic background and several common risk factors. The relationship between diabetes and cardiovascular illness is complex, encompassing dyslipidemia, hypertension, and a proinflammatory state associated with diabetes cardiovascular events, which remains the major cause of death for those with diabetes.

We call on clinicians, researchers, and healthcare professionals to contribute their expertise and findings to this Special Issue. By consolidating knowledge and fostering clinical innovation, we aim to improve the prevention, diagnosis, and treatment of chronic complications in type 2 diabetes, ultimately enhancing patient outcomes and quality of life.

Dr. Ilias Migdalis
Guest Editor

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Keywords

  • pathogenesis of diabetic complications
  • epidemiology of diabetic complications
  • diabetic retinopathy
  • diabetic chronic kidney disease
  • diabetes neuropathies
  • coronary heart disease
  • peripheral vascular disease
  • hypertension and dyslipidemia in diabetes

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Related Special Issue

Published Papers (4 papers)

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15 pages, 795 KiB  
Article
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 Clodiadd Show full author list remove Hide full author list
J. Clin. Med. 2025, 14(11), 3668; https://doi.org/10.3390/jcm14113668 - 23 May 2025
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 KiB  
Article
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 KiB  
Article
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
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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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29 pages, 3653 KiB  
Case 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
Viewed by 348
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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