Romanian Journal of Diabetes Nutrition and Metabolic Diseases

Adenosine deaminase isoenzyme activity in blood plasma of young patients with type 1 diabetes: a correlative analysis

Yelizaveta Sargisova — 2025-12-31

The global incidence of T1D is increasing, particularly among children, adolescents, and young adults. Adenosine deaminase (ADA) isoenzymes, specifically ADA1 and ADA2, are key regulators of the immune system and are potential biomarkers for autoimmune conditions such as T1D. This study investigated ADA isoenzyme activity in the plasma of young Armenian T1D patients to determine whether these enzymes could serve as biomarkers of immune status and disease progression. We analyzed ADA isoenzyme activity in young Armenian T1D patients and compared it to that of healthy controls. We also established normal ADA2 reference values for healthy children, noting age- and sex-dependent variations. Healthy children showed age- and sex-dependent variations in ADA2 activity, with levels correlating positively with age in adults but showing no significant change up to 20 years of age. T1D patients had significantly higher total ADA, ADA1, and especially ADA2 levels than the controls. ROC analysis confirmed ADA2’s strong diagnostic potential for T1D (AUC up to 0.822). Notably, ADA isoenzyme activities did not correlate with long-term glycemic control (HbA1c). In patients with T1D, ADA isoenzyme levels, particularly ADA2, are significantly elevated compared with healthy controls, suggesting heightened immune and inflammatory responses. The statistically significant AUC values across all comparisons underscore ADA2’s potential as a valuable diagnostic or monitoring biomarker, independent of blood sugar levels, particularly in the young population.

Prevalence of Type 2 Diabetes Mellitus and dyslipidemia in rural and urban patients from Faridabad, India

Umesh Kumar Sharma — 2025-12-31

Type 2 Diabetes Mellitus (T2DM) is a chronic endocrine disease linked to elevated blood sugar levels and dyslipidemia. This study focused on the prevalence of type 2 diabetes mellitus (T2DM) and dyslipidemia in the urban-rural setting of Faridabad. A retrospective cross-sectional study was carried out at the Department of Laboratory Services, Metro Heart Institute, Faridabad, Haryana, India. Patient’s data included their demography (urban versus rural), gender, blood analysis (fasting glucose level, HBA1C), and lipid profile-triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol (TC). This study included 590 urban and 357 rural patients, with more than 60% males. The prevalence of T2DM (urban: 36.27%; rural: 6.16%) and dyslipidemia (urban: 90.85%; rural: 80.96%) was higher in urban than in rural patients. The prevalence of fasting blood glucose, HbA1c, TC, and TG was also high in rural patients. No gender differences were observed in HbA1c, TC, and fasting blood sugar levels. In both rural and urban patients, males had higher TG than females. Hypercholesterolemia and hypertriglyceridemia were more common in urban than rural patients. In urban (34.05%) areas, mixed dyslipidemia was more widespread than in rural (23.24%) areas. Lifestyle, economic status, and hormonal differences may lead to a higher prevalence of T2DM and dyslipidemia in the urban population compared to the rural population.

Simultaneous effect of interval training and lipoic acid on adropin and vascular endothelial growth factor-C in skeletal muscle of type 2 diabetic male rats

Nazanin Saedi — 2025-12-31

Type 2 diabetes mellitus (T2DM) is a serious chronic metabolic disorder that has a significant impact on the health, quality, and life expectancy of patients as well as the health care system of communities. The study aimed to investigate the simultaneous effects of high-intensity interval training (HIIT), low-intensity interval training (LIIT), and lipoic acid (LA) on Adropin and vascular endothelial growth factor-c (VEGF-C) in the skeletal muscle of type 2 diabetic male rats. Twenty-one three-week-old diabetic male Wistar rats in seven groups were included in this study. An intense interval training program with a VO2 max intensity (maximum oxygen consumption) of 85–90% and a low VO2 max intensity of 65–70% VO2 max was performed for six weeks. The LA supplement was administered orally once a day for 6 consecutive weeks at a dose of 20 mg/kg. At the end of the training period, the posterior skeletal muscle tissue of their legs was removed. Fasting blood glucose (FBG), insulin, Adropin and VEGF-C levels were measured. Our results showed that low-intensity interval training programs and high-intensity interval training programs alone and with LA supplementation significantly decreased and increased FBG and insulin, respectively (P<0.01). There was a significant increase in the levels of VEGF-C (P=0.001) and Adropin (P=0.001) compared to the diabetic control group (P<0.001). Performing interval exercises with low and high intensities, along with lipoic acid supplementation, played a significant role in increasing diabetes-modulating parameters.

Features of endothelial dysfunction markers in patients with diabetes mellitus with diabetic foot syndrome

Petro Oleksandrovych Gerasymchuk — 2025-12-31

The study included 100 patients with DFS of grades I-IV according to the Meggitt-Wagner classification. The neuropathic form (NF) was diagnosed in 39 patients, while the ischemic form (IF) was observed in 61 patients. Among the participants, 72 were men, and 28 were women, with a mean age of 62.3 years. Type 1 diabetes was present in 24 patients, and Type 2 diabetes in 76 patients. The duration of DM ranged from 1 to 19 years. Microcirculation was studied using LDF with a “LAKK-02”(Lazma). Patients refrained from eating, smoking, or physical activity for an hour before the test and rested in a supine position for 15 minutes in a temperature-controlled room (20–23°C). These changes can be attributed to the longer disease duration in Type 2 DM patients (mean 12.3±1.3 years) compared to Type 1 DM (mean 4.9±0.7 years) and the presence of prolonged hyperglycemia, which damages the endothelium. Age also played a role, with Type 2 DM patients having a mean age of 67.2±2.5 years versus 46.7±1.8 years in Type 1 DM. Differences were also noted depending on the pathogenetic form of DFS. NO levels in NF were 21.42±1.27 μmol/L, 21.8% lower than control values, whereas IF patients exhibited a 39.7% reduction (16.61±0.87 μmol/L). Conversely, endothelin-1 levels increased by 62.7% (6.45±0.78 pg/mL) in NF and 132.5% (9.27±1.32 pg/mL) in IF DFS.

Evaluating albuminuria as a predictor of subclinical atherosclerosis in type 2 diabetes: a community-based cross-sectional study

Muhammad Rosyid Narendra — 2025-12-31

The burden of microvascular and macrovascular complications of type 2 diabetes mellitus (T2DM) in Indonesia is increasing. Albuminuria has been proposed as a marker of atherosclerosis, while carotid intima–media thickness (CIMT) is a validated indicator of subclinical atherosclerosis. Evidence from community-based populations in Indonesia remains limited. To assess the association between albuminuria and CIMT in individuals with T2DM. A cross-sectional study was conducted using secondary data from the PTM Bogor Cohort Follow-Up Study 2019–2020. Participants with available albumin-to-creatinine ratio (ACR) and CIMT measurements were included. Multivariate analyses adjusted for demographic factors, cardiovascular risk factors, and diabetes-related treatments. A total of 195 participants (mean age 56.9±9.0 years; 76.4% women) were analyzed. Normoalbuminuria, microalbuminuria, and macroalbuminuria were observed in 50.3%, 38.5%, and 11.3% of subjects, respectively. The median CIMT was 0.76 mm, with 39.5% exhibiting elevated CIMT. Albuminuria showed a weak correlation with CIMT (r=0.142; p=0.047). After adjustment, albuminuria was not independently associated with CIMT (p=0.878), whereas age (p=0.004) and hypertension (p<0.001) remained significant. ROC analysis demonstrated poor predictive value of ACR for elevated CIMT (AUC 0.489; p=0.795). Albuminuria was not an independent predictor of increased CIMT after adjustment for confounders. ACR has limited utility as a marker of subclinical atherosclerosis in community-based T2DM populations.

Relationship between self-care behaviors with psychological wellbeing, perceived social support, and self-efficacy among patients with type 2 diabetes: a structural model analysis

Razieh Farzi Kahekesh — 2025-12-31

Effectively managing type 2 diabetes depends on self-care activities. This study aimed to examine the relationship between self-care behaviors and psychological wellbeing, perceived social support, and self-efficacy among patients with type 2 diabetes. The current study was conducted on 300 patients referred to the diabetes clinic. The patients were chosen through a random sampling technique based on specific inclusion and exclusion criteria. Data were collected using five questionnaires: the demographic questionnaire, the Toobert Diabetes Self-Care Questionnaire, the Zimet Multidimensional Perceived Social Support Questionnaire, the Diabetes Management Self-Efficacy Scale, and the Ryff Psychological Wellbeing Questionnaire. The collected data were analyzed using SPSS software (version 22) and Amos software (version 16). The significance level for the analysis was set at below 0.05 to determine statistical significance. The findings showed that the effects of psychological wellbeing, self-efficacy, and social support had a significant impact on self-care (P<0.001). Self-efficacy was impacted by the medical care dimension and social support from friends and family (P<0.001). An increase in psychological wellbeing led to an increase in self-efficacy (P<0.001) and social support (P<0.001), which in turn led to an improvement in self-care activities. Psychological wellbeing and self-care are closely linked, while social support and self-efficacy have a strong relationship. Accordingly, to enhance the self-care behaviors of patients with type 2 diabetes, it is essential to engage in thorough planning and offer counseling aimed at improving psychological health, fostering social support, and improving their ability to manage their condition.

The relationship between therapeutic modalities and itch intensity in patients with diabetes mellitus

Desy Sahara Putri Simanjuntak — 2025-12-31

Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycaemia that can lead to various complications, including pruritus. The severity of pruritus in DM patients may vary and is influenced by factors such as blood glucose control, diabetic neuropathy, and skin conditions. Both pharmacological and non-pharmacological approaches are utilized to manage DM and its associated skin conditions. This study aims to analyze the relationship between treatment modalities and pruritus intensity in DM patients. This study employed an observational design with a cross-sectional approach. All eligible study participants were DM patients aged 18–60 years experiencing pruritus. The severity of pruritus was assessed using the Numerical Rating Scale (NRS). Statistical analysis was performed using the Chi-square test, with significance set at p<0.05. Among 76 participants, 46.1% received oral antidiabetic medications, 44.7% received injectable antidiabetic medications, and 9.2% received a combination of both. The majority of patients reported moderate pruritus intensity. Statistical analysis revealed no significant association between treatment modalities and pruritus intensity (p=0.157). There was no significant relationship found between treatment modalities and pruritus intensity in DM patients.

Platelet indices and ABO blood groups as predictive biomarkers for diabetes mellitus complications

Sawer Sabri Ahmed — 2025-12-31

Macrovascular and microvascular complications of diabetes mellitus are the main reasons for the high mortality and morbidity rates, as well as the decreased quality of life amongst patients with type II diabetes mellitus. This study aimed to evaluate platelet indices and blood group typing in type II diabetic patients and the changes in the values of these parameters in correlation with diabetes mellitus chronic diabetic complications. This cross-sectional study was carried out at the Azadi Teaching Hospital, Laboratory Department and Diabetes Center in Duhok governorate. Three mL of blood was collected from diabetic patients and put into EDTA tubes. Platelet parameters, including platelet count, platelet distribution width, mean platelet volume, platelet-large cell ratio, and platelet crit were obtained. ABO and Rh blood group typing was done using standard slide method. Diabetic patients were categorized into two groups; without and with documented and registered diabetes complications. Statistical analysis was done using software SPSS version 26.0 and OpenEpi Version 3.0.1 programs. The mean age of diabetic patients in this study was 50.694±10.318 years. The mean values of platelet indices apart from platelet counts were significantly higher among diabetic patients with complications than those without complications. Platelet parameter except platelet count were significantly higher amongst patients with diabetes related complications and suggests that these indices are reliable predictors for the development of complications in patients with type 2 diabetes mellitus and can be used as a simple, low-cost to-use method. Blood group O was significantly associated with diabetes-related complications.

Cardiovascular-kidney-metabolic syndrome in patients with acute forms of ischemic heart disease

Olga Koroliuk — 2025-12-31

The purpose of the study was to evaluate the cardiac and renal manifestations of cardiovascular-kidney-metabolic syndrome (CKMs) in patients of different glucometabolic categories. A total of 116 patients with ischaemic heart disease (IHD) and acute coronary syndrome aged 37 to 84 years were examined. Based on their carbohydrate metabolism status, they were divided into 5 groups: 24 patients with normal glucose regulation (NGR); 23 – with impaired fasting glycaemia (IFG); 21 – with impaired glucose tolerance (IGT); 24 – with a combination of IFG and IGT; 24 – with type 2 diabetes mellitus (DM). The patients underwent an oral glucose tolerance test, creatinine levels were determined by colorimetry, proteinuria was determined, and glomerular filtration rate (GFR) was calculated using the MDRD formula. In patients with acute forms of IHD, as carbohydrate metabolism deviated from NGR through IFG, IGT and combined prediabetic disorders leading to type 2 DM, a gradual stretching of the left heart chambers and an increase in their myocardial mass and indexed value were observed without affecting systolic function. At the same time, proteinuria and blood creatinine increased and GFR decreased, which may be manifestations of CKMs. Proteinuria directly correlated with total fibrinogen levels, and creatinine correlated with glucose at the end of the glucose tolerance test. Patients with acute forms of IHD may be diagnosed with CKMs, which manifests itself in gradual stretching of the left heart chambers and an increase in myocardial mass, increased proteinuria and blood creatinine with a decrease in GFR as carbohydrate metabolism deteriorates.

Some vital enzymes in Dupuytren’s disease and diabetes mellitus as a risk factor

Gayane Hekimyan — 2025-12-31

Dupuytren’s disease (DD) is a disease of unknown etiology, when the finger remains in a flexed position due to thickening of the aponeurosis. Our study aimed to investigate a possible relationship between adenosine deiminases 1 and 2 (ADA1, ADA2) and dipeptidyl peptidases 4 and 2 (DPP4, DPP2) with DD. The activity of named enzymes in aponeurosis and blood plasma from patients with DD and with various hand injuries (healthy individuals, HI) were compared. In aponeurosis from DD patients, ADA1 and ADA2 activities were higher by 5.6 and 7.8 times, respectively, compared to aponeurosis from HI. High levels of DPP4 and DPP2 activity were recorded in the DD aponeurosis, whereas they were untestable in the HI aponeurosis. Their activity in blood plasma was ~1.5 times higher in DD than HI subjects. In the aponeurosis, the highest activity of ADA1 was in sever level of DD, while of DPP4 and DPP2 in moderate level. ADA1 and DPP4 activity were significantly higher in DD with diabetes than without it. ADA and DPP can be recommended as targets in the fight against DD using their inhibitors assumed in medicine, which can help to avoid surgical intervention.

Innovative markers for the diagnosis of preeclampsia and their role in the management of treatment in obstetric practice

Ulyana Franchuk — 2025-12-31

The relevance of preeclampsia during pregnancy is due to its significant impact on the health of both the mother and the fetus. To explore the features of diagnosing novel markers of preeclampsia, particularly inhibin A, and assess their role in the management of treatment in obstetric practice, with an emphasis on predicting the development and severity of preeclampsia. Neural network methods were also applied to improve predictive results, particularly the decision tree model (data mining), which enabled the identification of important factors influencing the development of pathologies in pregnant women. The study highlights serious pregnancy complications in women at high risk of preeclampsia, particularly hemodynamic disorders in the uterine arteries and elevated levels of inhibin A, which may serve as an early marker for the diagnosis of preeclampsia. Women who received modified pathogenetically justified treatment showed better pregnancy outcomes compared to those receiving standard therapy. A comparison of the first and second study groups showed that women who received modified pathogenetically justified treatment had significantly better pregnancy outcomes compared to those who received standard therapy. In the high-risk group, there was a significantly higher incidence of complications, including hemodynamic disorders in the uterine arteries, the onset of preeclampsia, and preterm labor. With the development of new technologies, innovative markers have emerged that allow for early detection of this condition, enhancing the possibilities for personalized treatment.

Are systemic inflammatory markers linked to euthyroid nodular goiter?

Liljana Todorovska — 2025-12-31

The role of systemic inflammatory markers (SIMs) in euthyroid nodular goiter (ENG) is unclear. This study evaluated their associations and predictive value for ENG in iodine-sufficient adults. Material and methods: In this prospective, case-control study, 212 euthyroid participants (20–60 years) underwent thyroid ultrasound. Laboratory evaluations included thyroid-stimulating hormone, free thyroxine, anti-thyroid peroxidase antibodies, C-reactive protein, and blood cell counts. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic inflammation response index (SIRI), and the systemic immune-inflammation index (SII) were calculated, with logarithmic SIRI [log (SIRI)] and square root SII [sqrt (SII)] transformations. Logistic regression and receiver operating characteristic (ROC) curve analysis were applied. Results: Mean age was 43±9 years (83% female). ENG (n=103) and controls (n=100) did not differ in age, thyroid function, autoimmunity, or SIMs. Age correlated with ENG (ρ=0.148, P=0.032). Log (SIRI) (positive) and sqrt (SII) (inverse) were independent ENG predictors. ROC analysis confirmed log (SIRI) as the strongest, gender-independent predictor of ENG (an area under the curve=0.675, P<0.001; cut-off >0.760). SIRI was the strongest, gender-independent predictor of ENG, while SII was inversely associated.

Unlocking precision: evaluating the impact of K2 and K3 EDTA anticoagulants on HbA1c analysis

Saitharani Arumugam — 2025-12-31

HbA1c plays a vital role in the diagnosis and monitoring of diabetes mellitus. The variety of blood collection tubes is a significant pre-analytical aspect that could affect test results. The influence of blood assortment devices on laboratory tests is often unnoticed. This study investigates whether K2-ethylenediaminetetraacetic acid (EDTA) and K3-EDTA vacuum tubes affect the analytical results of glycosylated haemoglobin, type A1C (HbA1c), measured via a Bio-Rad Analyser D10 HPLC analyser. This study was an analytical, observational, cross-sectional study, where we collected samples from 100 patients at Chettinad Hospital and Research Institute, Kelambakkam. Blood was taken simultaneously in both K2 RDTA and K3 EDTA tubes. The samples were analyzed immediately in a Bio-Rad analyzer D10 after collection. We employed the Wilcoxon test and passed the Bonferroni regression for comparing the two tubes. The information are represented as median and interquartile range. The standard deviations for K2 and K3 were 2.06 and 2.05, indicating the degree of variability in the data. Even though there is a very minor difference in the Wilcoxon test, there was no statistically significant p-value and passing the Bablok regression showed the Y=0.000+1.000x. This study showed very little noteworthy variance between K2 and K3 EDTA anticoagulant tubes. K2 and K3 tubes have a very slight difference, but it is not statistically significant and falls within the limit of agreement (LOA) range of 95%.

Successful management of type 2 diabetes, obesity and urinary incontinence in a 45-year-old female patient

Ivana Mickovski — 2025-12-31

This case report presents a 45-year-old female patient with uncontrolled Type 2 Diabetes Mellitus (T2DM), with obesity, and stress urinary incontinence (SUI) requiring frequent diaper use. The patients underwent a stepwise treatment approach, starting with glycemic regulation and weight reduction using GLP1 receptor agonist (GLP-1RA) combined with insulin therapy and weight reduction strategies. After achieving significant metabolic improvement and weight loss, the patient successfully underwent surgical intervention with an artificial urinary sphincter (AUS) implantation, leading to complete resolution of incontinence. This case highlights the importance of a comprehensive, multidisciplinary approach in managing complex metabolic and urological conditions.

A systematic review on unveiling the potential of nutraceuticals: a new era in disease management

Anshuman Ashok Tripathy — 2025-12-31

Nutraceuticals are formulation that are designed with The sole purpose of fulfilling specific dietary requirements and prevent diseases, in this article, we will understand about what nutraceuticals is, the core History behind it, the various benefits that has been observed in treating and preventing various diseases over the past years, the economic value and its contribution in India and World GDP, and finally the future expects and development of the nutraceuticals. The combination of the words “nutrition” and “pharmaceutical”, or “nutraceuticals”, has drawn increasing interest due to its potential health benefits. This abstract provides an overview of the current state of nutraceuticals, including their categories, definitions, and mechanisms of action. Nutraceuticals encompass a broad category of products that include functional foods, herbal supplements, and dietary supplements. The idea behind these products is that they provide additional health benefits beyond basic nutrition. Nutraceuticals contain bioactive substances such vitamins, minerals, antioxidants, and phytochemicals that are essential for maintaining and preventing disease. Nutraceuticals may support immune system function, metabolic health, cardiovascular health, and cognitive function, among other areas of health, according to research. But there are still problems like inconsistent evidence, quality control, and regulations. Notwithstanding these difficulties, nutraceuticals are nonetheless gaining popularity as people seek natural alternatives to prescription drugs. To fully realize the potential advantages of nutraceuticals for human health and well-being, more investigation is required to determine their safety, effectiveness, and ideal dosage.

Obesity and digestive diseases

Antonija Mišković — 2025-12-31

Obesity is a prevalent, multifactorial disease in modern developed societies that significantly increases the risk of various noncommunicable diseases. It disrupts metabolic homeostasis by promoting excessive fat accumulation, which leads to an imbalance between proinflammatory and anti-inflammatory adipokines. As a potent endocrine organ, adipose tissue secretes adipokines that play a crucial role in metabolic regulation. Metabolic and inflammatory changes associated with obesity have a profound impact on the development and progression of digestive diseases. Dysfunction of excess adipose tissue leads to chronic low-grade inflammation, alterations in gut microbiota, and disruptions in neuroimmune signaling. These factors contribute to gastrointestinal and liver disorders, including conditions such as gastroesophageal reflux disease, non-alcoholic fatty liver disease, gallbladder disease, pancreatitis, and colorectal cancer. Metabolic disturbances associated with obesity may worsen inflammatory bowel disease and disrupt the gut-brain axis, ultimately affecting intestinal health. Obesity affects the intestinal barrier, leading to dysbiosis and immune system dysfunction. Additionally, obese patients have a higher risk of developing esophageal, liver, and pancreatic cancers. This review examines the impact of obesity on digestive diseases, highlighting its influence on gut health, inflammation, and related complications.

Role of platelet-rich fibrin in wound healing

Akshatha Shetty — 2025-12-31

Platelet-rich fibrin (PRF) is a fibrin matrix that can function as a resorbable membrane and trap platelet cytokines, growth factors, and cells. These particles may be discharged from the matrix within a predetermined time frame. Research has demonstrated the use of autologous platelet-rich fibrin in various fields, and it is considered a therapeutic biomaterial. The goal is to review and debate the various approaches to using platelet-rich fibrin as a healing aid in extraoral wound sites. A literature search of review articles, systematic reviews, and studies on platelet-rich fibrin was conducted using PubMed and Google Scholar search engines, focusing on the mesh terms wound healing, growth factors, and regeneration. Hemostasis, graft stabilization, wound sealing, bone regeneration, and wound healing can all be aided by PRF. The fibrin matrix can guide stem cell migration and the healing program more effectively due to its improved organization. Even though PRF is a member of a relatively novel class of platelet concentrates, its considerable cicatricial capacity can be explained by the fibrin molecule’s biologic activity alone. It has recently been demonstrated that there is an excellent opportunity for the PRF to be used as a healing aid in various extraoral treatment contexts, based on encouraging results. Although there was much debate regarding the advantages of first-generation platelet concentrates, second-generation platelet concentrate (L-PRF) appeared to yield better and more consistent outcomes. L-PRF has several benefits, including being autologous, easy to collect, chairside preparation, and straightforward clinical application, thereby avoiding the risks associated with allogeneic products. As such, it appears appropriate for application in both general and specialist practice.