Search Results (717)

The global transition toward plant-based diets has driven the inclusion and legumes as primary sources of proteins and micronutrients. However, the raw whole seed hosts complex matrices of antinutritional factors and crystalline starch arrangements that limit proteolytic digestibility, chelate essential minerals, and induce accelerated postprandial glycemic responses. Conventional culinary and thermal treatments applied in isolation are frequently insufficient to disrupt the physicochemical matrix of the seeds, leaving critical gaps regarding how to sustainably optimize mineral bioaccessibility and convert water-soluble starches into stable slowly digestible fractions. This scoping review synthesizes analytical evidence demonstrating that targeted fermentative bioprocessing acts as a microstructural modulator. However, these biochemical outcomes are not unidirectional; the expansion of nutritional value is strictly governed by a complex interplay of substrate properties, process moisture, pH adjustments, and thermal pretreatments in plant defense frameworks and spatially reorganizing starch polymers. Microbial organic acid production and the mechanical penetration of fungal hyphae promote a 90–100% degradation and elimination of phytates and condensed tannins, eliminating non-digestible galacto-oligosaccharides and inactivating trypsin inhibitors. These mechanisms optimize phytate-to-mineral molar ratios, doubling the bioaccessibility of iron, zinc, and calcium in the digestive aqueous phases, while microbial beta-glucosidase expression bioconverts conjugated glycosides into free aglycones with high antioxidant activity. Simultaneously, the induction of molecular retrogradation drives continuous increases in the resistant starch fraction, inducing significant reductions in the hydrolysis index and lowering the predictive glycemic index to low thresholds. These findings consolidate controlled fermentation as a viable biotechnological intervention, providing structural guidelines for the rational design of functional foods, biofortified baked goods, and vegan beverages with high digestive tolerance. Full article

Background/Objectives: Therapeutic education for children and adolescents with Type 1 Diabetes Mellitus (T1DM) is a continuous and essential process in the effective management of the disease. These programs consider the unique characteristics and developmental needs of each child or adolescent, aiming to empower them to take responsibility for their disease self-management, improve quality of life, and prevent complications. The purpose of this systematic review was to evaluate the impact of therapeutic education in children and adolescents with T1DM on self-management of their disease. Methods: International bibliography was reviewed using electronic databases such as PubMed, Cochrane Library, and Scopus. Key words such as “Therapeutic Education”, “Type 1 diabetes”, “children”, “self-management”, “glycemic control”, and “educational programs” in combination with Boolean operators (AND, OR) were used in English language to search for studies conducted during 2014–2024. Results: A total of 23 studies met the inclusion criteria. Most reported improvements in glycemic control, though not all showed statistically significant reductions in glycated hemoglobin (HbA1c). Enhanced treatment adherence and increased diabetes-related knowledge were common outcomes. Combined educational approaches incorporating psychoeducational interventions demonstrated greater effectiveness in promoting self-management. Digital tools, such as Continuous Glucose Monitoring (CGM), further supported adherence. Quality-of-life improvements were noted but were not always sustained long-term. Parental involvement appeared to improve children’s confidence in disease management. The critical role of interdisciplinary diabetes care teams, particularly nurses’ role, was also highlighted. Conclusions: Therapeutic education appears to support self-management among children and adolescents with T1DM, particularly when programs are individualized, family-centered, multidisciplinary, and supported by psychosocial or technological components. However, effects on glycemic control were not consistent across studies, and further research is needed to confirm long-term outcomes. Full article

Apolipoprotein A-IV (ApoA-IV) is a glycoprotein secreted by the small intestine to regulate lipid metabolism and satiety. Its role in insulin-independent glucose homeostasis remains largely unknown. In this study, we demonstrate that intestinal ApoA-IV overexpression significantly attenuates diet-induced obesity and hyperglycemia following severe β-cell loss. Over a 20-week high-fat diet challenge, ApoA-IV transgenic (ApoA-IV-Tg) mice maintained significantly lower adiposity than wild-type controls, driven by elevated energy expenditure and fatty acid oxidation rather than reduced caloric intake. Beyond weight maintenance, ApoA-IV maintained excellent systemic glycemic control and enhanced peripheral insulin sensitivity. Most notably, ApoA-IV significantly attenuated hyperglycemia following streptozotocin (STZ)-induced β-cell ablation, maintaining glucose stability despite severe insulin deficiency. Mechanistically, this protection results from a blunted glucagon response and the subsequent suppression of the hepatic pCREB-G6Pase gluconeogenic signaling pathway. In vitro evidence confirms that ApoA-IV directly inhibits pancreatic α-cell glucagon secretion through an LDL receptor-related protein 1 (LRP1)-dependent pathway, reinforced by the precise co-localization of LRP1 and glucagon in pancreatic islets. Furthermore, ApoA-IV-Tg mice were protected from the STZ-induced corticosterone surge and systemic lipolysis. Collectively, these findings establish the ApoA-IV–LRP1 signaling axis as a potent metabolic switch, providing a promising insulin-independent strategy for managing obesity and diabetes. Full article

Background/Objectives: Acromegaly is a chronic endocrine disorder caused mainly by GH-secreting pituitary adenomas, leading to excess GH and elevated IGF-1. Although surgery is first-line therapy, many patients require medical treatment, and remission is often not achieved with first-generation somatostatin receptor ligands (SRLs). Pasireotide, a second-generation SRL, offers superior biochemical and tumor control but is associated with hyperglycemia. This study aimed to evaluate real-world outcomes associated with pasireotide treatment in patients with acromegaly inadequately controlled on first-generation SRLs, with IGF-1 normalization as the primary endpoint. Secondary outcomes included GH control, tumor response, and glycemic safety. Methods: We conducted a historical cohort study of adults with acromegaly treated at Clínica Imbanaco (Cali, Colombia) between 2017 and 2024. Eligible patients had residual tumors and persistently elevated GH and/or IGF-1 levels above the age-adjusted upper limit of normal despite treatment with clinically adequate doses of first-generation SRLs, as well as 12 months of continuous pasireotide treatment and follow-up after pasireotide initiation. Demographic, biochemical, imaging, and glycemic data were collected. Statistical analysis included paired and independent Student’s t-tests, Wilcoxon signed-rank tests, McNemar’s test, and Fisher’s exact test, with significance set at p < 0.05. Results: Fourteen patients (50% female; mean age 52.1 ± 14.5 years) were included. After 12 months, mean IGF-1 decreased from 2.73 ± 0.73 to 0.99 ± 0.56 × ULN, and 50% achieved IGF-1 normalization. Additionally, 35.7% achieved GH < 1 ng/mL, and 14.3% achieved combined control. Mean tumor diameter decreased by −3.26 mm (95% CI −4.56 to −1.95; p < 0.001). HbA1c increased from 5.56% to 6.05%, while type 2 diabetes mellitus prevalence rose from 14.3% to 35.7%. No patient discontinued pasireotide due to metabolic adverse events. Conclusions: Pasireotide was associated with favorable biochemical and tumor responses in patients with acromegaly inadequately controlled on first-generation SRLs under real-world conditions. Although treatment was associated with higher HbA1c and increased diabetes incidence, proactive monitoring and early management of hyperglycemia may have supported treatment persistence. Full article

Pregnancy involves profound metabolic, hormonal, and immunological adaptations essential for fetal development; however, disturbances may lead to complications such as preeclampsia (PE), pre-gestational diabetes, and gestational diabetes mellitus (GDM). These conditions are closely linked to oxidative stress, inflammation, endothelial dysfunction, impaired placentation, and metabolic dysregulation. Consequently, dietary strategies capable of modulating these pathways are of increasing interest. Edible and medicinal mushrooms are widely studied as functional food due to the content of bioactive compounds with antioxidant, anti-inflammatory, immunomodulatory, and metabolic regulatory effects. This review summarizes the nutritional composition of mushrooms and highlights key bioactive constituents with antioxidant and metabolic regulatory properties. Among them, ergothioneine has emerged as a key molecule due to its potent redox-buffering capacity and its potential involvement in the activation of the Nrf2 signaling pathway, a master regulator of cellular antioxidant defense. Through modulation of Nrf2-dependent gene expression, mushroom-derived compounds may contribute to improved cellular resilience against oxidative damage relevant to PE and GDM pathophysiology. Mushroom consumption has additionally been associated with improved glycemic control and enhanced antioxidant defenses in experimental and limited clinical studies, although evidence regarding the prevention or management of hypertensive and metabolic pregnancy complications remains insufficient. Although preclinical findings are promising, clinical evidence remains limited. Further well-designed prospective studies and randomized controlled trials are required to determine efficacy, safety, optimal intake, and active compounds responsible for these effects. Nevertheless, current evidence supports the biological plausibility that edible and medicinal mushrooms are promising dietary modulators of the ergothioneine–Nrf2 axis with potential relevance for maternal–fetal health. Full article

Background: Epilepsy is a complex neurological disorder in which growing evidence supports a significant role for the microbiota–gut–brain axis (MGBA) in modulating neuroinflammation, neuronal excitability, and treatment responsiveness. Beyond their traditional role in inducing ketosis, dietary therapies may influence epilepsy by modulating gut microbial ecology, intestinal barrier integrity, immune signaling, and microbiota-derived metabolites. Methods: This narrative review critically examines current clinical and experimental evidence regarding the relationship between epilepsy, gut microbiota, and dietary interventions. Particular attention was given to ketogenic dietary therapies, the Modified Atkins Diet (MAD), low-glycemic-index treatment (LGIT), Mediterranean dietary patterns, restrictive diets, and microbiota-targeted supplementation, including probiotics, prebiotics, and postbiotics. Results: Available evidence suggests that patients with epilepsy exhibit alterations in gut microbial composition associated with impaired short-chain fatty acid production, intestinal inflammation, and altered neuroimmune regulation. Ketogenic and microbiota-supportive dietary approaches may modulate these pathways beyond ketosis alone, potentially contributing to seizure reduction through integrated metabolic, inflammatory, and microbial mechanisms. Emerging evidence also supports a role for probiotics, prebiotics, and postbiotics in modulating gut–brain communication and neuroinflammatory signaling, although current clinical data remain limited. Conclusions: Dietary therapies in epilepsy should no longer be viewed exclusively as metabolic interventions aimed at inducing ketosis, but rather as potential modulators of the microbiota–gut–brain axis and neuroimmune homeostasis. While further mechanistic and clinical studies are needed, microbiota-targeted nutritional approaches may represent valuable complementary strategies to be integrated alongside conventional antiseizure therapies within more personalized models of epilepsy management. Full article

Background: Type 2 diabetes mellitus is characterized by chronic low-grade inflammation, immune dysregulation, and metabolic impairment. This study investigated cytokine profiles associated with physical exercise and insulin therapy in patients with Type 2 diabetes mellitus. Methods: Blood samples were collected from 51 volunteers to evaluate metabolic parameters and cytokine concentrations. According to glycemic status and insulin use, participants were classified into non-diabetic, non-insulin-dependent Type 2 Diabetes Mellitus, and insulin-dependent Type 2 Diabetes Mellitus groups. Results: Physically active individuals with non-insulin-dependent Type 2 Diabetes Mellitus exhibited increased IL-4, IL-6, and IL-10 levels, suggesting enhanced immunoregulatory and anti-inflammatory responses. Physically active patients with insulin-dependent Type 2 Diabetes Mellitus showed elevated IL-17 concentrations. In contrast, sedentary individuals with insulin-dependent Type 2 Diabetes Mellitus exhibited higher TNF-α levels, indicating a more pronounced proinflammatory profile. IFN-γ concentrations were significantly higher in patients with insulin-dependent Type 2 Diabetes Mellitus, regardless of exercise status. Correlation analyses demonstrated distinct cytokinemetabolic interaction patterns according to metabolic condition and physical exercise. Conclusion: Cytokines can serve as molecular markers of immunometabolic responses associated with physical exercise and insulin therapy in Type 2 Diabetes Mellitus, reflecting alterations in systemic inflammatory regulation and immune–metabolic crosstalk related to glycemic adaptation. Full article

Background: Fixed-ratio combinations of basal insulin and glucagon-like peptide-1 receptor agonists have emerged as an effective strategy for treatment intensification in type 2 diabetes mellitus (T2DM). However, long-term real-world data on their metabolic, β-cell, and renal effects remain limited. This study aimed to evaluate the 12-month real-world outcomes of insulin glargine/lixisenatide (iGlarLixi) therapy. Methods: This retrospective observational study included 78 patients with T2DM who were initiated on iGlarLixi and followed for 12 months. Clinical and laboratory parameters were assessed at baseline, 3 months, and 12 months. Changes in anthropometric, glycemic, biochemical, and renal parameters were analyzed. Early (3-month) changes were evaluated as predictors of long-term outcomes using correlation and receiver operating characteristic (ROC) analyses. Results: Median HbA1c decreased from 9.0% to 8.2% at 12 months (p = 0.015), with clinically meaningful improvement (≥1% reduction) observed in 21 (26.9%) patients. Body weight decreased significantly from 93.0 kg to 89.5 kg (p < 0.001). C-peptide levels increased from 2.46 to 3.00 ng/mL (p = 0.016). Median albumin-to-creatinine ratio (ACR) showed statistically significant paired changes; however, group-level median values remained similar over time. A reduction in albuminuria was observed in 34 (54.8%) of patients with available paired data. Exploratory ROC analyses suggested that early changes in body weight (AUC: 0.82), HbA1c (AUC: 0.74), and C-peptide (AUC: 0.76) may be associated with long-term outcomes. A combined model incorporating early weight and C-peptide changes showed improved exploratory predictive performance (AUC: 0.88). Conclusions: In a real-world setting, iGlarLixi therapy was associated with significant improvements in glycemic control and body weight, along with increased C-peptide levels that may reflect improved endogenous insulin secretion. While group-level renal changes were modest, individual-level improvements in albuminuria were observed in a substantial proportion of patients. Early treatment responses may serve as practical predictors of long-term outcomes, supporting a personalized approach to diabetes management. These findings should be interpreted in the context of concomitant therapies and comorbidities that may have influenced metabolic and renal outcomes in routine clinical practice. Full article

Background: Honey possesses anti-inflammatory, antimicrobial, and wound-healing properties due to its complex mixture of carbohydrates, phenolics, flavonoids, vitamins, and minerals. However, comprehensive data on monofloral honeys from Saudi Arabia’s Qassim region are lacking. Objective: This study evaluated the nutritional composition, glycemic index, antioxidant and anti-inflammatory activities of five Qassim honeys (Talh, Keina, Samr, Berseem, Ashr) and identified chemical components responsible for their therapeutic potential. Methods: Physicochemical parameters, sugar profiles, minerals, vitamins, total phenolic content (TPC), total flavonoid content (TFC), diastase activity, and HMF were analyzed. Antioxidant activity was assessed by DPPH and ABTS assays, anti-inflammatory activity by BSA denaturation inhibition, and in vitro glycemic index by simulated digestion. Statistical comparisons used one-way ANOVA with Fisher’s LSD (n = 5). Results: All honeys met international quality standards (moisture < 20%, HMF < 40 mg/kg, F + G > 60 g/100 g). Samr honey showed the highest TPC (890 mg GAE/kg) and TFC (226 mg QE/kg). Ashr and Berseem exhibited the highest DPPH scavenging (92% and 91%). Samr was the most potent ABTS scavenger (IC₅₀ 26.7 μg/mL). Ashr displayed the strongest anti-inflammatory activity (86.9%), followed by Berseem (72.0%). All honeys had low glycemic index (51–55). Talh and Samr (Acacia-derived) were richest in K, Mg, P, Fe, and Zn; Keina (Eucalyptus) was highest in Ca; Berseem (clover) had the lowest mineral content. Samr honey contained the highest levels of vitamin C and B vitamins. Conclusions: The five Qassim monofloral honeys possess distinct nutritional and bioactive profiles. Samr honey is exceptionally rich in phenolics, flavonoids, and B vitamins, contributing to high antioxidant capacity. Ashr and Berseem honeys showed remarkable anti-inflammatory activity. All honeys are low-glycemic and meet quality standards. These findings support their use as functional foods and provide a basis for botanical authentication and quality control. Full article

Young barley, derived from the early vegetative stage of Hordeum vulgare L., constitutes a plant-based functional ingredient whose phytochemical profile differs markedly from that of mature grain. Two principal commercial forms exist—dried grass powder and juice-derived products—differing in matrix composition and bioactive compound concentration. This narrative review critically evaluates the current knowledge on the phytochemical composition, biological activity, and translational relevance of young barley preparations considered as a functional plant food. The phytochemical spectrum is dominated by C-glycosyl flavones, particularly saponarin and lutonarin, alongside phenolic acids, chlorophylls, enzymatic antioxidants, vitamins, and minerals. Experimental evidence implicates the modulation of redox homeostasis, inflammatory signaling, and metabolic regulators as the primary biological mechanisms. In vitro studies additionally demonstrate antiproliferative activity in human cancer cell lines and immunomodulatory properties mediated by polysaccharide-rich fractions, extending the biological profile of young barley beyond classical antioxidant activity. Although preclinical models consistently demonstrate antioxidant and metabolic effects, high experimental doses and limited preparation standardization restrict the direct extrapolation to human supplementation contexts. Available clinical trials suggest modest improvements in selected lipid, glycemic, and oxidative stress markers; yet, most are small in scale and brief in duration. Agronomic variables including fertilization strategy and soil composition represent additional, underappreciated sources of phytochemical variability and safety concern. Overall, the current evidence supports the biological plausibility of young barley as a functional plant food; yet, the clinical data remain preliminary. Future research should prioritize preparation standardization, dose–response characterization, and agronomic transparency to strengthen translational reliability. In conclusion, young barley preparations represent a biologically plausible functional plant food ingredient with preliminary clinical support, pending confirmation from adequately powered, standardised randomised controlled trials. Full article

Metformin, widely prescribed for type 2 diabetes mellitus (T2D), has emerged as a systemic immunomodulator with effects that extend far beyond glycemic control. Recent advances in immunometabolism reveal that metformin modulates innate immune responses through coordinated cellular metabolic reprogramming and epigenetic modification, which collectively modulate the functional phenotype of innate immune cells. This narrative review summarizes current evidence regarding the immunomodulatory effects of metformin on the innate immune system, with a focus on immunometabolism and epigenetic regulation. It explores how metformin modulates innate immunity by altering cellular energy sensing, mitochondrial function, and nutrient utilization. Such metabolic changes and alterations further reshape chromatin structure and architecture, as well as transcriptional profiles and programs. Through the regulation of glycolysis, fatty acid oxidation, and histone modification landscapes, metformin regulates the phenotypes of innate immune cells, which can be pro-inflammatory, tolerogenic, or homeostatic. This conceptual framework presents a new understanding of metformin. As well as acting as an anti-inflammatory agent, it may regulate immune memory. Full article

Background: The clinical impact of oral semaglutide on cardiac biomarkers in real-world patients with heart failure with preserved ejection fraction (HFpEF) and type 2 diabetes mellitus (T2DM) remains unclear. We evaluated whether initiation of oral semaglutide was associated with a reduction in B-type natriuretic peptide (BNP) levels and explored factors associated with this response. Methods: We retrospectively enrolled 27 patients with HFpEF who initiated oral semaglutide for T2DM management at a single academic center. Clinical data were collected at three time points: three months before treatment initiation (pre-treatment period), at initiation (baseline), and three months after semaglutide initiation (on-treatment period). The primary outcome was the change in the common logarithm of BNP levels (log BNP) during the on-treatment versus pre-treatment period. Results: Median age was 67 (59, 78) years and 21 (77.8%) were men. Log BNP remained stable during the pre-treatment period (p = 0.34) but decreased significantly during the on-treatment period (p < 0.001). The reduction in log BNP during the on-treatment period was significantly greater than during the pre-treatment period (mean difference −0.35, 95% confidence interval −0.44 to −0.11, p < 0.001). Concomitant reductions were observed in HbA1c, body weight, C-reactive protein, left atrial volume index, and left ventricular mass index. Changes in C-reactive protein levels were significantly correlated with those in log BNP (r = 0.46, p = 0.015). Conclusions: In patients with HFpEF and T2DM, three-month oral semaglutide therapy was associated with reductions in BNP, as well as improvements in glycemic control, systemic inflammation, left atrial volume index, and left ventricular mass index. Full article

The structure, functionality, nutritional value, and sensory properties of food are significantly influenced by interactions between proteins and carbohydrates. These interactions occur through hydrogen bonding, electrostatic forces, hydrophobic interactions, and, in many cases, the covalent attachment of sugars to proteins via the Maillard reaction. High starch content in food matrices promotes interactions between proteins and starch components such as amylose and amylopectin, affecting gelation, retrogradation, and thickening. These interactions improve shelf stability and product quality. Additionally, protein–carbohydrate interactions regulate nutrient digestibility and glycemic response, playing a crucial role in the development of functional foods for diabetes and weight management. In silico studies have demonstrated that dietary fibers like pectin and cellulose can improve water retention and textural properties in processed meat products. Furthermore, processing techniques such as enzymatic hydrolysis, fermentation, pulsed electric fields (PEF), and low-temperature drying have been found to improve the functional properties and shelf life of food products. This review synthesizes recent findings on protein–carbohydrate interactions and highlights their potential in creating healthier, more appealing, and sustainable foods that align with modern consumer preferences. Full article

Objective: Sodium–glucose cotransporter 2 (SGLT2) inhibitors, particularly empagliflozin, have attracted considerable attention because of their cardiovascular benefits beyond glycemic control. However, the interaction between empagliflozin and exercise-induced physiological cardiac remodeling in healthy individuals remains insufficiently understood. This study investigated the effects of different swimming exercise protocols (anaerobic, aerobic, and endurance), administered alone or in combination with empagliflozin, on cardiac structure and electrophysiology. Methods: Thirty-six male Sprague–Dawley rats were randomly assigned to six groups (n = 6 per group): anaerobic (An), aerobic (Ae), endurance (En), and the corresponding exercise groups combined with empagliflozin (An + Empa, Ae + Empa, and En + Empa). Empagliflozin was administered by oral gavage at a dose of 15 mg/kg/day for 30 days. Transthoracic echocardiography, electrocardiography (ECG), and gastrocnemius electromyography were performed at baseline and at the end of the study to assess cardiac remodeling, heart rate, and neuromuscular function. The study was carried out over a 30-day intervention period following ethics committee approval on 24 July 2024. Results: No significant between-group differences were observed in echocardiographic parameters before the intervention. On day 30, significant differences were identified among the groups in interventricular septal thickness at end-diastole (IVSd) (p = 0.027), left ventricular internal diameter at end-diastole (LVIDd) (p = 0.009), and end-diastolic volume (EDV) (p = 0.014). Bonferroni-corrected post hoc analysis showed that the aerobic exercise plus empagliflozin group differed from several exercise-only groups, particularly in parameters related to ventricular size and filling volume, including LVIDd and EDV (p < 0.008). On day 30, electrocardiographic repolarization-related parameters, including QT, QTc, JT, and Tpeak–Tend intervals, also differed significantly among the groups (all p < 0.05). In post hoc analysis, the anaerobic exercise group showed significant differences in QT and JT intervals compared with the aerobic and endurance groups (p < 0.008). In the anaerobic protocol, empagliflozin was associated with a reduction in heart rate compared with the corresponding control group (p = 0.019). No significant between-group differences were observed in EMG findings. Conclusions: Different exercise protocols induce distinct patterns of adaptation in cardiac structure and electrophysiology in healthy rats. Empagliflozin (15 mg/kg/day) may modulate exercise-induced cardiac responses in a modality-dependent manner; the most pronounced echocardiographic effects were observed in the aerobic protocol, whereas the effect on heart rate was observed in the anaerobic protocol. These findings highlight the need for longer-term and mechanistic studies to further clarify the effects of SGLT2 inhibitors on physiological cardiac remodeling. Full article

Adults with type 1 diabetes mellitus (T1DM) face elevated cardiovascular risk, and regular exercise is a key non-pharmacological mitigation strategy. However, safe prescription requires cardiovascular and glycemic monitoring, often unfeasible in real-world gyms. Low-cost psychophysiological tools (ratings of perceived exertion—RPE and enjoyment) may offer practical alternatives. This exploratory randomized crossover trial examined whether post-session RPE and enjoyment are associated with acute heart rate (HR) and capillary blood glucose (BG) responses to gym-based aerobic and resistance training. Twelve adults with T1DM (29.8 ± 7.8 years; HbA1c 7.7 ± 1.6%; LDL-c 119.5 ± 24.4 mg/dL) completed three ~30 min sessions: aerobic interval training (AE) and two resistance protocols (STA, STB). HR and BG were measured pre-, immediately post-, and 20 min post-exercise; RPE and enjoyment, post-session. Multiple linear regression, controlling for exercise session type, examined associations of RPE and enjoyment with resting HR, BG, and percentage of heart rate reserve (%HR). RPE was higher after STA and STB than AE (p < 0.001; η²p = 0.529), while enjoyment and %HR were similar across sessions. Neither variable was associated with resting HR or BG (all adjusted R² < 0; all p > 0.05). Controlling for exercise session type, RPE was a significant positive predictor of %HR (β = 0.44, p = 0.044), whereas enjoyment was not (β = −0.06, p = 0.719); however, the overall %HR model did not reach statistical significance (adjusted R² =0.119; F(4,31) = 2.183; p = 0.094). These exploratory findings suggest that RPE, but not enjoyment, may serve as a low-cost adjunct intensity marker to inform exercise prescription in adults with T1DM at elevated cardiovascular risk; however, replication in larger samples is needed before clinical recommendations can be drawn. Direct BG monitoring remains essential for safety. Full article