Search Results (899)

Background: Gustatory dysfunction represents an underrecognized complication that may influence dietary behaviors and metabolic control. Previous investigations have suggested alterations in taste in patients with diabetes, yet the relationship between disease duration and specific taste modalities remains incompletely characterized. Aim: This study aimed to (i) compare orosensory detection thresholds for lipid and sweet tastes between patients with recent type 2 diabetes mellitus (rT2DM) (duration ≤ 5 years) and chronic type 2 diabetes mellitus (cT2DM) (duration > 5 years), and (ii) determine whether diabetes duration is associated with alterations in chemosensory function in a North African population. Methods: A cross-sectional comparative pilot study was conducted at the National Institute of Nutrition and Food Technology in Tunis, Tunisia, from April to June 2021. Sixty-seven patients with type 2 diabetes mellitus (T2DM) receiving oral antidiabetic medication were recruited through systematic sampling and divided into two groups: rT2DM (n = 30, duration ≤ 5 years) and cT2DM (n = 37, duration > 5 years). Orosensory detection thresholds for lipid taste were assessed using eight ascending concentrations of linoleic acid ranging from 0.018 to 12 mmol/L. In contrast, sweet taste thresholds were evaluated using a sucrose concentration series ranging from 0.01 to 5 mmol/L. The three-alternative forced-choice method with an ascending-concentration presentation was employed for both taste modalities. Detection thresholds were defined as the lowest concentration at which participants correctly identified the taste quality. Results: Patients with cT2DM exhibited significantly elevated orosensory detection thresholds compared to those with rT2DM for both taste modalities tested. The median linoleic acid detection threshold was 6.000 mmol/L in cT2DM versus 0.058 mmol/L in rT2DM (p < 0.001), representing a 107-fold increase in detection threshold. For sweet taste, the median sucrose detection threshold was 1.0 mmol/L in cT2DM compared with 0.5 mmol/L in rT2DM (p < 0.001), indicating a 2-fold increase in the threshold. In the overall patient cohort, the duration of diabetes was positively correlated with both fat taste perception thresholds (r = 0.657, p < 0.001) and sweet taste perception thresholds (r = 0.466, p < 0.001). However, when analyses were performed by diabetes duration-based subgroups, these correlations were observed only for fat taste perception in cT2DM, with no statistically significant correlations found in rT2DM. In multivariate linear regression analyses adjusted for age, body mass index, and sex/gender, the duration of diabetes remained independently associated with fat and sweet taste perception. Conclusions: Extended T2DM duration is associated with substantial elevations in orosensory detection thresholds for both lipid and sweet tastes in a North African population. These findings suggest that disease chronicity may contribute to chemosensory impairment, potentially influencing dietary preferences and metabolic control in patients with diabetes. Full article

Endometrial cancer (EC) is the most common gynecological cancer in developed countries, with approximately 417,000 new cases reported worldwide in 2020. Its incidence has been rising for the past 30 years, primarily due to population aging, obesity, and type 2 diabetes; obesity accounts for almost half of cases due to excessive estrogen production. The classic division into types I and II was replaced in 2013 by the molecular TCGA classification, which distinguishes four subtypes: POLE-ultramutated (best prognosis), MSI-hypermutated, copy-number low, and copy-number high (worst prognosis). This classification (refined in ProMisE and TransPORTEC) enables precise treatment: immunotherapy (pembrolizumab, dostarlimab) works excellently in dMMR/MSI-H tumors, PI3K/AKT/mTOR inhibitors and trastuzumab deruxtecan in selected molecular subtypes, and hormone therapy in ER-positive tumors. ctDNA monitoring supports therapeutic decisions. Integrating the molecular profile with FIGO allows for truly personalized treatment, although MMRp/MSS tumors remain a challenge. The future lies in multi-omics, new biomarkers, and combination therapies. Full article

Glucagon-like peptide-1 (GLP-1) is an incretin hormone and therapeutic agent for Type II diabetes mellitus. However, recombinant production in E. coli yields insufficient quantities, increasing manufacturing costs and limiting patient access. Improving yield and productivity is crucial to make GLP-1 treatments more affordable. An optimized bioprocess was developed to enhance the yield of recombinant GLP-1 (rGLP-1) analogues. Expression constructs encoding monomeric and concatemeric GLP-1 fused to GST were designed. Batch fermentations of these clones at varying pre-induction specific growth rates guided the fed-batch strategy for yield enhancement. The specific yield of monomer construct exhibited higher yields than the concatemer. Process optimization achieved a specific yield (Yp/x) of 116.7 mg/g, a dry cell weight of 88.9 g/L, and a volumetric yield of 10.3 g/L. The specific productivity of soluble rGLP-1 reached 0.4 g/L/h. Purification via affinity chromatography and enterokinase cleavage yielded authentic GLP-1 peptide confirmed by Western blot and mass spectrometry. The developed high-yield fermentation process significantly enhances rGLP-1 productivity in E. coli, potentially reducing upstream production costs by 20–30% and enabling wider accessibility to affordable GLP-1 therapies. Full article

Metabolic syndrome (MetS) is a multifactorial disorder characterized by central obesity, insulin resistance, dyslipidemia, and hypertension, all of which increase the risk of type 2 diabetes and cardiovascular diseases. This study investigates the potential complementary effects of the standardized green and black ADM ComplexTea Extract (CTE) and the heat-treated postbiotic (BPL1^® HT) on the cardiometabolic alterations associated with MetS in a murine model. C57BL/6J mice were fed a high-fat/high-sucrose (HFHS) diet and treated with CTE, BPL1^® HT, or their combination for 20 weeks. Metabolic, inflammatory, oxidative, vascular parameters, and fecal microbiota composition were assessed. Both CTE and BPL1^® HT individually attenuated weight gain, organ hypertrophy, insulin resistance, and inflammation. However, their combined administration exerted synergistic effects, fully normalizing body weight, adipocyte size, lipid profiles, HOMA-IR index, and insulin sensitivity to levels comparable to lean controls. Co-treatment also restored PI3K/Akt signaling in liver and muscle, reduced hepatic steatosis, and normalized the expression of inflammatory and oxidative stress markers across multiple tissues. Furthermore, vascular function was significantly improved, with enhanced endothelium-dependent relaxation and reduced vasoconstrictor responses, particularly to angiotensin II. CTE, BPL1^®HT, and the blend prevented bacterial richness reduction caused by HFHS; the blend achieved higher bacterial richness than mice in Chow diet. Additionally, the blend prevented the increase in Flintibacter butyricus, which is associated with MetS clinical parameters, and showed a tendency to increase the abundance of Bifidobacterium. These findings suggest that the combination of CTE and BPL1^® HT offers a potential nutritional strategy to counteract the metabolic and cardiovascular complications of MetS through complementary mechanisms involving improved insulin signaling, reduced inflammation and oxidative stress, enhanced vascular function, and modulation of gut microbiota. Full article

Background/Objectives: The growing population of women aged ≥ 80 years poses a new challenge for urogynecology. Advanced age, comorbidities, and polypharmacy raise concerns regarding the safety of procedures in the management of pelvic floor disorders (PFDs) such as pelvic organ prolapse (POP), stress urinary incontinence (SUI), and overactive bladder (OAB). Individualized, frailty-based assessment is essential in this group. The aim of the study was to evaluate the safety profile of urogynecological surgical procedures among women aged ≥ 80 years at a single tertiary center. Methods: In a retrospective observational single-center study, we analyzed the medical documentation of 774 hospitalizations of women aged ≥ 80 years admitted between 2014 and 2023. The analysis included indications, comorbidities, treatment types, anesthesia, and complications. Comorbidity and surgical risk were evaluated using the Charlson Comorbidity Index (CCI) and Clavien–Dindo classification. Results: A total of 720 admissions with complete medical records were analyzed, of which 65% were for urogynecological conditions. In this group, the mean age was 83.0 years and mean BMI was 27.2 kg/m². Most patients (92.9%) had comorbidities, mainly hypertension (84.2%) and diabetes (21.1%). POP was the leading indication (52%), followed by SUI (35%) and OAB (27%). Surgical management was performed in 95% of POP cases, predominantly via vaginal native tissue repair (80%), especially LeFort colpocleisis (20%). The transobturator sling (TOT) was the most frequent SUI surgery. Intraoperative complications occurred in 1.5% of cases and postoperative ones were mainly minor (Clavien–Dindo I–II). No procedure-related deaths were recorded. Conclusions: In this cohort, surgical treatment of urogynecological problems in women ≥80 years was associated with a low rate of major complications, suggesting that it can be safely offered to elderly patients. Careful preoperative assessment based on frailty and comorbidity rather than chronological age remains essential. Full article

Background: Diabetes mellitus (DM) is a condition that may increase the severity of acute pancreatitis (AP) through chronic inflammation and disturbances in immune responses. However, the independent effect of DM on clinical outcomes in AP has not yet been fully elucidated. Methods: In this retrospective cohort study, 492 patients diagnosed with acute pancreatitis at the Gastroenterology Clinic of Ankara Bilkent City Hospital between January 2022 and March 2025 were included. Patients were divided into two groups based on the presence of diabetes, and outcomes were compared using statistical methods. Results: Of the total 492 patients (mean age 58.6 ± 17.2 years; 50.2% female) included, 98 (19.9%) had DM. Moderate-to-severe AP occurred in 67.3% of diabetic versus 37.8% of non-diabetic patients (p < 0.0001), and severe disease developed more frequently in the diabetic group (6.1% vs. 1.0%, p = 0.0057). Systemic complications were significantly more common in patients with diabetes (45.9% vs. 26.9%, p = 0.0004). Hospital mortality was higher among patients with diabetes (9.2% vs. 4.6%, p = 0.0344), and Kaplan–Meier analysis demonstrated numerically lower overall survival in patients with diabetes (log-rank p = 0.095), with early divergence in survival curves. Cox proportional hazards analysis confirmed diabetes as an independent predictor of in-hospital mortality (adjusted HR 2.64, 95% CI 1.17–5.97; p = 0.019). After adjustment for confounders, diabetes remained independently associated with the development of moderate/severe pancreatitis (adjusted OR 2.00, 95% CI 1.24–3.22; p = 0.004). Diabetes also independently predicted in-hospital mortality (adjusted OR 3.36, 95% CI 1.35–8.34; p = 0.009), along with APACHE II score. ROC analysis demonstrated that adding diabetes mellitus to the APACHE II score significantly improved mortality prediction compared with APACHE II alone (AUC 0.785 vs. 0.724). The retrospective and single-center design of this study may limit its generalizability and create potential selection bias. There were insufficient data on the type of diabetes, its duration, and glycemic control (e.g., HbA1c), and therefore, we could not assess these factors, all of which may influence risk estimates. Although the survival curves showed early divergence, the borderline log-rank significance (p = 0.095) highlights the limited statistical power to detect long-term survival differences in this cohort. Conclusions: DM is associated with substantially increased severity and in-hospital mortality in AP, primarily through an elevated risk of systemic organ failure. Incorporation of diabetes status into early severity stratification may improve prognostic accuracy and guide closer monitoring and timely interventions in this high-risk population. Full article

Exercise training reduces metabolic dysfunction and improves neural function; however, its cortical molecular effects in diabetic–obese conditions remain unclear. Here, we aimed to identify transcriptional pathways by integrating physiological evaluation with an in silico analysis of cortical RNA-seq data from Zucker Fatty Diabetes Mellitus rats following a 12-week swimming training program. Exercise training reduced body weight and improved glucose control and blood pressure. RNA-seq analysis revealed 814 differentially expressed genes, with pathway enrichment highlighting glutamatergic synapse, retrograde endocannabinoid signaling, and oxytocin signaling pathways. These coordinated transcriptional shifts involved genes related to excitatory neurotransmission, neuromodulatory feedback, and calcium-dependent regulation. As hypothesis-generating models, these pathway-level patterns suggest that exercise training may modulate cortical signaling properties in diabetic–obese states and provide a conceptual framework for future mechanistic investigation. Full article

Background: Type 2 diabetes (T2D) is a growing public health problem in Mexico. Lipid profile alterations have been shown to appear years before changes in glycemic biomarkers, and some of the latter are limited in availability, especially in underserved settings. Therefore, anthropometric variables and lipids represent relevant early indicators for the early detection of the disease. This study evaluates the capacity of non-glycemic clinical data—including lipid profile and anthropometric indicators—to detect T2D using machine learning, and compares the performance of different feature engineering approaches. Methods: Using more than a thousand clinical records of Mexican adults, three experiments were developed: (1) a distribution and normality analysis to characterize the variability of lipid variables; (2) an evaluation of the predictive power of multiple atherogenic indices (Castelli I, Castelli II, TG/HDL, and AIP); and (3) the implementation of statistical transformations (logarithmic, quare-root, and Z-standardization) to stabilize variance and improve feature quality. Logistic regression, SVM-RBF, random forest, and XGBoost models were trained on each feature set and evaluated using accuracy, sensitivity, specificity, F1-score, and area under the ROC curve. Results: The AIP index showed the greatest discriminatory power among the atherogenic indices, while normality-based transformations improved the performance of distribution-sensitive models, such as SVM. In the final experiment, the SVM-RBF and XGBoost models achieved AUC values greater than 0.90, demonstrating the feasibility of a diagnostic approach based exclusively on non-glycemic data. Conclusions: The findings indicate that the transformed lipid profile and anthropometric variables can constitute a solid and accessible alternative for the early detection of T2D in clinical and public health contexts, offering a robust methodological framework for future predictive applications in the absence of traditional glycemic biomarkers. Full article

Background: A key barrier to realizing the full potential and long-term collection of patient-reported outcomes (PROs) is the limited understanding of user experience (UX) factors that influence sustained patient engagement with digital PRO tools. Most existing research focuses on disease-specific or country-specific solutions, leaving a gap in identifying shared UX determinants that could inform scalable, cross-disease European digital health frameworks. This fragmentation hinders interoperability and increases development costs by requiring separate tools for each context. This case study aims to address this gap by identifying key UX features that optimize PRO collection across diverse chronic conditions in Europe within the Health Outcomes Observatory project, enhancing continuous (primary use) and large-scale (secondary use) data collection. Objective: This study aimed to identify and analyze key UX factors that support adoption and sustained use of PRO collection tools among patients with chronic diseases across multiple European countries. Methods: Patient focus groups were conducted in four chronic disease areas: cancer, inflammatory bowel disease (IBD), and diabetes (type I and II) across six European countries. Participants were recruited purposively through national patient advisory boards to ensure diversity in age, gender, and disease type. Sessions were moderated by trained qualitative researchers following a standardized guide, and discussions were transcribed verbatim and coded in researcher pairs to ensure intercoder reliability through iterative consensus. A modified thematic analysis, guided deductively by the UX Honeycomb model and inductively by emergent themes, was used to identify cross-disease UX determinants. Results: In total, 17 patients and patient representatives participated (76% female; 4 diabetes, 6 IBD and 7 cancer). We identified six core UX factors driving patient engagement for all disease groups: compatibility with other technologies, direct communication with the care team, personalization, ability to share data, the need for educational material and data protection were identified as key aspects of PRO technologies. However, the customizability of the app is crucial. Not all disease groups had the same needs, and participants specifically requested that the app provide information relevant to their own condition. Disease-specific needs, like T1D patients desiring glucose monitoring integration, were identified. IBD patients highlighted flare detection abilities and cancer patients especially sought side-effect comparisons. Conclusions: Our findings indicate that a unified yet customizable PRO platform can address shared UX needs across diseases, improving patient engagement and data quality. Incorporating features such as seamless data transfer, personalization, feedback, and strong privacy measures can foster trust and long-term adoption across European contexts. In addition to some disease-specific issues, most needs for the backbone of the app were shared among the disease areas. This shows that a shared app between diseases might be preferable and, in case of comorbidities, could ease self-management for patients. Last, to ensure full potential for every user and every disease, customization is crucial. Full article

Alginate nanocapsules loaded with Moringa oleifera extract, a plant traditionally used for its hypoglycemic properties, were developed as a therapeutic alternative for type II diabetes mellitus. The nanocapsules were obtained by manually spraying a WO emulsion with an airbrush and were stabilized in 2% calcium chloride. Characterization by atomic force microscopy revealed spherical particles with an average diameter of 10.087 nm, an area of 298.441 nm², and a density of 0.207556/nm², confirming efficient encapsulation and uniform morphology. This low-cost method is promising for the creation of controlled release systems in resource-limited settings. Full article

Background and Objectives: There is no universal agreement with regard to the correlation between Helicobacter pylori (H. pylori) infection, type 2 diabetes mellitus (T2DM), and ABO blood group antigens. The data related to these are limited. The purpose of this study is to explore the correlation and frequency of H. pylori infection with T2DM and ABO blood group of adults that reside in Jordan. Materials and Methods: This study adopts a cross-sectional comparison of 149 patients diagnosed with T2DM and 168 non-diabetic controls. The One-Step Immunochromatographic DiaSpot^® test was used to diagnose H. pylori, while standardized hemagglutination through the use of monoclonal anti-A, anti-B, and anti-D reagents was used for ABO blood grouping. Analyses were conducted on the correlation between H. pylori infection, diabetes, and ABO blood group through logistic regression. Results: A total of 89 out of the 317 participants tested positive for H. pylori infection (overall seroprevalence = 28.0%), consisting of 51 of the 149 T2DM patients (34.2%) and 38 (22.6%) of the 168 non-diabetic controls. A significant association was observed between diabetes status and H. pylori infection (χ²(1) = 4.71, p < 0.05), with the probability of being H. pylori-positive 1.78 times higher among diabetics (95% CI: 1.085–2.921). A significant association was found between blood group and H. pylori infection, (χ²(3), n = 317) = 15.01, p < 0.001. Of the 89 H. pylori-positive patients, 21 (23.6%) were in blood group A, 13 (14.6%) in group B, and 44 (49.4%) in group O, with the remaining 11 (12.4%) patients in blood group AB. Conclusions: Significant associations were found between H. pylori infection and both T2DM and blood type. Further longitudinal studies that include larger, more diverse populations and more potentially significant factors are needed to clarify these relationships. Full article

Background/Objectives: Type 2 diabetes mellitus (T2DM) is a major metabolic disorder and is frequently accompanied by liver steatosis. Apolipoprotein J (ApoJ) is a glucose-regulated molecular chaperone that has been implicated in hepatic lipid deposition under nutrient overload. This study aimed to investigate the role of hepatocyte-specific ApoJ deletion in hepatic metabolism under diabetic conditions. Methods: A T2DM mouse model with hepatocyte-specific ApoJ knockout (HKO) was established through a high-fat diet combined with streptozotocin injection. Hepatic metabolic profiles were analyzed using untargeted metabolomics with UHPLC–MS/MS. Differential metabolites were subjected to KEGG pathway and Sankey diagram analyses to identify biologically relevant pathways. Results: In total, 140 metabolites showed significant differential abundance in HKO mouse liver, primarily encompassing organic acids and derivatives as well as lipids and lipid-like molecules. KEGG analysis revealed that ApoJ deletion enhanced pathways related to vitamin digestion and absorption, thiamine metabolism, amino acid biosynthesis, lysine degradation, and 2-oxocarboxylic acid metabolism. In contrast, pathways associated with galactose metabolism, cysteine and methionine metabolism, purine metabolism, and the pentose phosphate pathway were suppressed. Sankey diagram analysis further demonstrated that ApoJ deletion markedly reshapes hepatic metabolic networks in T2DM. Conclusions: Given the central role of hepatic dysmetabolism in the pathogenesis of diabetes and its complications, targeting ApoJ may represent a promising therapeutic approach for restoring hepatic metabolic homeostasis and preventing diabetes-associated steatosis. Full article

Diabetes mellitus (DM) continues to be a global world health problem. Despite medical advances, both DM and chronic kidney disease (CKD) remain global health issues with high mortality and limited options to prevent end-stage renal failure. Current therapies encompass five classes of drugs: (1) angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin II receptor blockers (AIIRB); (2) sodium-glucose-transporter 2 (SGLT2) inhibitors; (3) glucagon-like peptide-1 receptor agonists (GLP-1 RA); and (4) an antagonist of type 1 endothelin receptor (ET1R) with proven efficacy to reduce albuminuria and proteinuria. (5) The mineralocorticoid receptor antagonist (MRA) finerenone has been tested in RCTs as a kidney protective agent. In our review, we summarize many of the principal trials that have generated evidence in this regard. Many novel agents—many of them proven not only for DM management but also for the treatment of obesity with or without DM or heart failure (HF)—are now in development and may be added to the five classical pillars: other non-steroidal MRA (balcinrenone); aldosterone synthase inhibitors (baxdrostat and vicadrostat); other GLP-1 RA (tirzepatide, survodutide, retatrutide, and cagrilintide); ET1 R antagonists, (zibotentan); and soluble guanylate cyclase activators (avenciguat). These new agents aim to slow disease progression further and reduce cardiovascular risk. Future strategies rely on integrated, patient-centered approaches and personalized therapy to curb renal disease and its related complications. Full article

Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for people living with obesity and type 2 diabetes due to their efficacy in reducing appetite and body weight. However, by inducing caloric restriction and altering gastrointestinal physiology, GLP-1RAs may predispose patients to nutritional deficiencies. This review aimed to synthesise current evidence on energy, protein, vitamin, and mineral status in GLP-1RA users, and contextualises these findings with metabolic and bariatric surgery (MBS) guidelines. While metabolic and bariatric surgery (MBS) guidelines mandate structured nutritional monitoring, no equivalent frameworks exist for GLP-1RA therapy, highlighting a critical gap that justifies the need for this review. Methods: A narrative review was conducted in three stages: (i) searching PubMed and Embase OVID (August 2025) using MeSH terms and free-text keywords related to GLP-1RAs, micronutrients, and obesity; (ii) screening abstracts and full texts for eligibility; and (iii) synthesising results with comparison to bariatric surgery protocols. Eligible studies included clinical trials, observational cohorts, and reviews reporting nutritional outcomes in GLP-1RA users or describing MBS monitoring guidelines. Results: GLP-1RA therapy consistently reduced caloric intake, with frequent inadequacy of protein intake and occasional sarcopenia. Observational data reported that users developed nutritional deficiencies within 12 months, most commonly vitamin D, followed by thiamine and other B vitamins. Mineral deficiencies, particularly in iron, calcium, magnesium, and potassium, were also observed. Conclusions: GLP-1RAs are associated with clinically relevant risks of protein, vitamin, and mineral deficiencies. The absence of formal monitoring protocols represents an unmet clinical need, and adaptation of surveillance, as seen in MBS, which may help mitigate long-term complications. Full article

Aim: To compare the effect of consuming three isocaloric diets that differed in macronutrient composition on substrate oxidation and glucose regulation during sustained submaximal exercise in adults with type 1 diabetes (T1D). Methods: In a randomised, crossover design, 12 adults with T1D (n = 4 female, age: 46 ± 15 years, HbA1c: 55.9 ± 7.8 mmol/mol) consumed three isocaloric diets over seven days: (i) HCLFLP (high-carbohydrate [48%], low-fat [33%], low-protein [19%]), (ii) LCHFLP (low-carbohydrate [19%]), high-fat [62%], low-protein [19%]), and (iii) LCLFHP (low-carbohydrate (19%), low-fat [57%], high-protein [24%]). On the morning of day eight, participants undertook 45 min of cycling (≈60% $\stackrel{.}{\mathrm{V}}$O_2peak) whilst fasting. Venous-derived plasma glucose and free fatty acids (FFA) were measured throughout the trial period. Indirect calorimetry was used to determine rates of substrate oxidation during exercise. Data were analysed via repeated measures ANOVAs with p ≤ 0.05 accepted as significant. Results: During exercise, rates of lipid oxidation were higher (1.2-fold, p = 0.030) and carbohydrate oxidation lower (0.8-fold, p = 0.030) in LCHFLP versus HCLFLP. Concentrations of FFA after exercise were higher in LCHFLP compared to HCLFLP (by ≈22%, p = 0.019). Overall time spent in euglycaemia was higher (HCLFLP: 55.6 ± 43.9, LCHFLP: 87.3 ± 28.7, LCLFHP: 95.2 ± 7.9%, p = 0.003) and hyperglycaemia lower (HCLFLP: 44.4 ± 43.9, LCHFLP: 12.7 ± 28.7, LCLFHP: 4.8 ± 7.9%, p = 0.003) in both LC diets relative to HC. No differences in any measured biomarkers were observed between the two LC diets. Conclusions: One-week consumption of isocaloric diets that differed in their macronutrient composition shifted patterns of energy metabolism during a standardised bout of moderate intensity exercise performed in the fasted state in adults with T1D. Full article