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Advances in the Diagnosis and Treatment of Type 2 Diabetes...
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Advances in the Diagnosis and Treatment of Type 2 Diabetes Mellitus

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Endocrinology".

Deadline for manuscript submissions: 15 August 2026 | Viewed by 23607

Special Issue Editors

Prof. Dr. Bogdan Timar

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Guest Editor
1. Department VII Internal Medicine—Diabetes, Nutrition, Metabolic Diseases, and Systemic Rheumatology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
2. Centre of Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
3. Diabetes, Nutrition, and Metabolic Diseases, “Pius Brinzeu” Emergency Hospital, Timisoara, Romania
Interests: glycemic variability; continuous glucose monitoring; diabetes technology; diabetic neuropathy; cardiac neuropathy
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Romulus Timar

E-Mail Website
Guest Editor
1. Department VII Internal Medicine—Diabetes, Nutrition, Metabolic Diseases, and Systemic Rheumatology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
2. Centre of Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
3. Diabetes, Nutrition, and Metabolic Diseases, “Pius Brinzeu” Emergency Hospital, Timisoara, Romania
Interests: heart failure; time in range; time in tight range; liposome; monoclonal antibodies; Lp a; MASH
Dr. Adina Braha

E-Mail Website
Guest Editor Assistant
1. Department of Second Internal Medicine—Diabetes, Nutrition, Metabolic Diseases, and Systemic Rheumatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
2. Department of Diabetes, Nutrition and Metabolic Diseases Clinic, Pius Brînzeu” Emergency Clinical County University Hospital, 300723 Timisoara, Romania
Interests: bariatric surgery; nutritional interventions; chronic kidney disease

Special Issue Information

Dear Colleagues,

The landscape of type 2 diabetes diagnosis is evolving rapidly with the advancements in technology and methodologies aimed at improving patient outcomes through more accurate and user-friendly monitoring solutions. These innovations not only enhance disease management but also hold promise for earlier detection and intervention.

This Special Issue aims to present the latest research findings in type 2 diabetes. Authors are encouraged to submit review/systematic reviews, meta-analysis papers, or original research articles focusing on new diagnostic markers for type 2 diabetes and its complications, nanotechnology as a tool for early diagnosis, continuous glucose monitoring, new drug classes, bariatric surgery, and gut–brain axis approaches for managing type 2 diabetes.

Prof. Dr. Bogdan Timar
Prof. Dr. Romulus Timar 
Guest Editors

Dr. Adina Braha
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • novel diagnostic markers of type 2 diabetes and its complications
  • continuous glucose monitoring in type 2 diabetes
  • time in tight range in type 2 diabetes
  • nanotechnology in type 2 diabetes
  • SGLT-2 inhibitors
  • GLP-1 receptor agonists, dual GIP/GLP-1 receptor agonists
  • next-generation GLP-1/GIP/glucagon triple agonists
  • amylin analogues
  • bariatric surgery in managing type 2 diabetes and obesity
  • gut microbiota in type 2 diabetes
  • liposome
  • monoclonal antibodies
  • Lp a
  • MASH in type 2 diabetes
  • differentiated thyroid cancer and pancreatic cancer in type 2 diabetes mellitus

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Published Papers (10 papers)

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Research

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12 pages, 910 KB  
Article
Association of Phoenixin-14 with Body Mass Index Categories and Proteinuria in Adults with Type 2 Diabetes
by Esra Suay Timurkaan, Hakan Ayyıldız, Mehmet Buğra Bozan, Muhammed Fuad Uslu and Mustafa Timurkaan
Medicina 2026, 62(4), 697; https://doi.org/10.3390/medicina62040697 - 4 Apr 2026
Viewed by 543
Abstract
Background and Objectives: Human data on obesity and type 2 diabetes mellitus (T2DM) remain limited and inconsistent, particularly with respect to adiposity-related phenotypes and renal involvement. We aimed to assess PNX-14 across body mass index (BMI) categories and to investigate its associations [...] Read more.
Background and Objectives: Human data on obesity and type 2 diabetes mellitus (T2DM) remain limited and inconsistent, particularly with respect to adiposity-related phenotypes and renal involvement. We aimed to assess PNX-14 across body mass index (BMI) categories and to investigate its associations with BMI, insulin resistance indicators, and proteinuria in adults with T2DM. Materials and Methods: In this prospective cross-sectional study, participants were classified into four groups according to World Health Organization body mass index (BMI) thresholds: 18.5–24.9, 25.0–29.9, 30.0–34.9, and ≥35.0 kg/m2. Serum PNX-14 was measured using a human ELISA kit. Group comparisons, trend analysis, false discovery rate-adjusted Spearman correlations, HC3-robust multivariable regression, and parsimonious structural equation modeling were performed. Results: PNX-14 differed significantly across BMI categories and increased monotonically with increasing BMI (p < 0.001 for both the overall comparison and the trend). PNX-14 showed a positive correlation with BMI (ρ = 0.491; qFDR < 0.001), whereas no significant relationship was observed with insulin or HOMA-IR after FDR correction (qFDR = 0.795 for insulin and qFDR = 0.793 for HOMA-IR). In the model adjusted for age, sex, and BMI, higher PNX-14 was independently associated with lower proteinuria (β = −0.326, 95% CI −0.584 to −0.067; p < 0.05), whereas BMI was positively associated with proteinuria (β = 0.407, 95% CI 0.132 to 0.682; p < 0.01). Structural equation modeling supported positive BMI→PNX-14 and BMI → proteinuria paths, a negative PNX-14→proteinuria path, and a non-significant PNX-14→HOMA-IR path. Conclusions: In adults with T2DM, PNX-14 appears to be more consistently related to adiposity than to glycemic or insulin resistance indicators. However, when evaluated together with proteinuria, it may offer a testable framework for phenotyping based on renal involvement within the obesity spectrum. Nevertheless, this approach needs to be validated in studies from different centers and with repeated measurements. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Type 2 Diabetes Mellitus)
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11 pages, 1155 KB  
Article
A Nationwide Analysis of Diabetes Mellitus and Intracranial Injuries: No Impact on Mortality but Prolonged Hospital Stays in Germany
by Theresia Sarabhai, Lavinia Jürgens and Karel Kostev
Medicina 2025, 61(12), 2187; https://doi.org/10.3390/medicina61122187 - 10 Dec 2025
Viewed by 687
Abstract
Background and Objectives: Diabetes mellitus (DM) is a growing global health concern linked to increased hospitalization rates, longer hospital stays, and higher mortality. Older adults with DM are particularly prone to intracranial injuries due to frailty and DM-related complications such as neuropathy and [...] Read more.
Background and Objectives: Diabetes mellitus (DM) is a growing global health concern linked to increased hospitalization rates, longer hospital stays, and higher mortality. Older adults with DM are particularly prone to intracranial injuries due to frailty and DM-related complications such as neuropathy and cardiovascular diseases. This study explores the impact of DM on in-hospital outcomes in patients with intracranial injuries. Material and Methods: This retrospective cohort study used data from 45 hospitals in Germany, including 12,720 patients aged ≥40 years hospitalized between January 2019 and December 2023 with a primary diagnosis of intracranial injury. Patients were categorized based on the secondary presence of DM diagnosis (ICD-10 E10-E14). Outcomes included in-hospital mortality, rehospitalization within 1 year and hospital length of stay (LOS). Multivariable logistic regression models were used to analyze associations between DM and the different outcomes, adjusting for age, sex, hospitalization year, and comorbidities. Results: Among 12,720 patients, 2394 had a known DM diagnosis. The median age was higher in DM patients (82 vs. 79 years). In-hospital mortality rates were similar for patients with and without DM (4.7% vs. 4.6%; OR: 0.98; 95% CI: 0.78–1.22). DM was not associated with rehospitalization risk (OR: 1.06; 95% CI: 0.89–1.26) but showed a trend toward longer hospital stays (≥7 days: OR: 1.13; 95% CI: 1.01–1.26). Conclusions: While DM did not significantly influence mortality or rehospitalization after intracranial injuries, it showed a non-significant trend towards extended LOS (≥7 days). These findings underscore the importance of targeted management strategies to optimize outcomes in this population. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Type 2 Diabetes Mellitus)
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11 pages, 769 KB  
Article
The Burden of Diabetic Gangrene: Prognostic Determinants of Limb Amputation from a Tertiary Center
by Florin Bobirca, Dan Dumitrescu, Octavian Mihalache, Horia Doran, Cristina Alexandru, Petronel Mustatea, Liviu Mosoia-Plaviciosu, Anca Pantea Stoian, Vlad Padureanu, Anca Bobirca and Traian Patrascu
Medicina 2025, 61(10), 1817; https://doi.org/10.3390/medicina61101817 - 11 Oct 2025
Viewed by 2317
Abstract
Background and Objectives: Diabetic foot gangrene remains a major cause of lower limb amputation, driven by vascular, neuropathic, and infectious mechanisms. Identifying predictors for amputation type is essential to optimizing outcomes and reducing disability. We aimed to analyze the burden of diabetic foot [...] Read more.
Background and Objectives: Diabetic foot gangrene remains a major cause of lower limb amputation, driven by vascular, neuropathic, and infectious mechanisms. Identifying predictors for amputation type is essential to optimizing outcomes and reducing disability. We aimed to analyze the burden of diabetic foot gangrene and the patients’ characteristics according to the type of surgery, minor or major amputations. Methods: We conducted a retrospective observational study including 295 diabetic patients who underwent surgery for foot lesions at a Romanian tertiary center (January 2023–December 2024). Patients were classified according to surgical outcome as minor (toe/foot-level) or major (below/above-knee) amputations. Clinical, demographic, and pathological variables were compared between groups. Statistical analysis was performed with IBM SPSS Statistics 20.0. Categorical variables were expressed as frequencies and percentages, and continuous variables as mean ± SD or median (min–max). Group comparisons used Student’s t-test, Mann–Whitney U, Chi-square, or Fisher’s exact test, and binary logistic regression was applied to calculate odds ratios (OR) with 95% confidence intervals (CI). Results: Among the patients included (mean age 64.8 ± 10.8 years; 69.2% male), 191 (64.7%) underwent minor amputations/debridement and 104 (35.3%) required major amputations. Patients with major amputations were older (66.8 ± 11.3 vs. 63.7 ± 10.4 years, p = 0.012) and less frequently male (56.7% vs. 75.9%, p = 0.001). Lesion extension to the foot or beyond strongly predicted major amputation (p < 0.001). Peripheral arterial disease was more prevalent in the major group (85.6% vs. 65.4%, OR = 3.13, 95% CI = 1.68–5.84), while neuropathy was associated with minor procedures (12.6% vs. 3.8%, p = 0.015). Anemia (70.2% vs. 56.5%, p = 0.021) and leukocytosis (68.3% vs. 49.2%, p = 0.002) were also independent predictors of major amputation. Conclusions: The study highlights the need for early detection, coordinated multidisciplinary care, and personalized assessment of diabetes burden and its complications to minimize the risk of major limb amputation. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Type 2 Diabetes Mellitus)
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13 pages, 1825 KB  
Article
Liraglutide Enhances Cell Viability and Reduces Oxidative Stress in Hyperglycemic H9c2 Cardiomyocytes
by Sinem Durmus, Zeki Dogan, Dilek Duzgun Ergun, Mahmut Ozdemir, Hakan Sahin, Gozde Erkanli Senturk, Remise Gelisgen and Hafize Uzun
Medicina 2025, 61(10), 1754; https://doi.org/10.3390/medicina61101754 - 26 Sep 2025
Viewed by 1601
Abstract
Background and Objectives: Cardiovascular disease remains a leading cause of mortality in Diabetes mellitus (DM), where chronic hyperglycemia induces oxidative stress, mitochondrial dysfunction, and hypoxia in cardiomyocytes. Liraglutide (Lir), a glucagon-like peptide-1 receptor agonist, is widely used for type 2 DM management [...] Read more.
Background and Objectives: Cardiovascular disease remains a leading cause of mortality in Diabetes mellitus (DM), where chronic hyperglycemia induces oxidative stress, mitochondrial dysfunction, and hypoxia in cardiomyocytes. Liraglutide (Lir), a glucagon-like peptide-1 receptor agonist, is widely used for type 2 DM management and has been shown to exert cardioprotective and antioxidant effects. This study aimed to evaluate whether Lir mitigates hyperglycemia-induced oxidative and hypoxic stress in H9c2 cardiomyoblasts while preserving cellular ultrastructure. Materials and Methods: H9c2 cells were cultured under normoglycemic (5.5 mM) or hyperglycemic (30 mM) conditions, with or without Lir. Cell viability was assessed using MTT assay. Ultrastructural changes were examined by transmission electron microscopy (TEM). Hypoxia-inducible factor-1α (HIF-1α), lipid peroxidation markers (LOOH, MDA), advanced oxidation protein products (AOPP), and total antioxidant capacity (TAC) were quantified by spectrophotometric assays. Results: MTT assays revealed that Lir significantly improved cell viability under hyperglycemic conditions and the EC50 was 1.05 ± 0.06 μM after 48 h of treatment. Under HG, HIF-1α, lipid hydroperoxides (LOOH), malondialdehyde (MDA) and advanced oxidation protein products (AOPP) increased and total antioxidant capacity (TAC) decreased (p < 0.001, for all); Lir significantly reversed these changes, restoring values to near-NG levels. Ultrastructural analysis of HG + Lir-treated cells revealed reduced granules, increased vacuolization, and slight rough endoplasmic reticulum dilatation, though mitochondria appeared normal. Conclusions: Lir significantly attenuated oxidative stress and cellular injury in cardiomyocytes under hyperglycemic conditions, improving viability, modulating HIF-1α expression, and restoring antioxidant balance. These findings support a dual role for Lir in diabetic cardiomyopathy: glucose-independent cytoprotection and regulation of mitochondrial and hypoxia pathways, highlighting its therapeutic potential beyond glycemic control. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Type 2 Diabetes Mellitus)
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15 pages, 1357 KB  
Article
Real-World Sex Differences in Response to Treatment with Glucagon-like Peptide-1 Receptor Agonists: Analysis of Single-Center Outpatient Case Series
by Georgeta Victoria Inceu, Anca-Elena Crăciun, Dana Mihaela Ciobanu, Antonia Berchisan, Adriana Fodor, Cornelia Bala, Gabriela Roman and Adriana Rusu
Medicina 2025, 61(8), 1343; https://doi.org/10.3390/medicina61081343 - 25 Jul 2025
Cited by 5 | Viewed by 6995
Abstract
Background and Objectives: Type 2 diabetes (T2D) is a global health burden with increasing prevalence, necessitating effective management strategies. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as beneficial therapies, promoting both glycemic control and weight loss, yet real-world data on sex [...] Read more.
Background and Objectives: Type 2 diabetes (T2D) is a global health burden with increasing prevalence, necessitating effective management strategies. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as beneficial therapies, promoting both glycemic control and weight loss, yet real-world data on sex differences in response are limited. This study aimed to investigate sex-based differences in glycemic and weight outcomes, as well as adverse effects, in T2D patients treated with GLP-1 RAs at a single diabetes center. Materials and Methods: In this retrospective analysis, 114 patients (58.8% men) with T2D who were initiated on GLP-1 RA therapy between 2015 and 2023 were evaluated. Data on HbA1c, BMI, and adverse events were collected at baseline and 3, 6, and 12 months post-treatment initiation. Results: Our findings indicated a statistically significant HbA1c reduction (from 8.6% at GLP-1 RA initiation to 6.9% at 12 months in men (p < 0.001) and from 8.4% at initiation to 7.0% at 12 months after GLP-1 RA initiation (p < 0.001) in women). By 12 months, a significantly greater proportion of women compared to men achieved ≥ 5% (51.1% vs. 28.4%, p = 0.019) and ≥10% weight loss (29.8% vs. 9.0%, p = 0.006), with both differences reaching statistical significance. A statistically significant difference in weight loss in mean weight change and percent weight change in men vs. women was observed from month 6 of therapy. Conclusions: These findings underscore the effectiveness of GLP-1 RAs in improving glycemic control and weight loss in a real-world setting and suggest that women may experience greater weight reduction. Understanding these differences could inform personalized treatment strategies for optimized outcomes in T2D management. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Type 2 Diabetes Mellitus)
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15 pages, 987 KB  
Article
Type 2 Diabetes Mellitus in Patients with Different Types of Thyroid Nodular Lesions Among Western Romanian Patients: A Comprehensive Clinical, Biochemical, and Hormonal Analysis
by Mervat Matei, Sergiu-Ciprian Matei, Flavia-Medana Petrașcu, Ioana Golu, Melania Balaş, Daniela Amzăr, Ana-Maria Ungureanu, Bianca Roxana Natarâş and Mihaela Maria Vlad
Medicina 2025, 61(7), 1270; https://doi.org/10.3390/medicina61071270 - 14 Jul 2025
Cited by 1 | Viewed by 1581
Abstract
Background and Objectives: The prevalence of thyroid nodules and type 2 diabetes mellitus (T2D) has increased. This study firstly aims to assess the prevalence of T2DM among thyroid nodules patients who underwent total thyroidectomy in the Western Romanian population. By focusing on [...] Read more.
Background and Objectives: The prevalence of thyroid nodules and type 2 diabetes mellitus (T2D) has increased. This study firstly aims to assess the prevalence of T2DM among thyroid nodules patients who underwent total thyroidectomy in the Western Romanian population. By focusing on the biochemical and hormonal parameters, it also aims to provide insights into possible connections between T2D and different types (benignant or malignant) of thyroid nodules. Materials and Methods: A total of 926 patients who underwent total thyroidectomy were analysed, comprising 99 (10.7%) T2D patients and 827 (89.3%) non-diabetic patients (non-T2D). Results: This study’s results revealed an increased prevalence of T2D among thyroid nodules patients. Among these patients, higher values of FT4 and inflammatory markers and a higher prevalence of malignant nodules (55%, p = 0.001) were noted. Conclusions: Our study revealed an increased prevalence of T2D among thyroid nodules patients. The biochemical profile of thyroid nodules in T2D patients presents aspects, like elevated FT4 and inflammatory markers, which should be considered in their clinical management. Furthermore, a T2D patient seems to be more likely to develop thyroid malignancies. Thyroid screening strategies in diabetic patients should be considered. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Type 2 Diabetes Mellitus)
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8 pages, 277 KB  
Article
Safety of SGLT2 Inhibitors and Urinary Tract Infections in Clinical Practice—A Cross-Sectional Study
by Liana Iordan, Vlad Florian Avram, Bogdan Timar, Adrian Sturza, Simona Popescu, Oana Albai and Romulus Zorin Timar
Medicina 2024, 60(12), 1974; https://doi.org/10.3390/medicina60121974 - 1 Dec 2024
Cited by 3 | Viewed by 3467
Abstract
Background and Objectives: Type 2 diabetes (T2DM) affects millions across the globe, generating a veritable public health issue through quality-of-life-reducing chronic complications, among which urinary tract infections are the most common. A shift in the disease managing paradigm from a glucose-centered view [...] Read more.
Background and Objectives: Type 2 diabetes (T2DM) affects millions across the globe, generating a veritable public health issue through quality-of-life-reducing chronic complications, among which urinary tract infections are the most common. A shift in the disease managing paradigm from a glucose-centered view to a concept of cardio-reno-metabolic health has uniquely placed SGLT2 inhibitors as viable medication for the complex management of T2DM and its comorbidities. Some concerns have been raised over the increased likelihood of urinary tract infections (UTIs) associated with SGLT2 inhibitor use. The current study aims to evaluate the risk of developing urinary tract infections if patients with type 2 diabetes take SGLT2 inhibitors and determine those factors which make these patients more prone to develop this undesired complication. Materials and Methods: A cross-sectional, noninterventional evaluation of 328 patients with type 2 diabetes consecutively admitted to the Diabetes Clinic of “Pius Brinzeu” County Emergency Hospital in Timisoara, between January and February of 2024, was performed by examining medical charts and running statistical analyses using MedCalc version 22.26.0.0. Results: There was no statistical difference between patients taking SGLT2 inhibitors and those taking other glucose lowering medications when examining the presence of UTIs. Those patients with a higher HbA1c or BMI showed an increased predisposition to contracting UTI. The female gender was also associated with an increased likelihood of UTI. A further evaluation of the sublot of patients taking SGLT2 inhibitors revealed that not only higher BMI or HbA1c could be a predictor for the likelihood of developing UTI, but also a longer duration of T2DM was a predisposing factor. Conclusions: The use of SGLT2 inhibitors did not increase the likelihood of developing a urinary tract infection in this patient population. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Type 2 Diabetes Mellitus)

Review

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31 pages, 4945 KB  
Review
MASH in Type 2 Diabetes: Pathophysiology, Diagnosis, and Therapeutic Management—A Narrative Review
by Adela Gabriela Ştefan, Adina Mitrea, Diana Clenciu, Ionela Mihaela Vladu, Maria Magdalena Roşu, Diana Cristina Protasiewicz-Timofticiuc, Theodora Claudia Radu-Gheonea, Ion-Cristian Efrem, Anca Maria Amzolini, Beatrice Elena Vladu, Ana-Maria Efrem, Delia-Viola Reurean Pintilei, Eugen Moţa and Maria Moţa
Medicina 2026, 62(2), 325; https://doi.org/10.3390/medicina62020325 - 5 Feb 2026
Cited by 1 | Viewed by 2083
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as one of the greatest challenges for the modern public health system and serves as the foundation for the development of advanced stages, such as metabolic dysfunction-associated steatohepatitis (MASH), which may progress to fibrosis, cirrhosis, [...] Read more.
Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as one of the greatest challenges for the modern public health system and serves as the foundation for the development of advanced stages, such as metabolic dysfunction-associated steatohepatitis (MASH), which may progress to fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). MASLD and type 2 diabetes mellitus (T2DM) mutually exacerbate one another. MASLD increases the incidence of T2DM and the risk of complications in patients already affected. T2DM accelerates progression to MASH, which has become the second leading cause of liver transplantation and end-stage liver disease, and is associated with hepatic decompensation, cirrhosis, HCC, chronic kidney disease, and cardiovascular disease. MASLD and MASH are strongly linked to T2DM and obesity, pathogenesis including genetic polymorphisms, environmental factors, and multiple metabolic disturbances: insulin resistance (IR), gut dysbiosis, altered adipokine signaling, such as reduced adiponectin alongside increased pro-inflammatory cytokines. Inflammation plays a central role in the development of HCC in MASH, even in the absence of significant fibrosis. The Fibrosis-4 index (FIB-4) should be used as a first-line noninvasive tool to assess fibrosis risk. Additionally, ultrasound-based transient elastography (FibroScan) supports clinicians in assessing steatosis and fibrosis severity. Histologically, MASH is characterized by steatosis, lobular inflammatory changes, and ballooning degeneration of hepatocytes, with or without associated fibrosis. Accurately diagnosing and stratifying MASLD based on fibrosis risk is crucial to identify patients who may benefit from pharmacological treatment or can be managed only with lifestyle interventions. Patients should attain above 10% weight loss through lifestyle modifications. Resmetirom is recommended in F2/F3 fibrosis stages. For treating T2DM, glucagon-like peptide-1 receptor agonists and coagonists, sodium–glucose cotransporter-2 inhibitors, metformin (if glomerular filtration rate exceeds 30 mL/min), and insulin (in decompensated cirrhosis) are preferred. Clinical insights derived from trials are expected to optimize quality of life and long-term outcomes in patients with MASH. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Type 2 Diabetes Mellitus)
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20 pages, 870 KB  
Review
Selected Emerging Biomarkers in Type 2 Diabetes Mellitus: Clinical Insights and Implications for Precision Care
by Andra Melissa Entuc, Maria Bogdan, Ianis Kevyn Stefan Boboc, Liliana Mititelu Tartau, Delia Reurean Pintilei, Liliana Lacramioara Pavel, Ana-Maria Pelin, Aurelia Spinei and Liliana Georgeta Foia
Medicina 2026, 62(1), 152; https://doi.org/10.3390/medicina62010152 - 12 Jan 2026
Cited by 1 | Viewed by 1590
Abstract
This paper aims to examine the current landscape of novel biomarkers in diabetes mellitus (DM), with particular emphasis on emerging candidates, and their roles in early diagnosis, monitoring disease progression, risk stratification, and managing complications. Given the global prevalence of DM and its [...] Read more.
This paper aims to examine the current landscape of novel biomarkers in diabetes mellitus (DM), with particular emphasis on emerging candidates, and their roles in early diagnosis, monitoring disease progression, risk stratification, and managing complications. Given the global prevalence of DM and its complex pathophysiology, identifying reliable biomarkers is critical for optimizing prevention strategies and personalized treatment approaches. This review highlights the shift from traditional glycemic markers, which remain clinically useful but limited, to a broader array of novel biomarkers that more accurately reflect the complex pathophysiology of DM. In addition to conventional measures, inflammatory and oxidative stress mediators, along with genetic and epigenetic regulators, provide added predictive value for disease susceptibility, progression, and complications. Recent research has identified emerging biomarkers, such as adiponectin, adropin, netrin-1, α-hydroxybutyrate, fetuin-A, lipo-protein(a), and lysophosphatidylcholine, which detect early metabolic imbalances and reveal mechanistic links to insulin resistance, β-cell dysfunction, and vascular injury. Their integration into multimarker panels holds particular promise for precision medicine, supporting tailored prevention, targeted therapy, and improved outcomes for individuals with prediabetes and DM. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Type 2 Diabetes Mellitus)
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15 pages, 1335 KB  
Review
Pancreatic Cancer Screening in Patients with Type 2 Diabetes Mellitus: A Narrative Review
by Mirela Dănilă, Ana-Maria Ghiuchici, Renata Bende, Iulia Rațiu and Felix Bende
Medicina 2026, 62(1), 67; https://doi.org/10.3390/medicina62010067 - 28 Dec 2025
Viewed by 1241
Abstract
Pancreatic ductal adenocarcinoma (PDAC) remains a high-burden disease worldwide with increasing incidence, poor prognosis, and high mortality. Complete surgical resection is the only potentially curative treatment; however, due to a lack of symptoms in the early stages, most patients have advanced disease when [...] Read more.
Pancreatic ductal adenocarcinoma (PDAC) remains a high-burden disease worldwide with increasing incidence, poor prognosis, and high mortality. Complete surgical resection is the only potentially curative treatment; however, due to a lack of symptoms in the early stages, most patients have advanced disease when diagnosed. Type 2 diabetes mellitus (T2DM) is a significant health concern characterized by hyperglycemia, insulin resistance, and impairment in insulin secretion. T2DM is linked with PDAC, sharing a complex bidirectional relationship. Therefore, dual causality between the two diseases represents significant challenges in practice, distinguishing existing T2DM as a PDAC risk factor from newly onset, potentially pancreatic cancer-related diabetes (PCRD). Evidence showed that new-onset diabetes (NOD) may serve as a biomarker for early diagnosis of PDAC, and several risk prediction models were developed to identify high-risk patients for further intervention. Although early PDAC detection is important, widespread screening is not currently recommended for T2DM patients due to a lack of cost-effective, efficient screening modalities. However, further risk stratification in diabetic patients is warranted to support a targeted screening strategy with economic viability. Diabetes confers ≈2-fold PDAC risk overall, with the highest relative risk in the first 2–3 years after diagnosis. Strategies using clinical signs (age ≥50–60 years, unintentional weight loss, rapid HbA1c escalation/insulin initiation) and predictive risk scores (e.g., ENDPAC) can triage NOD patients for magnetic resonance imaging/computed tomography (MRI/CT) and endoscopic ultrasound (EUS). A targeted screening approach may allow early diagnosis that could improve the prognosis of PDAC patients. This narrative review aims to synthesize current evidence linking T2DM and PDAC; delineate risk factors within diabetes populations; appraise predictive models and biomarkers for differentiating PCRD from typical T2DM; outline pragmatic, risk-adapted screening strategies, especially for NOD, and identify additional areas where further research is needed. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Type 2 Diabetes Mellitus)
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