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From Monitoring to Management: Addressing Challenges in Type 1 and...
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From Monitoring to Management: Addressing Challenges in Type 1 and Type 2 Diabetes Care

A special issue of Diseases (ISSN 2079-9721).

Deadline for manuscript submissions: 31 October 2026 | Viewed by 8022

Special Issue Editors

Dr. Lucas Fornari Laurindo

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Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
Interests: medicinal plants; bioactive compounds; phytochemicals; phytochemistry; cancer; metabolism; metabolic disorders; pharmacology; inflammation; oxidative stress; cardiovascular diseases; neurodegenerative diseases
Special Issues, Collections and Topics in MDPI journals
Dr. Sandra Barbalho

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Guest Editor
Laboratory for Systematic Investigations of Diseases, Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, SP, Brazil
Interests: inflammatory diseases; cardiovascular diseases; neurodegenerative diseases; inflammation; medicinal plants; oxidative stress
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Thank you for reading this Special Issue information. It is a true honor to welcome the submission of manuscripts.

Diabetes is a complex disorder characterized by uncontrolled blood glucose levels, ultimately leading to serious complications including diabetic cardiomyopathies, nephropathies, neuropathies, and more. In this context, preventing these complications is crucial, and interventions for diabetic patients are essential. To achieve these aims, it is essential to build an understanding of the clinical evolution of diabetic patients through personalized, multidisciplinary approaches as well as developing cohesive care-management strategies. This Special Issue delves into the rationale behind monitoring diabetes and managing its complications. It addresses the challenges in type 1 and type 2 diabetes care, including insulin dependence, glycemic variability, psychosocial burden, technology dependence, and educating and supporting diabetic patients and their families in type 1 diabetes, and explores the topics of delayed diagnosis, medication adherence, lifestyle interventions, health system limitations, and comorbidities in type 2 diabetes. The submission of clinical interventional and observational studies on access to affordable care, patient education, digital health integration, healthcare disparities, clinical evolution, and complications prevention are welcome, as well as critical, narrative, systematic, and simple reviews and meta-analyses. We are also open to publishing preclinical studies, if feasible.

We look forward to receiving your feedback on the proposed topic as well as your brilliant submissions. To have you contribute to this  Special Issue would be hugely meaningful and, we feel, guarantee the production of a successful project.

Yours sincerely,

Dr. Lucas Fornari Laurindo
Dr. Sandra Barbalho
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diseases is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • metabolism
  • metabolic diseases
  • medicinal plants
  • phytochemicals
  • bioactive compounds
  • metabolic diseases complications

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Published Papers (6 papers)

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Research

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12 pages, 338 KB  
Article
Association of Vitamin D Deficiency with Diabetic Nephropathy in Type 2 Diabetes: A Hospital-Based Cross-Sectional Study
by Shafia Bashir, Geer Mohammad Ishaq, Insha Mushtaq, Mohammad Ashraf Ganie, Imtiyaz Wani, Muteb Alanazi, Ibrahim Asiri, Arshad Hussain, Kashif Ullah Khan and Sirajudheen Anwar
Diseases 2025, 13(12), 405; https://doi.org/10.3390/diseases13120405 - 17 Dec 2025
Viewed by 561
Abstract
Background/Objective: Diabetic nephropathy (DN), a key microvascular complication of type 2 diabetes (T2DM), drives significant morbidity, mortality, and healthcare costs. Vitamin D deficiency has been linked to renal dysfunction, but its role in DN remains unclear. This study assessed the association between vitamin [...] Read more.
Background/Objective: Diabetic nephropathy (DN), a key microvascular complication of type 2 diabetes (T2DM), drives significant morbidity, mortality, and healthcare costs. Vitamin D deficiency has been linked to renal dysfunction, but its role in DN remains unclear. This study assessed the association between vitamin D status and DN versus T2DM without nephropathy. Methods: This cross-sectional hospital-based study included 399 participants (299 DN, 100 T2DM without nephropathy) at a tertiary endocrine clinic. Demographic, clinical, and biochemical data, including serum 25(OH)D, were collected. Chi-square and Mann–Whitney compared categorical and continuous variables, respectively, and multinomial logistic regression assessed the association between vitamin D status and DN (p < 0.05). Results: Patients with DN were older (58.2 ± 7.95 vs. 51.4 ± 9.94 years, p < 0.001), had more advanced CKD (stages 2–3b: 84.6% vs. 20.0%, p < 0.001), and higher albuminuria (moderate: 80.3% vs. 19.0%; severe: 18.4% vs. 0%, p < 0.001). They also showed poorer glycemic control, elevated urea and creatinine, lower serum albumin, dyslipidemia, elevated liver enzymes, and higher uric acid (all p < 0.05). Vitamin D deficiency was more prevalent in DN (37.7% vs. 8.0%, p < 0.001). Unadjusted multinomial regression indicated that T2DM patients without nephropathy had a 91% lower risk of vitamin D deficiency (RRR 0.09; 95% CI 0.04–0.19, p < 0.001) and an 87% lower risk of insufficiency (RRR 0.13; 95% CI 0.05–0.26, p < 0.001) compared with DN patients. After adjusting for age, HbA1c, creatinine, duration of diabetes and eGFR, the reduced risk of deficiency remained significant (RRR 0.04; 95% CI 0.01–0.16, p < 0.001), while the association with insufficiency was no longer significant (p = 0.310). Conclusions: This study shows a significant association between vitamin D deficiency and diabetic nephropathy, though its cross-sectional design precludes causal inference. Reverse causality and residual confounding cannot be excluded. Patients with DN had poorer glycemic control, dyslipidemia, and renal function, along with more frequent vitamin D deficiency. Routine vitamin D monitoring may support early detection and risk stratification in T2DM. Full article
(This article belongs to the Special Issue From Monitoring to Management: Addressing Challenges in Type 1 and Type 2 Diabetes Care)
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10 pages, 240 KB  
Article
Differences in Metabolic Control Between Different Insulin Use Patterns in Pediatric Patients with Type 1 Diabetes Through Intermittent Glucose Monitoring
by Rocio Porcel-Chacón, Leopoldo Tapia-Ceballos, Ana-Belen Ariza-Jimenez, Ana Gómez-Perea, José Manuel Jiménez-Hinojosa, Juan-Pedro López-Siguero and Isabel Leiva-Gea
Diseases 2025, 13(8), 254; https://doi.org/10.3390/diseases13080254 - 9 Aug 2025
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Abstract
Introduction: In healthcare centers with limited resources, or for patients who prefer to make continuous changes in their treatment themselves and do not want to rely solely on technology, intermittent glucose monitoring (isCGM) with an insulin pump is a viable option that warrants [...] Read more.
Introduction: In healthcare centers with limited resources, or for patients who prefer to make continuous changes in their treatment themselves and do not want to rely solely on technology, intermittent glucose monitoring (isCGM) with an insulin pump is a viable option that warrants further study. Material and methods: prospective single-center study that collected data at 3 months and after isCGM implantation in pediatric patients with Type 1 diabetes, categorized according to their insulin regimen. Results: We found statistically significant differences in the time in range (TIR) between 70 and 180 mg/dl at 3 months after using the sensor (p = 0.017), although these differences were not maintained at 1 year (p = 0.064). When stricter TIRs (70–140 mg/dl) were analyzed, statistically significant differences were observed at 3 months (p = 0.01) and at 1 year (p = 0.018) in favor of patients using CSII. While 75% of the patients in the CSII group had good control with HbA1c < 7% after one year of sensor use, only 34.6% in the MDI group achieved these values. However, the CSII group presented a higher coefficient of variation (62.31% at 3 months and 43.08% at 1 year) (p = 0.02), and a higher number of hypoglycemic episodes (7.38% and 7.32%, respectively) (p = 0.016). The CSII group also had a higher number of capillary blood glucose measurements at the beginning of the study (8.32/day) (p = 0.249), but this number became similar between both groups after one year. Conclusions: We found statistically significant differences in favor of CSII over MDI in terms of metabolic control after one year of isCGM use. However, the TIR values were still below the range considered to be indicative of good control. These findings lead us to question whether CSII should be initially considered in specific cases where HCL is not possible, or if it would be more effective to wait until the patient is ready, or the necessary resources are available to start directly CSII integrated in a closed loop system. Full article
(This article belongs to the Special Issue From Monitoring to Management: Addressing Challenges in Type 1 and Type 2 Diabetes Care)

Review

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21 pages, 734 KB  
Review
Diabetic Ketoacidosis in Young Adults with Type 1 Diabetes: The Impact of the Ketogenic Diet—A Narrative Literature Review
by Joanna Cielecka, Zuzanna Szkamruk, Maciej Walędziak and Anna Różańska-Walędziak
Diseases 2025, 13(10), 347; https://doi.org/10.3390/diseases13100347 - 17 Oct 2025
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Abstract
(1) Background: diabetic ketoacidosis (DKA) remains one of the most serious acute complications of type 1 diabetes, especially among young adults. At the same time the ketogenic diet, characterized by high fat and very low carbohydrate intake, is becoming increasingly popular, raising concerns [...] Read more.
(1) Background: diabetic ketoacidosis (DKA) remains one of the most serious acute complications of type 1 diabetes, especially among young adults. At the same time the ketogenic diet, characterized by high fat and very low carbohydrate intake, is becoming increasingly popular, raising concerns about its appropriateness and safety for individuals with type 1 diabetes, (2) Methods: a literature review was conducted using MEDLINE and SCOPUS databases, complemented by additional searches in Embase, Cochrane Library, and Web of Science to ensure broad coverage of both international and European studies with the focus on keywords including “diabetic ketoacidosis”, “type 1 diabetes”, and “ketogenic diet”. The most relevant and up-to-date studies were selected to evaluate both risks and potential clinical applications of this diet in T1D in young adults, (3) Results and Conclusions: While nutritional ketosis under controlled conditions is typically safe, individuals with T1D, especially young adults, may be more vulnerable to DKA due to factors such as inconsistent insulin administration, lack of ketone monitoring, and lifestyle changes. Reports of euglycemic DKA further highlight the importance of regular ketone tracking, even when blood glucose appears within target ranges. Although low-carbohydrate diets may offer improved glycemic profiles, their use in young adults with T1D must be carefully evaluated, emphasizing individualized care plans, close metabolic monitoring, and comprehensive patient education. Ongoing research is essential to clarify whether ketogenic diet can be safely integrated into diabetes management in this population. Full article
(This article belongs to the Special Issue From Monitoring to Management: Addressing Challenges in Type 1 and Type 2 Diabetes Care)
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21 pages, 1666 KB  
Review
Angiotensin-Converting Enzyme Gene Polymorphisms and Diabetic Neuropathy: Insights from a Scoping Review and Scientometric Analysis
by Rafaela Cirillo de Melo, Paula Rothbarth Silva, Nathalia Marçallo Peixoto Souza, Mateus Santana Lopes, Wellington Martins de Carvalho Ragassi, Luana Mota Ferreira, Fabiane Gomes de Moraes Rego and Marcel Henrique Marcondes Sari
Diseases 2025, 13(9), 289; https://doi.org/10.3390/diseases13090289 - 1 Sep 2025
Viewed by 937
Abstract
Background/Objectives: Diabetic neuropathy (DN) is one of the most common and disabling complications of diabetes mellitus (DM), affecting motor, sensory, and autonomic nerves. Genetic factors, particularly polymorphisms in the Angiotensin-converting enzyme (ACE) gene, have been proposed as contributors to DN susceptibility. [...] Read more.
Background/Objectives: Diabetic neuropathy (DN) is one of the most common and disabling complications of diabetes mellitus (DM), affecting motor, sensory, and autonomic nerves. Genetic factors, particularly polymorphisms in the Angiotensin-converting enzyme (ACE) gene, have been proposed as contributors to DN susceptibility. This study aimed to synthesize the scientific evidence on ACE gene polymorphisms and their association with DN through a scoping review combined with scientometric analysis. Methods: A comprehensive search of PubMed, Scopus, and Web of Science was performed in February 2025, following JBI and PRISMA-ScR guidelines. Observational studies involving individuals with DN and the genotyping of ACE polymorphisms were included. Scientometric mapping was conducted using the Bibliometrix package in RStudio to identify publication trends and key thematic terms. Results: From 100 screened articles, 11 met the inclusion criteria. Most studies (72.7%) addressed diabetic peripheral neuropathy, while 27.3% investigated cardiac autonomic neuropathy. All studies analyzed the I/D polymorphism in intron 16 of the ACE gene. The D allele and DD genotype were associated with increased susceptibility to DN in over half of the studies (6/11), while the II genotype was reported as protective in 3/11. Findings varied by ethnicity and study design. The scientometric analysis identified ‘peripheral diabetic neuropathy’, type 2 diabetes’, and ‘ACE gene polymorphism’ as the most frequently co-occurring terms, indicating that research on this topic has been concentrated around these themes, while showing limited diversity in geographic origin and scope. Conclusions: ACE I/D polymorphism appears to modulate susceptibility to DN, though interethnic variability and methodological heterogeneity challenge definitive conclusions. Broader, standardized studies are needed to validate its utility as a predictive biomarker. Full article
(This article belongs to the Special Issue From Monitoring to Management: Addressing Challenges in Type 1 and Type 2 Diabetes Care)
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Other

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12 pages, 816 KB  
Systematic Review
Can DPP-4 Inhibitors Improve Glycemic Control and Preserve Beta-Cell Function in Type 1 Diabetes Mellitus? A Systematic Review
by Henrique Villa Chagas, Lucas Fornari Laurindo, Victória Dogani Rodrigues, Jesselina Francisco dos Santos Haber, Eduardo Federighi Baisi Chagas and Sandra Maria Barbalho
Diseases 2026, 14(1), 28; https://doi.org/10.3390/diseases14010028 - 9 Jan 2026
Viewed by 200
Abstract
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 [...] Read more.
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
(This article belongs to the Special Issue From Monitoring to Management: Addressing Challenges in Type 1 and Type 2 Diabetes Care)
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28 pages, 502 KB  
Systematic Review
Zinc and Type 2 Diabetes: A Systematic Review with a Narrative Synthesis of Their Bidirectional Relationship and Clinical Perspectives for Personalized Nutritional Support
by Evgeniya Klein, Daria Velina, Sherzodkhon Mutallibzoda, Svetlana Tefikova, Olga Orlovtseva, Alexander N. Kosenkov, Dmitry Kulikov and Igor Nikitin
Diseases 2025, 13(12), 396; https://doi.org/10.3390/diseases13120396 - 11 Dec 2025
Viewed by 1201
Abstract
Background: Type 2 diabetes mellitus (T2DM) remains one of the most significant public health problems, and its incidence rate is steadily increasing worldwide despite scientific and technological progress in the field of medicine. The focus of research in this area is gradually shifting [...] Read more.
Background: Type 2 diabetes mellitus (T2DM) remains one of the most significant public health problems, and its incidence rate is steadily increasing worldwide despite scientific and technological progress in the field of medicine. The focus of research in this area is gradually shifting from classic risk factors—such as obesity, sedentary lifestyle and genetic predisposition—toward additional, potentially modifiable contributors such as micronutrient imbalances; among them are disturbances in zinc homeostasis that may influence glucose metabolism and oxidative stress. Objective: This systematic review with narrative synthesis aims to examine the bidirectional relationship between zinc status and T2DM and to evaluate whether zinc screening and personalized nutritional support could contribute to comprehensive metabolic management. Methods: A literature search was conducted in the PubMed database and the Cochrane library for studies published between 2010 and 2024. Studies assessing zinc status or supplementation in relation to the risk, progression, or management of T2DM were included. Data were synthesized narratively, focusing on clinical and mechanistic evidence. Results: Thirty studies met the inclusion criteria. Evidence indicates that zinc imbalance (both deficiency and excess) is associated with T2DM risk and outcomes. Zinc deficiency may impair insulin synthesis and signaling, promote oxidative stress and inflammation, while excessive zinc intake may induce metabolic disturbances. T2DM itself may lead to reduced zinc status via altered absorption and increased excretion. While some studies suggest modest improvements in glycemic or lipid parameters following zinc supplementation, findings remain inconsistent and context-dependent. The prevalence of suboptimal zinc status in certain populations supports the rationale for targeted screening rather than routine supplementation. Conclusions: Zinc is mechanistically involved in insulin synthesis, antioxidant defense, and inflammation control, but current clinical evidence does not justify its use as a therapeutic agent in T2DM. Instead, assessment of zinc status and individualized correction of deficiency may represent a component of personalized nutritional support, particularly for patients with long disease duration, poor dietary quality, or genetic predispositions affecting zinc metabolism. Full article
(This article belongs to the Special Issue From Monitoring to Management: Addressing Challenges in Type 1 and Type 2 Diabetes Care)
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