Type 1 diabetes (T1D) is characterized by the autoimmune destruction of pancreatic beta cells, leading to absolute insulin deficiency and the need for exogenous insulin. A significant concern in T1D management is hypoglycemia, which is worsened by impaired counterregulatory mechanisms. Effective counterregulation involves hormones such as glucagon and adrenaline, which work to restore normal blood glucose levels. However, in T1D, these mechanisms often fail, particularly after recurrent hypoglycemia, resulting in hypoglycemia-associated autonomic failure. Recent research indicates that elevated levels of intestinal glucagon-like peptide-1 (GLP-1) impair counterregulatory responses by reducing the secretion of glucagon and adrenaline. This editorial underscores GLP-1’s role beyond its incretin effects, contributing to impaired hypoglycemic counterregulation. This understanding necessitates a nuanced approach to GLP-1-based therapies in T1D, balancing the benefits of glycemic control with potential risks. Future research should delve into the mechanisms behind GLP-1’s effects and explore potential interventions to improve hypoglycemic counterregulation. The goal is to enhance the safety and quality of life for T1D patients.

• Type 1 diabetes
• Glucagon-like peptide-1
• Hypoglycemia
• Hypoglycemic counterregulation
• Hormonal reaction

Individuals with diabetes mellitus have a higher risk of developing malignant tumors, and diagnosing these tumors can be challenging.

To confirm the benefits of using peripherally inserted central catheters (PICCs) in contrast-enhanced computerized tomography (CECT) for diagnostic imaging in diabetic patients with malignant tumors and to provide a research basis for follow-up research.

This retrospective study analyzed 204 diabetic patients with malignancies treated at The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, from January 2024 to June 2024. The patients were divided into two groups: A control group (n = 102) with indwelling peripheral intravenous catheters and a research group (n = 102) with high-pressure-resistant PICC. The study compared baseline data, the incidence of iodine contrast extravasation during CECT, the incidence of adverse events (discomfort, redness and swelling at the puncture site, and blood oozing), imaging quality, nursing time, intubation success rate, number of venipuncture attempts, and catheter maintenance cost.

Male patients accounted for 51.96% in the control group and 55.88% in the research group; the average age was (59.68 ± 11.82) years in the control group and (61.41 ± 12.92) years in the research group; the proportions of lung cancer, colorectal cancer, and gastric cancer patients in the control group were 42.16%, 38.24%, and 19.61%, respectively, while those in the research group were 34.31%, 37.25%, and 28.43%, respectively. Except for the gender distribution, age, and cancer type mentioned above, other general information such as underlying diseases, puncture location, and long-term chemotherapy shows no significant differences as tested (P > 0.05). The results showed that the research group had significantly reduced incidence of iodine contrast extravasation (7 vs 1, P = 0.031), similar incidence of adverse events (11 vs 7, P = 0.324), reduced nursing time [(18.50 ± 2.68) minutes vs (13.26 ± 3.00) minutes, P = 0.000], fewer venipuncture attempts [(2.21 ± 0.78) times vs (1.49 ± 0.58) times, P = 0.000], lower catheter maintenance cost [(1251.79 ± 205.47) China yuan (CNY) vs (1019.25 ± 117.28) CNY, P = 0.000], increased intubation success rate (16.67% vs 58.82%, P = 0.000), and better imaging quality (85.29% vs 94.12%, P = 0.038).

High-pressure-resistant PICCs can lessen the physical burden of diabetic patients during nursing, reduce treatment costs, and improve the efficiency and quality of imaging for diagnosis malignant tumors.

• Diabetes mellitus complicated with malignant tumors
• Contrast-enhanced computerized tomography
• High-pressure-resistant peripherally inserted central catheters
• The incidence of adverse events
• Quality of computer tomography imaging

In this article, we comment on an original article published in a recent issue of the World Journal of Diabetes. That observational cross-sectional study focused on investigating the function of the glymphatic system and its clinical correlates in patients with different glucose metabolism states by using diffusion tensor imaging along the perivascular space (DTI-ALPS) index. It was shown that the cerebral glymphatic system may be dysfunctional in patients with type 2 diabetes. Various clinical variables affected the DTI-ALPS index in different glucose metabolism states. In conclusion, the study by Tian et al improves the understanding of the pathophysiology of diabetes-associated brain damage and provides insights for early diagnosis.

• Glymphatic system
• Prediabetes
• Type 2 diabetes mellitus
• Magnetic resonance imaging
• Diffusion tensor imaging along the perivascular space

The pathogenesis of diabetic peripheral neuropathy (DPN) has not been fully elucidated, and treatment options are limited. Currently, the main strategies for treating DPN are strict glycemic control and symptomatic pain relief. In this editorial, we comment on an article by Li et al, which suggested that modulating the gut microbiota using traditional Chinese medicine (TCM) may be a promising strategy for alleviating DPN symptoms. The regulation of the gut microbiota has received widespread attention in the study of various diseases. TCM can participate in the regulation of gut microbiota through multiple mechanisms, and this regulatory effect can alleviate the clinical symptoms of DPN. We briefly analyzed the promise of the gut microbiota in the early diagnosis, treatment, and clinical efficacy of TCM for DPN. The gut microbiota has potential value at multiple nodes in the occurrence and progression of DPN.

• Diabetic peripheral neuropathy
• Traditional Chinese medicine
• Gut microbiota
• Management
• Therapeutic mechanism
• Early detection

Shikonin is a natural remedy that is effective at treating diabetic wounds. NFAT5 is a potential therapeutic target for diabetes, and mitochondrial function is essential for wound healing. However, the relationship among Shikonin, NFAT5, and mitochondrial function has not been thoroughly studied. Here, we offer new perspectives on the advantages of shikonin for managing diabetes.

To assess the therapeutic mechanism of shikonin in diabetic wounds, its relationship with NFAT5, and its protection of mitochondrial function.

Hypertonic cell and diabetic wound mouse models were established. NFAT5 expression was measured through western blotting and immunofluorescence, in vivo and in vitro. Mitochondrial function was evaluated using reactive oxygen species (ROS) detection and JC-1 and Calcein AM dyes. Mitochondrial structures were observed using transmission electron microscopy. The NFAT5/AMPK pathway was analyzed using a transfection vector and an inhibitor. The effect of shikonin on cells under hypertonic conditions via the NFAT5/AMPK pathway was assessed using western blotting.

Shikonin treatment preserved HaCaT cell viability, while significantly reducing cyclooxygenase-2 expression levels in a high-glucose environment (P < 0.05). Additionally, shikonin maintained mitochondrial morphology, enhanced membrane potential, reduced membrane permeability, and decreased ROS levels in HaCaT cells under hyperosmolar stress. Furthermore, shikonin promoted wound healing in diabetic mice (P < 0.05). Shikonin also inhibited NFAT5, in vivo and in vitro (P < 0.05). Shikonin treatment reduced NFAT5 expression levels, subsequently inhibiting AMPK expression in vitro (P < 0.05). Finally, shikonin inhibited several key downstream molecules of the NFAT5/AMPK pathway, including mammalian target of rapamycin, protein kinase B, nuclear factor kappa-light-chain-enhancer of activated B cells, and inducible nitric oxide synthase (P < 0.05).

Shikonin protects mitochondria via the NFAT5/AMPK-related pathway and enhances wound healing in diabetes.

• Shikonin
• Diabetic wounds
• NFAT5
• Mitochondrial function
• AMPK
• Wound healing

Diabetes is one of the most devastating medical dilemmas impacting every region of the world severely. The study by Tian et al investigates glymphatic system dysfunction in the context of glucose metabolism and diabetes, using diffusion tensor imaging along the perivascular space. The study evaluated individuals with type 2 diabetes mellitus (T2DM), prediabetes, and normal glucose metabolism. It found that prediabetic and T2DM groups had significantly impaired glymphatic function. Glymphatic dysfunction may serve as an early indicator of cognitive deterioration in diabetes due to the correlations shown between these abnormalities and clinical factors as well as cognitive performance. The study has some positives, such as thorough evaluations and novel imaging methods, but its cross-sectional design and limited sample size restrict its applicability. More extensive, long-term research is required to verify these results. Furthermore, there are significant clinical implications. Patients with diabetes may benefit from immediate therapies to prevent microvascular and macrovascular damage if glymphatic dysfunction is identified early. The study promotes comprehensive diabetes care with a focus on maintaining cognitive function. In conclusion, the work of Tian et al is crucial because it opens the door to better treatment and diagnostic strategies for diabetes-related cognitive deterioration.

• Glymphatic system
• Diabetes mellitus
• Prediabetes
• Cognitive decline
• Diabetic brain damage

In this paper, we provide a commentary on an article focusing on diabetic foot ulcer (DFU) as a dreadful complication of diabetes mellitus. The development of this condition is influenced by factors such as diabetic peripheral neuropathy, lower extremity artery disease, and infection. However, the underlying mechanism remains elusive. Macrophages play a critical role in wound healing processes, suggesting that therapies targeting these cells could potentially improve the management of DFU. A comprehensive understanding of developmental trends of macrophages within the field of DFU may facilitate research advancements and the development of novel treatment strategies.

• Diabetic foot ulcer
• Macrophages
• Immune regulation
• Wound healing
• Bibliometrics

Diabetic foot ulcers (DFUs) are a real public health problem which carry a high risk of amputation. The treatment of DFUs is based on general management such as the treatment of infection, arterial disease, and offloading, but recent studies have shown that the quality of the local covering can impact the healing rate.

We report the case of a 39-year-old man, living with diabetes since the age of 15, who developed DFU on the dorsum of his left foot, with muscle and tendon involvement. Conventional management with intensive diabetes control, surgery, treatment of infection and negative pressure therapy gave only limited results. The patient benefited from the application of an intact fish skin graft with complete epithelialisation of the ulcer after 10 weeks of treatment.

The use of intact fish skin graft appears to be a promising option for deep DFUs.

• Intact fish skin graft
• Diabetic foot ulcer
• Foot amputation
• Case report

Glomerular endothelial cell (GENC) injury is a characteristic of early-stage diabetic nephropathy (DN), and the investigation of potential therapeutic targets for preventing GENC injury is of clinical importance.

To investigate the role of β-arrestin-2 in GENCs under DN conditions.

Eight-week-old C57BL/6J mice were intraperitoneally injected with streptozotocin to induce DN. GENCs were transfected with plasmids containing siRNA-β-arrestin-2, shRNA-activating transcription factor 6 (ATF6), pCDNA-β-arrestin-2, or pCDNA-ATF6. Additionally, adeno-associated virus (AAV) containing shRNA-β-arrestin-2 was administered via a tail vein injection in DN mice.

The upregulation of β-arrestin-2 was observed in patients with DN as well as in GENCs from DN mice. Knockdown of β-arrestin-2 reduced apoptosis in high glucose-treated GENCs, which was reversed by the overexpression of ATF6. Moreover, overexpression of β-arrestin-2 Led to the activation of endoplasmic reticulum (ER) stress and the apoptosis of GENCs which could be mitigated by silencing of ATF6. Furthermore, knockdown of β-arrestin-2 by the administration of AAV-shRNA-β-arrestin-2 alleviated renal injury in DN mice.

Knockdown of β-arrestin-2 prevents GENC apoptosis by inhibiting ATF6-mediated ER stress in vivo and in vitro. Consequently, β-arrestin-2 may represent a promising therapeutic target for the clinical management of patients with DN.

• Diabetic nephropathy
• Glomerular endothelial cell
• β-Arrestin-2
• Activating transcription factor 6
• Endoplasmic reticulum stress

The coronavirus disease 2019 (COVID-19) pandemic has been linked to an increased incidence of diabetes and diabetic ketoacidosis (DKA). However, the relationship between COVID-19 infection and progression to type 1 diabetes (T1D) in children has not been well defined.

To evaluate the influence of COVID-19 infection and inactivated vaccine administration on the progression of T1D among Chinese children.

A total of 197 newly diagnosed patients with T1D were retrospectively enrolled from Children's Hospital of Fudan University between September 2020 and December 2023. The patients were divided into three groups based on their history of COVID-19 infection and vaccination: the infection group, the vaccination-only group, and the non-infection/non-vaccination group. Comprehensive clinical assessments and detailed immunological evaluations were performed to delineate the characteristics and immune responses of these groups.

The incidence of DKA was significantly higher in the COVID-19 infection group (70.2%) compared to the non-infection/non-vaccination group (62.5%) and vacscination-only group (45.6%; P = 0.015). Prior COVID-19 infection was correlated with increased DKA risk (OR: 1.981, 95%CI: 1.026-3.825, P = 0.042), while vaccination was associated with a reduced risk (OR: 0.558, 95%CI: 0.312-0.998, P = 0.049). COVID-19 infection mildly altered immune profiles, with modest differences in autoantibody positivity, lymphocyte distribution, and immunoglobulin levels. Notably, HLA-DR3 positive children with a history of COVID-19 infection had an earlier T1D onset and lower fasting C-peptide levels than the HLA-DR3 negative children with a history of infection (both P < 0.05).

COVID-19 infection predisposes children to severe T1D, characterized by enhanced DKA risk. Inactivated vaccination significantly lowers DKA incidence at T1D onset. These findings are valuable for guiding future vaccination and T1D risk surveillance strategies in epidemic scenarios in the general pediatric population.

• COVID-19 infection
• Diabetic ketoacidosis
• Type 1 diabetes
• Vaccination
• Immune profiles

Patients with type 1 diabetes mellitus (T1DM) experience multiple episodes of hypoglycemia, resulting in dysfunctional counter-regulatory responses with time. The recent experimental study by Jin et al explored the role of intestinal glucagon-like peptide-1 (GLP-1) in impaired counter-regulatory responses to hypoglycemia. They identified intestinal GLP-1 along with GLP-1 receptor (GLP-1R) as the new key players linked with impaired counter-regulatory responses to hypoglycemia in type 1 diabetic mice. They also demonstrated that excessive expression of GLP-1 and GLP-1R was associated with attenuated sympathoadrenal responses and decreased glucagon secretion. The study has enormous clinical relevance as defective counter regulation and hypoglycemia unawareness negatively impacts the intensive glycemic management approach in this group of patients. However, the physiological processes must be validated in dedicated human studies to comprehensively understand the pathophysiology of this complex relationship, and to clarify the true extent of impaired hypoglycemia counter regulation by intestinal GLP-1. For now, following the results of the index study and other similar studies, GLP-1 analogues usage in T1DM must be carefully monitored, as there is an inherent risk of worsening the already impaired counter-regulatory responses in these patients. Further studies in the future could identify other key players involved in this clinically relevant interaction.

• Glucagon-like peptide-1
• Type-1 diabetes mellitus
• Hypoglycemia
• Counter-regulatory responses
• Catecholamines
• Adrenergic response
• Glucagon

Familial partial lipodystrophy disease (FPLD) is a collection of rare genetic diseases featuring partial loss of adipose tissue. However, metabolic difficulties, such as severe insulin resistance, diabetes, hypertriglyceridemia, and hypertension frequently occur alongside adipose tissue loss, making it susceptible to misdiagnosis and delaying effective treatment. Numerous genes are implicated in the occurrence of FPLD, and genetic testing has been for conditions linked to single gene mutation related to FPLD. Reviewing recent reports, treatment of the disease is limited to preventing and improving complications in patients.

In 2017, a 31-year-old woman with diabetes, hypertension and hypertriglyceridemia was hospitalized. We identified a mutation in her peroxisome proliferator-activated receptor gamma (PPARG) gene, Y151C (p.Tyr151Cys), which results in a nucleotide substitution residue 452 in the DNA-binding domain (DBD) of PPARG. The unaffected family member did not carry this mutation. Pioglitazone, a PPARG agonist, improved the patient’s responsiveness to hypoglycemic and antihypertensive therapy. After one year of treatment in our hospital, the fasting blood glucose and glycosylated hemoglobin of the patient were close to normal.

We report a rare PPARG mutation, Y151C, which is located in the DBD of PPARG and leads to FPLD, and the preferred agent is PPARG agonists. We then summarized clinical phenotypic characteristics of FPLD3 caused by PPARG gene mutations, and clarified the relationship between different mutations of PPARG gene and the clinical manifestations of this type of FPLD. Additionally, current treatments for FPLD caused by PPARG mutations are reviewed.

• Familial partial lipodystrophy
• Peroxisome proliferator-activated receptor gamma
• Tyr151Cys
• Phenotypic heterogeneity
• Case report

This article provides commentary on the article by Zhang et al. In this original research, Zhang et al investigated the therapeutic potential of teneligliptin for diabetic cardiomyopathy (DCM), which was mediated by targeting the NOD-like receptor protein 3 (NLRP3) inflammasome. Through the use of both in vivo and in vitro models, the study demonstrated that teneligliptin alleviates cardiac hypertrophy, reduces myocardial injury, and mitigates the inflammatory responses associated with DCM. These findings suggest that teneligliptin’s cardioprotective effects are mediated through the inhibition of NLRP3 inflammasome activation, positioning it as a promising therapeutic option for managing DCM in diabetic patients.

• Diabetic cardiomyopathy
• Teneligliptin
• Nucleotide-binding oligomerization domain-like receptor 3 inflammasome
• Inflammasome inhibition

Diabetes is one of the most catastrophic diseases ruling every corner of the world, and this has led to elevated incidents of end-stage kidney disease (ESKD). The standard treatment for ESKD is kidney transplantation/replacement, which is limited due to a deficiency of donors. Hence, dialysis has become the second-best option for treating patients with ESKD. Patients with ESKD with underlying diabetes have an additional risk of complications and infections over non-diabetic ESKD patients. Furthermore, these patients also experience variations in blood glucose levels and are more liable to develop malnutrition. This article elaborates on the different dialysis methods for ESKD patients. This editorial highlights the evidence-based studies that include randomized clinical trials, cohort studies, retrospective studies and case-control studies and suggests the most suitable type of dialysis under the following components.

• Type 2 diabetes mellitus
• End-stage renal disease
• Peritoneal dialysis
• Hemodialysis
• Glycemic control
• Diabetic nephropathy
• Renal function
• Kidney transplantation
• Malnutrition

Limited joint mobility is the proven risk factor for diabetic foot ulceration when present in the subtalar and first metatarsophalangeal joints. Evidence shows that a foot-related exercise program, combined with a health-promoting program, can improve the signs and symptoms of diabetic polyneuropathy, enhance gait, restore mobility in the foot and ankle joints, redistribute pressure while walking, and increase foot strength and function. As a result, these exercise programs can help mitigate the risk factors for diabetic foot ulceration.

To determine the effect of supervised stretching, strengthening, functional and walking exercises on joint mobility and muscle strength in patients with diabetic polyneuropathy.

This was a randomized controlled trial conducted in a tertiary hospital. The study included 82 participants allocated into the intervention group (alpha-lipoic acid and exercise on 15 consecutive therapeutic days, n = 42) and control group (alpha lipoic acid only, n = 40). Muscle strength included dorsal and plantar flexors dynamometry and strength score, while range of motion included ankle, subtalar and first metatarsophalangeal joint goniometry.

Change of motion range was significantly higher in the intervention group compared to the control group regarding ankle joint on day 15 (9.9 ± 7.2 vs 0.1 ± 3.3; P = 0.006) and month 6 (2.8 ± 7.3 vs -0.9 ± 4.1; P < 0.001), subtalar joint on day 15 (7.5 ± 5.1 vs -0.25 ± 2.25; P < 0.001) and month 6 (3.9 ± 6.4 vs -0.13 ± 3.49; P < 0.001). Change in dorsal flexors was significantly higher in the intervention group compared to the control group on day 15 (2.62 ± 1.69 vs 0.10 ± 1.35; P < 0.001) and month 6 (0.66 ± 2.38 vs -0.75 ± 1.94; P = 0.004) as well as plantar flexors on day 15 (3.3 ± 1.6 vs 0.3 ± 1.5; P < 0.001) and month 6 (1.8 ± 2.2 vs -0.9 ± 2.1; P < 0.001). Muscle strength score change was significantly lower in the intervention group compared to the control group on day 15 (-1.45 ± 1.42 vs -0.03 ± 0.16; P < 0.001) and month 6 (-1.17 ± 1.53 vs 0.20 ± 0.56; P < 0.001).

Exercise in combination with alpha-lipoic acid can improve joint mobility, as well as strength of the foot and lower leg muscles in patients with diabetic polyneuropathy.

• Diabetes
• Diabetic polyneuropathy
• Diabetic foot ulcer
• Muscle strength
• Range of motion
• Exercise

Chronic hyperglycemia can damage the microcirculation, which impairs the function of various organs and tissues and predisposes individuals to chronic complications. Sarcopenia (SP) is the age-related decline in muscle mass and function that contributes to the sequelae of type 2 diabetes. In particular, diabetic patients are at higher risk of SP because of insulin resistance, chronic inflammation, and decreased physical activity.

To identify SP-associated factors in middle-aged and elderly male type 2 diabetes mellitus (T2DM) patients and their correlation with bone mineral density (BMD).

A retrospective analysis was conducted on 196 middle-aged and elderly male T2DM inpatients in the First Affiliated Hospital of Chongqing Medical University between June 2021 and June 2023, with 60 concurrent healthy individuals as the control group. Differences in general information, blood biochemistry, glycosylated hemoglobin, muscle strength, and detection rate of SP were compared between groups. The BMD, appendicular skeletal muscle (ASM), and fat mass, as well as grip strength and gait speed, were determined for each patient, and the ASM index (ASMI) was counted. The quantitative data were subjected to correlation and logistic regression analyses to identify risk factors for SP.

Fifty-one of the 196 middle-aged and elderly male T2DM patients were diagnosed with SP, which accounted for 26.02%. The middle-aged and elderly T2DM patients with SP exhibited a longer diabetes mellitus (DM) course and a lower body mass index (BMI) and 25(OH)D₃ compared with the non-SP patients. The T2DM + SP patients exhibited lower BMI, ASM, ASMI, left- and right-hand grip strength, gait speed, and muscle and fat mass of the upper and lower limbs compared with the diabetic non-SP patients. The femoral neck, total hip, and lumbar spine L_1-4 BMD were markedly lower in T2DM + SP patients compared with those in the non-SP diabetics. Long-term DM course, low BMI, and low BMD of the femoral neck, lumbar spine L_1-4, and total hip were identified as risk factors for the development of SP.

T2DM patients are at risk for SP; however, measures can be taken to prevent the related risk factors.

• Male
• Type 2 diabetes mellitus
• Sarcopenia
• Bone mineral density
• Appendicular skeletal muscle

Diabetic retinopathy (DR) is one of the most common serious complications in diabetic patients, and early screening and diagnosis are essential to prevent visual impairment. With the rapid development of deep learning technology, network models based on attention mechanisms have shown significant advantages in medical image analysis, which can improve the accuracy and efficiency of screening.

To evaluate the efficacy of an attention mechanism-based deep learning network model in screening for DR in natural and diabetic populations, as well as in screening with unilateral and bilateral fundus photography.

From January 2023 to June 2024, a stratified multistage cluster sampling method was adopted to select a representative sample of permanent residents aged 18-70 years from our hospital. A total of 948 fundus images from 474 participants were included in the "deep learning model" system for scoring. The fundus images were graded via the early treatment of DR [Early Treatment Diabetic Retinopathy Study (ETDRS)] scoring system as the gold standard for the diagnosis of DR. With "DR to be referred (ETDRS > 31)" as the reference variable, a receiver operating characteristic curve was drawn to evaluate the area under the curve (AUC), sensitivity and specificity of the "deep learning model" to determine the screening efficiency of the system.

For each subject, in the natural population, the AUC of using the "deep learning model system" to screen "DR-requiring referral" was 0.941, and the sensitivity and specificity were 98.15% and 90.08%, respectively. The sensitivity and specificity of two-directional fundus photography were 100% and 86.91%, respectively. In the diabetic population, the AUC, sensitivity and specificity were 0.901, 98.08% and 82.10%, respectively, when "wise eye sugar net" unilateral fundus photography was used to screen for "DR-requiring referrals".

In both the natural population and the diabetic population, the deep learning model system has shown high sensitivity and specificity and can be used as an auxiliary means of DR screening.

• Diabetic retinopathy
• Artificial intelligence
• Stratified screening
• Deep learning

Diabetic osteoporosis (DOP) is a serious complication of diabetes mellitus. It is urgent to explore efficient clinical treatment strategies for DOP. It has been found that mesenchymal stem cell-derived extracellular vesicles (MSC-EVs), as an emerging cell-free therapy, show great potential in DOP treatment. MSC-EVs can effectively promote bone formation, inhibit bone resorption, and modulate the inflammatory microenvironment by delivering cargoes of microRNAs, long non-coding RNAs, and proteins to target cells, thereby ameliorating bone loss in DOP. However, there are limited reports on the treatment of DOP with MSC-EVs. To evoke more attention to this potential strategy, this article summarised the extant literature on MSC-EVs for DOP to provide new directions for further research and to promote the application of MSC-EVs in the clinical management of DOP.

• Bone marrow mesenchymal stem cells
• Adipose-derived mesenchymal stem cells
• extracellular vesicles
• MicroRNAs
• Long non-coding RNAs
• Diabetic osteoporosis

In this editorial, we comment on an article by Tang et al published in the World Journal of Diabetes. Obesity and diabetes are two pathological situations that are intrinsically related. Neither lifestyle changes nor pharmacological treatments have achieved diabetes remission. From this perspective, bariatric surgery has been widely used as an approach for weight loss in obese patients and as a strategy to promote metabolic modulation. The main effects of bariatric surgery involve direct action in improving cardiovascular function and endothelial function and reducing insulin resistance, leading to diabetes remission in the short term following surgery. In this context, it has been observed that hormones from the gastrointestinal tract and endothelium play a prominent role in this process. By reversing endothelial dysfunction, it is possible to balance pro-inflammatory cytokine production, improving the availability of nitric oxide and inhibiting vascular oxidative stress. Furthermore, it can be considered an efficient anti-inflammatory strategy, alleviating interferon-gamma-mediated adipose tissue inflammation. The current challenge must be to unravel the pathophysiological mechanisms and potential targets for treating metabolic diseases.

• Bariatric surgery
• Diabetes mellitus
• Oxidative stress
• Endothelial dysfunction
• Obesity

Diabetic retinopathy (DR), as one of the most common and significant microvascular complications of diabetes mellitus (DM), continues to elude effective targeted treatment for vision loss despite ongoing enrichment of the under-standing of its pathogenic mechanisms from perspectives such as inflammation and oxidative stress. Recent studies have indicated that characteristic neuroglial degeneration induced by DM occurs before the onset of apparent microvascular lesions. In order to comprehensively grasp the early-stage pathological changes of DR, the retinal neurovascular unit (NVU) will become a crucial focal point for future research into the occurrence and progression of DR. Based on existing evidence, ferroptosis, a form of cell death regulated by processes like fer-ritinophagy and chaperone-mediated autophagy, mediates apoptosis in retinal NVU components, including pericytes and ganglion cells. Autophagy-dependent ferroptosis-related factors, including BECN1 and FABP4, may serve as both biomarkers for DR occurrence and development and potentially crucial targets for future effective DR treatments. The aforementioned findings present novel perspectives for comprehending the mechanisms underlying the early-stage pathological alterations in DR and open up innovative avenues for investigating supplementary therapeutic strategies.

• Diabetic retinopathy
• Diabetes mellitus
• Retinal neurovascular unit
• Autophagy-dependent ferroptosis
• Early stage
• Mechanisms

This study critically examines the novel findings presented by Jin et al, which explores the role of intestinal glucagon-like peptide-1 (GLP-1) in impaired counterregulatory responses to hypoglycemia in mice with type 1 diabetes. The study identifies intestinal GLP-1 as a significant determinant in the physiological responses to hypoglycemia, offering new insights into its potential implications for diabetes management. The editorial synthesizes these findings, discusses their relevance in the context of current diabetes research, and outlines potential avenues for future investigation of intestinal GLP-1 as a therapeutic target. This analysis underscores the need for continued research into the complex mechanisms underlying impaired hypoglycemia responses and highlights the potential of targeting intestinal GLP-1 pathways in therapeutic strategies for type 1 diabetes.

• Intestinal glucagon-like peptide-1
• Type 1 diabetes
• Hypoglycemia
• Counterregulatory response
• Mouse model

The retrospective study by Lei et al is an investigation of the relationship between age and subfoveal choroidal thickness (SFCT) in Chinese patients with proliferative diabetic retinopathy. Elements of the study design prevent the generalizability of the study findings, limiting their clinical implications. We recommend consideration of stricter eligibility criteria, other variables like duration of diabetes, interpretation of gender-differences in SFCT, longitudinal follow-up, use of newer choroidal flow indices, comparison of values with normal controls, subgroup analysis to determine the effect of prior treatment, as well as consideration of various real-world scenarios in future studies.

• Diabetic retinopathy
• Optical coherence tomography
• Phenotypic sex
• Research design
• Visual acuity

Diabetes mellitus (DM) is a group of diseases characterized by high blood glucose caused by insufficient absolute or relative secretion of insulin. Once diagnosed, patients need long-term treatment with hypoglycemic drugs. Currently, the existing first-line hypoglycemic drugs do not provide effective treatment for DM and its complications. In the past, the first generation and the second generation of weight loss surgery, such as gastric bypass and sleeve gastric surgery, had strict body mass index requirements. Moreover, post-surgery, patients are prone to fluctuating hypoglycemia, gastroesophageal reflux, and dumping syndrome. Hence, the curative effect of this type of surgery was compromised to a certain extent. Jejunoileostomy is a third-generation surgery for patients with DM, which has been shown to improve glucose and lipid metabolism, without changing the original gas-trointestinal tract structure. Different from previous weight loss surgeries, jejunoileostomy has been clinically observed to delay the development of DM-related complications. Additionally, the postoperative complications are mild and do not affect the patient’s quality of life. Based on our clinical observations from multi-center large samples, our team developed a consensus on the operative period and perioperative management of jejunoi-leostomy as a reference for clinical researchers.

• Surgical
• Diabetes
• Weight loss surgery
• Y-shaped anastomotic jejunal loops
• Jejunoileostomy

In this editorial, we discuss the article by Wen et al published. Diabetic foot ulcers are prevalent and serious complications of diabetes, significantly impacting patients’ quality of life and often leading to disability or death, thereby placing a heavy burden on society. Effective diabetic wound healing is hindered by an imbalance in macrophage polarization; many macrophages fail to transition from the pro-inflammatory M1 phenotype to the anti-inflammatory M2 phenotype, which is crucial for tissue remodelling and repair. The wound healing process is both dynamic and complex. Healthy M1 macrophages, which have strong phagocytic abilities, are vital during the inflammatory phase of diabetic wound healing. However, the failure to transition to M2 macrophages during the proliferative phase hinders wound healing. We anticipate the development of new therapies that can repair damaged M1 macrophages during the inflammatory phase and promote M2 macrophage polarization during the proliferative phase, thereby enhancing the overall healing process.

• Diabetic wound healing
• Macrophages
• Inflammation
• Exosomes
• Natural medicines

Type 1 diabetes is increasing and the majority of patients have poor glycemic control. Although advanced technology and nanoparticle use have greatly enhanced insulin delivery and glucose monitoring, weight gain and hypo-glycemia remain major challenges and a constant source of concern for patients with type 1 diabetes. Type 1 diabetes shares some pathophysiology with type 2 diabetes, and an overlap has been reported. The above observation created great interest in glucagon-like peptide-1 receptor agonists (GLP-1) as adjuvants for type 1 diabetes. Previous trials confirmed the positive influence of GLP-1 agonists on β cell function. However, hypoglycemia unawareness and dysregulated glucagon response have been previously reported in patients with recurrent hypoglycemia using GLP-1 agonists. Jin et al found that the source of glucagon dysregulation due to GLP-1 agonists resides in the gut. Plausible explanations could be gut nervous system dysregulation or gut microbiota disruption. This review evaluates the potential of GLP-1 agonists in managing type 1 diabetes, particularly focusing on their impact on glycemic control, weight management, and glucagon dysregulation. We provide a broader insight into the problem of type 1 diabetes mellitus management in the light of recent findings and provide future research directions.

• Glucagon-like peptide-1 receptor agonists
• Glucagon response
• Hypoglycemia unawareness
• Gut
• Type 1 diabetes