Acta Diabetologica最新文献

{"title":"Selective SGLT2 inhibitors in MASLD/MASH: an outcome-specific systematic review and meta-analysis of hepatic and cardiometabolic outcomes.","authors":"Danilo Caponio, Giuseppina Alessia Acucella, Michele Acucella","doi":"10.1007/s00592-026-02759-5","DOIUrl":"https://doi.org/10.1007/s00592-026-02759-5","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely linked to obesity, insulin resistance and type 2 diabetes mellitus (T2DM). Selective sodium-glucose cotransporter 2 (SGLT2) inhibitors have established glycaemic, renal and cardiovascular benefits, but their hepatic effects in MASLD and metabolic dysfunction-associated steatohepatitis (MASH) remain incompletely defined. We conducted a PRISMA 2020 systematic review and meta-analysis of randomized controlled trials evaluating selective SGLT2 inhibitors in adults with MASLD, MASH or corresponding earlier non-alcoholic fatty liver disease/non-alcoholic steatohepatitis phenotypes. The protocol was registered in PROSPERO (CRD420261390850). Thirty randomized trials, including 2359 participants contributing to liver-outcome analyses, were included. Most evidence came from T2DM-associated MASLD trials. In a prespecified strict MR-based synthesis of two directly extractable double-blind placebo-controlled trials including 116 participants, SGLT2 inhibition reduced liver fat compared with placebo: mean difference - 2.54% points, 95% confidence interval - 4.39 to - 0.69; I²=41.2%. Certainty was rated as low because of serious indirectness and serious imprecision; publication bias could not be formally assessed because only two trials contributed to the pooled analysis. Additional placebo-controlled magnetic resonance evidence supported liver fat reduction in non-diabetic MASLD but was not pooled because of median-based reporting. Three biopsy-based randomized trials enrolled 245 participants overall, of whom 229 contributed evaluable data to the histological fibrosis-improvement meta-analysis. This analysis suggested a higher likelihood of histological fibrosis improvement: risk ratio 2.21, 95% confidence interval 1.52-3.23; I²=0%, but the finding was judged low certainty and hypothesis-generating. Elastography-based fibrosis-related outcomes were heterogeneous and should not be equated with histological fibrosis regression. SGLT2 inhibitors also improved body weight, body mass index, visceral adiposity and glycaemic control in T2DM-associated MASLD. Current evidence is most consistent with a modest but reproducible reduction in imaging-assessed hepatic steatosis, particularly in T2DM-associated MASLD, whereas evidence for histological disease modification remains preliminary. SGLT2 inhibitors should therefore be regarded primarily as cardiometabolic agents with liver fat-lowering effects and possible adjunctive hepatic relevance, rather than established liver-specific disease-modifying therapies for MASLD/MASH. Registration: PROSPERO CRD420261390850.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597358","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}

{"title":"The association between adapted dietary index for gut microbiota and carotid intima-media thickness among overweight or obese children and adolescents","authors":"Mobina Imannezhad,&nbsp;Ali Nikparast,&nbsp;Elahe Etesami,&nbsp;Golaleh Asghari","doi":"10.1007/s00592-026-02716-2","DOIUrl":"10.1007/s00592-026-02716-2","url":null,"abstract":"<div><p>Childhood obesity is associated with early vascular alterations that can be assessed by carotid intima-media thickness (cIMT). The dietary index for gut microbiota (DI-GM) was developed to reflect dietary patterns supportive of microbial diversity, but its use in pediatric populations has not been established. This study investigated the association between an adapted DI-GM (aDI-GM) and cIMT among children and adolescents with overweight or obesity. In this cross-sectional analysis, 354 participants aged 7–18 years were included. Dietary intake was assessed using a validated 147-item food frequency questionnaire, and an adapted 12-component DI-GM was calculated based on available dietary data. Carotid IMT was measured using high-resolution ultrasonography and categorized into tertiles, with the highest tertile defined as high cIMT. Associations were examined using multivariable linear and logistic regression models, adjusted sequentially for demographic, anthropometric, biochemical, lifestyle, and dietary factors. In tertile-based analyses, no statistically significant associations with cIMT were observed. In continuous analyses, higher aDI-GM scores were inversely associated with the odds of high cIMT in the fully adjusted model; specifically, each one-unit increase in aDI-GM was associated with lower odds of high cIMT (OR = 0.79, 95% CI: 0.68–0.92, <i>p</i> &lt; 0.01). These findings differed according to modeling approach and should therefore be interpreted cautiously. Given the cross-sectional design and the exploratory application of an adult-derived index in a pediatric population, these findings should be considered hypothesis-generating and require confirmation in longitudinal studies.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 10","pages":"1737 - 1747"},"PeriodicalIF":3.1,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597312","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}

{"title":"Molecular biomarkers in diabetes-related neurological complications: current evidence and translational challenges.","authors":"Athena Myrou, Christos Voucharas, Christos Savopoulos","doi":"10.1007/s00592-026-02754-w","DOIUrl":"https://doi.org/10.1007/s00592-026-02754-w","url":null,"abstract":"<p><p>Diabetes mellitus is increasingly recognized as a systemic disorder associated with a broad spectrum of neurological complications, including diabetic peripheral neuropathy, autonomic neuropathy, cerebrovascular disease, cognitive impairment, and neurodegenerative disorders. Because neurological injury may develop before the onset of overt clinical manifestations, the identification of reliable biomarkers for early risk assessment remains an important challenge in diabetes care. This narrative review summarizes current evidence regarding molecular biomarkers implicated in diabetes-related neurological complications. A literature search was conducted using major biomedical databases, with emphasis on human studies, systematic reviews, prospective cohorts, and clinically relevant translational research. Biomarker categories reviewed include inflammatory mediators, oxidative stress markers, advanced glycation end-products, neuronal injury proteins, metabolomic signatures, circulating microRNAs, extracellular vesicles, and multi-omics approaches. Current evidence suggests that several biomarkers are associated with neurological injury and adverse neurological outcomes in patients with diabetes. However, the strength of evidence varies substantially across biomarker classes. While some biomarkers demonstrate biological plausibility and consistent associations with disease burden, most remain at an exploratory stage and lack sufficient prospective validation for routine clinical implementation. Major barriers include study heterogeneity, assay variability, limited reproducibility, uncertainty regarding incremental predictive value, and insufficient evaluation in diabetes-specific populations. Future research should focus on rigorous validation of candidate biomarkers, standardization of analytical methods, and assessment of their added value beyond established clinical risk factors. The integration of molecular biomarkers with clinical variables, neuroimaging findings, and advanced analytical approaches may contribute to future risk stratification strategies; however, substantial validation is required before clinical implementation can be considered.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576830","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}

{"title":"Improving cognition through lifestyle-induced remission of type 2 diabetes: findings from DIABEPIC-2","authors":"Marie Ouellet,&nbsp;Christopher Gudas-Cantin,&nbsp;Valérie Dionne,&nbsp;Christine Gagnon,&nbsp;Mathieu Gayda,&nbsp;Florent Besnier,&nbsp;Élise Latour,&nbsp;Christos Badas,&nbsp;Sara Desmarais,&nbsp;Neus Camins-Vila,&nbsp;Louis Bherer,&nbsp;Josep Iglesies-Grau,&nbsp;Tanya Mailhot","doi":"10.1007/s00592-026-02755-9","DOIUrl":"10.1007/s00592-026-02755-9","url":null,"abstract":"<div><h3>Aims</h3><p>Cognitive deficits are common but underrecognized complications of type 2 diabetes (T2D), which may be mitigated by lifestyle factors. The DIABEPIC-2 pilot trial evaluated a 6-month lifestyle intervention targeting T2D remission. We aimed to assess post-intervention changes in cognitive performance and identify associations with metabolic, anthropometric and intervention-related parameters.</p><h3>Methods</h3><p>. This secondary analysis included thirty adults with T2D (mean age 63.0 years, 60% male) who completed neuropsychological testing before and after an intervention combining nutritional counseling and supervised exercise. Cognitive outcomes were analyzed using repeated-measures ANOVAs, and indicators were calculated to identify clinically meaningful changes. Associations with hemoglobin A1c (HbA1c), relative fat mass (RFM), exercise dose, dietary adherence and remission status were examined using multivariable or logistic regression models.</p><h3>Results</h3><p>Significant improvements were observed in global cognition (<i>p</i> = 0.03), verbal memory (<i>p</i> = 0.008), and executive function (<i>p</i> = 0.005). Clinically meaningful memory improvements occurred in 20% of participants. Reductions in HbA1c and RFM, as well as higher exercise dose, were independently associated with greater memory gains, whereas dietary adherence and remission status were not.</p><h3>Conclusion</h3><p>. A lifestyle intervention for T2D remission was associated with improvements in global cognition and executive function, as well as clinically meaningful gains in verbal memory. These benefits appear primarily driven by improvements in glycemic control, body composition, and exercise engagement rather than remission itself. Larger controlled trials are warranted to confirm these findings and document long-term cognitive effects.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 10","pages":"1727 - 1736"},"PeriodicalIF":3.1,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547538","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}

{"title":"Micronutrients in immune ageing and diabetic wound healing: modulating inflammation and promoting tissue repair.","authors":"Subhasri Bogadi, Md Ekhtiar Uddin, Shamima Aktar, Muhammed Ajmal, Marayat Ratanapateep","doi":"10.1007/s00592-026-02744-y","DOIUrl":"https://doi.org/10.1007/s00592-026-02744-y","url":null,"abstract":"<p><p>Immune ageing, characterized by a decline in immune function and increased chronic inflammation, significantly impacts tissue repair mechanisms, particularly in diabetic wounds. Diabetic individuals often experience delayed wound healing due to impaired immune responses and persistent inflammation, making effective management of chronic wounds a challenge. Recent studies suggest that micronutrients, which play an essential role in modulating immune responses and inflammatory pathways, have the potential to mitigate these age-related dysfunctions and improve wound healing outcomes. This review explores key micronutrients, including Vitamin D, Vitamin C, Zinc, and Selenium, in enhancing immune function and promoting tissue repair in diabetic wound healing. We discuss how deficiencies in these micronutrients contribute to increased inflammation, delayed immune responses, and prolonged wound healing. Furthermore, we examine emerging micronutrients and their potential therapeutic benefits, such as Magnesium, Folic Acid, and Curcumin, in reducing oxidative stress and modulating immune function. In addition, innovative delivery systems, including liposomal encapsulation and nanotechnology, are highlighted as promising strategies to enhance the bioavailability and efficacy of micronutrients, ensuring their optimal therapeutic effect in ageing and diabetic populations. By synthesizing current evidence and proposing future research directions, this review emphasizes the importance of micronutrient supplementation as a therapeutic strategy to address immune ageing and accelerate wound healing, offering new opportunities for managing chronic diabetic wounds and related complications in the ageing population.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547619","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}

{"title":"HALP score and risk of renal progression in diabetic kidney disease","authors":"Muhammed Emre Sevim,&nbsp;Pelda Zümrüt Sevim,&nbsp;Fatma Yılmaz Aydın,&nbsp;Şeyhmus Akçay,&nbsp;Adnan Önün,&nbsp;Yunus Avcı,&nbsp;Zülfükar Yılmaz,&nbsp;Yaşar Yıldırım,&nbsp;Emre Aydın","doi":"10.1007/s00592-026-02740-2","DOIUrl":"10.1007/s00592-026-02740-2","url":null,"abstract":"<div><h3>Aim</h3><p>Immunonutritional impairment driven by chronic inflammation and metabolic dysregulation plays a significant role in the progression of diabetic kidney disease (DKD). The hemoglobin–albumin–lymphocyte–platelet (HALP) score is a biomarker reflecting immunonutritional status; however, its prognostic value in patients with advanced DKD remains uncertain.</p><h3>Method</h3><p>In this retrospective cohort study, 348 patients with stage 3–4 chronic kidney disease (CKD) secondary to type 2 diabetes mellitus (eGFR 15–59 mL/min/1.73 m²) were included after screening 769 individuals (2012–2024). The primary endpoint was renal progression, defined as a ≥ 40% decline in eGFR or initiation of renal replacement therapy. HALP was initially categorized into tertiles to evaluate baseline differences. Subsequently, a ROC-derived cutoff was used to dichotomize patients into low- and high-HALP groups, followed by Kaplan–Meier and Cox regression analyses. Predictive performance was assessed using ROC analysis, and robustness was evaluated through subgroup analyses and 1:1 propensity score (PS) matching.</p><h3>Results</h3><p>Renal progression occurred in 181 patients. HALP components and urine protein creatinine ratio (UPCR) differed significantly across tertile groups (<i>p</i> &lt; 0.001 for components; <i>p</i> = 0.025 for UPCR). The ROC-derived cutoff was 34.15 (AUC 0.602; <i>p</i> = 0.001). After PS matching (<i>n</i> = 278), low-HALP group remained independently associated with an increased risk of renal progression (HR 1.627; <i>p</i> = 0.005). Subgroup analyses revealed no significant interaction, supporting the consistency of the findings across clinical strata.</p><h3>Conclusion</h3><p>The HALP score may serve as a simple, cost-effective and widely available adjunctive tool for risk stratification in patients with advanced DKD.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 10","pages":"1717 - 1726"},"PeriodicalIF":3.1,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519781","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}

{"title":"Circulating microRNAs as diagnostic biomarkers and pathogenic mediators in type 2 diabetic retinopathy: a systematic review.","authors":"Pragati Upadhayay, Ruhi Sikka, Himanshu Gupta","doi":"10.1007/s00592-026-02745-x","DOIUrl":"https://doi.org/10.1007/s00592-026-02745-x","url":null,"abstract":"<p><strong>Background: </strong>This systematic review synthesizes current evidence on circulating microRNAs (miRNAs) associated with diabetic retinopathy (DR) in individuals with type 2 diabetes (T2D). DR is a leading cause of vision impairment among adults with diabetes. Identifying circulating miRNAs as minimally invasive biomarkers could enable early DR detection, improve disease monitoring, and support therapeutic development.</p><p><strong>Methods: </strong>Following PRISMA guidelines, PubMed and Scopus were systematically searched for English-language studies published between January 2014 and 20 July 2024. Observational studies reporting quantitative expression data (fold-change) of circulating miRNAs in serum or plasma samples from patients with DR and T2D controls were included. Data extraction and quality assessment were independently performed by two reviewers.</p><p><strong>Results: </strong>From 957 screened records, 16 studies met all inclusion criteria. Most studies were conducted in Chinese cohorts and collectively identified numerous differentially expressed miRNAs implicated in NF-κB signaling, PI3K/Akt signaling, angiogenesis, and neuronal apoptosis. Several miRNAs, including hsa-miR-155, hsa-miR-320a, hsa-miR-320b and hsa-miR-338-3p showed consistent dysregulation across multiple studies and demonstrated promise as non-invasive biomarkers for DR diagnosis and progression monitoring. However, heterogeneity in study design, small sample sizes, and limited validation experiments reduced comparability across studies.</p><p><strong>Conclusion: </strong>Current evidence supports the potential of circulating miRNAs as biomarkers for early detection and monitoring of DR in T2D. Nevertheless, larger, multiethnic, and longitudinal studies with standardized protocols, coupled with mechanistic and functional validation, are essential to confirm their diagnostic and therapeutic utility.</p>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148443671","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}

{"title":"Impact of national continuous glucose monitoring reimbursement on utilization and glycemic outcomes in children and adolescents with type 1 diabetes","authors":"Leyla Kara","doi":"10.1007/s00592-026-02753-x","DOIUrl":"10.1007/s00592-026-02753-x","url":null,"abstract":"<div><h3>Background</h3><p>Continuous glucose monitoring (CGM) use is associated with improved glycaemic outcomes and reduced hypoglycaemia in type 1 diabetes; however, access remains limited due to cost and reimbursement disparities.</p><h3>Methods</h3><p>This retrospective observational study included children and adolescents with type 1 diabetes followed in a single center. Clinical outcomes before and after reimbursement were compared using paired statistical analyses.</p><h3>Results</h3><p>The implementation of the reimbursement policy in Türkiye was associated with improved access to diabetes technology through reduced financial barriers and with favourable changes in clinical outcomes. CGM usage increased significantly from 26% (<i>n</i> = 11) before reimbursement to 92% (<i>n</i> = 38) after reimbursement. A slight reduction in mean HbA1c levels was observed (from 9.08% to 8.99%). In children under 10 years of age, the proportion achieving target HbA1c levels (&lt; 7%) increased from 16% to 33% (<i>p</i> = 0.042). In addition, a decreasing trend in hypoglycemia frequency and emergency department visits was observed following continuous glucose monitoring use.</p><h3>Conclusion</h3><p>The introduction of a national reimbursement policy was associated with a marked increase in access to CGM in children and adolescents with type 1 diabetes. However, changes in glycaemic outcomes were limited and not statistically significant in the overall cohort. These findings suggest that the primary impact of reimbursement was improved adoption of diabetes technology rather than substantial short-term improvement in glycaemic control. Further large-scale studies are needed to evaluate long-term clinical outcomes and patient-reported benefits.</p><h3>Graphical abstract</h3><div><figure><div><div><picture><source><img></source></picture></div></div></figure></div></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 10","pages":"1707 - 1715"},"PeriodicalIF":3.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148443632","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}

{"title":"Predictive value of kynurenine pathway metabolites in patients with diabetic kidney disease","authors":"Mehmet Erdem,&nbsp;Hamit Hakan Alp,&nbsp;Nur Düzen Oflas,&nbsp;Ozan Aydemir,&nbsp;İbrahim Aydin,&nbsp;Cebrail Karaca,&nbsp;Yasin Sezgin,&nbsp;Senar Ebinç,&nbsp;Mehmet Naci Aldemir,&nbsp;Murat Alay","doi":"10.1007/s00592-026-02738-w","DOIUrl":"10.1007/s00592-026-02738-w","url":null,"abstract":"<div><h3>Aim</h3><p>Diabetic kidney disease (DKD) is a leading cause of end-stage kidney disease (ESKD). The kynurenine pathway, responsible for tryptophan metabolism, is linked to inflammation and renal injury. This study aimed to assess the predictive value of serum tryptophan and kynurenine pathway metabolites in diagnosing DKD and differentiating disease stages in patients with type 2 diabetes mellitus (T2DM).</p><h3>Methods</h3><p>A total of 164 individuals (134 with T2DM and DKD, 30 healthy controls) were included in this cross-sectional study. Serum tryptophan, kynurenine, kynurenic acid, quinolinic acid, picolinic acid, 3-hydroxykynurenine, and indoleamine 2,3-dioxygenase (IDO) levels were measured using ELISA. Analyses included ANOVA, correlation, logistic regression, and ROC curves.</p><h3>Results</h3><p>Tryptophan levels were significantly reduced, while kynurenine pathway metabolites were elevated in DKD patients. eGFR showed negative correlations with kynurenine, kynurenic acid, IDO, and 3-hydroxykynurenine. ROC analysis revealed kynurenic acid, IDO, and 3-hydroxykynurenine as accurate markers for DKD staging. Logistic regression identified IDO, kynurenine, and kynurenic acid as independent predictors. Kynurenine pathway metabolites, particularly kynurenic acid and IDO, exhibit high diagnostic performance for detecting and staging DKD.</p><h3>Conclusion</h3><p>Kynurenic acid, IDO, and 3-hydroxykynurenine demonstrated strong discriminative capacity across DKD stages (AUC up to 0.951), and IDO was identified as an independent predictor of DKD. These metabolites may serve as complementary biomarkers for early risk stratification in DKD.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 10","pages":"1697 - 1706"},"PeriodicalIF":3.1,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434727","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}

{"title":"The acute diabetic foot: different clinical patterns with a dedicated fast-track pathway","authors":"Laura Giurato,&nbsp;Roberto Da Ros,&nbsp;Alessia Scatena,&nbsp;Roberto De Giglio,&nbsp;Giuseppe Murdolo,&nbsp;Marco Mastinu,&nbsp;Maurizio Gicchino,&nbsp;Desiree Gabriele,&nbsp;Cesare Miranda,&nbsp;Luigi Uccioli,&nbsp;Marco Meloni","doi":"10.1007/s00592-026-02746-w","DOIUrl":"10.1007/s00592-026-02746-w","url":null,"abstract":"<div><p>Although scientific societies have made substantial efforts through the implementation of guidelines and by increasing awareness among both expert and non-expert healthcare professionals (HCPs), delayed referral of patients with diabetic foot ulcers (DFUs) to specialized diabetic foot services (DFS) remains a common issue. Early referral to a DFS has been widely documented as the most important intervention for achieving ulcer healing, reducing healing time, and avoiding major amputations. Furthermore, it has been reported that many HCPs working in primary care are not adequately trained in the recognition and management of DFUs. The onset of a DFU may rapidly deteriorate and evolve into a diabetic foot attack (DFA), a dangerous condition characterized by advanced ischaemia, severe infection, and/or acute Charcot neuroarthropathy, potentially leading to limb- and life-threatening consequences. The current document aims to identify the main clinical patterns of DFA, describing their clinical characteristics, appropriate management pathways, and indications for treatment. Accordingly, the authors aimed to develop a practical, fast-track model to define referral timing to specialized diabetic foot centers based on the severity of each clinical presentation. The proposed fast-track approach distinguishes between emergency conditions requiring immediate management within hours and urgent conditions requiring specialist evaluation within 24–48 h to prevent clinical deterioration and poorer outcomes.This document was developed on behalf of the Italian Diabetic Foot Study Group of Società Italiana di Diabetologia (SID) and Associazione Medici Diabetologi (AMD) with the aim of reducing cases of delayed referral and their severe consequences.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"63 11","pages":"1875 - 1886"},"PeriodicalIF":3.1,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00592-026-02746-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434732","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}