Search Results (859)

Background: Visceral adiposity has emerged as a clinically relevant determinant of early cardiometabolic dysfunction in pediatric type 1 diabetes mellitus (T1DM), yet its assessment remains underutilized in routine practice. This study evaluated ultrasonographically measured epicardial adipose tissue thickness (EATT) and perirenal adipose tissue thickness (PrATT) as markers of metabolic risk, insulin sensitivity, and subclinical atherosclerosis in children and adolescents with T1DM. Methods: This cross-sectional study included 150 participants with T1DM and 152 age- and sex-matched healthy controls. Anthropometric data, biochemical parameters, hepatic steatosis grade, and insulin sensitivity indices (eGDR) were collected. EATT and PrATT were measured via standardized echocardiographic and abdominal ultrasonographic protocols. Carotid intima–media thickness (cIMT) was assessed as an indicator of subclinical atherosclerosis. Correlation and multivariable logistic regression analyses were performed to identify independent predictors of T1DM status and cardiometabolic risk. Results: Children with T1DM exhibited significantly higher PrATT and EATT values compared with controls (both p < 0.05). All eGDR indices were markedly lower in the T1DM group, reflecting reduced insulin sensitivity. PrATT and EATT showed strong or moderate correlations with hsCRP, hepatic steatosis, atherogenic index of plasma, and multiple anthropometric markers. Both visceral fat depots were positively associated with cIMT. Logistic regression identified PrATT, EATT, hsCRP, cIMT, and eGDR-BMI as independent predictors of case status. Subgroup analyses demonstrated more pronounced visceral adiposity and metabolic impairment among participants with BMI ≥85th percentile. Conclusions: Ultrasonographically measured PrATT and EATT provide valuable insight into early cardiometabolic risk in youth with T1DM, independent of BMI. Their associations with insulin resistance, inflammation, and subclinical atherosclerosis highlight their potential utility as accessible markers for early risk stratification in pediatric diabetes. Routine incorporation of visceral fat assessment may support earlier identification of high-risk individuals and more targeted preventive strategies. 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: Multidisciplinary hybrid educational programs combined with continuous glucose monitoring may contribute to improved self-management in adults with type 1 diabetes mellitus (T1DM); however, real-world evidence remains limited. This study assessed the effects of an educational intervention integrated with continuous glucose monitoring on glycemic control and patient-reported outcomes in adults with T1DM. Methods: We conducted a single-group quasi-experimental study including 210 adults with T1DM from a public hospital. The nurse-led hybrid intervention consisted of a 2-h in-person group educational session followed by an individual telematic follow-up session. All participants used continuous glucose monitoring. The primary outcome was the change in HbA1c at 9 months. Secondary outcomes included continuous glucose monitoring metrics, diabetes-related quality of life, treatment satisfaction, and hypoglycemia awareness. Results: HbA1c showed a statistically significant but modest reduction from 7.70 ± 1.10% to 7.45 ± 0.91% following the intervention (p = 0.003). No statistically significant changes were observed in continuous glucose monitoring metrics, including time in range, time below and above range, mean glucose, glycemic variability, or sensor wear time. In terms of emotional well-being, treatment satisfaction increased significantly (8.17 ± 7.86 vs. 12.73 ± 5.49; p < 0.001), and the Clarke score showed a statistically significant but modest decrease (2.49 ± 1.90 vs. 2.12 ± 1.88; p = 0.017). Although the overall quality of life score did not change significantly, statistically significant differences were observed in several subscales, including satisfaction, impact, and diabetes-related concern. Conclusions: A multidisciplinary hybrid educational intervention integrated with continuous glucose monitoring was associated with modest improvements in HbA1c and statistically significant, though limited, enhancements in quality of life, treatment satisfaction, and hypoglycemia awareness in adults with T1DM. These findings suggest that similar educational models may have a supportive role in routine care. 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

Background: Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus (DM), leading to sensory loss, balance disturbances, and an increased risk of ulcers and amputations. Early screening is crucial, and devices for measuring vibration perception threshold (VPT) play an important role in the timely detection and management of this condition. Objective: The aim of this systematic review was to evaluate the diagnostic accuracy and reliability of VPT measurement devices in individuals with DM. Methods: A systematic search was conducted in four databases, including studies that assessed the diagnostic accuracy and reliability of VPT measurement devices in patients with type 1 or type 2 DM, with VPT compared against reference standards for DPN, including nerve conduction studies (NCS) and clinical diagnosis. Cross-sectional and case–control studies were included. Risk of bias was assessed using the Quality Appraisal of Reliability (QAREL) tool and the JBI Critical Appraisal Checklist for Diagnostic Test Accuracy Studies. Results: Eighteen studies were analyzed. Most studies demonstrated moderate sensitivity and specificity and an acceptable level of reliability, with results varying according to technical and methodological factors. Conclusions: VPT measurement devices appear to be useful screening tools for detecting DPN; however, their diagnostic accuracy and reliability are not uniform and largely depend on technical and methodological factors. Standardized threshold values and measurement procedures, along with further research comparing the effectiveness of different protocols, are needed to improve clinical utility. Full article

Background/Objectives: The objective was to analyze the effects of Dipeptidyl Peptidase-4 (DPP-4) inhibitors on glycemic control, insulin dose, and preservation of β-pancreatic function (C-peptide) in patients with type 1 diabetes mellitus (T1DM). Methods: A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with a search in the PubMed database. Five randomized clinical trials evaluating the use of different DPP-4 inhibitors in patients with T1DM were selected, measuring parameters including glycated hemoglobin (HbA1c), C-peptide, time in glycemic target/range (TIR), and daily insulin dose. Results: HbA1c showed significant reduction in some studies and no significant alterations in others. TIR increased in one study (~77.87% → ~84.40%). C-peptide showed variable effects across studies. The insulin dose did not show a substantial reduction. Conclusions: DPP-4 inhibitors demonstrated modest benefits for glycemic control and preservation of β-cell function in T1DM, but these effects were inconsistent due to methodological heterogeneity. Standardized studies are needed to define beneficial subgroups and long-term efficacy. Full article

Hypoglycaemia in patients with type 1 diabetes mellitus (T1DM) remains a major clinical burden and, beyond its metabolic complications, can cause serious cardiac arrhythmias. Multiple mechanisms lead to different types of arrhythmias during hypoglycaemia. However, existing studies often involve mixed diabetes populations, small cohorts, or limited monitoring during nocturnal periods, leaving a critical gap in understanding the links between glucose fluctuations and arrhythmic events. This review provides an updated combination of experimental and clinical evidence describing how autonomic dysfunction and ionic imbalances lead to electrophysiological instability and structural remodelling of the myocardium during hypoglycaemia. Continuous glucose monitoring (CGM) combined with electrocardiographic or wearable rhythm tracking may enable early detection of glycemic and cardiac disturbances and help identify high-risk individuals. Future prospective studies using combined CGM–ECG monitoring, particularly during sleep, are essential to clarify the relationship between hypoglycaemia and arrhythmic events. Full article

Background: Type 2 diabetes mellitus (T2DM) is typically characterized by the dysregulation of metabolic remodeling. As a systemic metabolic disease, T2DM can affect the mass and function of skeletal muscle by inducing impaired energy metabolism, mitochondrial dysfunction, and chronic low-grade inflammation. β-Hydroxybutyrate dehydrogenase 1 (BDH1) is a rate-limiting enzyme involved in ketone body metabolism, and its activity is down-regulated in various models of diabetic complications. Aerobic exercise (AE) is recognized as an effective intervention to promote energy homeostasis and alleviate metabolic stress. Whether its protective effect on skeletal muscle in T2DM involves the regulatory control of BDH1 expression remains unclear. Methods: Wild-type (WT) and systemic BDH1 knockout (BDH1^−/−) male C57BL/6J mice were used to establish the sedentary control (SED) and AE models of T2DM by providing a high-fat diet combined with streptozotocin injection. The indicators related to metabolic remodeling were detected by hematoxylin and eosin staining, immunofluorescence staining, quantitative real-time PCR, and Western blot assays. Results: After 8 weeks of AE, we found that AE improved glycolipid metabolic disorders and mitochondrial quality control in the gastrocnemius muscle of T2DM mice by up-regulating BDH1, thereby alleviating oxidative stress, inflammation, and fibrosis. Compared with the WT mice, the BDH1^−/− T2DM mice in the SED group exhibited more severe phenotypic impairment. The metabolic improvement effect of AE was attenuated in the BDH1^−/− mice. Conclusions: BDH1 is a key effector enzyme that may mediate the AE-induced improvement in metabolic remodeling in the gastrocnemius muscle of mice with T2DM. Full article

Diabetes mellitus (DM) is a chronic disease characterised by chronic hyperglycaemia due to a defect in the production of or cell insensitivity to insulin. If left untreated, it might result in severe side effects such retinal, nephropathy, neuropathy, and cardiovascular disease. Extensive research has been made to develop more effective and less expensive alternatives to existing treatment regimes. This review aims to evaluate research done thus far to test the effect of Saccharomyces boulardii (S. boulardii or Sb) in treating DM and its complications. Searches were conducted using Scopus, Web of Science, PubMed and Google Scholar on 26 July 2025. Overall, 227 articles were identified, and 5 fulfilled the inclusion criteria. Results extracted were from two models of diabetes (type 1 and 2) and two strains of Sb. In type 1 diabetes models, a significant reduction in glycaemia was observed, while in type 2 diabetes models, a non-significant effect was noted, depending on the strain used. Furthermore, an improvement in cardiac function was observed through reduced heart rate variability, a decrease in blood pressure, an increase in C-peptide and hepatic glycogen stores, enhanced liver healing, a nephroprotective effect, as well as a reduction in oxidative stress, blood triglyceride levels, and the inflammatory response. Administration of Sb induced positive modulation of the intestinal microbiota, with a decrease in pathobionts in the stools. Overall, the few studies evaluated indicate that the use of Sb appears to be a promising approach to improve the management of diabetes and its associated metabolic and related complications. The protocol of this review is registered in PROSPERO under ID CRD420251012919. Full article

Background/Objectives: Asthma, type 1 diabetes mellitus (T1DM), and epilepsy are prevalent chronic diseases among school-aged children, affecting safety, attendance, and academic performance. This systematic review evaluated school teachers’ knowledge, attitudes, and preparedness regarding these conditions and identified gaps that hinder effective management and inclusion. Methods: Following PRISMA guidelines, PubMed, Cochrane Library, Scopus, and Google Scholar were searched between 20 September and 9 October 2025. Forty-nine quantitative cross-sectional studies assessing teachers’ knowledge, attitudes, or preparedness toward asthma, T1DM, or epilepsy were included. The AXIS tool assessed methodological quality, focusing on clarity of objectives, sample justification, ethical transparency, and instrument validation. Results: Teachers’ knowledge was generally moderate and varied by region. Studies on epilepsy (n = 21) highlighted misconceptions and limited understanding of seizure first aid. Diabetes studies (n = 9) indicated moderate awareness but insufficient preparedness for hypoglycemia and insulin management. Asthma studies (n = 19) revealed inconsistent knowledge, particularly regarding symptom recognition and emergency response. AXIS assessment identified recurring limitations, including unjustified sample sizes, limited instrument validation, and poor reporting of non-responders. Conclusions: These findings emphasize the need to enhance school preparedness through targeted, evidence-based teacher training, clear health policies and emergency protocols, awareness and inclusion initiatives, improved collaboration among teachers, parents, and healthcare providers, and strengthened school health infrastructure. Addressing these areas is critical to ensure safe, inclusive, and supportive learning environments for children with chronic illnesses. Full article

Type 2 diabetes mellitus (T2DM) is a highly prevalent disease characterized by chronic hyperglycemia, commonly associated with intake of a high-calorie diet (HCD). Although numerous T2DM murine models have been developed using C57BL/6 mice, BALB/c mice typically fail to develop the disease under the same conditions. We hypothesized that diets optimized for C57BL/6 mice may be insufficient to induce T2DM in BALB/c mice. Female BALB/c and C57BL/6 mice (n = 48 each) were fed either a specific high-calorie diet (HCD) or a standard diet (SD) for ten weeks. BALB/c mice fed a specific HCD exhibited developed persistent hyperglycemia (112.6 mg/dL ± 3.4) from week 1 through week 10, while SD-fed controls maintained normal glucose levels (84.2 mg/dL ± 2.8). HCD-fed BALB/c mice showed elevated serum insulin (39.09 pg/dL ± 25.94), triglycerides (290.8 mg/dL ± 139.5), HOMA index (7.68 ± 1.49) and high post-challenge glucose along with visceral adiposity, hepatic steatosis, and pancreatic alterations. SD-fed BALB/c mice showed no such changes. Similar findings were observed in C57BL/6 mice, used as a positive disease-control group. This model demonstrates that a properly formulated HCD can induce T2DM in BALB/c mice, enabling the study of genes and molecules associated with diabetes susceptibility without requiring genetic or chemical manipulation. Full article

Chronic diseases disproportionately impact Indigenous peoples in Australia, with type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) representing leading causes of morbidity and mortality. Despite evidence supporting community-based exercise interventions for T2DM management, no culturally adapted programs utilizing wearable technology have been co-designed specifically with Indigenous Australian communities. This study protocol aims to determine if wearable-based exercise interventions can effectively prevent CVD development and manage T2DM progression in Indigenous Australians through culturally safe, community-led approaches. The PrIDE study protocol describes a mixed-methods translational research design incorporating Indigenous and Western methodologies across three phases: (1) co-designing culturally adapted exercise programs and assessment tools, (2) implementing interventions with wearable monitoring, and (3) conducting evaluation and scale-up assessment. Sixty-four Indigenous Australian adults with T2DM will be recruited across remote, rural/regional sites to self-select into either individual or group exercise programs using the Withings ScanWatch 2. Primary outcomes include cardiovascular risk factors, physical fitness, and health self-efficacy measured using culturally adapted tools. Indigenous governance structures will ensure cultural safety and community ownership throughout. The PrIDE protocol presents a novel approach to improving health equity while advancing understanding of wearable technology integration in Indigenous healthcare, informing future larger-scale trials and policy development. Full article

Background: We aimed to investigate the diagnostic performance between the oral glucose tolerance test (OGTT) and HbA1c in diagnosing prediabetes and diabetes among obese individuals, and to evaluate the diagnostic performance of HbA1c for detecting OGTT-defined diabetes in obese individuals referred for evaluation of suspected prediabetes. Methods: Individuals with prediabetes were included between 1 January 2020 and 31 December 2022. Participants were categorized as mildly, moderately, morbidly, or super obese based on body mass index (BMI). According to the 75 g OGTT results, patients were classified into three groups: isolated impaired fasting glucose (IFG), combined IFG + impaired glucose tolerance (IGT), and overt type 2 diabetes mellitus (T2DM). The threshold HbA1c value for T2DM diagnosis in obese patients was determined based on OGTT outcomes. Results: Of the 139 prediabetic obese patients included, 115 (82.7%) were female, with a mean age of 45.18 ± 11.74 years. Based on BMI, 34 patients (24.5%) were mildly obese, 41 (29.5%) moderately obese, 49 (35.3%) morbidly obese, and 15 (10.8%) super obese. According to the 75 g OGTT results, 37.4% (n = 52) had isolated IFG, 45.3% (n = 63) had combined IFG + IGT, and 17.3% (n = 24) had overt T2DM. A weak–moderate positive correlation was observed between HbA1c and fasting blood glucose (Spearman’s rho = 0.263, p = 0.002). ROC–AUC analysis showed that HbA1c had significant discriminatory power in detecting T2DM diagnosed by the 75 g OGTT (AUC = 0.881, 95% CI: 0.816–0.946, p < 0.001). The optimal HbA1c cut-off was 6.15%, with 83.3% sensitivity and 80% specificity. The positive predictive value was 46.1%, and the negative predictive value was 95.8%. Conclusions: An HbA1c threshold of 6.15% demonstrated optimal performance for detecting OGTT-defined diabetes in obese individuals with suspected prediabetes. This value should not be interpreted as a population-wide diagnostic threshold. These findings indicate that HbA1c may serve as a useful screening tool to identify obese individuals who warrant confirmatory OGTT testing, rather than as a stand-alone diagnostic criterion. Further large-scale studies are warranted to confirm these results and support future clinical guidelines. Full article

Objectives: Children may present with acute kidney injury (AKI) and polyuria under certain conditions which can complicate diagnosis and management. This review seeks to synthesize AKI presentations in children with polyuria. Methods: Publications for this systematic review were searched using Embase, PubMed, and Scopus. Methodological quality assessment of the included study and case reports was performed. Results: From the selected studies, we obtained data on 32 patients with a mean age of 11.02 ± 2.82 years, including 13 males and 19 females. Among them, 26 presented with polyuria: 19 with diabetic ketoacidosis (DKA), 5 with new-onset type 1 diabetes mellitus (T1DM) without DKA, 1 with Bartter syndrome, and 1 with neuroblastoma. In 12 patients with DKA, data to calculate AKI prevalence were not available. Among the remaining 20 patients (all with polyuria), 9 (45%) developed AKI. AKI stage 3 was observed in 4 patients and stage 2 in 1 patient. For the remaining 5 patients with AKI, no information about the AKI stage was available. Conclusions: AKI can present with polyuria as part of its pathophysiological mechanism. A relationship between polyuria and AKI (with KDIGO stage ≥ 2) was found in metabolic disorders (DKA), nephrological diseases (Bartter syndrome), and oncological conditions (neuroblastoma). Full article

Background and Hypothesis: Diabetic kidney disease (DKD) is one of the major risk factors for all-cause mortality and cardiovascular disease in patients with diabetes mellitus. Different phenotypes have been described. In view of their different pathophysiology, these subtypes may behave differently. Methods: In this retrospective study, patients with type 2 diabetes mellitus (T2DM) were followed up for a maximum of 10 years or until death, whichever came first. Subjects were categorized into four DKD phenotypes: no DKD (no albuminuria or decreased estimated glomerular filtration rate (eGFR)), albuminuria without decreased eGFR (DKD 1), decreased eGFR without albuminuria (DKD 2 or non-albuminuric DKD), and decreased eGFR with albuminuria (DKD 3). Data on laboratory results, hospitalization, and mortality were obtained through electronic patient records. Univariate analyses were performed and the variables that were significant were entered as covariates in multivariate logistic regression models to estimate the risks of death, hospitalization for CAD, HF, and CrVD, and CKD progression. Results: Among 778 patients, 53.3% had no DKD, 31.2% had DKD 1, 5.4% had DKD 2, and 10% had DKD 3. Patients with DKD 2 exhibited the highest odds of mortality compared to those with no DKD (odds ratio (OR) of 6.7 [95% CI 2.8–16.0], p < 0.001). Pairwise comparisons using the log-rank test showed a significant difference in mortality between DKD 1 and DKD 2 (p < 0.001) and DKD 1 and DKD 3 (p < 0.001). However, no statistically significant difference in mortality was found between DKD 2 and DKD 3. Additionally, the greater variability in HbA1c and higher neutrophil–lymphocyte ratio (NLR) independently predicted all-cause mortality as well as hospitalization for heart failure. Conclusions: This contemporary T2DM cohort demonstrated that the DKD phenotype, HbA1c variability, and elevated NLR are linked to increased mortality. These factors may improve existing risk stratification models by enabling better identification of high-risk DKD patients and guide more personalized management. Full article