Diabetic wounds (DWs), particularly those affecting the lower extremities, represent a significant clinical challenge due to their chronic nature and high risk of complications, including infection and amputation. Despite advances in diabetes management, conventional wound care strategies often fail to achieve satisfactory healing outcomes, largely due to the complex pathophysiology of DWs, are involving impaired angiogenesis, chronic inflammation, and compromised immune responses. The data on the conventional and emerging therapies used in the management of DWs were searched using PubMed, Scopus, and Web of Science databases to locate literature published. Studies have shown that conventional wound care interventions like debridement, dressing, and infection control mostly provide symptomatic treatment without eliminating underlying cellular and molecular diabetic wound pathophysiology. Recent years have witnessed the emergence of novel therapeutic approaches, including stem cell therapy, gene therapy, nanotechnology-based interventions, and tissue engineering. These strategies improve angiogenesis, alter the polarization of macrophages, and stimulate tissue repair, which can offer new hope for enhancing wound healing in diabetic patients. This review synthesizes current literature on the pathophysiology of diabetic wound healing, evaluates the limitations of traditional therapies, and provides a comprehensive overview of cutting-edge treatments that holds an effective diabetic wound management.
糖尿病性伤口（DWs），特别是那些影响下肢的伤口，由于其慢性性质和高风险的并发症，包括感染和截肢，代表了一个重大的临床挑战。尽管在糖尿病管理方面取得了进展，但传统的伤口护理策略往往不能达到令人满意的愈合结果，这主要是由于DWs的复杂病理生理，包括血管生成受损、慢性炎症和免疫反应受损。使用PubMed、Scopus和Web of Science数据库检索用于DWs管理的传统和新兴疗法的数据，以定位已发表的文献。研究表明，传统的伤口护理干预措施，如清创、敷料和感染控制，大多提供对症治疗，而不能消除潜在的细胞和分子糖尿病伤口病理生理。近年来出现了新的治疗方法，包括干细胞治疗、基因治疗、基于纳米技术的干预和组织工程。这些策略可以促进血管生成，改变巨噬细胞的极化，刺激组织修复，为促进糖尿病患者伤口愈合提供了新的希望。本文综述了目前关于糖尿病创面愈合病理生理学的文献，评估了传统治疗方法的局限性，并提供了有效的糖尿病创面管理的前沿治疗方法的全面概述。
{"title":"Advances in diabetic wound healing: from pathophysiology to emerging therapies.","authors":"Swati Swagatika Swain, Veera Venkata Satyanarayana Reddy Karri, Md Ekhtiar Uddin, Kuppuswamy Gowthamarajan, Manimaran Bhaskaran, Vetriselvan Subramaniyan","doi":"10.1007/s00592-025-02629-6","DOIUrl":"https://doi.org/10.1007/s00592-025-02629-6","url":null,"abstract":"<p><p>Diabetic wounds (DWs), particularly those affecting the lower extremities, represent a significant clinical challenge due to their chronic nature and high risk of complications, including infection and amputation. Despite advances in diabetes management, conventional wound care strategies often fail to achieve satisfactory healing outcomes, largely due to the complex pathophysiology of DWs, are involving impaired angiogenesis, chronic inflammation, and compromised immune responses. The data on the conventional and emerging therapies used in the management of DWs were searched using PubMed, Scopus, and Web of Science databases to locate literature published. Studies have shown that conventional wound care interventions like debridement, dressing, and infection control mostly provide symptomatic treatment without eliminating underlying cellular and molecular diabetic wound pathophysiology. Recent years have witnessed the emergence of novel therapeutic approaches, including stem cell therapy, gene therapy, nanotechnology-based interventions, and tissue engineering. These strategies improve angiogenesis, alter the polarization of macrophages, and stimulate tissue repair, which can offer new hope for enhancing wound healing in diabetic patients. This review synthesizes current literature on the pathophysiology of diabetic wound healing, evaluates the limitations of traditional therapies, and provides a comprehensive overview of cutting-edge treatments that holds an effective diabetic wound management.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-10DOI: 10.1007/s00592-025-02633-w
Utku Soyaltin, Ilgin Y Simsir, Baris Akinci
Objective: We aimed to evaluate the potential metabolic benefits of pioglitazone, a PPARG agonist, and sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with familial partial lipodystrophy (FPLD).
Methods: This retrospective medical chart study included 38 adult patients with FPLD (18 treated with pioglitazone and 20 with SGLT2 inhibitors).
Results: Treatment with pioglitazone reduced HbA1c from 8.6% (6.2-9.2) to 7.0% (5.9-8.8) at month 6 (p = 0.004) and 7.0% (6.1-8.7) at month 12 (p = 0.107). Triglycerides decreased by 25% (6-55%) at month 6 (p = 0.001) and 16% (4-44%) at month 12 (p = 0.008). A modest reduction in ALT was observed at month 12 (p= 0.046). Treatment with SGLT2 inhibitors reduced HbA1c from 8.7% (7.9-10.2) at baseline to 8.1% (7.4-9.4) at month 6 (p = 0.003) and 7.9% (7.3-8.9) at month 12 (p = 0.003). Median triglyceride levels decreased by 11% (0-33%) at month 6 (p = 0.013), while changes at month 12 were not significant. No meaningful changes were observed in weight, ALT, or AST.
Conclusions: We observed modest metabolic improvements following treatment with pioglitazone and SGLT2 inhibitors in patients with FPLD.
{"title":"Metabolic effects of pioglitazone and sodium-glucose cotransporter 2 inhibitors in familial partial lipodystrophy.","authors":"Utku Soyaltin, Ilgin Y Simsir, Baris Akinci","doi":"10.1007/s00592-025-02633-w","DOIUrl":"https://doi.org/10.1007/s00592-025-02633-w","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to evaluate the potential metabolic benefits of pioglitazone, a PPARG agonist, and sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with familial partial lipodystrophy (FPLD).</p><p><strong>Methods: </strong>This retrospective medical chart study included 38 adult patients with FPLD (18 treated with pioglitazone and 20 with SGLT2 inhibitors).</p><p><strong>Results: </strong>Treatment with pioglitazone reduced HbA1c from 8.6% (6.2-9.2) to 7.0% (5.9-8.8) at month 6 (p = 0.004) and 7.0% (6.1-8.7) at month 12 (p = 0.107). Triglycerides decreased by 25% (6-55%) at month 6 (p = 0.001) and 16% (4-44%) at month 12 (p = 0.008). A modest reduction in ALT was observed at month 12 (p= 0.046). Treatment with SGLT2 inhibitors reduced HbA1c from 8.7% (7.9-10.2) at baseline to 8.1% (7.4-9.4) at month 6 (p = 0.003) and 7.9% (7.3-8.9) at month 12 (p = 0.003). Median triglyceride levels decreased by 11% (0-33%) at month 6 (p = 0.013), while changes at month 12 were not significant. No meaningful changes were observed in weight, ALT, or AST.</p><p><strong>Conclusions: </strong>We observed modest metabolic improvements following treatment with pioglitazone and SGLT2 inhibitors in patients with FPLD.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1007/s00592-025-02593-1
Katrine Christiansen, Sidse K Nørgaard, Kirsten Nørgaard, Tine D Clausen, Peter Damm, Elisabeth R Mathiesen, Lene Ringholm
{"title":"Correction: Treatment with non-automated insulin pumps or multiple daily injections during pregnancy and post-delivery in women with type 1 diabetes: A secondary analysis of the copenfast trial.","authors":"Katrine Christiansen, Sidse K Nørgaard, Kirsten Nørgaard, Tine D Clausen, Peter Damm, Elisabeth R Mathiesen, Lene Ringholm","doi":"10.1007/s00592-025-02593-1","DOIUrl":"10.1007/s00592-025-02593-1","url":null,"abstract":"","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-03DOI: 10.1007/s00592-025-02619-8
Riccardo Candido, Raffaella Buzzetti, Agostino Consoli, Concetta Irace, Enrico Torre, Roberto Trevisan, Gian Paolo Fadini, T2D once-Weekly Insulin Expert Panel Group
Background
Despite major advancements in diabetes management, insulin therapy continues to have a prominent role in glycemic control, aiding numerous patients. However, treatment-associated unmet needs pose a hindrance to therapy acceptance and adherence, negatively affecting patient outcomes due to less effective glycemic management.
Method
A consensus study was conducted using a Delphi-like methodology, with the aim of highlighting and discussing the potential benefits and challenges with the introduction of once-weekly basal insulin icodec in the management of diabetes.
Results
The consensus firmly highlights the transformative approach and the timely adoption of once-weekly basal insulin for patients affected by type 2 diabetes. Once-weekly insulin icodec was broadly supported as a viable alternative to daily basal insulin, particularly for insulin-naïve individuals and those on basal-only regimens. Key advantages included reduced injection burden, improved adherence, and potential cost savings. The therapy was also seen as a way to counteract therapeutic inertia and improve quality of life. Although some implementation challenges were noted, namely patient selection and titration, most experts endorsed educational efforts and digital tools to support adoption. The panel supported the progressive replacement of daily with weekly basal insulin.
Conclusion
The advent of once-weekly insulin icodec therapy is an unprecedent breakthrough in diabetes care. Compared with once-daily insulin analogues, it offers a simplified, secure, enhanced, and sustained glycemic control, counteracting therapeutic inertia, expectedly improving adherence to insulin therapy. Insulin icodec can not only enable personalized treatment and positively impact the clinical outcome, but also improve patient satisfaction and overall quality of life.
{"title":"Once-weekly administration of insulin in the real-world management of type 2 diabetes. A Delphi-like consensus","authors":"Riccardo Candido, Raffaella Buzzetti, Agostino Consoli, Concetta Irace, Enrico Torre, Roberto Trevisan, Gian Paolo Fadini, T2D once-Weekly Insulin Expert Panel Group","doi":"10.1007/s00592-025-02619-8","DOIUrl":"10.1007/s00592-025-02619-8","url":null,"abstract":"<div><h3>Background</h3><p>Despite major advancements in diabetes management, insulin therapy continues to have a prominent role in glycemic control, aiding numerous patients. However, treatment-associated unmet needs pose a hindrance to therapy acceptance and adherence, negatively affecting patient outcomes due to less effective glycemic management.</p><h3>Method</h3><p>A consensus study was conducted using a Delphi-like methodology, with the aim of highlighting and discussing the potential benefits and challenges with the introduction of once-weekly basal insulin icodec in the management of diabetes.</p><h3>Results</h3><p>The consensus firmly highlights the transformative approach and the timely adoption of once-weekly basal insulin for patients affected by type 2 diabetes. Once-weekly insulin icodec was broadly supported as a viable alternative to daily basal insulin, particularly for insulin-naïve individuals and those on basal-only regimens. Key advantages included reduced injection burden, improved adherence, and potential cost savings. The therapy was also seen as a way to counteract therapeutic inertia and improve quality of life. Although some implementation challenges were noted, namely patient selection and titration, most experts endorsed educational efforts and digital tools to support adoption. The panel supported the progressive replacement of daily with weekly basal insulin.</p><h3>Conclusion</h3><p>The advent of once-weekly insulin icodec therapy is an unprecedent breakthrough in diabetes care. Compared with once-daily insulin analogues, it offers a simplified, secure, enhanced, and sustained glycemic control, counteracting therapeutic inertia, expectedly improving adherence to insulin therapy. Insulin icodec can not only enable personalized treatment and positively impact the clinical outcome, but also improve patient satisfaction and overall quality of life.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 2","pages":"313 - 323"},"PeriodicalIF":2.9,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00592-025-02619-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145666764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-27DOI: 10.1007/s00592-025-02626-9
Riccardo Candido, Barbara Toffoli, Gabriele Baccichetto, Francesca Marchese, Silvia Carpenè, Sara Gaiotti, Bruno Fabris, Stella Bernardi
Aims
Glucagon-like peptide-1 receptor (GLP-1R) has become one of the most promising ligand-receptor systems to target for type 2 diabetes mellitus (T2DM) treatment. Over the last two decades, several GLP-1 receptor agonists (GLP-1RAs) have been developed and semaglutide is the first and only GLP-1RA available as an oral formulation. GLP1R single nucleotide polymorphisms may affect GLP-1R response to oral semaglutide. Here we aimed to evaluate the impact of rs6923761 and rs761387 GLP1R polymorphisms on the response to oral semaglutide.
Methods
This is a retrospective cohort study including adult patients with T2DM who had been treated with oral semaglutide for at least one year. Patients were enrolled between November 2023 and April 2024, and then genotyped.
Results
We selected 210 adult patients with a median age of 71 years. Their median BMI was 29.1 kg/m2, HbA1c was 7.2% (55 mmol/mol), duration of diabetes was 12 years. After a median follow-up of 18 months, oral semaglutide reduced HbA1c by −0.3% (−3 mmol/mol), BMI by −1.1 kg/m2, SBP by −5 mmHg, total cholesterol by -8 mg/dL, triglycerides by -6.5 mg/dL. In addition, a reduction of ACR by −44.02 mg/g was observed in patients with baseline ACR > 30 mg/g, along with a decrease of liver transaminases in patients with baseline levels ≥ 35 U/L. Multivariate linear regression did not show any significant association between rs6923761 or rs761387 GLP1R genotypes and changes in HbA1c, BMI, SBP and DBP.
Conclusions
Our findings confirm the effectiveness of oral semaglutide in improving metabolic control and providing cardiorenal protection in different clinical scenarios. Conversely, they fail to show a clear benefit of GLP1R genotyping to guide treatment decisions, at least in patients with HbA1c < 7.5% (< 58 mmol/mol). Further studies are needed to confirm and extend our findings.
{"title":"Influence of GLP1 receptor rs6923761 and rs761387 genetic variants on oral semaglutide response in patients with type 2 diabetes","authors":"Riccardo Candido, Barbara Toffoli, Gabriele Baccichetto, Francesca Marchese, Silvia Carpenè, Sara Gaiotti, Bruno Fabris, Stella Bernardi","doi":"10.1007/s00592-025-02626-9","DOIUrl":"10.1007/s00592-025-02626-9","url":null,"abstract":"<div><h3>Aims</h3><p>Glucagon-like peptide-1 receptor (GLP-1R) has become one of the most promising ligand-receptor systems to target for type 2 diabetes mellitus (T2DM) treatment. Over the last two decades, several GLP-1 receptor agonists (GLP-1RAs) have been developed and semaglutide is the first and only GLP-1RA available as an oral formulation<i>. GLP1R</i> single nucleotide polymorphisms may affect GLP-1R response to oral semaglutide. Here we aimed to evaluate the impact of <i>rs6923761</i> and <i>rs761387 GLP1R</i> polymorphisms on the response to oral semaglutide.</p><h3>Methods</h3><p>This is a retrospective cohort study including adult patients with T2DM who had been treated with oral semaglutide for at least one year. Patients were enrolled between November 2023 and April 2024, and then genotyped.</p><h3>Results</h3><p>We selected 210 adult patients with a median age of 71 years. Their median BMI was 29.1 kg/m<sup>2</sup>, HbA1c was 7.2% (55 mmol/mol), duration of diabetes was 12 years. After a median follow-up of 18 months, oral semaglutide reduced HbA1c by −0.3% (−3 mmol/mol), BMI by −1.1 kg/m2, SBP by −5 mmHg, total cholesterol by -8 mg/dL, triglycerides by -6.5 mg/dL. In addition, a reduction of ACR by −44.02 mg/g was observed in patients with baseline ACR > 30 mg/g, along with a decrease of liver transaminases in patients with baseline levels ≥ 35 U/L. Multivariate linear regression did not show any significant association between <i>rs6923761</i> or <i>rs761387 GLP1R</i> genotypes and changes in HbA1c, BMI, SBP and DBP.</p><h3>Conclusions</h3><p>Our findings confirm the effectiveness of oral semaglutide in improving metabolic control and providing cardiorenal protection in different clinical scenarios. Conversely, they fail to show a clear benefit of <i>GLP1R</i> genotyping to guide treatment decisions, at least in patients with HbA1c < 7.5% (< 58 mmol/mol). Further studies are needed to confirm and extend our findings.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 2","pages":"303 - 311"},"PeriodicalIF":2.9,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00592-025-02626-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145627587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-27DOI: 10.1007/s00592-025-02624-x
Andrea Da Porto, Riccardo Candido, Valeria Manicardi, Alberto Rocca, Salvatore De Cosmo, Giuseppina Russo, AMD Annals Study Group
Background and aims
Thanks to the efforts made in the last century many patients with Type 1 Diabetes (T1D) are reaching and surpassing the age of 75, however, data on their clinical characteristics, prevalence of diabetes complications and quality of care are lacking.
Methods
This multicenter, observational, retrospective study includes data from participants with T1D aged over 75 years, regularly evaluated in the year 2023 in 296 Diabetes Clinics in Italy included in the Associazione Medici Diabetologi (AMD) Annals Initiative. Socio-demographic characteristics, data on glycemic, lipid, and blood pressure control, data on the current insulin therapy regimen, the use of insulin pumps, as well as data on the prevalence of microvascular and macrovascular complications of diabetes was evaluated. Additionally, we evaluated some indicators of quality of care.
Results
We included 2443 participants with mean age of 79.9 ± 3.9 years, in prevalence (54.9%) female. The mean duration of diabetes was 34.1 ± 17.5 years. Participants were evaluated regularly in person at the diabetes clinic on average 2.7 ± 2.1 times per year. 5% of participants were treated with insulin pumps. Mean glycated hemoglobin (HbA1c) was 7.8 ± 1.1. In comparison to standard therapy, better glycemic control was seen in participants on insulin pumps. Despite the high prevalence of diabetic retinopathy (33.3%) and chronic kidney disease (CKD) (39%) only a small portion of participants presented with end-stage complication, with 2.3% of participants having Proliferative Retinopathy (0.4% vision loss), 0.3% being on dialysis, and 2.5% having a history of amputation or foot ulcer. Cardiovascular disease was detected in 17.8% of participants. 77% of participants with previous CV event were treated with anti-platelet therapy. 68% of participants with proteinuria were treated with renin-angiotensin-aldosterone system (RAAS) inhibitors. LDL target of < 100 mg/dl was achieved in almost 2/3 of participants. Overall quality of care, expressed as Q-Score, was 27.4 ± 8.2.
Conclusion
Our data show that a consistent number of T1D participants regularly followed up by Italian diabetes centers reached an advanced age. The overall quality of care for participants regularly followed was good, within a lower-than-expected burden of end-stage renal disease, visual loss, and diabetic foot. Management of CV risk factors could be improved, as well as the use of technology in this setting.
{"title":"A perspective on clinical profile and quality of care of “Octogenarians” living with type 1 diabetes in Italy, AMD Annals Initiative","authors":"Andrea Da Porto, Riccardo Candido, Valeria Manicardi, Alberto Rocca, Salvatore De Cosmo, Giuseppina Russo, AMD Annals Study Group","doi":"10.1007/s00592-025-02624-x","DOIUrl":"10.1007/s00592-025-02624-x","url":null,"abstract":"<div><h3>Background and aims</h3><p>Thanks to the efforts made in the last century many patients with Type 1 Diabetes (T1D) are reaching and surpassing the age of 75, however, data on their clinical characteristics, prevalence of diabetes complications and quality of care are lacking.</p><h3>Methods</h3><p>This multicenter, observational, retrospective study includes data from participants with T1D aged over 75 years, regularly evaluated in the year 2023 in 296 Diabetes Clinics in Italy included in the Associazione Medici Diabetologi (AMD) Annals Initiative. Socio-demographic characteristics, data on glycemic, lipid, and blood pressure control, data on the current insulin therapy regimen, the use of insulin pumps, as well as data on the prevalence of microvascular and macrovascular complications of diabetes was evaluated. Additionally, we evaluated some indicators of quality of care.</p><h3>Results</h3><p>We included 2443 participants with mean age of 79.9 ± 3.9 years, in prevalence (54.9%) female. The mean duration of diabetes was 34.1 ± 17.5 years. Participants were evaluated regularly in person at the diabetes clinic on average 2.7 ± 2.1 times per year. 5% of participants were treated with insulin pumps. Mean glycated hemoglobin (HbA1c) was 7.8 ± 1.1. In comparison to standard therapy, better glycemic control was seen in participants on insulin pumps. Despite the high prevalence of diabetic retinopathy (33.3%) and chronic kidney disease (CKD) (39%) only a small portion of participants presented with end-stage complication, with 2.3% of participants having Proliferative Retinopathy (0.4% vision loss), 0.3% being on dialysis, and 2.5% having a history of amputation or foot ulcer. Cardiovascular disease was detected in 17.8% of participants. 77% of participants with previous CV event were treated with anti-platelet therapy. 68% of participants with proteinuria were treated with renin-angiotensin-aldosterone system (RAAS) inhibitors. LDL target of < 100 mg/dl was achieved in almost 2/3 of participants. Overall quality of care, expressed as Q-Score, was 27.4 ± 8.2.</p><h3>Conclusion</h3><p>Our data show that a consistent number of T1D participants regularly followed up by Italian diabetes centers reached an advanced age. The overall quality of care for participants regularly followed was good, within a lower-than-expected burden of end-stage renal disease, visual loss, and diabetic foot. Management of CV risk factors could be improved, as well as the use of technology in this setting.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 2","pages":"295 - 301"},"PeriodicalIF":2.9,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145627538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diabetic kidney disease (DKD), a significant microvascular complication of diabetes, is a multifactorial condition and a primary cause of both chronic kidney disease (CKD) and end-stage renal disease (ESRD). Interleukin-17 A (IL-17 A), an essential pro-inflammatory cytokine, is gaining recognition for its role in the development of DKD, highlighting its potential as a new therapeutic target. The pathogenic roles of IL-17 A may be mediated through several mechanisms, including the amplification of inflammatory responses, disruption of immune homeostasis, promotion of renal fibrosis, inhibition of mitochondrial autophagy, and perturbation of gut microbiota balance. Importantly, IL-17 A appears to exert both deleterious and potentially protective effects, reflecting a complex regulatory role in disease progression. However, the current evidence supporting these dual functions remains limited and context-dependent. Comparative analyses with other cytokines, such as IL-6, IL-1β, TNF-α, IL-22, and other IL-17 family members, are needed to position IL-17 A within the broader cytokine network and clarify its relative pathogenic and therapeutic significance. In this review, we critically examine the mechanistic basis of IL-17 A-mediated therapeutic strategies for DKD, drawing on recent advances from both established and emerging research. Furthermore, we identify key unresolved questions and propose future directions to guide ongoing and prospective investigations in this evolving field.
{"title":"Interleukin-17 A and diabetic kidney disease: emerging evidence on its pathogenic role and targeted modulation.","authors":"Bingheng Qu, Tianchi Xie, Yuxin Xie, Zixuan Guang, Yaoyu Han, Mengling Li, Xiaopeng Tong","doi":"10.1007/s00592-025-02621-0","DOIUrl":"https://doi.org/10.1007/s00592-025-02621-0","url":null,"abstract":"<p><p>Diabetic kidney disease (DKD), a significant microvascular complication of diabetes, is a multifactorial condition and a primary cause of both chronic kidney disease (CKD) and end-stage renal disease (ESRD). Interleukin-17 A (IL-17 A), an essential pro-inflammatory cytokine, is gaining recognition for its role in the development of DKD, highlighting its potential as a new therapeutic target. The pathogenic roles of IL-17 A may be mediated through several mechanisms, including the amplification of inflammatory responses, disruption of immune homeostasis, promotion of renal fibrosis, inhibition of mitochondrial autophagy, and perturbation of gut microbiota balance. Importantly, IL-17 A appears to exert both deleterious and potentially protective effects, reflecting a complex regulatory role in disease progression. However, the current evidence supporting these dual functions remains limited and context-dependent. Comparative analyses with other cytokines, such as IL-6, IL-1β, TNF-α, IL-22, and other IL-17 family members, are needed to position IL-17 A within the broader cytokine network and clarify its relative pathogenic and therapeutic significance. In this review, we critically examine the mechanistic basis of IL-17 A-mediated therapeutic strategies for DKD, drawing on recent advances from both established and emerging research. Furthermore, we identify key unresolved questions and propose future directions to guide ongoing and prospective investigations in this evolving field.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145585843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1007/s00592-025-02615-y
Dariusz Naskret, Stanislaw Pilacinski, Pawel Niedzwiecki, Michal Kulecki, Dorota Zozulinska-Ziolkiewicz
Introduction
We evaluated the association between Red Cell Distribution Width (RDW) and predicted 10-year cardiovascular disease (CVD) risk, as estimated by the Steno Type 1 Risk Engine (ST1RE), in individuals with type 1 diabetes (T1D).
Methods
We conducted a retrospective analysis of 342 adults with T1D duration > 5 years, (163 women, 179 men) from a tertiary Diabetes Center electronic database. Participants were stratified into tertiles of RDW: Group 1 (G1: < 12.6), Group 2 (G2: 12.6–13.2), and Group 3 (G3: >13.2).
Results
Higher RDW was associated with older age and longer diabetes duration. The prevalence of microvascular complications did not differ across RDW tertiles. Predicted 10-year CVD risk (ST1RE 10Y) increased with higher RDW: median (IQR) 4.5 (3.2–6.1) in G1, 4.5 (2.9–7.2) in G2, and 6.2 (3.5–12.0) in G3 (p < 0.01). In multiple linear regression, RDW was positively associated with ST1RE 10Y, (β = 1.13;95% CI, 0.57–1.70; p < 0.01; R2 = 0.36). In multivariable logistic regression, RDW was independently associated with moderate/high versus low ST1RE 10Y risk (OR = 1.87;95%CI, 1.28–2.75; p = 0.001). Models were adjusted for presence of hypertension, dyslipidemia, diabetic kidney disease, BMI value and hsCRP concentration.
Conclusion
Our results suggest that RDW is independently associated with predicted 10-year CVD risk in individuals with T1D. These findings support RDW as a potential marker for cardiovascular risk stratification. However, external validation is required before clinical application.
{"title":"Red cell distribution width positively correlates with 10-year risk of cardiovascular disease among people with type 1 diabetes as assessed by the Steno Type 1 Risk Engine","authors":"Dariusz Naskret, Stanislaw Pilacinski, Pawel Niedzwiecki, Michal Kulecki, Dorota Zozulinska-Ziolkiewicz","doi":"10.1007/s00592-025-02615-y","DOIUrl":"10.1007/s00592-025-02615-y","url":null,"abstract":"<div><h3>Introduction</h3><p>We evaluated the association between Red Cell Distribution Width (RDW) and predicted 10-year cardiovascular disease (CVD) risk, as estimated by the Steno Type 1 Risk Engine (ST1RE), in individuals with type 1 diabetes (T1D).</p><h3>Methods</h3><p>We conducted a retrospective analysis of 342 adults with T1D duration > 5 years, (163 women, 179 men) from a tertiary Diabetes Center electronic database. Participants were stratified into tertiles of RDW: Group 1 (G1: < 12.6), Group 2 (G2: 12.6–13.2), and Group 3 (G3: >13.2).</p><h3>Results</h3><p>Higher RDW was associated with older age and longer diabetes duration. The prevalence of microvascular complications did not differ across RDW tertiles. Predicted 10-year CVD risk (ST1RE 10Y) increased with higher RDW: median (IQR) 4.5 (3.2–6.1) in G1, 4.5 (2.9–7.2) in G2, and 6.2 (3.5–12.0) in G3 (<i>p</i> < 0.01). In multiple linear regression, RDW was positively associated with ST1RE 10Y, (β = 1.13;95% CI, 0.57–1.70; <i>p</i> < 0.01; R<sup>2</sup> = 0.36). In multivariable logistic regression, RDW was independently associated with moderate/high versus low ST1RE 10Y risk (OR = 1.87;95%CI, 1.28–2.75; <i>p</i> = 0.001). Models were adjusted for presence of hypertension, dyslipidemia, diabetic kidney disease, BMI value and hsCRP concentration.</p><h3>Conclusion</h3><p>Our results suggest that RDW is independently associated with predicted 10-year CVD risk in individuals with T1D. These findings support RDW as a potential marker for cardiovascular risk stratification. However, external validation is required before clinical application.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 2","pages":"277 - 283"},"PeriodicalIF":2.9,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00592-025-02615-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145585793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1007/s00592-025-02616-x
Nathalia Isabella Gonçalves Romeira, Larissa Paula Dias Barroso, Mariana Roque, Jéssica de Aquino Pereira, Priscila Peruzo Apolinário, Maria Helena Melo Lima
Aims
To evaluate quality of life (QoL) and health literacy (HL) in Brazilian individuals with Diabetes Mellitus type 2 (DM2) and diabetes-related foot ulcers (DFU).
Methods
An observational, cross-sectional study was conducted at a tertiary outpatient clinic in Southeastern Brazil. A total of 100 adult study participants, aged ≥ 18 years, who were diagnosed with type 2 DM and presented with at least one DFU were included. Instruments included a sociodemographic and clinical questionnaire, the Diabetic Foot Ulcer Scale-Short Form (DFS-SF), and the Short Assessment of Health Literacy for Portuguese-speaking Adults (SAHLPA-18). DFUs were classified using the Wound, Ischemia, and foot Infection (WIfI) system. Statistical analyses included comparison, correlation, and multiple linear regression tests.
Results
Based on the present study, the level of diabetes HL among the study participants was inadequate. Taking into consideration the sample size, exploratory regression analyses suggest that hypertension and a moderate-to-high amputation risk (WIfI classification) were both significantly associated with poorer QoL, with respect to leisure activities and a greater perceived dependency during daily activities, respectively. Participants expressed considerable concern regarding their foot health and the challenges associated with foot ulcer management. A connection between neuropathy and increased anxiety regarding foot conditions was also found.
Conclusions
Older age, longer disease duration, hypertension, and neuropathy were associated with poorer QoL in DM patients with DFU. Although no overall association was found between HL and the DFS-SF domains, adequate HL was associated with higher scores in the “Bothered by ulcer care” domain. These findings highlight the multi-faceted impact of clinical and demographic factors on QoL in this population, and warrant further investigation using larger, longitudinal cohorts.
{"title":"Quality of life and health literacy in individuals with diabetes-related wounds","authors":"Nathalia Isabella Gonçalves Romeira, Larissa Paula Dias Barroso, Mariana Roque, Jéssica de Aquino Pereira, Priscila Peruzo Apolinário, Maria Helena Melo Lima","doi":"10.1007/s00592-025-02616-x","DOIUrl":"10.1007/s00592-025-02616-x","url":null,"abstract":"<div><h3>Aims</h3><p>To evaluate quality of life (QoL) and health literacy (HL) in Brazilian individuals with Diabetes Mellitus type 2 (DM2) and diabetes-related foot ulcers (DFU).</p><h3>Methods</h3><p>An observational, cross-sectional study was conducted at a tertiary outpatient clinic in Southeastern Brazil. A total of 100 adult study participants, aged ≥ 18 years, who were diagnosed with type 2 DM and presented with at least one DFU were included. Instruments included a sociodemographic and clinical questionnaire, the Diabetic Foot Ulcer Scale-Short Form (DFS-SF), and the Short Assessment of Health Literacy for Portuguese-speaking Adults (SAHLPA-18). DFUs were classified using the Wound, Ischemia, and foot Infection (WIfI) system. Statistical analyses included comparison, correlation, and multiple linear regression tests.</p><h3>Results</h3><p>Based on the present study, the level of diabetes HL among the study participants was inadequate. Taking into consideration the sample size, exploratory regression analyses suggest that hypertension and a moderate-to-high amputation risk (WIfI classification) were both significantly associated with poorer QoL, with respect to leisure activities and a greater perceived dependency during daily activities, respectively. Participants expressed considerable concern regarding their foot health and the challenges associated with foot ulcer management. A connection between neuropathy and increased anxiety regarding foot conditions was also found.</p><h3>Conclusions</h3><p>Older age, longer disease duration, hypertension, and neuropathy were associated with poorer QoL in DM patients with DFU. Although no overall association was found between HL and the DFS-SF domains, adequate HL was associated with higher scores in the “Bothered by ulcer care” domain. These findings highlight the multi-faceted impact of clinical and demographic factors on QoL in this population, and warrant further investigation using larger, longitudinal cohorts.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 2","pages":"285 - 294"},"PeriodicalIF":2.9,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145585779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-18DOI: 10.1007/s00592-025-02613-0
Emilia M.C. Franzén, Marika I. Eriksson, Susanna Satuli-Autere, Anni Ylinen, Fanny Jansson Sigfrids, Jenna Nicklén, Hanna Öhman, Per-Henrik Groop, Lena M. Thorn, the FinnDiane Study Group
Aims
Ageing in people with type 1 diabetes is identified as a research gap. Therefore, the aim of our study is to characterize above 65-year-olds with type 1 diabetes, and to identify potential protective factors or factors related to increased risk of mortality in this age group.
Methods
This observational study includes 864 participants aged 55 years or older with type 1 diabetes (age at onset below 40) from the Finnish Diabetic Nephropathy Study, grouped according to age into three categories: 55–60, 60–65, and > 65 years old. Multivariable logistic regression analysis was used to identify factors independently associated with age above 65. Cox regression analysis was conducted to assess how these factors impact survival.
Results
Factors that were independently associated with age above 65 years included: higher diabetes onset age, higher pulse pressure, lower mean arterial pressure, absence of current smoking and diabetic kidney disease, history of severe diabetic retinopathy and cardiovascular events, lower daily insulin dose, lower HbA1c, and lowerApoB-100 concentrations. Of these factors, the ones associated with mortality in above 65-year-olds during follow-up were presence of diabetic kidney disease, higher HbA1c, and history of cardiovascular events.
Conclusion
Above 65-year-olds were characterized by both factors generally related to positive and negative health outcomes. Additionally, different factors were found to be associated with reaching older age and with survival beyond the age of 65.
{"title":"Characteristics of above 65-year-olds with type 1 diabetes in the Finnish diabetic nephropathy study","authors":"Emilia M.C. Franzén, Marika I. Eriksson, Susanna Satuli-Autere, Anni Ylinen, Fanny Jansson Sigfrids, Jenna Nicklén, Hanna Öhman, Per-Henrik Groop, Lena M. Thorn, the FinnDiane Study Group","doi":"10.1007/s00592-025-02613-0","DOIUrl":"10.1007/s00592-025-02613-0","url":null,"abstract":"<div><h3>Aims</h3><p>Ageing in people with type 1 diabetes is identified as a research gap. Therefore, the aim of our study is to characterize above 65-year-olds with type 1 diabetes, and to identify potential protective factors or factors related to increased risk of mortality in this age group.</p><h3>Methods</h3><p>This observational study includes 864 participants aged 55 years or older with type 1 diabetes (age at onset below 40) from the Finnish Diabetic Nephropathy Study, grouped according to age into three categories: 55–60, 60–65, and > 65 years old. Multivariable logistic regression analysis was used to identify factors independently associated with age above 65. Cox regression analysis was conducted to assess how these factors impact survival.</p><h3>Results</h3><p>Factors that were independently associated with age above 65 years included: higher diabetes onset age, higher pulse pressure, lower mean arterial pressure, absence of current smoking and diabetic kidney disease, history of severe diabetic retinopathy and cardiovascular events, lower daily insulin dose, lower HbA<sub>1c</sub>, and lowerApoB-100 concentrations. Of these factors, the ones associated with mortality in above 65-year-olds during follow-up were presence of diabetic kidney disease, higher HbA<sub>1c</sub>, and history of cardiovascular events.</p><h3>Conclusion</h3><p>Above 65-year-olds were characterized by both factors generally related to positive and negative health outcomes. Additionally, different factors were found to be associated with reaching older age and with survival beyond the age of 65.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 2","pages":"267 - 275"},"PeriodicalIF":2.9,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00592-025-02613-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145538524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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