Search Results (3,048)

Leukocyte telomere length (LTL) is shortened in adults with type 1 diabetes (T1D), but less data is available concerning pediatric cases. Multiple factors affect LTL, namely genes, epigenetics, environmental factors, oxidation, and psychological stress. Children with T1D and their families experience chronic stress. This study aimed to investigate LTL in children with T1D (n = 35) aged 6–13 years old, in comparison to age-matched healthy counterparts (n = 35), and assess any correlation of LTL with perceived stress. Relative LTL (rLTL) was assessed through real-time qPCR. Morning serum cortisol, high-sensitivity C-Reactive Protein (hsCRP), and glycated hemoglobin (HbA1c) were measured. Children completed the validated questionnaires “Stress in Children” and “Pediatric Quality of Life”. Parents answered the “Perceived Stress Scale”. Children with T1D had a lower rLTL (p = 0.02) compared to age-matched healthy controls, higher hsCRP (p = 0.031), and a lower estimated quality of life (p = 0.01). RLTL was found to be lower in females with T1D (p < 0.001) and was positively related to the ‘gender–social support’ factor (p = 0.002) and diabetes duration (p = 0.045), adjusted for children’s age, parental age, and sociodemographic characteristics. These pilot findings indicate early emergence of shorter rLTL in T1D, pointing to a sexual dimorphism pattern. Insights into preventing LTL shortening in pediatric T1D can be gained from large-scale studies examining the impact of gender and social support. Full article

Type 1 diabetes (T1DM) is associated with elevated cardiovascular (CV) risk, often exacerbated by the rising prevalence of obesity. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) reduce CV risk in type 2 diabetes, but their role in T1DM is less well-defined. This umbrella review synthesizes evidence from systematic reviews, meta-analyses, and Mendelian Randomization (MR) studies to evaluate the metabolic efficacy and safety of GLP-1 RAs in T1DM. Adjunctive therapy, particularly with liraglutide and exenatide, was associated with clinically meaningful weight reduction (mean difference: −4.35 kg to −5.1 kg) and lower total daily insulin doses. HbA1c reductions were statistically significant but modest (0.2–0.3%), with no improvement in Time in Range. Secondary benefits included lower systolic blood pressure. Safety data were mixed: the risk of severe hypoglycemia was not increased, whereas Time Below Range and gastrointestinal adverse events were more frequent. Evidence on diabetic ketoacidosis (DKA) was inconsistent across studies. Overall, GLP-1 RAs improve weight and reduce insulin requirements in T1DM, potentially mitigating indirect CV risk factors; however their direct cardiovascular benefits remain unproven in the absence of dedicated outcome trials. Full article

Background: Cardiorenal syndrome (CRS) arises from interconnected cardiovascular, renal, and metabolic dysfunction driven by shared risk factors such as hypertension, diabetes, and obesity. Cardiac rehabilitation (CR) is a multidisciplinary intervention; however, its impact on CRS risks remains unclear. Methods: This retrospective cohort study analyzed electronic medical record data from 394 participants enrolled in a three-month CR program. Baseline and post-program measures included functional capacity, cardiometabolic risk factors, and psychosocial outcomes. Results: Participants (mean age 62.44 ± 12.15 years; 66.8% male) had a high burden of CRS risk factors, including hypertension (85.8%), diabetes (60.6%), and obesity (57.8%). Significant improvements were observed in functional capacity (6 min walk distance increased by 213 m, p < 0.001), muscular strength, flexibility, and psychosocial outcomes (anxiety, depression, perceived health; all p < 0.001). In contrast, changes in CRS risk factors were modest: fasting blood glucose decreased slightly (p = 0.043), while HbA1c, body fat, and cholesterol showed no significant change. Systolic blood pressure and body weight increased significantly. Cardiac rehabilitation improves functional and psychosocial outcomes but demonstrates limited short-term impact on CRS risk factors. Conclusions: These findings suggest CR may serve as an initial platform for CRS risk modification but requires integration with comprehensive cardio–renal–metabolic management strategies. Full article

Hepatitis B virus (HBV) is the smallest partially double-stranded, reverse-transcribing DNA virus, with four open reading frames (ORFs) encoding viral proteins. It is classified into nine geographically distributed genotypes (A–I). In Kenya, the molecular characterization of HBV among patients seeking medical care remains poorly defined. This observational study aimed to characterize HBV among patients seeking medical care in Kenya’s endemic region, focusing on circulating genotypes and ORF mutations. Serum samples were collected from the outpatient departments of selected health facilities, with demographic and clinical information extracted from patients’ medical records. Hepatitis B surface antigen (HBsAg) was tested at the facilities, and 85 HBsAg-positive samples were collected for molecular analysis. The basal core promoter and pre-core (BCP/PC), polymerase, and surface regions of the viral genome were amplified and sequenced to determine genotypes and to profile their mutations. Out of 85 HBsAg-positive samples, 38 samples tested positive for HBV DNA, and 26 samples were successfully sequenced. HBV genotype A was prevalent at 73.1% (19/26), followed by genotype D at 23.1% (6/26), and genotype E at 3.8% (1/26). Genotype A sequences clustered with both A1 Asian and African subgenotypes, whereas genotype D clustered with subgenotypes D6 and D1. All HBV genotype A, D, and E sequences were serotypes adw2, ayw2, and ayw4, respectively. HBV core promoter mutations (A1762T/G1764A) were detected in both genotype D and genotype A isolates. The pre-core G1896A mutation was highly prevalent in genotype D samples (5/6; 83.3%) but was not observed in genotypes A or E. Analysis of mutations within the “a” determinant region revealed genotype-specific patterns: genotype A predominantly harbored V14A, P46H, S58C, and P67Q substitutions; genotype E showed N59S; and genotype D exhibited V14A, C69stop, S104T, and W182stop mutations. Two drug resistance mutations (V191I and A194T) were present in two chronic patients, one with genotype A and the other with genotype D. In conclusion, HBV genotypes A and D are the most prevalent among Kenyan patients with chronic HBV infection. The presence of point mutations in the ORFs among patients seeking medical care highlights the need for molecular surveillance to better understand the viral diversity and its potential clinical and public health implications. Full article

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and impaired insulin secretion, and curcumin—a polyphenolic compound derived from Curcuma longa—has shown potential anti-inflammatory and antioxidant effects. This randomized, double-blind, placebo-controlled trial evaluated the effects of 1500 mg/day curcumin supplementation for 12 months in 114 adults with T2DM, with assessments including fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), insulin resistance (HOMA-IR), inflammatory cytokines (IL-6, IL-1β, TNF-α), high-sensitivity C-reactive protein (hs-CRP), neutrophil-to-lymphocyte ratio (NLR), antioxidant markers (SOD, GPx, TAS), and malondialdehyde (MDA). Curcumin supplementation was associated with significant reductions in pro-inflammatory cytokines (p < 0.001), hs-CRP and NLR (p < 0.05), and with improved antioxidant status as shown by increased TAS, SOD, and GPx together with reduced MDA levels (p < 0.001). Additionally, improvements in metabolic parameters were observed, including lower FPG (112.0 mg/dL vs. 134.5 mg/dL; p < 0.001), HbA1c (6.10% vs. 6.40%; p < 0.05), and HOMA-IR (4.88 vs. 6.71; p < 0.001). Overall, the findings suggest that long-term curcumin supplementation may contribute to improved inflammatory, antioxidant, and glycemic profiles in obese individuals with T2DM; however, further multi-center studies are needed to confirm these observations and clarify their clinical relevance. Full article

Background: The benefits of metabolic bariatric surgery (MBS) in people with a body mass index (BMI) ≥ 50 kg/m² are not well-established, with concerns of increased risk and poorer weight loss. The optimal surgical type (gastric bypass [GB] versus sleeve gastrectomy [SG]) is unclear, with studies comparing complication rates, weight loss, and glycaemic outcomes reporting mixed results. Methods: Participants with a BMI ≥ 50 kg/m² undergoing MBS (SG or GB) from 2008 to 2022 were recruited. Demographics, anthropometrics, biochemistry, and diabetes status were analysed at baseline, 12 months, and 24 months post-operatively. Surgical outcomes and complications were analysed. Results: The study included n = 184, with BMI ≥ 50 kg/m² (57.6% female, age 38.6 ± 10.5 years, and BMI 55.3 ± 6.0 kg/m²). Pre-operatively, 21.1% had pre-diabetes, and 33.2% had diabetes (mean HbA1c 8.0 ± 1.7%). Most subjects (89.1%) underwent SG. The overall 30-day adverse event rate was 4.9%, with a higher, but not statistically significant, rate in the GB group (15.0% vs 3.7%, p = 0.061). The GB group had a longer length of stay (GB =4.5 ± 0.6 days, SG = 3.1 ± 0.2, and p = 0.023). The rate of revisional surgery was 2.7%, with no significant difference between groups. The follow-up rate was 67.9% at 12 months and 51.1% at 24 months. The average %total weight loss (%TWL) at 12 months (27.4 ± 9.0%, SG = 27.6 ± 9.0%, GB = 26.0 ± 9.4%, and p = 0.481) and 24 months (27.1 ± 10.9%, SG = 27.4 ± 11.1%, GB = 24.9 ± 8.9%, and p = 0.495) were similar between groups. The GB group had a larger HbA1c reduction (3.2 ± 1.1%) than SG (1.9 ±1.3%, p = 0.030) but no difference in diabetes remission rates (69.2% at 12 months, 76.7% at 24 months). Conclusions: MBS is safe and effective for individuals with a BMI ≥ 50 kg/m², with low complication rates and good weight loss and glycaemic outcomes at 2 years. No statistically significant differences in %TWL, diabetes remission, or complication rates were noted between SG and GB groups, though results are limited by the small number of participants who underwent GB. Full article

Postprandial variability in glucose and protein levels is one of the elements of insulin resistance (IR) and prediabetes, which is an area precursor to type 2 diabetes mellitus (DM). The objective of the study was a comprehensive proteomic analysis according to glucose tolerance in the general population who did not self-report DM or other diseases. We used Olink^® Reveal, a novel, high-throughput platform by Olink Proteomics based on their Proximity Extension Assay (PEA), to identify levels of 1034 circulating proteins in small volumes (4 µL) of plasma samples. The study enrolled 508 participants (mean age 52 ± 10.5 years, 47.2% men) from the population-based study, Bialystok PLUS Polish Longitudinal University Study. The study population was categorized according to glucose metabolism in comparison to impaired fasting blood glucose (IFG), impaired glucose tolerance (IGT), and newly diagnosed DM. Analysis of variance (ANOVA) adjusted for age, weight, fat mass, lean mass, and body mass index (BMI), identified 19 proteins significantly associated with categories of glucose tolerance. Of the five markers with the greatest ability to distinguish newly diagnosed diabetes from non-diabetic participants, paralemmin 2 performed best (AUC = 0.81; 77% sensitivity, 75% specificity), whereas furin was the most accurate for detecting any abnormal glucose regulation (AUC = 0.69). A linear regression model adjusted for the same confounding factors showed statistically significant associations between Hb_A1c levels and 37 proteins. Our findings highlight multiple proteins with significantly different levels across categories of glucose tolerance, especially between the healthy controls and the group with newly diagnosed DM. The consistent patterns of protein level differences, independent of body composition, suggest potential involvement in the progression of glucose metabolism disturbances and provide unique insights into pathomechanisms. These findings identify PALM2, FURIN, PDZK1, ACAA1, and IL18R1 as potential biomarkers of early dysglycemia. Full article

Background: Neck circumference (NC) is a simple anthropometric index of upper-body subcutaneous adiposity. Its relationship with inflammatory cytokines, particularly the anti-inflammatory cytokine IL-10, remains poorly explored, especially in Latin-American populations. Methods: This cross-sectional study analyzed data from 80 Mexican adults with obesity (40 women and 40 men). NC, waist circumference (WC), and body mass index (BMI) were measured according to standardized ISAK and NHANES protocols. Fasting glucose, insulin, lipid profile, and HbA1c were evaluated. Finally, serum TNF-α, IL-6, IL-18, IL-10, and hs-CRP were quantified from a subsample. Correlation coefficients and sex-stratified multiple linear regression models adjusted for age and BMI were performed. Results: In the overall sample, neck circumference (NC) was positively associated with triglycerides, VLDL-C, insulin, and HbA1c, and inversely associated with HDL-C. Sex-stratified analyses revealed marked differences. In women, NC showed strong and independent associations with triglycerides, VLDL-C, IL-10, and the IL-10/TNF-α ratio, whereas these associations were not observed in men. Similarly, waist circumference was independently associated with IL-10, and BMI was associated with hs-CRP. Conclusions: NC may serve as a useful surrogate marker of upper-body adiposity and is independently associated with triglycerides, VLDL-C, IL-10, and the IL-10/TNF-α ratio exclusively in women with obesity. These exploratory findings highlight sex-specific differences in the adiposity–inflammation axis and underscore the need for larger longitudinal studies and sex-tailored approaches in obesity research. Full article

Background/Aim: Long non-coding RNAs (lncRNAs) such as NEAT1, HULC, and MALAT1, which are expressed in adipose tissue, are known to play a role in regulating adiposity. However, how the plasma expression of these lncRNAs changes in obese patients following rapid adipose tissue loss after sleeve gastrectomy remains unclear. This study aimed to investigate the relationship between plasma NEAT1, HULC, and MALAT1 expression levels and short-term weight loss after sleeve gastrectomy. Materials and Methods: Plasma samples prospectively collected from patient groups were used for total RNA extraction to measure the expression levels of NEAT1, HULC, and MALAT1 both before sleeve gastrectomy and 30 days after the procedure. Additionally, patients were followed for changes in body mass index (BMI) and HbA1C levels over a 12-month period. Associations between lncRNA expression levels and clinical parameters were evaluated. Results: Before sleeve gastrectomy, the expression levels of NEAT1 and HULC were significantly higher in obese patients compared to non-obese individuals (p < 0.0001). Sleeve gastrectomy was associated with decreased expression levels of NEAT1 (p = 0.004) and HULC (p = 0.0027). NEAT1 and HULC expression levels showed significant associations with changes in HbA1C and BMI, respectively (p < 0.05). Conclusions: NEAT1 and HULC expression levels were associated with short-term metabolic and anthropometric changes following sleeve gastrectomy. These findings are exploratory and hypothesis-generating, and further studies with larger cohorts and longer follow-up are needed to determine their potential clinical relevance. Full article

Background: We aimed to study the association between accelerometer-measured physical activity and metabolic markers of diabetes in a nationwide representative sample of U.S. adults. Methods: This cross-sectional analysis included 1259 adults aged ≥18 years from the 2003–2004 National Health and Nutrition Examination Survey (NHANES), the only cycle incorporating objective accelerometry. Physical activity was assessed using hip-worn accelerometers, with moderate-to-vigorous physical activity (MVPA) and sedentary time derived from validated count thresholds. Metabolic outcomes included fasting glucose, fasting insulin, glycated hemoglobin (HbA1c), and insulin resistance estimated by the Homeostatic Model Assessment (HOMA-IR). Survey-weighted linear regression models accounting for the complex sampling design were applied, with sequential adjustment for demographic, socioeconomic, anthropometric, and behavioral covariates. Sensitivity analyses tested alternative MVPA thresholds and wear-time criteria. Results: In unadjusted models, higher MVPA was inversely linked with fasting glucose and insulin concentrations; but, these associations were attenuated after full multivariable adjustment. In contrast, MVPA established a constant inverse association with insulin resistance. Higher MVPA was connected with lower HOMA-IR values, and this relationship remained statistically significant in fully adjusted models and across all sensitivity analyses (all p < 0.001). Associations between sedentary time and metabolic markers were non-sustainable after multivariable adjustment. No significant effect modification by sex was detected. Conclusions: Objectively measured moderate-to-vigorous physical activity is independently linked with lower insulin resistance in U.S. adults. These results emphasize the value of accelerometer-based assessments for identifying early metabolic risk and reinforce physical activity promotion as a key strategy for improving insulin sensitivity. Full article

Background: Artificial intelligence (AI) is increasingly incorporated into nutrition research and practice; however, the extent of its clinical integration and impact on health outcomes remains unclear. This systematic review evaluated how AI-based systems have been implemented in human nutritional interventions and summarized reported outcomes. Methods: PubMed, Scopus, Google Scholar, SpringerLink, JMIR, and MDPI were searched from January 2020 to March 2025 (search completed in March 2025). Randomized controlled trials and prospective or retrospective cohort studies published in English or Spanish were included if they evaluated AI-driven nutritional interventions in human populations and reported health-related outcomes. Risk of bias was assessed using RoB 2 and ROBINS-I. A qualitative synthesis was performed. Results: Sixteen studies involving 10,863 participants were included. Most were randomized controlled trials targeting metabolic disorders, particularly type 2 diabetes and obesity. Eleven studies evaluated metabolic outcomes, including HbA1c, body weight, fat mass, lipid levels, and insulin resistance indices. Six studies assessed gastrointestinal symptom severity scores, and two examined quality-of-life or patient-reported outcomes. Several trials reported short-term improvements favoring AI-supported interventions in glycemic control, weight reduction, and symptom severity. However, effects were heterogeneous and often observed within multimodal programs, limiting attribution of outcomes solely to the AI component. Conclusions: AI integration in nutrition remains in an early phase of clinical implementation. Although preliminary findings suggest potential benefits, interpretation should be cautious given methodological heterogeneity and moderate-to-high risk of bias across studies. Larger, rigorously designed investigations are required to determine sustained clinical effectiveness. Full article

Diabetes complications may increase frailty rates among the elderly, leading to falls, immobility, dependency, hospitalizations, and death. The study aimed to assess any association between frailty status and glycaemic control among older adults with type 2 diabetes mellitus at Kenyatta National Hospital, Kenya. We conducted a cross-sectional study of 430 older individuals aged 60+ years with type 2 diabetes at a specialized diabetes clinic using a modified FRAIL scale. Mean age was 69.1 years; 65.7% were female and 76.2% completed primary school. Frailty prevalence was 3.8%, pre-frailty constituted 24.3%, and robust/non-frail comprised 71.9%. It was associated with age, social status, health knowledge, duration of DM, blood pressure, body mass index, high-density lipoprotein-C, and renal failure. Mean fasting plasma glucose (FPG) was 8.7 mmol/L, with 60% having FPG > 7 mmol/L; mean glycated haemoglobin (HbA1C) was 8.0%, with 41% having HbA1C > 8%. Glycaemic control was correlated with number of medications, blood pressure, and lipidaemia, but not age, sex, or social status. No correlation was found between frailty and glycaemic control: frailty versus FPG (r = 0.038, p = 0.459; χ² = 0.699, p = 0.705) and HbA1C (r = −0.009, p = 0.877; χ² = 0.046, p = 0.977). Low frailty prevalence was noted, with no association to glycaemic control. Our findings provide evidence for conducting frailty assessments in chronic disease care. Full article

Background/Objectives: Sphingosine-1-phosphate (S1P) is implicated in glycemic control. However, its circulating levels and clinical significance in type 2 diabetes mellitus (T2DM) remain controversial. We assessed plasma S1P levels in T2DM patients, its associations with metabolic parameters and complications, and explored its biomarker potential and non-linear (U-/J-shaped) relationships. Methods: This cross-sectional study enrolled 140 patients with T2DM and 63 matching healthy controls. Plasma S1P was measured by competitive ELISA. Statistical analyses included comparisons, correlation, ROC analysis, multivariable logistic regression, and quadratic/spline regression for U-shaped relationships. Results: Plasma S1P was significantly elevated in T2DM patients [1256.7 (149.4–1510.0) ng/mL] compared to controls [1075.1 (202.0–1510.0) ng/mL; p < 0.001]. S1P correlated positively with age, disease duration, HbA1c, insulin resistance, TyG index, triglycerides, systolic blood pressure, and negatively with HDL-C. Patients with complications had higher S1P than those without (p = 0.001), with progressive increases from retinopathy to nephropathy to mixed complications. Insulin-treated patients exhibited the highest S1P levels (p < 0.001). ROC analysis showed moderate diagnostic accuracy (AUC = 0.724). S1P is an independent associated factor with complications (OR = 1.18 per 100 ng/mL, p = 0.003). Non-linear analysis revealed a U-shaped relationship with HDL-C (optimal S1P: 1100–1350 ng/mL) and a J-shaped relationship with complication risk (threshold ~1250 ng/mL). Conclusions: Plasma S1P is elevated in T2DM and correlates with disease severity, glycemic control, insulin resistance, and complications. S1P demonstrates moderate biomarker potential and exhibits non-linear U-/J-shaped relationships with metabolic parameters, suggesting an optimal therapeutic window of 1100–1280 ng/mL. These findings support S1P as a marker of cumulative disease burden and a potential therapeutic target. Full article

Diabetic retinopathy (DR) is a common cause of vision loss in diabetes, and it often progresses without early symptoms. DR reflects injury of the retinal neurovascular unit (NVU), which includes neurons, Müller glia, astrocytes, endothelial cells, pericytes, and immune cells. Chronic hyperglycemia drives oxidative stress, advanced glycation end products–receptor for advanced glycation end products (AGE–RAGE) signaling, mitochondrial injury, and low-grade inflammation. These changes disrupt endothelial junctions, promote leukostasis, weaken pericyte support, increase basement membrane thickening, and lead to capillary dropout and hypoxia. Hypoxia-related signaling increases anti-vascular endothelial growth factor (VEGF) activity, which raises vascular leakage and supports neovascular disease. Glial stress and microglial activation add cytokines and reactive oxygen species, and neural dysfunction can appear early and can weaken neurovascular coupling. Modern diabetes care changes the short-term risk landscape because potent therapies can lower HbA1c quickly. Large and rapid HbA1c reductions can trigger early worsening of diabetic retinopathy (EWDR), mainly in patients with high baseline HbA1c and moderate-to-severe baseline DR. Semaglutide’s retinopathy complication signal in SUSTAIN-6 fits an EWDR-like pattern that tracks with rapid glycemic improvement in vulnerable eyes. In parallel, surgery adds acute stress, inflammation, glucose swings, hemodynamic shifts, and medication interruptions. These factors can worsen microvascular instability during recovery. Current perioperative guidelines and regulatory recommendations describe glucose targets and medication safety considerations, including preoperative interruption of SGLT2 inhibitors to reduce euglycemic ketoacidosis risk; however, the retina-specific implications of these measures remain indirect. This review summarizes current evidence linking NVU biology, EWDR risk, and perioperative diabetes-related factors. It discusses how these factors may interact in patients with diabetes and how they may influence retinal outcomes. The review is intended to synthesize current evidence and mechanistic interpretations rather than to provide formal clinical practice recommendations. Full article

Background: Diabetes mellitus is a metabolic disturbance characterized by chronic hyperglycemia, which stems from defective secretion and/or action of insulin. D-Limonene has been studied for the confirmation of its antidiabetic and antioxidant effects. This paper aims to investigate the antidiabetic and antioxidants effects of D-Limonene in an experimental model of DM1. Methods: Female Wistar rats (180–250g) received streptozotocin (STZ, 45 mg/kg) intraperitoneally. Animals with capillary glycemia ≥ 250 mg/dL were considered diabetic. D-Limonene at oral doses of 12.5 mg/kg, 25 mg/kg and 50 mg/kg was administered during 28-day treatment. Water and food intake, weight gain and capillary glycemia were evaluated. At the end of the treatment, the following biochemical parameters were assessed: serum glucose, HbA1c, urea, creatinine, AST, ALT, GGT, ALP and albumin. The oxidative stress markers were determined in plasma, erythrocytes, and aortic homogenates: malondialdehyde, nitrite, myeloperoxidase, superoxide dismutase and catalase. Results: D-Limonene (25 and 50 mg/kg) significantly reduced serum glucose, HbA1c, AST, ALT, GGT and ALP when compared to DC, as well as plasma MDA and nitrite concentrations. Interestingly, D-Limonene (25 and 50 mg/kg) decreased both plasma and aortic myeloperoxidase activities, as well as increased both erythrocytic and aortic catalase activities. Conclusions: These findings, besides a marked D-Limonene-induced hypoglycemic effect, pave the way for further studies comprising a multi-target treatment by providing benefits on hepatic and vascular complications related to the diabetic condition. Full article