Search Results (5,486)

Pregnancies complicated by diabetes, including pregestational and gestational diabetes mellitus, are associated with increased maternal and fetal morbidity. Early identification of at-risk pregnancies is crucial for timely intervention and improved outcomes. Emerging evidence highlights the interplay of genetic predisposition, epigenetic modifications, and non-invasive biomarkers in the early detection of diabetic pregnancies. Genetic factors influencing insulin signaling, glucose metabolism, and pancreatic β-cell function may contribute to susceptibility to gestational hyperglycemia. Concurrently, epigenetic alterations, such as DNA methylation and histone modifications in maternal and placental tissues, have been linked to dysregulated metabolic pathways and adverse pregnancy outcomes. Non-invasive biomarkers, including circulating cell-free DNA and microRNAs in maternal blood, show promise for early diagnosis by offering a safer and more practical alternative to invasive testing. Integrating genetic, epigenetic, and molecular marker data could enhance risk stratification and enable personalized monitoring and management strategies. This review synthesizes current knowledge on the molecular underpinnings of diabetic pregnancies, evaluates the potential of emerging biomarkers for early diagnosis, and discusses the challenges and future perspectives for translating these findings into clinical practice. Understanding these mechanisms may pave the way for precision medicine approaches, ultimately improving maternal and neonatal outcomes in pregnancies affected by diabetes. Full article

Background and Clinical Significance: Overlap of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) in children is a rare but life-threatening metabolic emergency. The coexistence of hyperosmolality and ketoacidosis increases neurologic vulnerability and complicates fluid and insulin management. Early identification and osmolality-guided therapy are essential to prevent cerebral edema and other complications. This case describes a 5-year-old boy with new-onset type 1 diabetes mellitus (T1D) presenting with DKA/HHS overlap two weeks after influenza vaccination—an unusual temporal association without proven causality. Case Presentation: A previously healthy 5-year-old presented with progressive polyuria, polydipsia, nocturnal enuresis, fatigue, and drowsiness. Two weeks earlier, he had received the influenza vaccine. Examination revealed moderate dehydration without Kussmaul respiration or altered consciousness. Laboratory evaluation showed glucose 45.9 mmol/L (826 mg/dL; reference 3.9–7.8 mmol/L), venous pH 7.29 (reference 7.35–7.45), bicarbonate 12 mmol/L (reference 22–26 mmol/L), moderate ketonuria, and measured serum osmolality 344 mOsm/kg (reference 275–295 mOsm/kg), fulfilling diagnostic criteria for DKA/HHS overlap. After an initial 20 mL/kg 0.9% NaCl bolus, fluids were adjusted to maintenance plus approximately 10% deficit using 0.45–0.75% NaCl according to sodium/osmolality trajectory. Intravenous insulin (approximately 0.03–0.05 IU/kg/h) was initiated once blood glucose no longer decreased adequately with fluids alone and had stabilized near 22.4 mmol/L (≈400 mg/dL). Dextrose was added when glucose reached 13.9 mmol/L (250 mg/dL) to avoid rapid osmolar shifts. Hourly neurological and biochemical monitoring ensured a glucose decline of 2.8–4.2 mmol/L/h (50–75 mg/dL/h) and osmolality decrease ≤3 mOsm/kg/h. The patient recovered fully without cerebral edema or neurologic sequelae. IA-2 antibody positivity with low C-peptide and markedly elevated HbA1c confirmed new-onset T1D. Conclusions: This case highlights the diagnostic and therapeutic challenges of pediatric DKA/HHS overlap. Osmolality-based management, conservative insulin initiation, and vigilant monitoring are crucial for preventing complications. The temporal proximity to influenza vaccination remains incidental. Full article

Non-communicable diseases (NCDs) such as Diabetes Mellitus (DM) and Sickle Cell Disease (SCD) pose an escalating health challenge in Africa, underscored by diagnostic deficiencies, inadequate surveillance, and limited health system capacity that contribute to late diagnoses and consequent preventable complications. This review adopts a comparative framework that considers DM and SCD as complementary indicator diseases, both metabolic and genetic, and highlights intersecting diagnostic, infrastructural, and governance hurdles relevant to AI-enabled screening in resource-constrained environments. The study synthesizes epidemiological data across both African and high-income regions and methodically catalogs machine learning (ML) and deep learning (DL) research by clinical application, including risk prediction, image-based diagnostics, remote patient monitoring, privacy-preserving learning, and governance frameworks. Our key observations reveal significant disparities in disease detection and health outcomes, driven by underdiagnosis, a lack of comprehensive newborn screening for SCD, and fragmented diabetes surveillance systems in Africa, despite the availability of effective diagnostic technologies in other regions. The reviewed literature on ML/DL shows high algorithmic accuracy, particularly in diabetic retinopathy screening and emerging applications in SCD microscopy. However, most studies are constrained by small, single-site datasets that lack robust external validation and do not align well with real-world clinical workflows. The review identifies persistent implementation challenges, including data scarcity, device variability, limited connectivity, and inadequate calibration and subgroup analysis. By integrating epidemiological insights into AI diagnostic capabilities and health system realities, this work extends beyond earlier surveys to offer a comprehensive, Africa-centric, implementation-focused synthesis. It proposes actionable operational and policy recommendations, including offline-first deployment strategies, federated learning approaches for low-bandwidth scenarios, integration with primary care and newborn screening initiatives, and enhanced governance structures, to promote equitable and scalable AI-enhanced diagnostics for NCDs. Full article

Plants from the Zingiberaceae family, particularly Zingiber officinale, Curcuma longa, and Alpinia galanga, are rich sources of bioactive compounds with documented antidiabetic and anti-inflammatory properties. This review summarizes current evidence on their phytochemical profiles and pathways relevant to metabolic regulation. Key compounds, including gingerols, shogaols, curcuminoids, and phenylpropanoids, support glucose homeostasis by enhancing insulin sensitivity, promoting Glucose Transporter Type 4 (GLUT4)-mediated glucose uptake, improving β-cell function, and modulating metabolic signaling pathways such as PI3K/Akt, AMPK, PPARγ, and NF-κB. Their potent antioxidant and anti-inflammatory activities further reduce oxidative stress and chronic low-grade inflammation, both central to the progression of type 2 diabetes and its complications. Evidence from selected clinical and experimental studies suggests that dietary supplementation with whole-rhizome preparations or standardized extracts (including formulation-enhanced products) may improve fasting blood glucose (FBG), glycated hemoglobin (HbA1c), lipid metabolism, and oxidative stress markers. Recent advances in delivery systems, including nanoemulsions, liposomes, and curcumin–piperine complexes, substantially enhance the bioavailability of poorly soluble phytochemicals, strengthening their therapeutic potential. Overall, Zingiberaceae plants emerge as promising natural supplements in nutritional and pharmacological strategies targeting diabetes. Further clinical research is required to refine dosage, confirm long-term efficacy, and support their integration into evidence-based metabolic interventions. Full article

The prevalence and incidence of prediabetes in children and youth continue to increase in parallel with the obesity epidemic. While prediabetes is defined by elevated HbA1c and/or impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG), the risk of clinical disease is a continuum. Individuals with prediabetes are at a higher risk of developing youth-onset type 2 diabetes, which is considered a more aggressive form of the disease. This condition is associated with increased cardiovascular and metabolic risks and leads to an earlier onset of complications compared to adults with type 2 diabetes. Additionally, significant damage to beta cells may occur even before dysglycemia develops. Recent data indicate that mortality rates are higher in youths with type 2 diabetes compared to those with type 1 diabetes. Childhood prediabetes and cardiovascular complications associated with it are a significant health concern. This review provides the latest insights into this complex issue. We will present an overview of pathophysiology, screening methods, and therapeutic options to prevent the progression from prediabetes to type 2 diabetes in children. In summary, it is crucial to identify prediabetes in children, as this underscores the importance of appropriate screening and timely intervention. Full article

Diabetic retinopathy (DR) has been classically considered a microvascular disease with all diagnostic and therapeutic resources focusing on its vascular components. However, during the past years, the obtained evidence highlighted the critical pathogenic role of early neuronal impairment redefining DR as a neurovascular complication. Retinal neurodegeneration is triggered by chronic hyperglycemia, which activates harmful biochemical pathways that lead to oxidative stress, metabolic overload, glutamate excitotoxicity, inflammation, and neurotrophic factor deficiency. These drivers of neurodegeneration can precede detectable vascular abnormalities. Simultaneously, endothelial injury, pericyte loss, and breakdown of the blood–retinal barrier compromise neurovascular unit integrity and establish a damaging cyclic loop in which neuronal and vascular dysfunctions reinforce each other. The interindividual variability of these processes highlights the need to properly redefine patient phenotyping by using advanced imaging and functional biomarkers. This would allow early detection of neurodegeneration and patient subtype classification. Nonetheless, translation of therapies based on neuroprotection has been limited by classical focus on vascular impairment. To meet this need, several strategies are emerging, with the most promising being those delivered through innovative ocular routes such as topical formulations, sustained-release implants, or nanocarriers. Future advances will depend on proper guidance of these therapies by integrating personalized medicine with multimodal biomarkers. Full article

Background and Objectives: Obesity has been increasing sharply worldwide and is related to diabetes, cardiovascular diseases, liver disease, and cancer. Sleeve gastrectomy is the most used surgical approach to reduce body weight and treat metabolic implications observed in patients with moderate-to-severe obesity. On the other hand, this procedure affects the musculoskeletal system, and investigating skeletal muscle is not routinely recommended for bariatric surgery. This study aimed to evaluate the psoas muscle in patients in the preoperative period of sleeve gastrectomy and six months after the procedure using abdominal computed tomography scans. Materials and Methods: This clinical, exploratory, and observational study, with a prospective longitudinal observational study design, was conducted at a single center with 31 women who underwent sleeve gastrectomy. The evaluations were performed before and after six months of the procedures. Results: Anthropometric, muscle strength, hepatic ultrasound, and psoas computerized tomography evaluations were performed. A significant reduction in body weight, body mass index, waist, neck, and calf circumference was observed. There was also a substantial reduction in right-hand strength and the area and index of the psoas muscle (but with an increase in density). Most presented a routine abdominal ultrasound. Conclusions: Our results suggest that muscle evaluation provides valuable information for clinical monitoring before and after bariatric surgery, helping to identify potential risks and guide multidisciplinary follow-up. Psoas muscle area and psoas muscle index decreased, but psoas muscle density increased, all significantly. These results indicate that conducting a muscle evaluation is helpful for patients undergoing bariatric surgery, supporting the use of the clinical approach before and after the procedure, predicting possible complications, and providing more accurate prognoses. Full article

Type 2 diabetes mellitus (T2DM) is a multifaceted metabolic disorder marked by impaired insulin action, pancreatic β-cell dysfunction, and the involvement of several interconnected mechanisms, including inflammation, oxidative stress, and epigenetic alterations. Despite progress in conventional therapies, achieving durable glycemic control and minimizing complications remain major challenges. This review discusses the emerging role of bioactive phytochemicals—such as curcumin, berberine, resveratrol, flavonoids, and polysaccharides—in modulating essential molecular pathways including AMPK, PI3K/AKT, and cAMP/PKA, which contribute to enhanced insulin sensitivity, glucose regulation, and β-cell protection. These natural compounds also influence gut microbiota modulation and epigenetic mechanisms, offering additional metabolic and anti-inflammatory benefits. This review synthesizes evidence from peer-reviewed studies published between 2000 and 2024, incorporating bibliometric trends showing an increasing research focus on phytochemicals for T2DM management. However, limitations such as low solubility, instability, and poor absorption restrict their clinical application. Advances in nanotechnology-based delivery systems, including nanoparticles, liposomes, and nanoemulsions, have shown potential to overcome these barriers by improving stability, bioavailability, and targeted delivery of phytochemicals. The integration of gut microbiota modulation with nanocarrier-enabled phytochemical therapy supports a precision medicine approach for managing T2DM. Preliminary clinical evidence highlights significant improvements in glycemic control and inflammatory status, yet further large-scale, well-controlled trials are essential to ensure safety, optimize dosages, and standardize combination regimens. Overall, phytochemical therapies, reinforced by nanotechnology and microbiota modulation, present a promising, safe, and holistic strategy for T2DM management. Continued interdisciplinary research and clinical validation are crucial for translating these advances into effective therapeutic applications and reducing the global diabetes burden. Full article

Prediabetes is a serious and major global problem afflicting approximately 21% of the world’s population. It is the intermediate stage between normal glucose levels and type 2 diabetes mellitus (T2DM). Prediabetes is associated with major complications including the development of T2DM and increased cardiovascular disease (CVD). It can be easily diagnosed with an inexpensive plasma glucose level and/or a hemoglobin A1c (HbA1c) measurement. The mainstay of treatment is intensive lifestyle (ILS) intervention, including reduction in calories, especially saturated fats, refined carbohydrates, etc., coupled with regular physical activity of 150 min per week since ILS changes, with at least a 5% weight loss, have been shown to reduce progression to T2DM in multiple studies globally. Also, metformin therapy has been shown to prevent the progression to T2DM. In conclusion, serious consideration by guideline committees to classify prediabetes as a disease is highly recommended based on its global burden, easy and cost-effective diagnosis, association with serious conditions of diabetes and CVD, and effective ILS intervention. Therapy targeting those at an especially high risk for T2DM, such as persons with impaired glucose tolerance (IGT), impaired fasting glucose (IFG) with values ≥ 110 mg/dL (6.1 mmol/L), and/or HbA1c ≥ 6.0% (42 mmol/mol) coupled with overweightness or obesity. Full article

Background: Acute kidney injury (AKI) is a frequent and clinically relevant complication in cancer patients, with highly variable incidence. AKI increases morbidity and mortality, prolongs hospitalization, and may limit access to oncologic therapies. This study evaluated the incidence, risk factors, and outcomes of AKI in hospitalized cancer patients. Methods: We retrospectively analyzed patients admitted between 1 January 2016 and 31 December 2019. Individuals with cancer were identified and categorized into three groups: hematologic malignancies, solid cancers with metastases, and solid cancers without metastases. Demographic, clinical, and laboratory data were collected, and AKI was defined and staged according to KDIGO criteria, evaluating serum creatinine changes. Results: Among 56,390 hospitalized patients, 6723 (11.9%) had a cancer diagnosis. AKI incidence was significantly higher in cancer versus non-cancer patients (30.1% vs. 19.6%). Hematologic cancers showed the highest incidence (39.3%). Among hematologic patients, ICU admission, sepsis, and diabetes were strongly associated with AKI. In non-metastatic solid cancers, more conventional factors—including female sex, older age, sepsis, and ICU admission—were significant predictors. In contrast, in metastatic solid cancers, traditional AKI risk factors did not correlate with increased AKI occurrence. In cancer patients overall, AKI per se did not increase mortality risk; however, stage 3 AKI was associated with significantly higher mortality (HR 1.37, 95% CI 1.13–1.66, p < 0.001). Conclusions: AKI is common in hospitalized cancer patients, with specific patterns and heterogeneous risk factors and impact on outcomes. Implementation of tailored preventive strategies and early recognition are necessary to mitigate progression and improve clinical trajectories. Full article

Ketones are metabolites primarily produced by the liver and are utilized by various organs outside of the liver. Recent advances have demonstrated that ketones serve not only as alternative energy sources but also as signaling molecules. Research indicates that ketones can influence cancer development and metastasis, cardiac metabolic and structural remodeling, physical performance, vascular function, inflammation, and the aging process. Emerging evidence from preclinical and early-phase clinical studies suggests that strategies such as ketone salts, ketone esters, and the ketogenic diet may offer therapeutic benefits for conditions like heart failure, acute cardiac injury, diabetic cardiomyopathy, vascular complications, atherosclerosis, hypertension, and aortic aneurysm. This literature review updates the current understanding of ketone metabolism and its contributions to cardiovascular health and diseases. We highlight the underlying molecular mechanism with post-translational modification known as β-hydroxybutyrylation, which affects the fate and function of target proteins. Additionally, we discuss the therapeutic challenges associated with ketone therapy, the potential of using ketone levels as biomarkers for cardiovascular diseases, as well as gender- and age-specific differences in ketone treatment. Finally, we explore future research directions and what is needed to translate these new insights into cardiovascular medicine. Full article

Background: Sex-based disparities in the presentation, management, and outcomes of infective endocarditis (IE) remain insufficiently characterized despite their growing recognition. This study systematically evaluates current evidence on sex differences in the presentation, treatment, and outcomes of IE. Methods: A systematic review and meta-analysis were conducted according to PRISMA and Cochrane guidelines. EMBASE, MEDLINE, PubMed, the Cochrane Library, and Google Scholar were searched up to October 2024. Twenty-four studies including 139,952 patients (79,698 men and 60,254 women) were analyzed. Primary outcomes were mortality (in-hospital, 30-day, and 1-year), stroke, and treatment modality (medical vs. surgical). Secondary outcomes included complications, procedural characteristics, and hospital course. Results: Men were younger at diagnosis and had higher rates of substance abuse and coronary artery disease, while women more often had hypertension, diabetes, chronic lung disease, and prior valvular pathology. Men more frequently had aortic and prosthetic valve IE, whereas women had mitral and tricuspid involvement. Men were about 65% more likely to undergo surgery for infective endocarditis than women, while women were predominantly managed medically. Men had lower in-hospital (OR 0.81, 95% CI 0.72–0.92) and 1-year mortality (OR 0.76, 95% CI 0.61–0.94), though 30-day mortality did not differ significantly. Women experienced shorter hospital stays but longer ICU admissions and more heart failure, whereas men had more recurrent IE. Conclusions: Men underwent surgery more often and had better short- and long-term survival. Women presented later, with greater comorbidity and higher complication rates. Enhanced recognition of sex-specific risk and equitable surgical referral may improve IE outcomes. Full article

The limitations of conventional diabetes management are increasingly evident. As a result, both type 1 and 2 diabetes in pediatric populations have become major global health concerns. As new technologies emerge, particularly artificial intelligence (AI), they offer new opportunities to improve diagnostic accuracy, treatment outcomes, and patient self-management. A PRISMA-based systematic review was conducted using PubMed, Web of Science, and BIREME. The research covered studies published up to February 2025, where twenty-two studies met the inclusion criteria. These studies examined machine learning algorithms, continuous glucose monitoring (CGM), closed-loop insulin delivery systems, telemedicine platforms, and digital educational interventions. AI-driven interventions were consistently associated with reductions in HbA1c and extended time in range. Furthermore, they reported earlier detection of complications, personalized insulin dosing, and greater patient autonomy. Predictive models, including digital twins and self-learning neural networks, significantly improved diagnostic accuracy and early risk stratification. Digital health platforms enhanced treatment adherence. Nonetheless, the barriers included unequal access to technology and limited long-term clinical validation. Artificial intelligence is progressively reshaping pediatric diabetes care toward a predictive, preventive, personalized, and participatory paradigm. Broader implementation will require rigorous multiethnic validation and robust ethical frameworks to ensure equitable deployment. Full article

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

Background/Objectives: Type 1 diabetes mellitus (T1DM) is a chronic autoimmune condition that requires continuous glycemic monitoring to prevent acute and long-term complications. In recent years, Diabetic Alert Dogs (DADs) have been increasingly used as an adjunctive strategy to assist individuals with T1DM by alerting glycemic fluctuations through olfactory detection of physiological changes. Despite growing interest, the available evidence remains heterogeneous and fragmented. Methods: Therefore, this scoping review was conducted to address the following research question: “What evidence is available regarding the relationship between Diabetic Alert Dogs (DADs) and glycemic monitoring in individuals with T1DM?”, conducted in accordance with the Joanna Briggs Institute methodology and reported following the PRISMA Extension for Scoping Reviews. Results: Searches were performed in PubMed, Scopus, and Web of Science without time restrictions. After duplicate removal (n = 485), 2379 records were screened, of which 24 articles underwent full-text assessment and 10 studies met the predefined inclusion criteria. Regarding glycemic alteration detection, most studies (7/10) reported that DADs could identify both hypoglycemic and hyperglycemic episodes, while the remaining studies focused exclusively on hypoglycemia detection. Sensitivity values were consistently higher for hypoglycemia than for hyperglycemia, and none reported false alert rates exceeding 20%. In addition to glycemic alert performance, improvements in perceived safety, independence, and quality of life were described in half of the included studies (5/10). Conclusions: By systematically mapping the characteristics, outcomes, and methodological approaches of studies involving DADs, this scoping review provides an overview of current evidence and identifies key knowledge gaps in training protocols, outcome standardization, and performance reporting. Full article