Acta Diabetologica[JOURNAL]
Sun
200 papers
Combined respiratory muscle training and photobiomodulation improve systemic and tissue-specific redox homeostasis in a rat model of type 2 diabetes.
Trevisan ME, Gonzatti N, da Silva CCF … +9 more , Tonetto LDS, Guex CG, Puntel GO, da Silva AMV, Signori LU, de Andrade CM, Dal Lago P, Bauermann LF, Jaenisch RB
Acta Diabetol · 2026 Jun · PMID 42348006 · Publisher ↗
AIMS: Oxidative stress plays a central role in the pathophysiology of type 2 diabetes and contributes to multiorgan dysfunction. Non-pharmacological strategies targeting redox imbalance may provide complementary benefits...
AIMS: Oxidative stress plays a central role in the pathophysiology of type 2 diabetes and contributes to multiorgan dysfunction. Non-pharmacological strategies targeting redox imbalance may provide complementary benefits beyond glycemic control. This study investigated the effects of combined respiratory muscle training (RMT) and photobiomodulation (PBM) on systemic and tissue-specific redox homeostasis in an experimental model of type 2 diabetes. METHODS: Male rats were allocated into four groups: sedentary Sham (non-diabetic), Sham submitted to RMT combined with PBM, sedentary type 2 diabetes, and type 2 diabetes submitted to the RMT/PBM protocol. Type 2 diabetes was induced by a high-fat diet associated with low-dose streptozotocin. Interventions were performed five days per week for six weeks. Hematological and biochemical parameters were evaluated. Oxidative stress was assessed by lipid peroxidation (thiobarbituric acid reactive substances) and reactive oxygen species production (dichlorofluorescein), while antioxidant defenses were determined by superoxide dismutase activity and non-protein thiol levels in plasma and multiple tissues. RESULTS: In diabetic rats, the combined RMT/PBM protocol increased mean corpuscular hemoglobin concentration, reduced leukocyte and monocyte counts, and restored plasma protein levels. Oxidative damage was attenuated in plasma, diaphragm, lungs, and kidneys, while antioxidant defenses were enhanced, particularly in the diaphragm, heart, and kidneys. In normoglycemic rats, RMT/PBM also enhanced tissue antioxidant capacity, indicating preserved redox responsiveness. CONCLUSIONS: Combined RMT and PBM promote systemic and tissue-specific redox adaptations and improve hematological and biochemical parameters in diabetic rats. These findings support the potential of this combined intervention as a non-pharmacological strategy to mitigate oxidative dysfunction associated with type 2 diabetes.
Quality of care for migrant populations with type 2 diabetes mellitus in Italy: a retrospective analysis of data from the the Italian AMD (Associations of Medical Diabetologists) annals initiative.
Occhipinti M, Ragusa I, Manicardi V … +11 more , Bellone F, Calabrese M, Esposito L, Manicardi E, Nicolucci A, Ceriello A, Rocca A, Rossi MC, Russo G, Candido R, di Cianni G
Acta Diabetol · 2026 Jun · PMID 42340410 · Publisher ↗
PURPOSE: Italy is a major hub for migration routes. Disparities in health management across different geographic regions, particularly among individuals with type 2 diabetes mellitus (T2D), are well recognized, yet compr...
PURPOSE: Italy is a major hub for migration routes. Disparities in health management across different geographic regions, particularly among individuals with type 2 diabetes mellitus (T2D), are well recognized, yet comprehensive data on the quality of T2D care in migrant populations remain limited. METHODS: Quality indicators of T2D care were analyzed for foreign patients compared with European patients using the 2022 AMD Annals database. The Italian National Institute of Statistics classification defined geographic origins. RESULTS: Data on country of origin were available for 179,536 T2D patients, with 19.3% being foreign, mainly from North Africa, Central and Eastern Europe, Central and South Asia, Central and South America.Foreign T2D patients were generally younger, resulting in shorter disease duration. While annual screening rates for risk factors and major complications were as European subjects, critical gaps were noted in microalbuminuria and retinopathy assessments. Treatment intensity was lower for patients from North and West Africa and Central and South Asia, though the use of innovative therapies like GLP-1RAs and SGLT2i was comparable to European patients. The overall quality of care, measured by the Q-score, was lowest in West African patients (26.4 ± 9.1 vs. 29.1 ± 8.0), while 51.6% of those from Central and South Asia had satisfactory care quality (Q-score > 25). CONCLUSION: Study showed differences in age, disease duration, and treatment among patients from various geographic regions, while indicating equitable access to therapies and comparable overall quality of care. These findings may inform management strategies to improve T2D care for migrant populations.
Bidirectional association between obstructive sleep apnea and diabetic retinopathy: a severity-stratified systematic review and meta-analysis with GRADE assessment.
Abdelaal A, Mahmoud YA, Alsouri W … +5 more , Al-Nawaflh M, Al Issa K, Yaldo L, Elaraby O, Abu Serhan H
Acta Diabetol · 2026 Jun · PMID 42334598 · Publisher ↗
PURPOSE: To synthesise the bidirectional evidence on the association between obstructive sleep apnea (OSA) and diabetic retinopathy (DR), separating studies framing OSA as the exposure for DR (Arm 1) from studies framing...
PURPOSE: To synthesise the bidirectional evidence on the association between obstructive sleep apnea (OSA) and diabetic retinopathy (DR), separating studies framing OSA as the exposure for DR (Arm 1) from studies framing DR as the exposure for OSA (Arm 2). METHODS: Systematic review and meta-analysis of observational studies (PROSPERO: CRD420251135427). PubMed, Scopus, Web of Science, and Google Scholar were searched from inception to July 13, 2025, supplemented by structured re-screening of five prior systematic reviews and forward and backward citation searching. Eligible studies enrolled individuals with diabetes mellitus and reported binary OSA (or, in Arm 2, DR) exposure with an unexposed comparator. Within each arm, exposure and outcome were severity-stratified; unadjusted and adjusted odds ratios (ORs) were pooled separately using random-effects models in MetaAnalysisOnline.com. Risk of bias was assessed with the Newcastle-Ottawa Scale (NOS) and certainty of evidence with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. RESULTS: Twenty-six studies met eligibility criteria. In Arm 1 (OSA → DR), the unadjusted pooled OR for any DR with OSA classified as a binary exposure was 2.41 (95% confidence interval [CI] 1.53-3.80; 10 studies; very low certainty), but attenuated to 1.03 (95% CI 0.64-1.66; 2 studies; low certainty) in confounder-adjusted analyses. OSA-severity-stratified Arm 1 estimates for mild, moderate, and severe OSA were directionally consistent but not statistically significant in either unadjusted or adjusted pooling. DR-stage-specific Arm 1 analyses (background DR, mild/moderate/severe non-proliferative DR [NPDR], proliferative DR [PDR]) were directionally aligned with the overall Arm 1 finding but imprecise. In Arm 2 (DR → OSA), pooled estimates showed inverse or null associations across DR severity strata; severe OSA as an outcome of DR yielded a pooled OR of 1.24 (95% CI 0.92-1.68; 4 studies; low certainty). CONCLUSIONS: The OSA-DR association is sensitive to the direction of the framed exposure-outcome relationship, to confounder adjustment, and to severity classification. Substantial attenuation of the unadjusted Arm 1 signal after adjustment, together with the inverse or null Arm 2 pattern, indicates that previously reported pooled estimates were influenced by confounding and by directional misclassification. Polysomnography-confirmed prospective cohorts with uniform DR grading and individual-participant-level adjustment for body mass index, diabetes duration, and metabolic comorbidities are needed to clarify the direction and magnitude of the relationship.
Therapeutic strategies to enhance proliferation in diabetic wound contraction: a comprehensive review from 1991-2025.
Islam I, Dey P, Thalluri C
Acta Diabetol · 2026 Jun · PMID 42334597 · Publisher ↗
The global rise in diabetes mellitus has been accompanied by a marked increase in associated complications, most notably impaired wound healing. Diabetic non-healing wounds arise from multifactorial pathophysiological me...
The global rise in diabetes mellitus has been accompanied by a marked increase in associated complications, most notably impaired wound healing. Diabetic non-healing wounds arise from multifactorial pathophysiological mechanisms, including excessive and prolonged inflammation, immune dysregulation, impaired angiogenesis, defective fibroblast-to-myofibroblast transition and aberrant growth factor signaling. These abnormalities delay wound contraction and re-epithelialization, increasing susceptibility to infection, chronic ulceration and limb amputation. Traditional and complementary approaches such as herbal formulations, Ayurvedic practices, and natural bioactive compounds have demonstrated potential in mitigating oxidative stress, modulating inflammation and promoting neovascularization. In parallel, advanced technological interventions, including nanocomposite hydrogels, smart and responsive biomaterials, gene therapy and targeted growth factor delivery systems, are being developed to create a pro-regenerative wound microenvironment. Modern clinical strategies such as electromagnetic therapy, negative pressure wound therapy, electrospun nanofiber scaffolds and 3D/4D bioprinting further contribute to enhanced wound contraction and tissue regeneration. Additionally, bioengineered skin substitutes, stem cell-based therapies and innovative growth factor delivery platforms offer promising translational prospects. This review critically summarizes traditional, complementary, and innovative approaches reported up to 2025, with an emphasis on smart biomaterials, emerging therapies and relevant preclinical models, highlighting future directions for improving diabetic wound care and patient quality of life.
Adjunctive use of glucagon-like peptide-1 receptor agonists after bariatric surgery: updated systematic review and meta-analysis of randomized controlled trials.
Arora S, Amna F, Akbarpoor F … +6 more , Rajdeep D, Khalid M, Machado GM, Maalin N, Rehman AU, Abreu M
Acta Diabetol · 2026 Jun · PMID 42334596 · Publisher ↗
AIMS: We meta-analyzed randomized trials to assess efficacy and safety of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) after bariatric surgery. METHODS: We searched PubMed, Embase, and Cochrane Central for rando...
AIMS: We meta-analyzed randomized trials to assess efficacy and safety of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) after bariatric surgery. METHODS: We searched PubMed, Embase, and Cochrane Central for randomized trials comparing GLP-1 RAs with placebo after bariatric surgery. Primary outcomes were change in body weight (kg) and HbA1c (%) at 6 and 12 months. We also assessed percent total body weight loss (%TBWL), quality of life, and adverse events. We pooled mean differences (MDs) with 95% confidence intervals (CIs) using random effects and assessed heterogeneity with I² statistic. We also performed an exploratory subgroup analysis that compared very early (≤ 2 months) versus late (≥ 18 months) initiation after surgery. RESULTS: Seven RCTs (n = 460) met inclusion criteria; all evaluated liraglutide. GLP-1 RAs increased weight loss at 6 months (MD - 5.33 kg; 95% CI - 9.42 to - 1.23; p = 0.02) but not at 12 months (MD - 5.05 kg; 95% CI - 22.14 to 12.05; p = 0.33). GLP-1 RAs increased %TBWL at 6 months (MD 5.13%; 95% CI 2.14 to 8.11; p = 0.007) but not at 12 months (MD 3.96%; 95% CI - 3.33 to 11.26; p = 0.18). HbA1c did not differ at 6 or 12 months. Quality of life improved at 6 months in the trials reporting this outcome. Gastrointestinal adverse events were similar between groups. Subgroup analyses suggested differences by initiation timing. CONCLUSION: GLP-1 RA therapy improved short-term weight outcomes after bariatric surgery, with no statistically significant between-group differences at 12 months. Timing of initiation may influence response and should be explored in trials with longer follow up. TRIAL REGISTRY: PROSPERO ID CRD420251251321.
Clarifying metformin exposure when interpreting glycemic responses after imeglimin initiation.
Zheng J, Zhang J
Acta Diabetol · 2026 Jun · PMID 42334595 · Publisher ↗
Abstract loading — click title to view on PubMed.
Therapeutic footwear in patients with diabetes: a position statement from the Italian diabetic foot study group.
Giurato L, Scatena A, De Giglio R … +9 more , Murdolo G, Mastinu M, Gicchino M, Gabriele D, Vermigli C, Panunzi A, Uccioli L, Da Ros R, SID-AMD Diabetic Foot Study Group
Acta Diabetol · 2026 Jun · PMID 42334594 · Publisher ↗
Prevention of diabetic foot ulcers is crucial, given the high risk of ulcer development (34%) and recurrence (> 40%), with up to 85% of amputations being preceded by ulceration. The most effective preventive intervention...
Prevention of diabetic foot ulcers is crucial, given the high risk of ulcer development (34%) and recurrence (> 40%), with up to 85% of amputations being preceded by ulceration. The most effective preventive intervention is the use of therapeutic footwear combined with custom-made insoles, which should be considered a true therapeutic strategy, comparable to metabolic control. Scientific evidence demonstrates that therapeutic footwear, particularly rigid-soled models with multilayer total-contact insoles, significantly reduces the risk of ulcer recurrence, provided that specific plantar pressure targets are achieved (< 200 kPa or a ≥ 30% reduction). Moreover, treatment adherence (at least 60-80% of daily active time) represents a critical determinant of effectiveness. This document aims to provide a practical approach to orthotic therapy by identifying the most appropriate prescription according to the patient's ulceration risk level (IWGDF classification) and the presence of foot deformities, while matching orthotic features to the clinical status of the foot for protective purposes. Prescriptions should be individualized and validated by a multidisciplinary team.
Maternal and neonatal outcomes in migrant women with gestational diabetes. A retrospective cohort study in Italy.
Citro F, Placenza N, Venturi C … +7 more , Galleano F, Aragona M, Battini L, Marchetti P, Penno G, Bianchi C, Bertolotto A
Acta Diabetol · 2026 Jun · PMID 42334593 · Publisher ↗
BACKGROUND: Migrant women have a higher risk of gestational diabetes (GDM), and often poorer metabolic control during pregnancy. However, evidence on neonatal outcomes compared to Italian women is limited and inconsisten...
BACKGROUND: Migrant women have a higher risk of gestational diabetes (GDM), and often poorer metabolic control during pregnancy. However, evidence on neonatal outcomes compared to Italian women is limited and inconsistent. This study aimed to compare neonatal outcomes between migrant and Italian women, and to identify predictors of adverse outcomes. METHODS: Clinical and metabolic data of pregnant women, who underwent selective screening (based on risk factors) for GDM at the University Hospital of Pisa from 2014 to 2022, were retrospectively collected. Neonatal outcomes (preterm delivery, large (LGA) and small (SGA) for gestational age, caesarean delivery, Apgar score 5') were compared between Italian and migrant women, with a specific focus on high-risk ethnic groups. RESULTS: Among 3499 women (78% Italian and 22% non-Italian), 1419 (41%) had GDM. Neonatal outcomes were comparable between Italian and migrant women, both in the whole cohort and in the subgroup with GDM. However, women with high-risk ethnicity reported a higher rate of SGA infants, both overall (12% vs. 7%, p = 0.001) and in the GDM subgroup (11% vs. 6%, p = 0.046), without significant differences in the Ponderal Index. At multivariable analysis, high-risk ethnicity was independently associated with an almost twofold increased risk of SGA (OR: 1.843 [1.196-2.838], p = 0.006). CONCLUSIONS: Close monitoring during gestation, management by a multidisciplinary team and free access to healthcare services may explain the similarity of neonatal outcomes in Italian and migrant women. The lack of ethnic-specific guidelines for fetal growth may explain the greater risk of SGA among women with high-risk ethnicity.
Health-related quality of life in adults with type 2 diabetes mellitus: the role of multi morbidity, glycaemic control and insulin therapy in an Albanian outpatient cohort.
Shabani Z, Haxhija E, Drishti E
Acta Diabetol · 2026 Jun · PMID 42334592 · Publisher ↗
AIMS: To describe health-related quality of life (HRQoL) across the eight SF-36 domains in Albanian adults with type 2 diabetes mellitus (T2DM), identify demographic and clinical correlates of HRQoL, and assess whether a...
AIMS: To describe health-related quality of life (HRQoL) across the eight SF-36 domains in Albanian adults with type 2 diabetes mellitus (T2DM), identify demographic and clinical correlates of HRQoL, and assess whether associations with multimorbidity were robust to an alternative principal component analysis (PCA)-derived weighted multimorbidity index. METHODS: In this cross-sectional study, 176 adults with T2DM completed the SF-36 questionnaire. Sociodemographic characteristics, diabetes duration, HbA1c, insulin therapy and physician-confirmed comorbidities were recorded. Multivariable linear regression models with robust standard errors examined adjusted associations between clinical characteristics and SF-36 domains. To address limitations of an unweighted comorbidity count, a PCA-derived weighted multimorbidity index was constructed and used in sensitivity analyses. Interaction analyses were considered exploratory. RESULTS: Participants had a mean age of 65.1 years, mean diabetes duration of 10.8 years, and mean HbA1c of 7.74%; 54.0% were receiving insulin therapy and 43.8% had multimorbidity. General Health, Role-Physical and Vitality were the most impaired SF-36 domains. In adjusted analyses, multimorbidity was independently associated with lower Physical Functioning, Vitality, Mental Health, Social Functioning, Bodily Pain and General Health scores. Older age was also associated with poorer HRQoL across several domains. After adjustment, neither insulin therapy nor HbA1c was independently associated with most physical HRQoL domains. Findings were materially unchanged when multimorbidity was operationalised using the PCA-derived weighted index. CONCLUSIONS: In this Albanian outpatient cohort, multimorbidity was the strongest independent cross-sectional correlate of impaired HRQoL across both physical and psychosocial domains. The association remained robust to alternative operationalisations of comorbidity burden. Given the cross-sectional design, modest sample size and potential residual confounding, findings should be interpreted as hypothesis-generating and warrant confirmation in larger longitudinal studies.
Maturity onset diabetes of the young in pregnancy: management, treatment and neonatal outcomes-a systematic review.
Romandini A, Vergani M, Pani A … +2 more , Bertuzzi F, Pintaudi B
Acta Diabetol · 2026 Jun · PMID 42329282 · Publisher ↗
Maturity Onset Diabetes of the Young (MODY) is a type of genetically inherited diabetes. As it generally arises in early adulthood, it can affect pregnant women with significant neonatal outcomes. Our study aimed to cond...
Maturity Onset Diabetes of the Young (MODY) is a type of genetically inherited diabetes. As it generally arises in early adulthood, it can affect pregnant women with significant neonatal outcomes. Our study aimed to conduct a systematic review on pregnancy management and outcomes of all subtypes of MODY, browsing the Cochrane, EMBASE and PubMed databases to find clinical studies on the topic. They were last searched on June 29, 2025. The inclusion criteria for our review were: published articles, available in their full-text version, about MODY, reporting data about its management during pregnancy and neonatal outcomes, in English language, specifying therapeutic approaches used. The exclusion criteria were: study designs reported below, written in other languages, not present in above mentioned databases. The risk of bias was assessed through the ROBIS tool. Our systematic review analyzed data on 1408 live births of 1183 pregnant women, and found specific guidelines for the management of pregnant women affected with GCK-MODY and HNF1A-MODY, but none on rarer subtypes. Thus, indications on pregnancy management and outcomes of rarer MODYs were identified through an additional literature review, and its findings were summarized in Table 1. Our systematic review was limited by the lack of data on rarer subtypes of MODY and the specific keywords and databases selected. However, our work lays an important step in the direction of much-needed clinical data and recommendations in treating rare MODY subtypes during pregnancy, towards healthy offspring delivery and growth. A further literature review was carried out to identify any data on other subtypes of MODY and their neonatal outcomes, and the findings were summarized in Table 1. No funding was needed to carry out the present systematic review. PROSPERO registration number: CRD420251062633.
Super learner model for predicting carotid plaque regression in type 2 diabetes on PCSK9 inhibitors.
Chen J, Yang Q, Hou G … +4 more , Bi J, Xu Q, Guo H, Sun J
Acta Diabetol · 2026 Jun · PMID 42329281 · Publisher ↗
OBJECTIVES: Evidence regarding the effects of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors on carotid plaque regression in patients with type 2 diabetes mellitus (T2DM) and subclinical atherosclerosis...
OBJECTIVES: Evidence regarding the effects of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors on carotid plaque regression in patients with type 2 diabetes mellitus (T2DM) and subclinical atherosclerosis remains limited; therefore, this study aimed to develop and validate a machine learning-based model for predicting carotid plaque regression in this population. METHODS: This retrospective study included a development cohort of 204 patients with T2DM and subclinical atherosclerosis receiving combined statin and evolocumab therapy, with external validation performed in an independent cohort. The primary outcome was the change in mean carotid plaque thickness. Thirteen predictors were selected using the Boruta algorithm to construct a Super Learner model, which was validated through repeated five-fold cross-validation. Model interpretability was assessed using SHapley Additive exPlanations analysis. RESULTS: After 24 weeks of treatment, carotid plaque regression was observed in 52.9% of patients. The model demonstrated strong discriminatory performance in the internal validation set (area under the curve [AUC] = 0.958; sensitivity = 0.881; specificity = 0.908) and moderate performance in the external validation cohort (AUC = 0.755; sensitivity = 0.875; specificity = 0.560). Low-density lipoprotein cholesterol, total cholesterol, high-sensitivity C-reactive protein, high-density lipoprotein cholesterol, and alanine aminotransferase were identified as the most influential predictors. CONCLUSIONS: This study demonstrates the feasibility of applying machine learning algorithms to predict responses to evolocumab in patients with T2DM and subclinical atherosclerosis. Machine learning may support individualized risk stratification by identifying individuals most likely to benefit from therapy, thereby supporting personalized strategies for secondary cardiovascular disease prevention.
Identification and functional characterization of a novel mutation in the NEUROD1 gene in a Chinese family with maturity-onset diabetes of the young.
Li J, Zhang J, Ren S … +8 more , Liu Y, Wu C, Dong J, Zhu C, Chen S, Zhang H, Li T, Jiang Y
Acta Diabetol · 2026 Jun · PMID 42329280 · Publisher ↗
AIMS: Few families with maturity-onset diabetes of the young (MODY) caused by neurogenic differentiation factor 1 (NEUROD1) mutations have been identified. The aim of this study is to identify the affected gene in a Chin...
AIMS: Few families with maturity-onset diabetes of the young (MODY) caused by neurogenic differentiation factor 1 (NEUROD1) mutations have been identified. The aim of this study is to identify the affected gene in a Chinese family with MODY using whole exome sequencing (WES) and explore the potential pathogenicity of the identified mutation. METHODS: WES was performed in patients with clinically suspected MODY, and candidate variants were verified with Sanger sequencing for family co-segregation. Structure-function alterations in the newly identified mutant protein were analyzed using three-dimensional modeling and dual luciferase reporter gene assays to assess pathogenicity. RESULTS: A novel heterozygous missense mutation, Y297D (c.889T > G, p.Tyr297Asp), in the NEUROD1 gene (NM_002500.5) was identified in a MODY proband and his affected relatives. Y297D mutation disrupted a C-H conjugated interaction and introduced a new hydrogen bond, altering the protein's local structure. These alterations reduced transcriptional activity in the transactivation domain of the Y297D mutant compared with that of the wild-type protein (P < .05). CONCLUSIONS: A novel NEUROD1 mutation has been identified in Chinese MODY, and the abnormal conformation of NEUROD1-Y297D reduced insulin transcription activity, impairing pancreatic β-cell function in patients with MODY6. Glucagon-like peptide-1 receptor agonist (GLP-1RAs) may be a precision hypoglycemic strategy to consider in diabetic patients with NEUROD1 mutations.
Long-term outcomes of autologous cell therapy in patients with ischaemic diabetic foot ulcers and no-option chronic limb threatening ischaemia.
Marco M, Ermanno B, Luigi U … +7 more , Daniele M, Laura G, Rolando BF, Valeria R, Aikaterini A, Alfonso B, Davide L
Acta Diabetol · 2026 Jun · PMID 42329279 · Publisher ↗
AIM: Patients with ischaemic diabetic foot ulcers (DFUs) and no-option chronic limb-threatening ischaemia (CLTI) are reported to have a high risk of major amputation and mortality. Peripheral blood mononuclear cell (PB-M...
AIM: Patients with ischaemic diabetic foot ulcers (DFUs) and no-option chronic limb-threatening ischaemia (CLTI) are reported to have a high risk of major amputation and mortality. Peripheral blood mononuclear cell (PB-MNCs) therapy has emerged as a promising adjunctive strategy, but long-term data remain limited. The study aimed to evaluate the long-term outcomes of PB-MNC therapy in patients with DFUs and NO-CLTI. METHODS: This prospective, single-centre, observational, controlled study included patients with ischaemic DFUs and no-option CLTI enrolled between January 2017 and September 2023. No-option CLTI was defined by a technical failure of lower limb revascularization with the absence of any below-the-ankle vessel and/or indirect revascularization with TcPO₂ values < 30 mmHg in the wound angiosome area. Patients were divided into two groups: those receiving PB-MNCs therapy plus standard of care (SoC) and those treated only with SOC based on conventional guidelines. PB-MNCs were administered by intramuscular injections along the anatomical area of the wound-related artery (2 or 3 cycles, 21-42 days apart). At 24 months of follow-up, outcomes assessed were healing, major amputation, and mortality. In the PB-MNC group, hospital readmission for recurrent CLTI requiring repeat revascularization was also recorded. RESULTS: Overall, 78 patients were included: 48 in the PB-MNCs group and 30 in the conventional therapy group. The mean age was 73.7 years, 84.6% were male, and most had type 2 diabetes (92.3%). At the baseline assessment, 71.8% of DFUs were infected, 83.3% were > 5 cm², and 88.5% had gangrene. At 24 months, the PB-MNCs group showed a higher rate of healing (60.4 vs. 20%, p < 0.0001), lower rate of major amputation (12.5 vs. 26.7%, p = 0.0004), and mortality (27.1 vs. 46.7%, p = 0.0002) than the control group. CLTI recurrence requiring readmission occurred in 3/48 (6.2%) among patients in the PB-MNC group. CONCLUSIONS: In patients with ischaemic DFUs and NO-CLTI, adjunctive PB-MNCs therapy was associated with better long-term outcomes in comparison to conventional therapy.
Metrics and insulin variations in women with type 1 diabetes on automated insulin delivery system during strict peripartum period.
Fresa R, Napoli A, Bitterman O
Acta Diabetol · 2026 Jun · PMID 42329278 · Publisher ↗
INTRODUCTION: the use of Automated Insulin Delivery (AID) systems has increased in pregnant women with type 1 diabetes (DM1). To date, little data exist regarding glucose control and insulin modifications with AID in aut...
INTRODUCTION: the use of Automated Insulin Delivery (AID) systems has increased in pregnant women with type 1 diabetes (DM1). To date, little data exist regarding glucose control and insulin modifications with AID in automode during delivery and in the postpartum period. METHODS: we retrospectively evaluated pregnancy-specific metrics and insulin variations in a short peripartum period in 14 DM1 users of the MiniMed™780G pump in closed loop mode from pregestational care to the postpartum period. RESULTS: glycemic control during labour and delivery was optimal, with Time In Range 63-140 mg/dl (pTIR) did not significantly change, remaining nearly the same from 48 h before to 48 after the time of birth (85%). Variations in the Total insulin daily dose (TDD) were mainly influenced by manual boluses rather than the autobasal insulin in all examined periods. Auto basal insulin + autocorrection boluses reduced by 17.5% immediately after delivery and by 31% in the early postpartum period (14 days). CONCLUSIONS: this is the first study to report on insulin variations with an AID system in automode during the strict peripartum period, before and after the time of birth. pTIR did not significantly change, remaining nearly the same from 48 h before to 48 after the time of birth, despite the dramatic variations in insulin requirements, with unexpected little variation in autobasal insulin. It is possible that, for patients with very good glycemic control using Minimed780G, the manual basal rate needs to be reduced less than the usual 50% after delivery, if switching to manual mode for any reason. Further research is needed to develop a protocol for glucose management in women with AID systems during and after delivery.
Glycemic control and clinical outcomes in patients with diabetes and atrial fibrillation: a nationwide cohort study.
Kouki E, Salmela B, Aro A … +10 more , Halminen O, Teppo K, Niskanen L, Haukka J, Putaala J, Linna M, Mustonen P, Hartikainen J, Airaksinen KEJ, Lehto M
Acta Diabetol · 2026 Jun · PMID 42329277 · Publisher ↗
AIMS: To evaluate the association of HbA1c level at the time of atrial fibrillation (AF) diagnosis with adverse outcomes (death, ischemic stroke (IS), myocardial infarction (MI), bleeding) in an unselected nationwide coh...
AIMS: To evaluate the association of HbA1c level at the time of atrial fibrillation (AF) diagnosis with adverse outcomes (death, ischemic stroke (IS), myocardial infarction (MI), bleeding) in an unselected nationwide cohort of patients with AF and diabetes mellitus (DM). METHODS: The retrospective FinACAF registry study covered all patients with incident AF in Finland between 2010 and 2017. Outcomes were analyzed using HRs and sHRs (hazard ratios and subdistribution hazard ratios), with HbA1c modelled both categorically and continuously. RESULTS: Among 157 658 patients with incident AF, DM was present in 23% (n = 35 872). Baseline HbA1c was available in 49% (17 519) of DM patients. DM was associated with increased hazards of all evaluated outcomes. Elevated HbA1c in categorical analyses was associated with progressively increased adjusted HRs and sHRs, with highest ratios seen in HbA1c > 63 mmol/mol for death (HR 1.56, 95% CI 1.45-1.68), IS (sHR 1.38 95% CI 1.20-1.59), and MI (sHR 1.70 95% CI 1.48-1.94), when compared to patients without DM. In continuous analyses, higher HbA1c levels were associated with increasing hazards for mortality, IS, and MI. Bleeding hazards remained stable across the HbA1c spectrum. CONCLUSIONS: Higher baseline HbA1c levels were associated with progressively increased hazards of mortality, IS, and MI in patients with incident AF and DM.
Metabolic-inflammatory axis linking diabetes and sarcopenia: cross-population evidence and explainable ai-based risk modeling.
He L, Wang S, Cao Y … +4 more , Zhang S, Li J, Zhao Z, Yue S
Acta Diabetol · 2026 Jun · PMID 42329276 · Publisher ↗
BACKGROUND: Diabetes and sarcopenia frequently coexist in aging populations and share intertwined metabolic and inflammatory pathways. However, the mechanisms underlying their coexistence and the ability to predict funct...
BACKGROUND: Diabetes and sarcopenia frequently coexist in aging populations and share intertwined metabolic and inflammatory pathways. However, the mechanisms underlying their coexistence and the ability to predict functional decline across populations remain poorly understood. METHODS: Data were obtained from two nationally representative cohorts-NHANES (19,931 participants) and CHARLS (96,628 participants). Diabetes and sarcopenia were defined according to international standards, yielding four groups: control, diabetes only, sarcopenia only, and comorbidity. Metabolic-inflammatory profiles were characterized by CRP, HDL, triglycerides, albumin, and BMI. Cross-sectional and longitudinal analyses were performed to evaluate metabolic-inflammatory-muscle interactions. Logistic, LASSO, and XGBoost models were trained in NHANES to predict functional decline, and their performance and feature importance patterns were evaluated for consistency in CHARLS, with model calibration, decision-curve, and SHAP-based explainability. RESULTS: Individuals with diabetes-sarcopenia comorbidity exhibited the most adverse metabolic-inflammatory pattern, characterized by higher CRP and triglycerides but lower albumin and HDL. Functional performance declined progressively from control to comorbidity groups. The XGBoost model achieved robust discrimination for functional decline (AUC = 0.80 in NHANES; 0.78 in CHARLS) and consistent calibration across subgroups. SHAP interpretation identified albumin, CRP, and HDL as dominant predictors. Mechanistic correlation analysis revealed strengthened negative coupling between glucose, inflammation, and muscle indices in the comorbidity phenotype, supporting an observed association of the metabolic-inflammatory-muscle axis. CONCLUSIONS: Across two independent populations, diabetes-sarcopenia comorbidity was characterized by a convergent metabolic-inflammatory burden that predicted functional decline. The integrated model provided explainable and generalizable risk estimation, highlighting the metabolic-inflammatory-muscle axis as a potentially relevant associated pathway.
Diabetes, prediabetes, and mild cognitive impairment among older adults: the Hitachi Health Study II.
Fukunaga A, Ito A, Inoue Y … +5 more , Inada H, Nakagawa T, Yamamoto S, Konishi M, Mizoue T
Acta Diabetol · 2026 Jun · PMID 42329275 · Publisher ↗
AIM: We examined associations of diabetes, prediabetes, and glycemic markers with mild cognitive impairment (MCI) in older adults, and whether these associations are modified by treatment status, diabetes duration, and g...
AIM: We examined associations of diabetes, prediabetes, and glycemic markers with mild cognitive impairment (MCI) in older adults, and whether these associations are modified by treatment status, diabetes duration, and glycemic control. METHODS: We used data from 2486 adults (mean age: 65 years) undergoing health check-ups and cognitive screening. Prediabetes and diabetes were defined by fasting plasma glucose (FPG), HbA1c, or history/medication use. Diabetes was divided into screen-detected and treated cases. Cognitive function was tested using a computerized test battery evaluating immediate memory, temporal orientation, delayed recall, and three-dimensional visual-spatial perception. Participants scoring ≤ 13 (range, 0-15) were considered to have MCI. RESULTS: Overall, 251 participants (10.1%) were classified with MCI. Compared with normoglycemia, odds ratios (95% CIs) were 1.45 (0.90, 2.33) for prediabetes and 1.67 (0.99, 2.81) for diabetes. When stratified by treatment status, the odds ratios were larger in treated diabetes than in screen-detected diabetes (1.77 [1.03, 3.06] vs. 1.48 [0.77, 2.84]). Larger odds ratios were also found among those with diabetes duration ≥ 10 years (2.26, 95% CI: 1.27, 4.02) and HbA1c ≥ 7% (1.90, 95% CI: 1.00, 3.60). Diabetes was associated with lower scores in temporal orientation and visual-spatial perception. Among participants without diabetes, higher FPG was associated with higher odds of MCI; the odds ratio for FPG 110-125 vs. <100 mg/dL was 1.85 (95% CI: 1.18, 2.89). CONCLUSION: Older adults with diabetes, particularly those with treated, longstanding, or uncontrolled diabetes, had a higher prevalence of MCI. Among those without diabetes, higher FPG was associated with MCI.
Glycemic assessment in diabetic patients with secondary polycytheamia: limitations of HbA1c and the potential role of fructosamine-a prospective comparative study.
Erarslan S, Kilit TP, Acet A
Acta Diabetol · 2026 Jun · PMID 42329274 · Publisher ↗
OBJECTIVE: This study aimed to evaluate the reliability of haemoglobin A1c (HbA1c) for assessing glycaemic status in patients with type 2 diabetes mellitus (T2DM) and secondary polycythaemia, and to determine whether fru...
OBJECTIVE: This study aimed to evaluate the reliability of haemoglobin A1c (HbA1c) for assessing glycaemic status in patients with type 2 diabetes mellitus (T2DM) and secondary polycythaemia, and to determine whether fructosamine serves as a more reliable complementary glycaemic marker in this population. METHODS: In this prospective observational study, patients with T2DM and secondary polycythaemia (n = 62) and T2DM controls with normal haematological indices (n = 40) were enrolled. HbA1c- and fructosamine-derived estimated mean plasma glucose (eMPG) were compared with structured home capillary blood glucose (CBG; 7 measurements/day × 5 days). Bland-Altman analysis and multivariate linear regression (adjusting for age, sex, diabetes duration, BMI, smoking, fasting glucose, haemoglobin, haematocrit) were performed. RESULTS: Fasting plasma glucose and HbA1c were similar between groups (p = 0.352 and p = 0.816), while fructosamine (456.53 ± 90.18 vs. 404.18 ± 97.63 µmol/L; p = 0.001) and Home-CBG (207.23 ± 49.18 vs. 181.98 ± 55.31 mg/dL; p = 0.002) were significantly higher in the polycythaemia group. Bland-Altman analysis confirmed a systematic negative bias of HbA1c-derived eMPG (mean bias: -23.73 mg/dL; 95% LoA: -45.97 to - 1.48). On multivariate regression, polycythaemia group assignment was the strongest independent association with HbA1c underestimation (β=-16.80 mg/dL; 95% CI: -25.53 to - 8.07; p < 0.001). Fructosamine-derived eMPG showed substantially better agreement with Home-CBG (bias: +7.68 mg/dL). Overall, 60% of polycythaemia patients would have been assigned to a different glycaemic control category based on fructosamine versus HbA1c. CONCLUSION: HbA1c systematically underestimates glycaemic status in patients with polycythaemia and may lead to clinically relevant misclassification. In contrast, fructosamine appears to provide a more reliable estimate of glycaemic control in this population.
Identifying barriers to diabetes technology use: LIFESTEPS, a newly developed clinical support tool for healthcare professionals.
Geraldine G, Alice R, Núria AC … +12 more , Sima A, Virginie B, Vanessa B, Kerstin E, Verena S, Audrey H, Amy J, Rea J, Anna SB, Julie T, Paola C, Katarzyna C
Acta Diabetol · 2026 Jun · PMID 42329273 · Publisher ↗
BACKGROUND: Psychosocial, behavioural, and lifestyle-related barriers can substantially affect the uptake, continued use, and discontinuation of diabetes technology in people with type 1 diabetes (PWT1D). However, struct...
BACKGROUND: Psychosocial, behavioural, and lifestyle-related barriers can substantially affect the uptake, continued use, and discontinuation of diabetes technology in people with type 1 diabetes (PWT1D). However, structured tools to support healthcare professionals (HCPs) in systematically exploring these barriers in routine care remain limited. To address this gap, a clinically oriented questionnaire was developed by a multidisciplinary panel of diabetes experts. This paper describes the development of the questionnaire and its preliminary evaluation in terms of clarity, comprehensibility, usability, relevance, and perceived acceptability. METHODS: A panel of 12 diabetes experts from 11 countries across Europe, the Middle East, and Africa (EMEA) reviewed the literature on barriers to diabetes technology use, grouped these barriers into key thematic domains, and developed a structured questionnaire that was translated into multiple languages. The questionnaire then underwent a two-round end-user evaluation involving HCPs and PWT1D to assess clarity, comprehensibility, practicality, relevance, and potential bias. Feedback from the first round informed refinement of the questionnaire before reassessment in a second round. The evaluation was descriptive and focused on end-user feedback; formal psychometric testing and hypothesis-driven validation analyses were not undertaken. RESULTS: The expert panel named the questionnaire LIFESTEPS, reflecting its core thematic domains. The questionnaire covers the following areas of discussion related to barriers to technology: psychological and relational aspects of diabetes, experience with technology and body image, and anticipation and adaptation to new technology. In the first evaluation round, feedback was obtained from 19 HCPs and 37 PWT1D recruited by panel members. Following revision of the questionnaire, a second round involving 5 HCPs and 7 PWT1D was conducted to reassess clarity and usability. Overall, participants reported that the final version of the questionnaire was understandable, perceived as easy to complete, and potentially useful for supporting discussion of barriers to diabetes technology use in clinical practice. CONCLUSIONS: LIFESTEPS is a newly developed, multilingual clinical support tool designed to facilitate structured discussion of psychosocial and lifestyle-related barriers to diabetes technology use. The findings provide preliminary support for its clarity, acceptability, and perceived clinical usefulness. Further psychometric and prospective clinical evaluation is needed before broader analytical or predictive applications can be considered. Accordingly, LIFESTEPS should be interpreted as a preliminary conversation-support tool rather than as a validated measurement instrument.
Phenylketonuria and type 1 diabetes: a clinical and nutritional challenge in a young adult-a case report.
Piccolo C, de Candia S, Natalicchio A … +5 more , Di Molfetta S, Caruso I, Laviola L, Giorgino F, Sorice GP
Acta Diabetol · 2026 Jun · PMID 42319439 · Publisher ↗
AIMS: Phenylketonuria and type 1 diabetes are lifelong metabolic disorders requiring complex and potentially conflicting nutritional strategies. Their coexistence is rare, yet management may become particularly challengi...
AIMS: Phenylketonuria and type 1 diabetes are lifelong metabolic disorders requiring complex and potentially conflicting nutritional strategies. Their coexistence is rare, yet management may become particularly challenging during transition from pediatric to adult care. We describe the case of a young adult with phenylketonuria who developed type 1 diabetes. METHODS: A 27-year-old man with longstanding phenylketonuria was referred to an adult metabolic-diabetes center after the diagnosis of type 1 diabetes. Clinical, biochemical, nutritional, and continuous glucose monitoring data were reviewed. The intervention included structured therapeutic education, transition from fixed insulin doses to a dynamic regimen based on carbohydrate counting, and revision of medical nutrition therapy using phenylketonuria-adapted low-protein foods and sugar-free phenylalanine-free amino acid supplements. RESULTS: At diagnosis, HbA1c was 11.5%, with markedly reduced C-peptide levels and high titer anti-GAD antibodies. Initial diabetes management was associated with poor adherence to the phenylketonuria diet, increased intake of conventional protein sources, and elevated phenylalanine levels. After individualized insulin titration and nutritional intervention, HbA1c improved from 11.5% to 7.8%, phenylalanine levels decreased from 842 to 705 μmol/L, insulin requirement declined from 0.55 to 0.3 IU/kg/day, and continuous glucose monitoring showed improved glycemic control without increased hypoglycemia. The Glycemia Risk Index improved from high-risk Zone E to low-intermediate-risk Zone B. CONCLUSIONS: This case highlights the need for personalized multidisciplinary care integrating continuous glucose monitoring, carbohydrate counting, and phenylketonuria specific nutrition to optimize both metabolic conditions.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe