Diabetic cardiomyopathy (DCM), a severe complication of type 2 diabetes mellitus (T2DM), lacks specific and effective biomarkers for early diagnosis. This study constructed a plasma-specific spectral library by integrating proteomic and nonenzymatic glycation data from eight pretreatment workflows via data-dependent acquisition. Data-independent acquisition was then applied to profile plasma proteomes and glycation modifications in controls, DM patients, and DCM patients, revealing clear disparities in protein abundance and glycation modification patterns among the three groups. Functional enrichment analysis indicated that these differentially expressed proteins and modified peptides were involved primarily in immune responses, inflammatory processes, and metabolic pathways. Subsequently, parallel reaction monitoring was used to validate the proteins and glycation sites with significant changes. Specific peptides of complement 5 and specific glycation modifications on human serum albumin demonstrated a strong capacity to discriminate DCM from DM, achieving the highest area under the curve values of 0.97 in receiver operating characteristic analyses, underscoring their promising potential as DCM biomarkers. In conclusion, integrated proteomic and glycation modification analysis revealed candidate biomarkers for DCM diagnosis and offered novel insights into DCM pathogenesis.

Bilateral coronary microfistulas with redirection to the left ventricle are extremely rare clinical events. Although most cases are asymptomatic, the severity varies according to the redirection of blood flow, possibly leading to type 2 myocardial infarction.

A 79-year-old woman with a medical history of hypertension, type 2 diabetes mellitus, hypothyroidism, and anxiety presented with atypical chest pain. Electrocardiogram revealed sinus rhythm with an electrically inactive area in the inferior wall, and serial troponin measurements indicated myocardial injury. Coronary angiography demonstrated bilateral coronary microfistulas draining into the left ventricle, in the absence of obstructive coronary artery disease. The patient was discharged with atenolol and acetylsalicylic acid and remained stable during follow-up.

This case contributes to the growing recognition of coronary microfistulas as a rare but clinically meaningful cause of type 2 myocardial infarction, emphasizing the diagnostic value of coronary angiography and reinforcing the importance of individualized conservative management in such diffuse presentations of fistulas.

Coeliac disease (CD) is a chronic, immune-mediated enteropathy triggered by gluten ingestion in genetically predisposed individuals carrying HLA-DQ2 and/or -DQ8 alleles. Its diagnosis traditionally combines serology and confirmatory duodenal biopsy. IgA anti-tissue transglutaminase is the first-line test, supported by endomysial antibody. Duodenal histology remains the gold standard, though limitations include patchy involvement and variability in interpretation. Recent advances have proposed biopsy-sparing approaches, whereas applicability in adults remains debated. Moreover, CD is increasingly recognized in association with autoimmune conditions, including type 1 diabetes mellitus and autoimmune thyroid disease, underscoring the importance of proactive screening. However, distinguishing true CD from potential CD or false-positive serology requires careful clinical integration and, often, biopsy confirmation. Mass screening appears to demonstrate high yield and potential cost-effectiveness compared with case-finding. However, evidence is emerging and not yet definitive, and its implementation remains limited. For patients already on a gluten-free diet, gluten challenge protocols combined with HLA genotyping enhance diagnostic accuracy. Overall, while duodenal biopsy is still pivotal in most guidelines, evolving evidence supports a tailored, less invasive approach that integrates serology, genetics, histology, and novel diagnostics to improve early detection and management of CD.

Neonatal Diabetes Mellitus (NDM) is a rare, heterogeneous monogenic disorder typically presenting within the first six months of life. Unlike type 1 or type 2 diabetes, NDM is caused by single-gene mutations that disrupt pancreatic β-cell function or development. With the advent of next-generation sequencing, the genetic spectrum of NDM has expanded significantly, necessitating a shift from symptomatic management to precision medicine. This narrative review summarizes the genetic basis and pathogenic mechanisms of NDM, categorizing them into three major pathways: (1) ATP-sensitive potassium (K_ATP) channelopathies (e.g., ABCC8, KCNJ11), where gain-of-function mutations inhibit insulin secretion; (2) Transcription factor defects (e.g., GLIS3, PAX6, GATA6), which impair pancreatic development and often present with syndromic features; and (3) Endoplasmic reticulum (ER) stress-mediated β-cell apoptosis, exemplified by WFS1 mutations. Furthermore, we highlight the clinical complexity of these mutations, including the "biphasic phenotype" observed in ABCC8 and HNF1A variants. Understanding these molecular mechanisms is critical for clinical decision-making. We discuss the transformative impact of genetic diagnosis in treatment, particularly the successful transition from insulin to oral sulfonylureas in patients with K_ATP channel mutations, and emphasize the importance of early genetic testing to optimize glycemic control and prevent complications.

Diabetes mellitus (DM) is a complex, heterogeneous, hyperglycemic chronic metabolic disorder. Type 2 diabetes mellitus (T2DM) is characterized by progressive loss of insulin secretion from pancreatic islet β-cells due to IR (insulin resistance), which is a feature of metabolic syndrome (MetS). Chronic hyperglycemia in patients with T2DM in synergy with other metabolic abnormalities causes complications such as diabetic ketoacidosis, osmotic diuresis and hyperglycemic diabetic coma, as well as chronic microvascular and macrovascular complications such as atherosclerotic cardiovascular disease (ASCVD), peripheral artery disease (PAD) and cerebrovascular events, which implicate the formation of reactive species and the promotion of inflammatory pathways. In these events, natural or synthetic antioxidants and minerals seem to have ameliorative effects and may serve as beneficial co-treatment options. In view of these terms, the aim of this study is to investigate the underlying mechanisms of T2DM, its clinical presentation, and its complications. Additionally, the association of the pathogenesis of T2DM and the occurrence of its complications with obesity, chronic inflammation, oxidative stress (OS), insulin resistance (IR), hepatic steatosis, and dyslipidemia is examined, whilst molecular pathways, such as NF-κB and JAK/STAT, are also summarized, under the scope of the effects of several antioxidant compounds and minerals on their progression. The interrelation of T2DM with these conditions, as well as the effects of antioxidant supplementation, seems to be bidirectional, and it is recommended that obese patients be screened for T2DM and adopt lifestyle changes, including exercise, diet modification, and weight loss, in addition to potentially taking multifunctional supplements that offer antioxidant and anti-inflammatory potential. However, many aspects of the protective mechanisms of such antioxidants remain to be elucidated, with more drawbacks in their pharmacokinetic behavior, such as their poor absorption and solubility, waiting to be resolved.

The morphological alterations of the tibial nerve in patients with diabetes mellitus, both with and without diabetic peripheral neuropathy (DPN), are challenging to differentiate using B-mode ultrasound. In this study, we assessed the stiffness changes of the tibial nerve by 2-dimensional shear-wave elastography (2D-SWE).

We gathered data from 70 adults with valid 2D-SWE measurements, comprising 25 individuals in DPN Group A who were diagnosed with DPN and had peripheral nerve symptoms in the past 6 months, 15 individuals in DPN Group B who were diagnosed with DPN but had no peripheral nerve symptoms in the past 6 months, 16 individuals with type 2 diabetes but without DPN, and 14 healthy individuals. The maximal thickness, cross-sectional area, and stiffness of the tibial nerve among groups were analyzed.

DPN Group A had higher tibial nerve stiffness than Group B, non-DPN, and control groups (p < .05). The area under the curve (AUC) for 2D-SWE parameters in detecting increased nerve stiffness was 0.956 for G₁ (mean stiffness) and 0.979 for G₃ (distal stiffness), respectively, with optimal cut-off values of 20.01 and 28.41 kPa.

2D-SWE is a promising non-invasive technique for early diagnosis of DPN, effectively reflecting changes in nerve stiffness associated with the condition. This method may enhance clinical interventions aimed at preventing disease progression.

Diabetic kidney disease (DKD) is a microvascular complication of diabetes, characterized by region‑specific metabolic reprogramming that disrupts kidney function and markedly impairs patient prognosis. By enabling in situ visualization and analysis of metabolite distribution within kidney tissue, spatial metabolomics offers a unique advantage in detecting spatial heterogeneity in metabolic alterations, which is inaccessible through conventional metabolomics. This approach not only enhances the understanding of DKD pathophysiology but also provides a solid foundation for the development of precision nephrology strategies informed by spatial metabolite data. The present review discusses the fundamental workflows and spatial resolution capabilities of spatial metabolomics, summarizing the key metabolites involved in regional metabolic disruptions in multiple DKD animal models. Moreover, it highlights notable metabolites, including glucose, succinate, phosphatidylserine, lysophosphatidylglycerol, phosphatidylglycerol, sphingomyelin, phosphatidylcholine, phosphatidylethanolamine, taurine, glutamate, L‑carnitine, choline, adenosine monophosphate and guanosine monophosphate. The continued advancement of imaging technologies and data analysis methodologies is expected to further refine the spatial resolution and precision of spatial metabolomics, thereby facilitating its broader application in clinical practice.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for type 2 diabetes mellitus and obesity. Beyond metabolic effects, GLP-1 signaling influences central pathways involved in mood, reward, and stress regulation, raising interest in possible psychiatric implications.

We conducted a retrospective chart review of adults (≥18 years) prescribed GLP-1 RAs at a private university hospital between January 2021 and April 2024. Demographic, medication, and psychiatric data were extracted from electronic health records. Primary outcomes included stability, improvement, worsening, or new onset of psychiatric disorders during treatment.

Among 226 patients (mean age 53.5 years; 66.8 % female; mean BMI 33.6 kg/m²), semaglutide was most frequently prescribed (73 %). The mean treatment duration was 20.2 months, with an average 6.7 % weight loss. Major depressive disorder (MDD) and generalized anxiety disorder (GAD) were most prevalent (68.6 % and 65.9 % of patients, respectively). Most remained stable (MDD: 73.6 %; GAD: 78.5 %). New-onset MDD occurred in 9.0 % and GAD in 8.7 % of affected patients, with mean latencies of 15.8 and 16.8 months, respectively. Adjustment disorder, ADHD, and insomnia also emerged in a subset, with ADHD showing the shortest latency to onset (7.8 months). Rare new-onset alcohol use disorder, trichotillomania, and opioid use disorder were observed.

GLP-1 RAs appear psychiatrically well-tolerated for most patients, though new-onset or worsening symptoms occur in a minority, underscoring the need for monitoring, particularly in high-risk populations. Prospective studies are warranted to clarify causality, mechanisms, and potential therapeutic roles in psychiatric care.

Robot-assisted adrenalectomy using the da Vinci platform offers theoretical advantages over conventional laparoscopy, including enhanced visualization, superior instrument articulation, and improved ergonomics. However, their comparative effectiveness remains controversial, with previous meta-analyses confounded by the inclusion of retrospective cohort studies. No systematic synthesis has exclusively evaluated prospective randomized controlled trials with formal GRADE certainty assessments. To compare the perioperative, postoperative, and economic outcomes of da Vinci robotic versus laparoscopic adrenalectomy for adrenal neoplasms through GRADE-assessed meta-analysis restricted to prospective randomized trials. This systematic review and meta-analysis was registered in PROSPERO (ID: CRD420251276037) on December 27, 2025. A systematic literature search (inception to December 2025) was performed to identify prospective randomized trials comparing robotic and laparoscopic adrenalectomy. Two independent reviewers performed the screening, extraction, and Cochrane RoB 2. Random-effects meta-analyses were used to pool operative time, blood loss, conversion, length of stay, complications, and cost. Heterogeneity was assessed using I² with pre-specified sensitivity and subgroup analyses. The GRADE system was used to evaluate the certainty of the evidence. Three randomized trials (n = 214 patients) met the inclusion criteria. Robotic adrenalectomy showed no statistically significant difference compared with laparoscopy in terms of operative time (MD 14.88 min, 95% CI - 25.18 to 54.95; P = 0.47; I²=94%; very low certainty), hospital stay (MD 0.04 days, 95% CI - 0.29 to 0.38; P = 0.80; I²=0%; low certainty), conversion rates (RR 0.72, 95% CI 0.05 to 10.58; P = 0.81; I²=60%; very low certainty), postoperative complications (RR 1.52, 95% CI 0.69 to 3.36; P = 0.30; I²=0%; low certainty), or total costs (MD $2444.02, 95% CI -$906.62 to 5794.66; P = 0.15; I²=99%; very low certainty). Estimated blood loss showed a statistically significant reduction with robotics (MD - 4.86 mL, 95% CI - 9.55 to - 0.18; P = 0.04; I²=0%; low certainty), but this 5 mL difference had no clinical relevance in procedures with typical blood loss under 50 mL. Sensitivity analysis identified Morino et al.2004 as the primary driver of heterogeneity in operative duration and conversion rates. Robotic adrenalectomy achieves perioperative and postoperative outcomes equivalent to laparoscopy for adrenal neoplasms, with low-to-very-low certainty evidence showing no meaningful differences in operative efficiency, recovery, complications or costs. Platform selection should prioritize surgeon expertise and case complexity rather than the expectation of universal benefit. Adequately powered trials in high-complexity populations are needed to identify the contexts in which robotic assistance provides measurable clinical value.