Frontiers in clinical diabetes and healthcare最新文献

[This corrects the article DOI: 10.3389/fcdhc.2025.1682012.].

Background: The increasing prevalence of Type 1 Diabetes Mellitus (T1D) has led to the development of advanced technologies such as Continuous Glucose Monitors (CGMs) and insulin infusion pumps. These devices rely on adhesives to attached to the skin, which can trigger Allergic Contact Dermatitis (ACD) in some individuals. Despite their growing use, data on ACD prevalence among children/adolescents with T1D using adhesive-based medical devices in the United Arab Emirates (UAE) and the Gulf Cooperation Council (GCC) region remains limited. This study aimed to assess the prevalence of ACD in children/adolescents with T1D using CGMs in the UAE, and evaluate the association between device use and ACD. It also explored trends in immune-related comorbidities that could impact glycemic control.

Methods: A cross-sectional observational study was conducted in collaboration with Dubai Diabetes Center (DDC). Medical records of 232 children/adolescents with T1D, receiving care at DDC between January 2020 and January 2023, were analyzed. Descriptive statistics were used to calculate proportions, and ACD prevalence was determined with a 95% Confidence Interval (CI) using Poisson distribution. Fisher's exact test was applied to explore associations between categorical variables.

Results: Among 232 study individuals, 87% (202 out of 232 individuals) used smart medical devices for glucose monitoring. Of these, 16 had a documented history of ACD, indicating a prevalence rate of 7.92% (95% CI: 4.6, 12.54). No statistically significant association was found between smart devices use and ACD development (p-value = 0.581). ACD prevalence was higher among females using adhesives (9.37%) compared to their male counterparts (6.6%).

Conclusion: This study aligns with United Nations' Sustainable Development Goals 3 and 4 by highlighting ACD prevalence among children/adolescents with T1D using CGMs in the UAE. It underscores the need for biomedical manufacturers to disclose adhesive chemical compositions to facilitate the development of safer alternatives. Additionally, healthcare professionals should be educated on dermatological risks associated with adhesive-based devices, enabling them to provide more comprehensive care and improve individual outcomes.

Ferroptosis and pyroptosis are two emerging forms of regulated cell death. The former encompasses cell death by excessive accumulation of lipid hydroperoxides in an iron-dependent way. The latter pertains to inflammation-associated cell death following activation of caspase-1, caspase-11/4/5 through gasdermin D (GSDMD). Recent evidence confirms the implication of ferroptosis and pyroptosis in diabetes mellitus (DM) and its complications, notably diabetic kidney disease (DKD), and also in metabolic-dysfunction associated liver disease (MASLD). The aim of this narrative review was to summarise current experimental evidence on the potential beneficial actions of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in DM and diabetic complications via reduction of ferroptosis and pyroptosis. Data points to their therapeutic potential in DKD and MASLD. Treatment with GLP-1RAs was comparable with ferrostatin-1 (Fer-1), a well-known-ferroptosis inhibitor: ferroptosis-associated markers (e.g. Acyl-CoA Synthetase Long Chain Family Member 4, ASCL4) were decreased and factors alleviating ferroptosis were increased. Similarly, caspase-1, GSDMD, interleukin-1β (IL-1β) and/or nucleotide-binding oligomerization domain, leucine-rich repeat-containing receptor-containing pyrin domain 3 (NLPR3), which induce pyroptosis, were restored following GLP-1RAs therapy. The pleiotropic effects of GLP-1RAs included improvements in inflammatory markers, fibrosis-associated indices, mitochondrial ultrastructure and oxidative stress. Nevertheless, these positive effects mediated by GLP-1RAs are almost exclusively based on experimental models. Therefore, clinical trials are required to explore these promising outcomes in clinical practice.

Neonatal diabetes mellitus (NDM) is a rare cause of diabetes characterized by the presence of severe hyperglycemia typically diagnosed within the first six months of life. Among the main causes are activating variants in heterozygosity in the KCNJ11 gene. Variants in this gene can lead to a spectrum of clinical manifestations, from transitory neonatal diabetes mellitus to DEND syndrome, the most severe form, characterized by developmental delay, epilepsy, neonatal diabetes, and muscle hypotonia. The disease may be present in a milder intermediate form named iDEND syndrome. Patients with KCNJ11 variants may present with attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), developmental coordination disorder (DCD), and learning difficulties due to diminished intelligence quotient (IQ) and dyslexia. These patients can benefit from genetic counseling as most of them can switch from insulin to sulfonylurea treatment with good glycemic control and no severe side effects; besides, some studies report a neurological improvement after the treatment switch. In the present work, we reported a follow-up of a 24-year-old Brazilian male with DEND syndrome due to the KCNJ11 c.754G>A; p.(Val252Met) variant. He was diagnosed with diabetes at 25 days of age and presented with bilateral hypoacusis in the first years of life. He started insulin at the diagnosis. However, the genetic diagnosis was made only at the age of 15 years, and he was switched from insulin to sulfonylurea. At 24 years of age, he presents with good glycemic control and reports no severe episodes of hypoglycemia or hyperglycemia. However, no neurological improvement was observed. This report highlights the potential benefits of switching to sulfonylurea treatment, even in patients with long-standing diagnoses of DEND syndrome, and underscores the importance of genetic diagnosis, as early initiation of sulfonylurea therapy may improve metabolic control and, in some cases, neurological outcomes.

Introduction: The prevalence of gestational diabetes mellitus (GDM) is significantly increasing. Hyperglycaemia and dyslipidaemia have been demonstrated to contribute to endothelial dysfunction linked to foetal-placental circulation. Glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1 (GPIHBP1) is crucial for the lipolytic processing of TG-rich lipoproteins through the anchoring of lipoprotein lipase (LPL). In this study, circulating GPIHBP1 levels during pregnancy were evaluated, and their associations with hypertriglyceridaemia and the perinatal outcomes of GDM were evaluated.

Methods: This study included 12 pregnant women with GDM and 21 pregnant women with normal glucose tolerance (NGT).

Results: No significant differences in obstetrical outcomes were detected between the two groups. In participants with NGT, circulating GPIHBP1 levels were markedly lower in the 3rd trimester than in the 2nd trimester and at delivery. In women with GDM, circulating GPIHBP1 levels were unchanged during the 3rd trimester, and circulating GPIHBP1 levels throughout the 3^rd trimester were negatively correlated with neonatal birth weight percentile and umbilical venous pO₂ (ρ=-0.636, p=0.026; ρ=-0.657, p=0.020).

Discussion: Our findings suggest a possible association between circulating GPIHBP1 levels and perinatal outcomes in patients with GDM.

Type 1 diabetes mellitus (T1DM) is an autoimmune disorder characterized by the destruction of pancreatic β-cells, necessitating lifelong exogenous insulin. This review synthesizes key advances that are shifting T1DM management from symptomatic control to disease modification and potential cure. We examine progress in novel insulin formulations and automated insulin delivery systems, alongside groundbreaking immunomodulatory therapies and gene-edited stem cell therapies that aim to restore native β-cell function and achieve insulin independence. The article also discusses the potential of phytomedicines and gut microbiota modulation. This review provides insights into the unique challenges of implementing these innovations within the Chinese healthcare context, highlighting the need for high-quality clinical research, personalized strategies, and improved healthcare accessibility to enhance long-term patient outcomes.

Introduction: There are limited data regarding the role of oral glucose tolerance test (OGTT) in classifying glycemic alterations in patients with adrenal incidentaloma (AI). This study aims to compare the frequency of dysglycemia [pre-diabetes mellitus (DM) and DM] among patients with non-functioning adrenal incidentalomas (NFAI), mild autonomous cortisol secretion (MACS), and controls; and to assess the area under the curve (AUC) in the OGTT and determine whether the OGTT was decisive in diagnosing dysglycemia in each population.

Methods: A cross-sectional study was conducted on 65 NFAI (1mg-dexamethasone suppression test [DST] ≤1.8μg/dL), 45 MACS (1mg-DST ≥1.9μg/dL), and 56 controls. The control group was selected based on normal adrenal imaging. Patients were classified as normoglycemic or dysglycemic based on fasting glucose, glycated hemoglobin, and OGTT.

Results: AUC >290mg.h/dL was found in 75% of MACS, 55% of NFAI, and 22% of controls (p=0.008). The presence of AI was determinant for this result. Glucose levels ≥155 mg/dL at the 1-hour during the OGTT were observed in 75% of MACS, 65% of NFAI, and 28% of controls (p=0.01). Dysglycemia frequency was higher in MACS and NFAI than controls (91.1 vs. 90.8 vs. 73.2%; p=0.01). The OGTT changed the classification in 27% of MACS, 23% of NFAI, and 3% of controls (p=0.03). Presence of AI increased the odds ratio for benefiting from OGTT to obtain a more accurate dysglycemia classification by 9.5 times.

Conclusion: Patients with AI had a higher dysglycemia frequency, and a significant number of these patients benefited from OGTT in classifying glycemic alterations.