Search Results (193)

Background: Chronic Kidney Disease (CKD) is a major global health issue, with diabetes being its primary cause and cardiovascular disease contributing significantly to patient mortality. Recently, two classes of medications—sodium–glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs)—have shown promise in protecting both kidney and heart health beyond their effects on blood sugar control. Methods: We conducted a narrative review summarizing the findings of different clinical trials and mechanistic studies evaluating the effect of SGLT2i and GLP-1 RAs on kidney function, cardiovascular outcomes, and overall disease progression in patients with CKD and DKD. Results: SGLT2i significantly mitigate kidney injury by restoring tubuloglomerular feedback, reducing intraglomerular hypertension, and attenuating inflammation, fibrosis, and oxidative stress. GLP-1 RAs complement these effects by enhancing endothelial function, promoting weight and blood pressure control, and exerting direct anti-inflammatory and anti-fibrotic actions on renal tissues. Landmark trials—CREDENCE, DAPA-CKD, and EMPA-KIDNEY—demonstrate that SGLT2i reduce the risk of kidney failure and renal or cardiovascular death by 25–40% in both diabetic and non-diabetic CKD populations. Likewise, trials such as LEADER, SUSTAIN, and AWARD-7 confirm that GLP-1 RAs slow renal function decline and improve cardiovascular outcomes. Early evidence suggests that using both drugs together may offer even greater benefits through multiple mechanisms. Conclusions: SGLT2i and GLP-1 RAs have redefined the therapeutic landscape of CKD by offering organ-protective benefits that extend beyond glycemic control. Whether used individually or in combination, these agents represent a paradigm shift toward integrated cardiorenal-metabolic care. A deeper understanding of their mechanisms and clinical utility in both diabetic and non-diabetic populations can inform evidence-based strategies to slow disease progression, reduce cardiovascular risk, and improve long-term patient outcomes in CKD. Full article

Children and adolescents with type 1 diabetes (T1D) often experience abnormalities in bone health. Studies have consistently demonstrated that youth with T1D have lower bone mineral density (BMD) compared to their healthy peers. Additionally, children with T1D show impaired bone microarchitecture and reduced bone turnover. These factors collectively contribute to an increased risk of fractures across the life span of this population. To optimize bone accrual and reduce fracture risk, several strategies can be employed during childhood and adolescence. First, maintaining good glycemic control is critical, as poor glycemic control has been associated with lower BMD and an increased risk of fractures. Second, specific nutritional recommendations can help improve bone health, including a balanced diet, adequate calcium and vitamin D intake, and careful monitoring of both macronutrient and micronutrient intake. Third, regular physical activity plays a vital role. A systematic review and meta-analysis have shown that youth with T1D are generally less physically active, more sedentary, and have lower cardiorespiratory fitness levels than their non-diabetic peers. This review emphasizes targeted strategies aimed at optimizing skeletal health in the pediatric population with T1D, with a particular focus on the critical roles of glycemic control, nutritional adequacy, and regular physical activity. These modifiable factors may contribute to the reduction of fracture risk across the life span in individuals with T1D. Full article

Cataract surgery, while commonly considered a routine, highly effective, and generally low-risk ophthalmic procedure, has been associated with corneal endothelial cell loss (ECL), a phenomenon particularly pronounced in patients with type 2 diabetes mellitus (DM2). This increased susceptibility in diabetic patients is often attributed to pre-existing corneal abnormalities, including compromised structural integrity and reduced endothelial cell density. Additionally, metabolic stress factors inherent to diabetes, such as chronic hyperglycemia and associated oxidative stress, further exacerbate endothelial vulnerability. Consequently, diabetic patients may experience significantly greater endothelial cell loss during and after cataract surgery, necessitating targeted surgical strategies and careful perioperative management to preserve corneal health and visual outcomes. This paper aims to conduct an extensive and detailed review of the existing scientific literature to thoroughly investigate the relationship between ECL and cataract surgery in patients diagnosed with DM2. This study conducts a critical evaluation to elucidate the mechanisms contributing to high endothelial vulnerability in individuals with diabetes. It systematically compares the rates of ECL observed in diabetic and non-diabetic populations undergoing cataract surgery, examines molecular alterations following the procedure in patients with and without DM2, identifies key risk factors influencing surgical outcomes, evaluates the impact of various surgical techniques, discusses preventative measures, and examines the long-term consequences of ECL in this specific population. Furthermore, this review analyzes the existing research to identify gaps in knowledge and suggest potential directions for future investigations. Full article

Background and Objectives: The prevalence of thyroid nodules and type 2 diabetes mellitus (T2D) has increased. This study firstly aims to assess the prevalence of T2DM among thyroid nodules patients who underwent total thyroidectomy in the Western Romanian population. By focusing on the biochemical and hormonal parameters, it also aims to provide insights into possible connections between T2D and different types (benignant or malignant) of thyroid nodules. Materials and Methods: A total of 926 patients who underwent total thyroidectomy were analysed, comprising 99 (10.7%) T2D patients and 827 (89.3%) non-diabetic patients (non-T2D). Results: This study’s results revealed an increased prevalence of T2D among thyroid nodules patients. Among these patients, higher values of FT4 and inflammatory markers and a higher prevalence of malignant nodules (55%, p = 0.001) were noted. Conclusions: Our study revealed an increased prevalence of T2D among thyroid nodules patients. The biochemical profile of thyroid nodules in T2D patients presents aspects, like elevated FT4 and inflammatory markers, which should be considered in their clinical management. Furthermore, a T2D patient seems to be more likely to develop thyroid malignancies. Thyroid screening strategies in diabetic patients should be considered. Full article

Heart failure (HF) treatment evolved in the last 5 years with the introduction of new agents capable of reducing HF hospitalization and HF-related mortality. However, some categories such as patients with renal dysfunction tend to be excluded from larger randomized clinical trials. Additionally, most patients with HF experienced unavoidable glomerular filtration rate (GFR) deterioration during the clinical course. This is related to both cardio–renal interaction pathways and common cardiovascular risk factors that affect HF and chronic kidney disease (CKD). However, mineralocorticoid antagonists (MRAs) remain a cornerstone of HF therapy regardless of left ventricular ejection fraction (LVEF) values; some concerns remain about their utilization in CKD. Nevertheless, three studies (FIDELIO, FIGARO, and FINEARTS) have recently showed beneficial effects in both patients with HF and CKD associated with diabetes. Notably, finerenone a new non-steroidal MRA represents a significant step forward in cardiovascular therapy; its application spans a wide spectrum of HF phenotypes and CKD stages, and ongoing investigations will further elucidate its role in combination regimens and in broader patient populations. Further study may investigate the role of the drug in patients with heart failure with reduced ejection fraction (HFrEF) and in the severe CKD stage of non-diabetic etiology. In the current review paper, we provide a chronological overview of major trials evaluating the renal outcomes of MRAs, culminating in the emergence of finerenone as a novel therapeutic option for high-risk CKD populations, particularly those with type 2 diabetes mellitus (T2DM). Full article

Hypoglycemia is defined by the presence of Whipple’s triad, which is (1) low plasma glucose concentration, (2) neurogenic and neuroglycopenic symptoms and/or signs, and (3) their resolution with normalization of plasma glucose concentration. Hypoglycemia in adult patients without diabetes is rare and much less common compared to patients with diabetes. Because of its rarity in the general adult population, recognition and treatment may be delayed. Our review provides a comprehensive summary of non-insulin-mediated and insulin-mediated hypoglycemia in adult patients without diabetes. It explores the pathophysiology of various causes of hypoglycemia and reviews diagnostic approaches such as clinical history, key biochemical findings, and other relevant diagnostic modalities that aid in distinguishing among the different causes, from non-insulin-mediated (e.g., critical illness) to insulin-mediated causes (e.g., post-bariatric hypoglycemia). Our aim is to present the most up-to-date information regarding the diagnosis and management of non-diabetic hypoglycemia to increase awareness and understanding of the condition and promote prompt recognition in patients to expedite diagnosis and treatment. Full article

Background/Objectives: Type 2 diabetes mellitus (T2DM) is a metabolic disease whose importance rises with aging, though it is also looming large in younger populations due to increasing obesity. Its effects may damage renal and heart functioning. Plasma biomarkers of T2DM have been shown through metabolomic studies under different conditions, mainly obesity, but untargeted metabolomic studies on T2DM are lacking for elderly people. Methods: A UPLC-MS-based metabolomic approach was conducted to ascertain potential plasma biomarkers in a cohort older than 65 years. Results: The dipeptide Gly-His, along with diverse lysophosphatidylcholines (LPCs), mainly LPC(14:0) and LPC(20:4), and three gangliosides were found to have different plasma content in T2DM subjects compared to control (non-diabetic) subjects (NT2DM). LPC(20:4) exhibited a gender dependence, with statistically significant differences only in females. Gly-His correlated with MEDAS-14, whereas LPC(14:0) correlated with sugar-rich food consumption. Conclusions: As previously demonstrated for other conditions, mainly obesity, altered lipid metabolism was shown in this study to be a hallmark of T2DM in elderly people also. Full article

Background and Objective: Dietary interventions are the first-line treatment for overweight individuals (OW) and individuals with obesity (OB) with high-normal blood pressure (BP) or grade I hypertension, especially when at low-to-moderate cardiovascular risk (CVR). However, current guidelines do not specify the most effective dietary approach for optimising cardiovascular and metabolic outcomes in this population. This study aimed to compare the effects of a low-calorie, high-protein ketogenic diet (KD) vs. a low-calorie, low-sodium, and high-potassium Mediterranean diet (MD) on BP profiles assessed via ambulatory BP monitoring (ABPM), as well as on anthropometric measures, metabolic biomarkers, and body composition evaluated by bioelectrical impedance analysis (BIA). Methods: This prospective observational bicentric pilot study included 26 non-diabetic adult outpatients with central OW status or OB status (body mass index, BMI > 27 kg/m²) and high-normal BP (≥130/85 mmHg) or grade I hypertension (140–160/90–100 mmHg), based on office BP measurements. All participants had low-to-moderate CVR according to the second version of the systemic coronary risk estimation (SCORE2) and were selected and categorized as either KD (n = 15) or MD (n = 11). Comprehensive blood analysis, BIA, and ABPM were conducted at baseline and after three months. Results: At baseline, no significant differences were observed between the groups. Following three months of dietary intervention, both groups exhibited substantial reductions in body weight (KD: 98.6 ± 13.0 to 87.3 ± 13.4 kg; MD: 93.8 ± 17.7 to 86.1 ± 19.3 kg, p < 0.001) and waist circumference. Mean 24 h systolic BP (SBP) and diastolic BP (DBP) significantly declined in both groups (24 h mean SBP decreased from 125.0 ± 11.3 to 116.1 ± 8.5 mmHg (p = 0.003) and 24 h mean DBP decreased from 79.0 ± 8.4 to 73.7 ± 6.4 mmHg (p < 0.001)). Fat-free mass (FFM) increased, whereas fat mass (FM), blood lipid levels, and insulin concentrations decreased significantly. The ΔFM/ΔFFM correlates with ABP improvements. However, no significant between-group differences were detected at follow-up. Conclusions: The KD and the MD mediated weight loss and body composition changes, effectively improving bio-anthropometric and cardiovascular parameters in individuals with OW status or OB status and high BP. Although more extensive studies are warranted to elucidate potential long-term differences, our findings suggest the manner in which these two different popular dietary approaches may equally confer metabolic and cardiovascular benefits, emphasising the importance of weight and FM loss. Full article

Background/Objectives: Despite the high incidence of sickle cell anemia in Saudi Arabia, little is known about the sociodemographic characteristics, behavioral risk factors, and concomitant conditions of the condition. We performed this study to measure the prevalence of sickle cell anemia and its associated predictors among Saudi residents. Methods: This cross-sectional study was conducted in 48 primary healthcare centers across Saudi Arabia. A total of 14,239 Saudi residents were included through multi-stage random sampling. Data on sociodemographic variables, behavioral factors, and comorbidities were collected using a validated and reliable questionnaire. Univariate and multivariate logistic regression analyses were performed to identify the predictors of sickle cell anemia, with the statistical significance set at a p-value of <0.05. All analyses were carried out using SPSS version 26 for Windows. Results: Overall, the prevalence of sickle cell anemia was found to be 3.2% among Saudi residents. There was a positive association between insurance coverage and sickle cell anemia (AOR: 1.87; 95% CI: 1.52, 2.31). The odds of sickle cell anemia were 1.39 times higher among diabetic than non-diabetic individuals (AOR: 1.39; 95% CI: 1.01, 1.91). There were positive associations between sickle cell anemia and hypertension (AOR: 1.70; 95% CI: 1.23, 2.35), high cholesterol (AOR: 2.38; 95% CI: 1.74, 3.24), and heart disease (AOR: 8.05; 95% CI: 6.05, 10.71). Conclusions: Our findings indicate significant associations between sickle cell anemia and insurance coverage, smoking, obesity, diabetes mellitus, hypertension, hypercholesterolemia, and heart disease. While the overall prevalence of sickle cell anemia in our study was relatively modest, the Saudi Arabian government should prioritize the objective quantification of the disease burden across the population to effectively mitigate its consequences. Full article

Background: Anterior cervical discectomy and fusion (ACDF) is a common treatment for cervical radiculopathy and myelopathy. While generally effective, diabetes mellitus may increase postoperative complications and healthcare costs. This study evaluated the impact of type 2 diabetes on perioperative outcomes in ACDF patients. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample (2016–2019), including 85,585 single-level ACDF patients. Propensity score matching (PSM) was applied, creating two balanced cohorts (16,260 diabetic and 16,260 non-diabetic patients). Outcomes analyzed included postoperative complications, length of stay, hospital charges, and mortality. Results: Diabetic patients had significantly higher risks of ACDF-specific complications, including cerebrospinal fluid leaks (2×), dysphagia (2.5×), dysphonia (2.9×), and cervical spinal cord injury (5×). General complications were also increased, with higher rates of pulmonary embolism (2.4×), sepsis (3×), stroke (3×), pneumonia (3.3×), and heart failure (12×). Diabetic patients had longer hospital stays (1.99 vs. 1.79 days, p < 0.001) and higher hospital charges (USD 71,884 vs. USD 67,998, p = 0.004). Conclusions: T2DM significantly increases postoperative risks, length of stay, and costs for ACDF patients. Optimized perioperative management and glucose control are essential to improve outcomes in this high-risk population. Full article

Vitamin D has been shown to improve immunity as well as vascular function. We investigated the effect of cholecalciferol on T-cell phenotype in cultured peripheral blood mononuclear cells (PBMCs) from twenty vitamin D-deficient, non-diabetic chronic kidney disease (CKD) subjects. We also studied vitamin D effects on endothelial and vascular function markers in human aortic endothelial cells (HAECs) and in human aortic smooth muscle cells (HASMCs), respectively. We studied endothelial nitric oxide synthase (eNOS), mitogen-activated protein kinase 38 (p38 Map kinase), protein kinase B (Akt), and nicotinamide adenine dinucleotide phosphate oxidase (NADPH oxidase) in HAECs and α-smooth muscle actin (α-SMA), smooth muscle calponin (SM-Calponin), smooth muscle myosin heavy chain (SM-MHC), and calcium-sensing receptor (CaSR) in HASMCs. Vitamin D receptors (VDRs) and CYP27B1 were studied in both cell types. In cultured PBMCs isolated from CKD subjects, the percentage of T helper 1(TH1) cells significantly decreased while that of T helper 2 (TH2) cells increased after cholecalciferol treatment. No significant change in intracellular and surface markers of T helper 17 (TH17) and T regulatory (Treg) cells was observed. In vitro treatment of HASMCs and HAECs with cholecalciferol led to significant and favorable alterations in mRNA expression of markers of vascular smooth muscle cells, i.e., α-SMA, SM-Calponin, and SM-MHC. Regarding endothelial cell markers, mRNA encoding eNOS, p38 Map kinase, protein kinase B (Akt), NADPH oxidase, VDR, and CYP27B1 were also significantly changed. Finally, the expression levels of the following proteins were notably altered: NADPH oxidase and protein kinase B (Akt) (in HAECs); SM-MHC and SM-Calponin (in HASMCs). In vitro treatment of PBMCs with cholecalciferol led to a favorable change in T-cell population, decreasing TH1 and increasing TH2 cell percentage, along with beneficial alterations in mRNA expression of HASMCs and HAECs’ cell markers. This study provides evidence that cholecalciferol can influence immune and vascular function in CKD. Full article

Background: Diabetic foot ulcers (DFUs) affect millions worldwide, significantly increasing the risk of amputation, mortality, and reduced quality of life. While conventional interventions such as specialized footwear and podiatric care can mitigate ulceration risks, they do not address the biomechanical factors contributing to ulcer recurrence. Emerging evidence suggests that lower limb exercises may play a role in secondary DFU prevention. This scoping review aims to synthesize available research on home-based lower limb exercise programs for individuals with diabetes mellitus, focusing on feasibility, adherence, and their impact on foot biomechanics and ulcer prevention. Methods: A search was conducted across six electronic databases (PubMed, Web of Science, Cochrane Library, EBSCO, Scopus, and ScienceDirect) for studies published between January 2014 and December 2024. Eligible studies included those assessing home-based lower limb exercises in diabetic individuals, with interventions lasting at least four weeks. Studies focusing on supervised exercises, pharmacological interventions, or non-diabetic populations were excluded. Results: Nine studies met the inclusion criteria, featuring a range of home-based exercise interventions, such as muscle strengthening, stretching routines, proprioceptive training, functional mobility exercises, and range-of-motion activities. These interventions demonstrated notable effectiveness, leading to improved foot biomechanics, more even plantar pressure distribution, enhanced balance, and reduced ulcer recurrence (in some cases). One study, for instance, reported a significant decrease in ulcer recurrence, with only 16% of participants in the intervention group experiencing relapse compared to 72% in the control group after 24 weeks. Adherence rates varied across studies but were generally higher when programs included structured guidance through educational booklets, mobile applications, or consistent phone follow-ups ranging from 41% to 92.5%. Nonetheless, the findings tend to be tempered by methodological differences between studies and a lack of robust long-term follow-up data. Conclusions: Home-based lower limb exercises show promise in improving foot function and preventing DFU recurrence. Further research is needed to standardize protocols, enhance adherence, and confirm long-term effectiveness. Full article

Background: Glucose metabolism disorders are major contributors to morbidity and mortality. Elevated serum uric acid (SUA) is closely linked to the cardiometabolic consequences of glucose metabolism disorders, various other comorbidities, and mortality. In this study, we explore the relationship between SUA and fasting plasma glucose (FPG), insulin levels, and insulin resistance in an older Finnish adult cohort. Methods: We used data from the GOAL (GOod Ageing in Lahti region) study—a prospective, population-based study of Finnish individuals aged 52–76 years. A total of 2322 non-diabetic subjects were included in the study. Data of SUA, FPG, and other laboratory parameters, comorbidities, lifestyle habits, and socioeconomic factors were collected. Subjects with SUA values of >410 μmol/L (≈6.9 mg/dL; 75th percentile) were regarded as hyperuricemic. We investigated the relationship between SUA and FPG, insulin levels, and insulin resistance [homeostatic model assessment of insulin resistance (HOMA-IR) ≥2.65]. Results: We found statistically significant sex-, age- and BMI-adjusted small to moderate relationships (Cohen’s standard for β values above 0.10 and 0.30, respectively) between SUA and FPG, insulin levels, and insulin resistance in the whole study population as well as in the female and male subgroups. The higher the SUA level, the higher the HOMA-IR [(adjusted β = 0.21 (95% CI: 0.17 to 0.25)], and it rises drastically if SUA is above 400 μmol/L (≈6.7 mg/dL). The probability of a subject having insulin resistance is related to SUA level. Conclusions: Hyperuricemia is associated with elevated FPG and insulin resistance, emphasizing the importance of addressing both conditions. Further research may explore hyperuricemia treatment’s role in preventing glucose metabolism disorders and their cardiometabolic consequences. Full article

Background: Dietary factors, such as vegetable, fruit, and red meat consumption, have varying effects on the disease burden of diabetes, the world’s third leading health concern. This study aims to evaluate the global impact of vegetable/fruit/red meat consumption on disease burdens. Methods: Diabetes disease burden, vegetable/fruit/red meat consumption, and covariates data were obtained from the Global Burden of Disease Study (GBD) 2021, Food and Agriculture Organization (FAO), and WHO, respectively, and matched by country/region and year. Global vector maps assessed the status of diabetes disease burden and the consumption of three dietary factors in 2021, and their trends from 2010 to 2021 were illustrated through local regression curves. Generalized additive mixed models (GAMMs) were used to analyze relationships, with weights assigned based on log-transformed values relative to the mean population of each country. Results: A comprehensive dataset spanning 2010–2021, encompassing 175 countries/regions, was successfully matched and utilized in the analysis. In 2021, Oceania had the highest diabetes burden, whereas East Asia had a lower one. Globally, the disease burden increased from 2010 to 2021, accompanied by rising per capita vegetable and fruit consumption but declining red meat consumption. Vegetable consumption was inversely correlated with the age-standardized incidence rate (ASIR) and exhibited a “J-shaped” curve with the age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life year (DALY) rate (ASDR) (nadir at approximately 80 kcal/capita/day (kcal/cap/day). Fruit consumption had a “U-shaped” relationship with ASDR (nadir at approximately 100 kcal/cap/day). Red meat consumption was negatively correlated to ASIR and had a “U-shaped” relationship with ASMR and ASDR (nadir at 200 kcal/cap/day). Conclusions: The global diabetes disease burden is heavy, and dietary consumption varies widely. Vegetable-related risks differ between diabetics and non-diabetics. Proper fruit consumption decreases ASDR. Moderate red meat increases can reduce the disease burden, but excessive consumption increases ASMR and ASDR. Full article

Background: Upper gastrointestinal (GI) motility disorders, such as gastroparesis and functional dyspepsia (FD), contribute significantly to morbidity, especially in populations at risk for type 2 diabetes. However, the prevalence and clinical manifestations of these disorders in India, and associated gastric dysrhythmias, are not well studied within this population. Methods: This retrospective, cross-sectional study analyzed 3689 patients who underwent electrogastrography with water load satiety test (EGGWLST) testing across multiple motility clinics in India. The prevalence of gastroparesis and FD-like symptoms, symptom severity, and their association with diabetes and other comorbidities were evaluated. Symptom severity was assessed using the Gastroparesis Cardinal Symptom Index (GCSI). EGGWLST findings were documented, including the gastric myoelectric activity threshold (GMAT) scores. Results: The study population had a mean age of 43.18 years. GCSI scores indicated that patients had symptoms that were mild (55%), moderate (33%), and severe (8%). Compared with the non-diabetic population, diabetic subjects had significantly higher rates of early satiety (56% vs. 45%, p < 0.0001), bloating (73% vs. 67%, p = 0.005), and reflux (28% vs. 24%, p = 0.029). WLST data analysis revealed that significantly more diabetic subjects ingested <350 mL (16% vs. 12%, p = 0.000016). EGG analysis revealed gastric dysthymias in one-third (65%) of patients. Significantly more diabetic subjects (22% vs. 18% p = 0.015) had a GMAT score >0.59. Conclusions: Upper GI motility disorders are prevalent in India, particularly among diabetic patients. EGG is a valuable tool for characterizing these disorders, and may help in personalizing therapeutic approaches. Further research is required to optimize treatment strategies. Full article