Trivalent chromium is an essential trace element involved in carbohydrate and lipid metabolism. The widespread global prevalence of metabolic syndrome and its close association with cardiovascular diseases and type 2 diabetes mellitus have increased scientific interest in the potential metabolic effects of chromium. However, currently available evidence regarding its clinical significance remains inconsistent.

This narrative review describes the role of trivalent chromium in the context of metabolic syndrome. A systematic literature search was conducted in the Scopus and Web of Science databases for studies published between 2015 and 2025. The review included randomized controlled trials, observational studies, experimental studies, systematic reviews, and meta-analyses that investigated chromium intake, supplementation, or the association between chromium levels and components of metabolic syndrome.

The reviewed studies reported heterogeneous findings regarding the effects of trivalent chromium on components of metabolic syndrome. While some studies demonstrated improvements in glucose metabolism, insulin sensitivity, and lipid profiles, other studies reported no clear or statistically significant effects. The inconsistency of results has been attributed to differences in study design, studied populations, types and dosages of chromium supplementation, and duration of interventions.

The lack of uniform research methodologies, limited sample sizes, and the absence of standardized protocols for chromium supplementation hinder the comparability of results. In addition, the heterogeneity of the studied populations limits the reliability of the available data.

Available evidence does not support the widespread clinical use of trivalent chromium. Therefore, further large-scale studies are required to determine its efficacy and safety.

Chronic kidney disease (CKD) attributable to type 2 diabetes mellitus (T2DM) represents a growing global health concern. However, comprehensive long-term epidemiological trends and projections, stratified by sociodemographic and geographic variables, remain inadequately delineated.

To evaluate the global, regional, and national burden of CKD due to T2DM from 1990 to 2021, and to forecast its trends through 2035 using Bayesian age-period-cohort (BAPC) modeling.

This population-based observational study used data from the Global Burden of Disease Study 2021 (GBD 2021), which includes 204 countries and territories across five sociodemographic index (SDI) quintiles and 21 GBD regions. The study covers the period 1990-2021 with projections to 2035.

Diagnosis of T2DM mellitus as an underlying cause for CKD.

Incident and prevalent cases, mortality, and disability-adjusted life-years (DALYs) attributable to T2DM-related CKD. Age-standardized incidence (ASIR), prevalence (ASPR), mortality (ASDR), and DALY (ASR) rates were computed, alongside estimated annual percentage changes (EAPC).

From 1990 to 2021, the global number of incident CKD cases due to T2DM increased by 167.2%, while the ASIR rose by 21.0% (EAPC: 0.61). Prevalent cases nearly doubled (+85.1%), although ASPR declined slightly (-5.1%, EAPC: -0.17). Deaths surged by 222.6%, and ASDR increased by 37.8% (EAPC: 1.17). DALYs rose by 173.6%, with a 24.0% increase in ASR (EAPC: 0.81). Males and older adults consistently exhibited higher burden across all indicators. Low- and middle-SDI nations experienced the most pronounced burden growth, yet high-SDI regions also registered substantial increases in mortality and DALYs.

Projections to 2035 suggest a continued escalation, with incident cases exceeding 2.6 million and deaths surpassing 700,000 annually by mid-century. These findings highlight the importance of targeted prevention, early detection, and improved management strategies, particularly in high-growth regions and vulnerable populations.

To evaluate the association between myo-inositol supplementation and the risk of fetal macrosomia in pregnant women with a history of large-for-gestational-age infants, and to assess its relationship with gestational weight gain in women with overweight or obesity.

A prospective observational study was conducted in antenatal clinics and the Almaty Center for Perinatology and Pediatric Cardiac Surgery. Myo-inositol supplementation was recommended as part of routine clinical practice and taken daily for up to 6 months. Participants attended four visits: baseline (<12 weeks), 20 weeks, 30 weeks, and delivery. The main group included women with a BMI of 25-35 kg/m² and a history of delivering infants weighing >4000 g. The comparison group was formed using a clinical risk scoring system to improve group comparability.

Gestational weight gain was significantly lower in the myo-inositol group (11.82 kg) compared with the comparison group (17.85 kg; p<0.001). The incidence of macrosomia was lower in women who used myo-inositol supplementation (5.9% vs. 55.9%). Mean neonatal birth weight was also lower in the supplementation group (3658.9 g vs. 3972.5 g), with a mean difference of 313.6 g (95% CI 173.5-453.8). Emergency cesarean delivery occurred less frequently in the supplementation group (3.9% vs. 15.7%), indicating improved obstetric outcomes.

In this high-risk cohort, the use of myo-inositol supplementation was associated with lower gestational weight gain and a lower incidence of fetal macrosomia. These findings suggest a potential beneficial role of myo-inositol in the prevention of excessive fetal growth; however, randomized controlled trials are needed to confirm causality.

To examine associations between physical activity (PA) characteristics and psychosocial outcomes - quality of life (QoL) and fear of hypoglycemia (FH) - in children, adolescents, and young adults with type 1 diabetes (T1D).

In this cross-sectional study, 100 insulin pump-treated outpatients T1D completed 7-day PA logs capturing timing, type, intensity, and volume. QoL and FH were assessed using age-appropriate validated instruments. General linear models evaluated associations between PA characteristics and psychosocial outcomes, accounting for age group and, in sensitivity analyses, sex and HbA1c.

In pooled analyses (N = 82 complete cases), age group was significantly associated with both QoL (p = 0.037) and FH (p < 0.001), with a large effect size observed for FH. In sensitivity analyses adjusting for sex and HbA1c, the age-group effect on FH remained robust, whereas associations with QoL were attenuated. Exercise timing was associated with FH (p = 0.047), with higher adjusted FH scores observed among individuals reporting evening exercise. However, pairwise comparisons were not significant after correction. No significant AgeGroup×Timing interactions were detected. Preferred exercise type and intensity were not independently associated with psychosocial outcomes. In sensitivity analyses adjusted for sex and HbA1c (N = 62), the age-group effect on FH remained robust, whereas timing showed borderline significance.

Developmental stage appears to be a major determinant of fear of hypoglycemia in youths with T1D. Exercise timing may contribute modestly to perceived hypoglycemia risk, particularly for evening activity, although findings were attenuated after adjustment. These cross-sectional associations highlight the importance of developmentally tailored exercise counselling, while longitudinal studies are needed to clarify directionality.

To compare the elastosonographic changes of the tibial nerve (TN) and Achilles tendon (AT) in patients with type 2 diabetes mellitus (T2DM) and explore their relationship and respective relevant factors.

This case-control study enrolled 165 subjects, comprising 126 patients with T2DM and 39 healthy controls matched for age and gender. The patients were further divided into those with and without diabetic peripheral neuropathy (PN-DM and NPN-DM groups). Clinical and laboratory data were collected. Conventional ultrasound and elastography were performed to assess the changes in the morphology and elasticity of the bilateral TN and AT. Sonographic features were compared across the three groups, relevant factors affecting the stiffness of TN and AT were analyzed, respectively.

Diabetic patients exhibited significantly higher levels of HbA1C and a higher rate of smoking than healthy controls (P < 0.01 and P = 0.02, respectively). Their levels of body mass index (BMI) and total cholesterol have a significant difference between the NPN-DM group and healthy controls (both P = 0.02). The incidence of other microvascular complications in the NPN-DM group was significantly lower among diabetic patients (P = 0.04). Compared with healthy controls, the cross-sectional area (CSA) and transverse diameter of TN in diabetic patients were significantly larger (both P < 0.01), and CSA and anteroposterior diameter of AT were notably greater (P = 0.02 and P < 0.01). Besides, the stiffness of TN in the longitudinal section was significantly higher (P < 0.01), and the stiffness of AT in the cross-section was remarkably lower (P < 0.01). There was no significant difference in the morphology or elastography of TN or AT between NPN-DM and PN-DM groups. Furthermore, the stiffness of TN was not linearly related to that of AT, but independently correlated with age, HbA1C, and other microvascular complications (P < 0.05). The stiffness of AT was only independent of age (P < 0.01).

The size of both TN and AT in diabetic patients was significantly larger. The stiffness of TN increased, and that of AT decreased; however, these changes were independent of each other.

Not applicable.

Hypertension is common among patients with type 2 diabetes mellitus (T2DM) and represents a major contributor to cardiovascular and renal morbidity. Real-world data from primary care are essential to characterise associated clinical profiles and cardiometabolic multimorbidity patterns in routine clinical practice.

To assess the prevalence of hypertension among patients with T2DM managed in primary care, to characterise associated clinical profiles, and to explore sex-related differences using real-world data.

A cross-sectional study was conducted including 680 adults with T2DM receiving routine care in primary care settings. Clinical, sociodemographic and laboratory data were obtained from electronic health records, direct clinical assessment, and structured patient interviews. Hypertension was defined as a previously recorded clinical diagnosis, current antihypertensive treatment, or blood pressure ≥ 140/90 mmHg. Comparisons were performed according to sex. Factors independently associated with hypertension were analysed using bivariate analyses and multivariable logistic regression models adjusted for age, sex, duration of T2DM, pharmacologically treated dyslipidaemia, and established cardiovascular disease.

The mean age of participants was 69.8 ± 13.3 years and the mean duration of diabetes was 9.9 ± 4.6 years; 52.1% were men. Overall hypertension prevalence was 84.3%, with no significant difference between men (85.9%) and women (82.5%). Hypertension prevalence increased with age in both sexes. Women had lower educational and socioeconomic levels, higher abdominal obesity, and higher lipid concentrations, whereas men showed higher fasting glucose, serum creatinine, and markers of renal damage. In multivariable analysis, hypertension was independently associated with older age (OR 1.04 per year; 95% CI 1.02-1.06), pharmacologically treated dyslipidaemia (OR 1.83; 95% CI 1.17-2.86), established cardiovascular disease (OR 2.03; 95% CI 1.16-3.55), and longer duration of T2DM (OR 1.06 per year; 95% CI 1.00-1.12). Sex was not independently associated with hypertension after adjustment.

Hypertension was common among patients with T2DM in primary care and was associated with older age, longer diabetes duration, and established cardiovascular disease. Sex-related differences in clinical profiles were observed but should be interpreted as descriptive. This cross-sectional secondary analysis has limitations, including the lack of blood pressure control data and the potential for residual confounding.

Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (T1DM) and a leading cause of pediatric mortality. Prevention depends on caregivers' ability to recognize early signs and initiate proper sick-day management. However, data on DKA awareness among Iranian parents remains limited. This study aimed to evaluate both subjective self-ratings and objective calculated knowledge regarding DKA among parents of children with T1DM.

This cross-sectional study was conducted among 217 parents at a pediatric diabetes clinic in Shiraz, Iran. A validated questionnaire (Cronbach's alpha = 0.8), adapted through forward-backward translation, assessed demographics, disease duration, HbA1c, and DKA knowledge. Data were analyzed using descriptive statistics, Kruskal-Wallis tests, and Spearman's correlations (r_s) to identify predictors of awareness.

Most participants were mothers (80.6%), and 38.7% reported DKA as the initial presentation at diagnosis. Subjective knowledge scores (0-10) were 1.86 ± 3.07 for mothers and 0.89 ± 2.16 for fathers (P = 0.06). Mothers demonstrated significantly higher calculated objective awareness than fathers (P = 0.007). Higher objective knowledge significantly correlated with higher education levels (r_s=0.280, P = 0.01), longer disease duration (P = 0.01), and prior DKA admission (P = 0.02). Awareness showed no significant relationship with the child's most recent HbA1c levels (P = 0.98).

Parental DKA knowledge is critically inadequate. As DKA mortality is preventable through early detection, targeted educational interventions and accessible resources are urgently needed to empower parents and improve clinical outcomes for children with T1DM.

This study aimed to investigate the ability of an ultrasound-based risk stratification model integrating carotid intima thickness (CIT) and carotid-femoral pulse wave velocity (cfPWV) to aid in risk stratification and assessment of atherosclerotic cardiovascular disease (ASCVD) in patients with type 2 diabetes mellitus (T2DM), thereby providing an objective basis for identifying high-risk individuals and informing individualized management strategies.

A total of 105 patients with T2DM were enrolled in this study. According to the 10-year ASCVD risk score, patients were further classified into T2DM patients with low-to-moderate burden of other cardiovascular risk factors and T2DM patients with high burden of other cardiovascular risk factors. CIT was measured using high-resolution ultrasound to assess vascular structure, while cfPWV was evaluated using the automatic measurement of arterial stiffness (AMAS) system to assess vascular function. Logistic regression and least absolute shrinkage and selection operator (LASSO) regression analyses were performed to identify independent risk factors of high ASCVD risk. Based on these risk factors, individual discriminative models and a nomogram were constructed. Receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were used to evaluate model performance, and differences among models were assessed using the DeLong test.

CIT, cfPWV, and estimated glomerular filtration rate (eGFR) were identified as independent risk factors of high 10-year ASCVD risk in patients with T2DM. The areas under the curve (AUCs) for the CIT model, cfPWV model, eGFR model, combined CIT-cfPWV model, and the nomogram were approximately 0.781, 0.808, 0.797, 0.831, and 0.875, respectively. The constructed nomogram demonstrated excellent discrimination, calibration, and clinical applicability.

CIT and cfPWV show strong potential for identifying T2DM patients at high ASCVD risk as estimated by the China-PAR model. Incorporating these parameters into vascular evaluation may aid in risk stratification and provide a robust basis for individualized clinical intervention strategies. Prospective studies are needed to validate their prognostic value for future ASCVD events.

The number of patients taking glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose co-transporter 2 (SGLT 2) inhibitors presenting for elective surgery is increasing. Patients taking GLP-1 RAs with the highest risk of aspiration are non-fasters who have recently initiated the drug, have had a recent dose escalation, and/or have active gastrointestinal symptoms. Asymptomatic patients on stable doses of GLP-1 RAs can continue the medication throughout the peri-operative period. SGLT 2 inhibitor use carries a risk of euglycemic diabetic ketoacidosis, particularly in patients on insulin with prolonged fasting and should be held prior to elective procedures.

Mechanotransduction is a process converting mechanical cues into electrochemical signals. Piezo1, a mechanically sensitive cation channel protein, is widely distributed in non-sensory cells of mammals, particularly highly expressed in the endothelial cells (ECs). Piezo1 is implicated in various physiological activities, including the regulation of vascular tone, angiogenesis, and maintenance of the endothelial barrier. Under pathological mechanical forces, Piezo1 is involved in the development of endothelial dysfunction-related diseases, including atherosclerosis (AS), hypertension, heart failure (HF), myocardial infarction (MI), pulmonary arterial hypertension (PAH), acute respiratory distress syndrome (ARDS), and diabetes mellitus (DM). In this review, we focus on the underlying mechanisms of Piezo1 in different endothelial dysfunction-related diseases, highlighting its roles in regulating endothelial function. Moreover, we present some activators and inhibitors targeting Piezo1, and discuss their different effects in distinct contexts. Overall, targeting Piezo1 may open a novel avenue of therapeutic tactic for endothelial dysfunction-related diseases.