Milani I, Carreno Dextre GAL, Elisei RF
… +8 more, Ripa P, Capatti SR, Magon A, Cilluffo S, Terzoni S, Lusignani M, Petralito M, Caruso R
Acta Diabetol
· 2025 Nov · PMID 40856814
·
Full text
BACKGROUND: Mental health is a critical yet often underemphasized dimension in the management of individuals with Type 1 Diabetes Mellitus (T1DM), who are at elevated risk for psychological disorders. Educational interve...BACKGROUND: Mental health is a critical yet often underemphasized dimension in the management of individuals with Type 1 Diabetes Mellitus (T1DM), who are at elevated risk for psychological disorders. Educational interventions, including traditional education, psychoeducational, and psychosocial programs, are increasingly recognized as supporting self-care and promoting psychological well-being. AIM: This scoping review aims to systematically map the existing literature on educational programs for individuals with T1DM, with a specific focus on their impact on mental health outcomes. METHODS: The review was conducted according to the Joanna Briggs Institute (JBI) methodology and guided by the Population, Concept, and Context (PCC) framework. A comprehensive search was performed across six major biomedical databases (PubMed, Embase, CINAHL, Web of Science, Scopus, PsycINFO), including studies that examined educational interventions addressing mental health in individuals with T1DM. RESULTS: A total of 18 studies were included, covering a range of educational interventions, such as digital tools, psychological therapies (e.g., ACT, CBT), and self-care interventions, most of which were delivered by multidisciplinary teams. Many interventions demonstrated positive effects on mental health, including reduced anxiety, enhanced mood, and improved self-management. Key facilitators included professional support, peer involvement, and the integration of psychological components. Barriers included high dropout rates and limited tailoring to age-specific needs. CONCLUSIONS: Educational interventions can positively influence mental health outcomes in individuals with T1DM. However, the literature remains fragmented, and program effectiveness varies. There is a pressing need for more flexible, personalized, and age-sensitive educational interventions that incorporate emotional and psychological support and address implementation challenges.
AIMS: This study tested the hypothesis that the anti-diabetes drug dapagliflozin (DAPA) alleviates heart dysfunction induced by type 3 cardiorenal syndrome (CRS-3) by normalizing mitochondrial quality control (MQC). MQC...AIMS: This study tested the hypothesis that the anti-diabetes drug dapagliflozin (DAPA) alleviates heart dysfunction induced by type 3 cardiorenal syndrome (CRS-3) by normalizing mitochondrial quality control (MQC). MQC is a stress-activated mechanism, regulated by Dual specificity phosphatase 1 (DUSP1), that maintains mitochondrial homeostasis to support heart function. Due to its known renal and cardioprotective effects, DAPA was investigated as a potential treatment for CRS-3. METHODS: CRS-3 was induced in mice through renal ischemia/reperfusion. The effects of DAPA pre-treatment were assessed by measuring heart function, serum levels of myocardial injury biomarkers, oxidative stress, inflammation, and cardiomyocyte apoptosis. Assays in cardiomqyocytes from CRS-3 mice were used to analyze MQC, including mitochondrial dynamics, mitophagy, and biogenesis. The role of DUSP1 was investigated using DUSP1-knockout mice, and a docking analysis was performed to assess the DAPA-DUSP1 interaction. RESULTS: DAPA pre-treatment dose-dependently improved heart function and reduced serum markers of myocardial injury, oxidative stress, inflammation, and cardiomyocyte apoptosis in CRS-3 mice. DAPA treatment stabilized MQC in cardiomyocytes, shown by improved mitochondrial dynamics and restored mitophagy and biogenesis. Docking analysis suggested that DAPA directly interacts with DUSP1 and suppresses its nuclear translocation. Notably, in DUSP1-knockout mice, the stabilizing effect of DAPA on MQC was abolished. Furthermore, upon DUSP1 deletion, DAPA failed to prevent CRS-3-related oxidative stress, inflammation, apoptosis, and heart dysfunction. CONCLUSIONS: Defective MQC critically contributes to CRS-3-related myocardial dysfunction. The study proposes that DAPA therapy may normalize DUSP1-dependent MQC and consequently alleviate the cardiac depression associated with CRS-3.
AIMS: Autoreactive memory T cells are considered to be a primary contributor to chronic islet inflammation in individuals with type 1 diabetes (T1D). OX40-expressing T cells not only facilitate and sustain the presence o...AIMS: Autoreactive memory T cells are considered to be a primary contributor to chronic islet inflammation in individuals with type 1 diabetes (T1D). OX40-expressing T cells not only facilitate and sustain the presence of CD4 memory T cells but also promote the generation of CD8 memory T cells. We aimed to investigate the role of OX40CD4/CD8 memory T lymphocytes in the pathogenesis of T1D. METHODS: A total of 35 patients diagnosed with Type 1 diabetes and 40 healthy control individuals were enrolled in this study. Peripheral Blood Mononuclear Cells (PBMCs) were isolated from the study participants and analyzed by flow cytometry. Inflammatory cytokines in the plasma were quantitatively measured. The pancreatic islet autoantibodies as well as islet function were also evaluated. RESULTS: The frequencies and the mean fluorescence intensity (MFI) of OX40 on CD4 effector memory T (Tem) cells significantly increased in patients with T1D compared to healthy controls. Importantly, the expression of OX40 on CD8 Tem and central memory T (Tcm) cells was also significantly higher in T1D compared with healthy controls. However, the expression of OX40 on CD4 Tem cells was not significantly higher in T1D with two or more autoantibodies than control group. Furthermore, the frequencies of OX40CD8 Tem cells significantly increased in T1D patients with two or more autoantibodies but not in those with one autoantibody, compared with control groups. Meanwhile, the frequencies of OX40CD8 Tcm cells were consistently higher across all three subgroups of T1D patients (AAb, 1AAb, ≥2AAb) compared to the control group. Notably, both the frequencies of OX40CD4 and OX40CD8 Tem cells exhibited significant negative correlations with the serum C-peptide levels in T1D patients. Additionally, the expression levels of OX40 on peripheral CD4/CD8 memory T cells were positively correlated with the levels of plasma inflammatory cytokines in patients with T1D. CONCLUSIONS: The elevated expression of OX40 on CD4/CD8 memory T cells was associated with the autoimmune-mediated destruction of islet beta cells in T1D. Our findings indicate that the expression levels of OX40 on peripheral CD4 and CD8 memory T lymphocytes may serve as potential predictive biomarkers for the severity of T1D. Additionally, OX40 expression on memory T cells may serve as a potential biomarker for assessing the efficacy of immunotherapy in T1D patients.
Fatica M, Ferrigno S, Çela E
… +6 more, D'Antonio A, Conigliaro P, Cardellini M, Longo S, Federici M, Chimenti MS
Acta Diabetol
· 2025 Nov · PMID 40810768
·
Full text
Emerging evidence highlights a complex interconnection between metabolic dysfunction and chronic inflammation in psoriatic arthritis (PsA), positioning glucose and lipid abnormalities not only as comorbidities but as act...Emerging evidence highlights a complex interconnection between metabolic dysfunction and chronic inflammation in psoriatic arthritis (PsA), positioning glucose and lipid abnormalities not only as comorbidities but as active contributors to disease pathogenesis. In fact, rather than being incidental findings, conditions such as insulin resistance, atherogenic dyslipidemia, and visceral obesity interact with the immune system, amplifying inflammatory circuits and promoting joint and systemic damage. This review delves into the metabolic dimension of PsA, shedding light on how pro-inflammatory cytokines and adipokine imbalances reshape glucose and lipid homeostasis. Special attention is given to molecular pathways, such as impaired insulin signaling and altered lipid uptake, that link systemic inflammation to cardiometabolic risk. Furthermore, we examine the impact of these metabolic alterations in clinical practice and how antirheumatic therapies might improve metabolic balance and promote long-term cardiovascular protective effects. By unraveling these interactions, we aim to provide new insights into the clinical management of PsA and underscore the need for integrated therapeutic strategies that address both inflammation and metabolic health.
Hermanns N, Cerletti P, Laurent J
… +2 more, Scibilia R, Skovlund S
Acta Diabetol
· 2026 Jan · PMID 40779203
·
Full text
AIMS: This study examines the use, perceptions, and inequalities in access to Digital Health Solutions (DHS) among people with diabetes (PwD). It aims to identify factors influencing adoption and explore perceived benefi...AIMS: This study examines the use, perceptions, and inequalities in access to Digital Health Solutions (DHS) among people with diabetes (PwD). It aims to identify factors influencing adoption and explore perceived benefits and barriers to using DHS, focusing on person-important outcomes such as physical health, mental burden, and access to care. METHODS: The primary objective of this feasibility study was to assess the intervention acceptability, feasibility, and app usability. The secondary aim is to explore preliminary intervention effects. METHODS: A cross-sectional online survey was conducted in France from April to July 2022. A total of 301 PwD (149 with type 1 diabetes [T1D], 152 with type 2 diabetes [T2D]) completed the study. The survey assessed the use of three DHS categories: information/education (DHS1), self-management support (DHS2), and data-sharing/collaborative care (DHS3). We used univariate and multivariate logistic regression to identify predictors of DHS use, including demographic, socioeconomic, psychological, and medical variables. RESULTS: DHS1 was the most commonly used category, followed by DHS2 and DHS3. PwD with T1D were more likely to use multiple DHS. Type of diabetes and perceived health status were the strongest predictors of DHS use. Surprisingly, people in poorer health were less likely to use DHS despite potentially benefiting most from them. DHS-naïve individuals expected more benefits but reported greater concerns, especially about information overload and data security. These concerns were stronger than the perceived benefits. For example, concerns about data security reduced the likelihood of using DHS2 and DHS3 by up to 89%. CONCLUSION: The study highlights disparities in DHS adoption and the critical role of perceived barriers. Addressing these concerns-particularly among PwD in poorer health-and aligning DHS with outcomes that matter to patients may improve equitable adoption and diabetes care.
Irace C, Assaloni R, Avogaro A
… +20 more, Candido R, Cherubini V, Coluzzi S, Dicembrini I, Di Bartolo P, Di Molfetta S, Franceschi R, Frattolin E, Grancini V, Guardasole V, Marcello D, Neri M, Nervo S, Rabbone I, Rapellino A, Scarpitta AM, Tinti D, Trombetta M, Zanfardino A, Scaramuzza A
Do-It-Yourself Artificial Pancreas Systems (DIY-APS)-which combine commercially available devices with open-source software-are increasingly used for the management of type 1 diabetes, despite a lack of formal regulatory...Do-It-Yourself Artificial Pancreas Systems (DIY-APS)-which combine commercially available devices with open-source software-are increasingly used for the management of type 1 diabetes, despite a lack of formal regulatory approval in many jurisdictions, including in Italy. This position statement, endorsed by Italian diabetes societies (Associazione Medici Diabetologici, Societa Italiana di Diabetologia, and Società Italiana di Endocrinologia e Diabetologia Pediatrica) and "Diabete Italia", the national patient association, addresses the efficacy, safety, and legal implications of DIY-APS in Italy. Real-world evidence and clinical trials demonstrate that DIY-APS improves glycemic control and quality of life and reduce fear of hypoglycemia in users. This statement outlines the reasons driving patient adoption of DIY-APS, including limitations of commercial systems and the need for greater personalization. It emphasizes the ethical responsibility of healthcare professionals to support patients using DIY-APS while acknowledging the legal complexities surrounding their unregulated use. The statement concludes with recommendations to enhance education for patients and healthcare professionals and advocates for clearer regulatory pathways to ensure patient safety and optimize care.
Christiansen K, Nørgaard SK, Nørgaard K
… +4 more, Clausen TD, Damm P, Mathiesen ER, Ringholm L
Acta Diabetol
· 2026 Jan · PMID 40759795
·
Full text
AIM: To evaluate pregnancy and post-delivery outcomes with non-automated insulin pumps or multiple daily injections (MDI) in women with type 1 diabetes (T1D). METHODS: A preplanned secondary analysis of the CopenFast tri...AIM: To evaluate pregnancy and post-delivery outcomes with non-automated insulin pumps or multiple daily injections (MDI) in women with type 1 diabetes (T1D). METHODS: A preplanned secondary analysis of the CopenFast trial including women with T1D using continuous glucose monitoring (CGM), primarily intermittently scanned CGM, routinely. Pregnancy and post-delivery outcomes were compared between insulin pump users and MDI users. Insulin pump settings during pregnancy and post-delivery were compared to pre-pregnancy. RESULTS: Of 141 women, 39 used non-automated insulin pumps and 102 used MDI. Median diabetes duration was 17 (IQR 12-20) vs. 14 (8-21) years (P = 0.12). HbA was 48 (44-53) mmol/mol vs. 47 (42-53) at 9 weeks (P = 0.65) and 43 (40-46) vs. 43 (39-46) at 35 weeks (P = 0.53). Mean sensor glucose decreased from ~ 7.0 mmol/l at 9 weeks to 6.3 mmol/l at 33 weeks in both groups. Preterm delivery (< 37 weeks) was more common with insulin pumps (25.9% vs. 16.7%, P = 0.01), as was caesarean section (59% vs. 40%, P = 0.04), which was independent of diabetes duration, age and microvascular complications. At 1 and 3 months post-delivery, maternal and infant outcomes, including breastfeeding, were similar between groups. In insulin pump users, basal insulin rates were ~ 37% higher, and carbohydrate-to-insulin ratios ~ 61% lower at 33 weeks while basal insulin rates were ~ 20% lower, and carbohydrate-to-insulin ratios were similar 3 months post-delivery, compared to pre-pregnancy. CONCLUSION: Despite routine use of CGM and similar glycaemic control, non-automated insulin pump users did not achieve improved pregnancy outcomes compared to MDI users.
Murdolo G, Gaggia F, Bianchini E
… +10 more, Monami M, Miranda C, Monge L, Uccioli L, Gargiulo M, Scatena A, Scevola G, Stabile E, Vermigli C, Panel of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome
BACKGROUND AND AIMS: Dual pathway inhibition (DPI) with aspirin and low-dose rivaroxaban (LDR) has shown benefits in reducing major adverse cardiovascular (MACEs) and limb (MALEs) events in patients with lower extremity...BACKGROUND AND AIMS: Dual pathway inhibition (DPI) with aspirin and low-dose rivaroxaban (LDR) has shown benefits in reducing major adverse cardiovascular (MACEs) and limb (MALEs) events in patients with lower extremity peripheral artery disease (LE-PAD). This study aimed to determine whether DPI is preferable to anti-platelet therapy alone in reducing adverse outcomes in diabetic patients with "symptomatic" LE-PAD and to assess the safety of DPI, specifically bleeding risks. The findings aim to support development of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome. METHODS: A Medline and Embase search was conducted through October 31, 2024, to identify RCTs comparing DPI with anti-platelet therapy in diabetic patients with symptomatic LE-PAD. Key efficacy outcomes included MALEs, MACE, and a composite of cardiovascular death, myocardial infarction, ischemic stroke, acute limb ischemia, and major amputation. Safety outcomes primarily focused on major bleeding and fatal/critical organ bleeding. Mantel-Haenzel odds ratios and 95% confidence intervals (MH-OR, 95%CI) were calculated. RESULTS: From a total 153 items retrieved, 4 studies were assessed for eligibility; however only one study met the inclusion criteria for efficacy and safety outcomes component of the review. Due to lack of disaggregated data, efficacy and safety outcomes were estimated indirectly through proportional calculations. DPI demonstrated a reduced risk of MALEs [MH-OR 0.52; (95% CI 0.26-1.06)], MACE or MALE [MH-OR 0.67; (95% CI 0.45-1.00)], and the overall composite (MH-OR 0.70 [95% CI, 0.46-1.05]) compared to aspirin alone. A similar pattern was observed for MACE [MH-OR 0.70; (95% CI 0.44-1.11)]. While DPI did not significantly increase the risk of major or fatal/critical organ bleeding, a trend towards lower major bleeding rate in favor of aspirin was found. The net clinical benefit favored DPI (MH-OR 0.55 [95%CI, 0.36-0.84]). CONCLUSIONS: In diabetic patients with symptomatic LE-PAD, LDR plus aspirin is preferable to aspirin alone in reducing cardiovascular and limb outcomes, with acceptable bleeding risk.
AIMS: Glucokinase activators (GKAs) lower glucose by directly activating glucokinase (GK) or dissociating it from GK regulatory protein (GK-GKRP). Their long-term effects on gastrointestinal (GI) diseases remain unclear....AIMS: Glucokinase activators (GKAs) lower glucose by directly activating glucokinase (GK) or dissociating it from GK regulatory protein (GK-GKRP). Their long-term effects on gastrointestinal (GI) diseases remain unclear. This study explores how two approaches influence GI disorders through metabolic-immune interplay. METHODS: We used genetic variants near GCK and GCKR associated with fasting glucose as proxies for direct GK activation and GK-GKRP dissociation. Using Mendelian Randomization and meta-analysis, we assessed their associations with 20 GI diseases and explored mediation by lipid traits and inflammatory proteins (pQTL). MR-prioritized lipid and immune mediators underwent multi-omics analysis including functional enrichment, protein-protein interaction networks, single-cell RNA sequencing (scRNA-seq) and Cellchat in disease models, investigating metabolic-immune interactions and intercellular signaling. RESULTS: Direct GK activation and GK-GKRP dissociation exerted distinct causal effects on GI diseases. GK-GKRP dissociation increased risks of irritable bowel syndrome, Crohn's disease, ulcerative colitis, beyond its established association with metabolic dysfunction-associated steatotic liver disease (MASLD). Lipid traits and inflammatory proteins interconnected through PPAR and NF-κB signaling, mediating GCKR's associations with GI diseases. Key mediators such as FGF-21, CSF1, CD40, CXCL9 were localized to disease-specific niches in MASLD and IBD scRNA-seq models, highlighting GCKR-centered metabolic-immune crosstalk. Intercellular communication via CSF, CXCL, CCL, TGFβ, Visfatin, Galectin, and MIF signaling linked immune, parenchymal, and stromal cells in disease pathogenesis. CONCLUSIONS: GK-GKRP dissociation, but not direct GK activation, increases IBD and MASLD risks through metabolic-immune interplay in gut-liver axis. Tailoring GKA therapies for patients with comorbidities is essential.
BACKGROUND: Diabetic nephropathy (DN) is a prevalent and serious complication of diabetes, characterized by high incidence and significant morbidity. Despite growing evidence that the tricarboxylic acid (TCA) cycle plays...BACKGROUND: Diabetic nephropathy (DN) is a prevalent and serious complication of diabetes, characterized by high incidence and significant morbidity. Despite growing evidence that the tricarboxylic acid (TCA) cycle plays a crucial role in DN progression, the diagnostic potential of TCA-related genes has yet to be fully explored. METHODS: This study began by analyzing the GSE131882 dataset to reveal the expression patterns of TCA-related genes in various renal cell types and to identify genes that differ in expression between high and low subgroups. The GSE30122 dataset was then examined to identify genes with differential expression in DN. Single-sample gene set enrichment analysis (ssGSEA) and weighted gene co-expression network analysis (WGCNA) were applied to pinpoint TCA-related gene modules. Following this, multiple machine learning techniques were employed to analyze the TCA gene set that showed differential expression at both cellular and sample levels, allowing us to identify the hub genes. A diagnostic model was constructed, with its effectiveness validated through ROC analysis. The immune landscape of DN was assessed using ssGSEA. GeneMANIA and NetworkAnalyst were also utilized to predict genes with similar functions, as well as miRNAs and transcription factors (TFs) that may regulate these diagnostic genes. Finally, single-cell RNA sequencing (scRNA-seq) data confirmed the expression patterns of these genes. RESULTS: Two TCA-related genes, HPGD and G6PC, were identified as potential diagnostic markers for DN. ROC analysis demonstrated that these genes and their predictive model exhibited strong diagnostic performance in both training and validation cohorts. Immune landscape analysis revealed a more active immune microenvironment in DN patients compared to controls. Additionally, 59 miRNAs and 15 TFs were predicted to regulate the expression of HPGD and G6PC, along with 20 functionally related genes. scRNA-seq data highlighted that HPGD and G6PC are predominantly expressed in glomerular and proximal tubular cells. CONCLUSION: Two reliable TCA-related biomarkers were pinpointed, potentially advancing early diagnosis and management of DN.
BACKGROUND: Diabetic nephropathy (DN) is one of the most abundant microangiopathy complications among diabetic patients. Gut dysbiosis and the correlation with dietary factors in diabetic participants is undeniable. This...BACKGROUND: Diabetic nephropathy (DN) is one of the most abundant microangiopathy complications among diabetic patients. Gut dysbiosis and the correlation with dietary factors in diabetic participants is undeniable. This study aims to evaluate the alteration of intestinal microbiota and its association with dietary indices, including dietary total antioxidant capacity (dTAC), dietary inflammatory index (DII), and alternative healthy eating index (AHEI) scores among healthy controls (HC) and diabetic participants with and without DN. METHODS: The participants were categorized into type 2 diabetes mellitus (T2DM) group, DN group, and HC group. The intestinal microbiota was assessed using a quantitative real-time polymerase chain reaction (qPCR) method targeting the bacterial 16 S rRNA gene. Dietary data were obtained using a 168-item semi-quantitative food frequency questionnaire (FFQ). RESULTS: A higher level of Escherichia, Prevotella, Facalibacterium, and Bacteroides was observed among the HC group than the T2DM and DN individuals. Higher AHEI was observed in the DN group than T2DM group. Lower DII was seen among the T2DM group compared to the HC and DN groups. dTAC index had no significant differences between the studied groups. Furthermore, in the HC group, dTAC showed a marginally significant positive correlation with Bacteroides. dTAC was negatively correlated with Lactobacillus in T2DM subjects. In the whole studied population, a marginally significant positive correlation between Prevotella and dTAC and DII was observed. CONCLUSIONS: Alterations in the intestinal microbiota were observed in participants suffering from T2DM and DN. Furthermore, some intestinal microbiota were associated with AHEI, DII, and dTAC dietary indices.
Hu M, Le MH, Yeo YH
… +4 more, Wijarnpreecha K, Likhitsup A, Kim D, Chen VL
Acta Diabetol
· 2025 Dec · PMID 40736548
·
Full text
BACKGROUND: Diabetes is a leading cause of morbidity and mortality in the United States. We aimed to characterize secular trends in diabetes prevalence, control of glucose and associated comorbidities, and medication use...BACKGROUND: Diabetes is a leading cause of morbidity and mortality in the United States. We aimed to characterize secular trends in diabetes prevalence, control of glucose and associated comorbidities, and medication use. METHODS: This was a retrospective analysis of National Health and Nutrition Examination Series data from 2001 to 2023. We focused on three outcomes: (1) prevalence of diabetes defined by known diagnosis, hemoglobin A1c ≥ 6.5%, or fasting glucose ≥ 126 mg/dL, and among individuals with diabetes (2) control of glucose levels, low-density lipoprotein, and blood pressure and (3) medication therapy. Predictors were cycle (year) and demographics, specifically age, sex, race/ethnicity, educational level, and household income. RESULTS: We included 27,437 participants of whom 3467 had diagnosed diabetes and an additional 1602 had undiagnosed diabetes. Diabetes prevalence increased from 10.0% in 2001-2002 to 15.1% in 2021-2023 and was higher in men versus women, and Hispanic/Latino or non-Hispanic Black vs. non-Hispanic White participants. Glycemic control declined over time, from 61.5 to 44.9% having hemoglobin A1c < 7% in 2001-2002 vs. 2021-2023; control was lower in younger participants and those with lower educational attainment. Lipid control improved over time but remained poor: 73.1% had low-density lipoprotein ≥ 70 mg/dL in 2017-2020, and only half of these individuals were taking a statin. There were no significant changes over time in blood pressure control, with 44-56% having blood pressure ≥ 130/80 mmHg. Other than lower lipid control in women, we did not observe differences in control of lipids or blood pressure, or in medication treatment, based on sex and race/ethnicity. DISCUSSION: Diabetes has increased in prevalence from 2001 to 2023 and management of hyperglycemia and associated risk factors remains inadequate.
OBJETIVE: To analyze the Time in Tight Range (TITR) (70-140 mg/dL) and assess their possible differences according to Time Below Range (TBR) in a cohort of type 1 diabetes mellitus people with Múltiple Daily Injections....OBJETIVE: To analyze the Time in Tight Range (TITR) (70-140 mg/dL) and assess their possible differences according to Time Below Range (TBR) in a cohort of type 1 diabetes mellitus people with Múltiple Daily Injections. PATIENTS AND METHODS: 355 adult users of Continuous Glucose Monitoring (CGM) with at least a HbA1c during the period October 1, 2023-October 1, 2024, and glucose data in the 90 days prior were included. RESULTS: Age 46.9 years (SD 13.6); 57.2% male; time of evolution 21.6 years (SD 12.6). Mean TITR was 38.4% (SD 14.6) and 20.3% had a TITR ≥ 50%. The correlation TITR-TIR was strong (β = 0.83; CI 95% 0.8-0.87; R [2] Adjusted 0.89; p < 0.001) and varied according to TBR [TBR < 4% group (β = 0.81; CI 95% 0.78 to 0.85; R [2] Adjusted 0.9; p < 0.001) vs. TBR ≥ 4% (β = 0.9; CI 95% 0.86 to 0.94; R [2] Adjusted 0.93; p < 0.001)]. The variables independently associated with TITR in patient with TBR < 4% were HbA1c (β = -9.58; CI 95% -10.88 to -8.29; p < 0.001) and Coefficient of Variation (CV) (β = -0.38; CI 95% -0.66 to -0.11; p = 0.007). However, in those with TBR ≥ 4% were male gender (β = 2.86; CI 95% 0.26 to 5.45; p = 0.031), HbA1c (β = -7.53; CI 95% -9.1 to -5.96; p < 0.001) and CV (β = -0.69; CI 95% -1.01 to -0.37; p < 0.001). CONCLUSIONS: The correlation between TITR and TIR and the factors that were independently associated with TITR differ depending on the TBR.
INTRODUCTION: There is varied phenotypic presentations of diabetic striatopathy (DS), traditionally characterized by hyperglycemia, acute-onset choreoballism, and/or specific neuroimaging findings. Emerging evidence indi...INTRODUCTION: There is varied phenotypic presentations of diabetic striatopathy (DS), traditionally characterized by hyperglycemia, acute-onset choreoballism, and/or specific neuroimaging findings. Emerging evidence indicates that DS may coexist with stroke, complicating diagnosis and treatment, as both conditions can influence each other's progression. MATERIALS AND METHODS: Two cases of DS with concurrent stroke at a single center and 15 similar previously published cases have been analyzed. The detailed evaluation included demographics, symptomatology, glycemic data, neuroimaging, management, and prognosis. Appropriate descriptive statistical analyses have been performed. RESULTS: This study demonstrates how stroke symptoms and involuntary movements can coexist and interact. Four distinct phenotypes of the "stroke-striatopathy model" have been identified. It raises the possibility of patients with DS being at risk of imminent cerebrovascular events rather than being a mere bystander. CONCLUSION: The study underscores the necessity for ongoing monitoring of DS patients for potential cerebrovascular incidents and the implications for clinical management and long-term patient outcomes.