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Medicina
Special Issues
Clinical Management of Diabetes and Complications
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Clinical Management of Diabetes and Complications

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

Deadline for manuscript submissions: 15 November 2026 | Viewed by 7277

Special Issue Editors

Dr. Anca Pantea Stoian

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Guest Editor
Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
Interests: obesity; diabetes mellitus; MAFLD; renal failure; metabolic syndrome; prediabetes; atherosclerosis; metabolic inflammation; insulin resistance
Special Issues, Collections and Topics in MDPI journals
Dr. Delia V. Reurean-Pintilei

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Guest Editor Assistant
Department of Medical-Surgical and Complementary Sciences, Faculty of Medicine and Biological Sciences, “Stefan cel Mare” University, 720229 Suceava, Romania
Interests: type 2 diabetes mellitus; obesity; insulin resistance; atherosclerosis; cardiovascular risk; metabolic syndrome; diabetes technology; cardiorenal–metabolic interactions; diabetes complications; digital health; diabetes education

Special Issue Information

Dear Colleagues,

The clinical management of diabetes and its complications represents a central challenge in contemporary medicine, requiring continuous adaptation to emerging therapies, comorbidities, and patient needs. This Special Issue, “Clinical Management of Diabetes and Complications”, aims to provide a comprehensive overview of current clinical strategies and emerging therapeutic options in the management of diabetes and its associated complications.

This Special Issue will address advances in pharmacological treatment—including novel antidiabetic agents with proven cardiorenal–metabolic benefits—as well as lifestyle and digital interventions for glycaemic and complication control. Particular focus will be given to the early recognition and individualized management of diabetic complications such as cardiovascular disease, nephropathy, neuropathy, retinopathy, and diabetic foot syndrome.

We will also explore comorbid conditions closely linked to the pathophysiology of diabetes, such as obesity and metabolic dysfunction-associated fatty liver disease (MAFLD), which play growing roles in cardiovascular as well as metabolic risk assessment and therapeutic decision making. In addition, contributions on diabetes remission—through nutritional interventions, bariatric surgery, or pharmacotherapy—are encouraged, reflecting a paradigm shift in the long-term management of type 2 diabetes.

We welcome papers exploring innovative care models, structured education programs, and integrated multidisciplinary approaches, with the aim to improve the outcomes and quality of life of people living with diabetes. Additionally, the use of artificial intelligence, continuous glucose monitoring systems, insulin delivery devices, remote monitoring, and precision medicine in diabetes care will be considered as priorities.

Original research articles, clinical trials, systematic reviews, and expert perspectives contributing to the optimization of care in diabetes and its complications are invited. This Special Issue welcomes submissions from both clinical and translational researchers for evidence-based, patient-centred approaches.

Dr. Anca Pantea Stoian
Guest Editor

Dr. Delia V. Reurean-Pintilei
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

  • diabetic complications’ multidisciplinary management
  • MAFLD
  • diabetes remission
  • cardiovascular risk
  • precision medicine
  • antidiabetic therapy
  • diabetes mellitus
  • digital health
  • chronic disease management
  • obesity

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Published Papers (5 papers)

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Research

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10 pages, 468 KB  
Article
Use of the Pay-for-Performance Program in Reducing Sarcopenia Risk: A Nested Case–Control Study Among Patients with Type 2 Diabetes Mellitus
by Hui-Ju Huang, Pin-Fan Chen, Chieh-Tsung Yen, Ming-Chi Lu, Wei-Jen Chen and Tzung-Yi Tsai
Medicina 2026, 62(1), 161; https://doi.org/10.3390/medicina62010161 - 13 Jan 2026
Viewed by 674
Abstract
Background and Objectives: Despite substantial advances in treatment strategies for patients with type 2 diabetes mellitus (T2DM), its complication, particularly sarcopenia, has emerged as a global healthcare challenge. Pay-for-performance (P4P), an incentive-based payment scheme, has long been used to improve the quality [...] Read more.
Background and Objectives: Despite substantial advances in treatment strategies for patients with type 2 diabetes mellitus (T2DM), its complication, particularly sarcopenia, has emerged as a global healthcare challenge. Pay-for-performance (P4P), an incentive-based payment scheme, has long been used to improve the quality of care; however, few studies have explored its effect on sarcopenia prevention. Therefore, we conducted a nested case–control study to investigate the association between P4P participation and the risk of sarcopenia among patients with T2DM. Materials and Methods: Using a large claims dataset, we identified individuals aged 20–70 years with newly diagnosed T2DM between 2001 and 2010 in Taiwan. All enrollees were followed up until 2013 to determine the occurrence of sarcopenia. For each case, we randomly matched two controls without sarcopenia. The risk of sarcopenia in relation to P4P participation was estimated by fitting conditional logistic regression to yield the adjusted odds ratio (aOR) and corresponding 95% confidence interval (CI). Results: A total of 3475 individuals with sarcopenia and 6948 matched controls were included. Patients enrolled in the P4P program had a lower risk of sarcopenia than their matched counterparts (aOR = 0.66; 95% CI: 0.61–0.74). Earlier P4P enrollment (within 1 year of T2DM diagnosis) and high-intensity P4P participation were associated with additional reductions in sarcopenia risk. Conclusions: Integrating P4P into routine T2DM care may help prevent sarcopenia, highlighting the importance of interdisciplinary collaboration and timely program implementation. Full article
(This article belongs to the Special Issue Clinical Management of Diabetes and Complications)
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16 pages, 2218 KB  
Article
The Effectiveness of Semaglutide on a Composite Endpoint of Glycemic Control and Weight Reduction and Its Effect on Lipid Profile Among Obese Type 2 Diabetes Patients
by Sumaiah J. Alarfaj
Medicina 2025, 61(8), 1393; https://doi.org/10.3390/medicina61081393 - 31 Jul 2025
Cited by 2 | Viewed by 2535
Abstract
Background and Objectives: Obesity and type 2 diabetes (T2D) are closely linked and associated with a higher risk of complications. This study aims to evaluate the effectiveness of once-weekly semaglutide in achieving a composite endpoint of A1C and weight reduction. Materials and Methods: [...] Read more.
Background and Objectives: Obesity and type 2 diabetes (T2D) are closely linked and associated with a higher risk of complications. This study aims to evaluate the effectiveness of once-weekly semaglutide in achieving a composite endpoint of A1C and weight reduction. Materials and Methods: This retrospective cohort study assessed the effectiveness of semaglutide in obese patients with T2D at a tertiary care hospital in Saudi Arabia. This study included patients who received semaglutide treatment for 12 months, and the endpoint was reducing A1C by ≥ 1% and body weight by ≥ 5% after 12 months of starting semaglutide. Secondary endpoints include predictors of achieving the composite endpoint and the effect on the lipid profile. Results: The present study enrolled 459 participants, with dyslipidemia and hypertension being the most common comorbidities. After 12 months of treatment with semaglutide, 42% of the patients achieved the composite endpoint. Semaglutide significantly reduced weight, BMI, A1C, FBG, total cholesterol, LDL, and triglycerides. The subgroup analysis showed that patients who achieved the composite endpoint were younger and had significantly lower use of insulin. Females in the study had significantly higher BMI, A1C, and HDL levels and lower levels of triglycerides compared to males. Multivariate analysis revealed that baseline BMI (aOR = 0.953; 95% CI: 0.915 to 0.992; p = 0.02), baseline A1C (aOR = 1.213; 95% CI: 1.062 to 1.385; p = 0.004), and receiving insulin (aOR = 0.02; 95% CI: 0.001 to 0.343; p = 0.007) were significant predictors of composite endpoint achievement. Conclusions: Semaglutide is a valuable option for the treatment of obese patients with T2D. This study found that semaglutide is effective in reducing weight and A1C and improving the lipid profile. The predictors of achievement of the composite endpoint were lower baseline BMI, higher baseline A1C, and insulin non-use. Full article
(This article belongs to the Special Issue Clinical Management of Diabetes and Complications)
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18 pages, 1736 KB  
Article
Does the Interaction Between Alcohol Use and Depression Exacerbate Hyperglycemia Risk? A Cross-Sectional Study Beyond Additive Effects
by Simona-Dana Mitincu-Caramfil, Anca Pantea Stoian, Lavinia-Alexandra Moroianu, Catalin Plesea-Condratovici, Andrei Vlad Bradeanu and Eduard Drima
Medicina 2025, 61(8), 1380; https://doi.org/10.3390/medicina61081380 - 30 Jul 2025
Cited by 1 | Viewed by 1444
Abstract
Background and Objectives: This study investigated whether the interaction between heavy alcohol use and depression amplifies the risk of hyperglycemia in psychiatric patients. Materials and Methods: We conducted a cross-sectional study on 172 patients (aged 18–65) hospitalized at the “Elisabeta Doamna” [...] Read more.
Background and Objectives: This study investigated whether the interaction between heavy alcohol use and depression amplifies the risk of hyperglycemia in psychiatric patients. Materials and Methods: We conducted a cross-sectional study on 172 patients (aged 18–65) hospitalized at the “Elisabeta Doamna” Clinical Psychiatric Hospital, Romania. The data included fasting blood glucose, gamma-glutamyl transferase (GGT), Beck Depression Inventory (BDI), and Alcohol Use Disorders Identification Test (AUDIT) scores. Results: Moderate positive correlations were observed between depression scores and blood glucose (r = 0.44) and between alcohol consumption and blood glucose (r = 0.43). The interaction term (BDI × AUDIT) was statistically significant in multiple regression (β = 0.012, p = 0.001), and the model explained 39.1% of glucose variability. Logistic regression analysis revealed that neither high alcohol consumption (OR = 1.38, p = 0.441) nor severe depression alone (OR = 1.30, p = 0.582) were significantly associated with hyperglycemia. However, their interaction demonstrated a strong and statistically significant effect (OR = 19.3, 95% CI: 3.22–115.81, p = 0.001). The prevalence of hyperglycemia reached 95.8% in patients with both risk factors. Conclusions: The combined presence of high alcohol consumption and severe depression significantly increases the risk of hyperglycemia. These findings highlight the importance of integrated screening and interventions in psychiatric settings. Full article
(This article belongs to the Special Issue Clinical Management of Diabetes and Complications)
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Review

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16 pages, 838 KB  
Review
The Diabetes–Viral Respiratory Syndemic: Pathophysiological Insights and Precision Management: A Scoping Review
by Ana Maria Mihai, Monica Marc, Florina Lucaciu and Alexandra Sima
Medicina 2026, 62(4), 770; https://doi.org/10.3390/medicina62040770 - 16 Apr 2026
Viewed by 605
Abstract
Background/Objectives: Viral respiratory tract infections (VRTIs) in patients with diabetes mellitus (DM) are characterized by a severity gap rather than an infection gap. This review synthesizes evidence from the 2023–2026 respiratory seasons to provide a post-pandemic framework for managing the synergistic metabolic and [...] Read more.
Background/Objectives: Viral respiratory tract infections (VRTIs) in patients with diabetes mellitus (DM) are characterized by a severity gap rather than an infection gap. This review synthesizes evidence from the 2023–2026 respiratory seasons to provide a post-pandemic framework for managing the synergistic metabolic and viral threats in this population. Materials and Methods: A scoping review of literature from PubMed, Scopus, and Embase (2023–2026) was conducted, focusing on clinical outcomes and mechanistic interactions between DM and emerging respiratory pathogens. Results: Recent data identify human Metapneumovirus (hMPV) and adenovirus as significant threats to diabetic hosts, with mortality risks equivalent to seasonal influenza (HR 1.00 for hMPV vs. influenza). The two-hit model combines a baseline of innate immune paralysis, characterized by impaired neutrophil chemo-taxis and mechanical SP-D dysfunction, with a cellular signaling environment primed for cytokine overreaction by epigenetic metabolic memory. The stress hyperglycemia ratio (SHR) has emerged as a promising predictor of mortality compared to absolute glucose or HbA1c, with a proposed threshold of ≥1.14 identifying patients at 3.5-fold increased risk for mechanical ventilation. Precision management should consider the prudent suspension of SGLT2 inhibitors to mitigate euglycemic DKA risks and considering the early use of GLP-1 receptor agonists for their hypothesized pulmonary anti-inflammatory properties. Conclusions: Closing the mortality gap may require a shift from generic viral care to a precision model that treats metabolic susceptibility with high clinical priority alongside the treatment of the viral pathogen. Full article
(This article belongs to the Special Issue Clinical Management of Diabetes and Complications)
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Other

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12 pages, 994 KB  
Systematic Review
Effects of Intravenous or Inhalation Anesthesia on Blood Glucose in Patients with Type 2 Diabetes Mellitus: A PRISMA-Compliant Systematic Review and Meta-Analysis
by Sang Min Yoon, Hyun Kang, Yoon Ji Choi, Sang Hun Kim, Seongtae Jeong and Sejong Jin
Medicina 2026, 62(1), 128; https://doi.org/10.3390/medicina62010128 - 8 Jan 2026
Cited by 1 | Viewed by 1231
Abstract
Background and Objectives: Perioperative hyperglycemia is associated with increased risks of infection and mortality. Patients with type 2 diabetes mellitus (T2DM) exhibit variable glycemic responses to surgical stress, highlighting the importance of optimal perioperative glucose control. The aim of this study is [...] Read more.
Background and Objectives: Perioperative hyperglycemia is associated with increased risks of infection and mortality. Patients with type 2 diabetes mellitus (T2DM) exhibit variable glycemic responses to surgical stress, highlighting the importance of optimal perioperative glucose control. The aim of this study is to conduct a systematic review and meta-analysis comparing the effects of intravenous versus inhalation anesthesia on perioperative blood glucose levels in patients with T2DM undergoing surgery. Materials and Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and non-randomized studies identified from Medline, EMBASE, CENTRAL, and Google databases up to 24 October 2024. Eligible studies included adult surgical patients with type 2 diabetes mellitus. Two investigators independently screened studies, extracted data, and assessed methodological quality using the GRADE approach. Results: Five studies (3 RCTs and 2 non-RCTs) involving a total of 512 participants were included. Intraoperatively, inhalation anesthesia was associated with significantly higher blood glucose levels compared to intravenous anesthesia (mean difference [MD]: 12.52 mg/dL; 95% confidence interval [CI]: 0.70–24.35) in the overall analysis. However, subgroup analysis by study design showed no significant differences. Postoperatively, inhalation anesthesia resulted in significantly higher glucose levels than intravenous anesthesia, both in the overall analysis (MD: 23.56 mg/dL; 95% CI: 3.65–43.48) and in RCTs alone (MD: 28.20 mg/dL; 95% CI: 3.67–52.73). Conclusions: Intravenous anesthesia is associated with lower perioperative blood glucose levels compared to inhalation anesthesia, both during and after surgery. Although the effect was not consistently significant across all subgroups, these findings suggest a potential advantage of intravenous anesthesia in patients with T2DM and warrant validation in larger randomized trials. Full article
(This article belongs to the Special Issue Clinical Management of Diabetes and Complications)
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