Drawing lines in the sand: The growing threat of obesity in type 1 diabetes

In this editorial,we comment on the article by Zeng et al published in the recent issue of the World Journal of Diabetes in 2024.We focus on the epidemiological,pathophysiological,and clinical interplay between obesity and type 1 diabetes mellitus(T1DM).Overweight and obesity represent a growing threat for modern societies and people with T1DM could not be an exception to this rule.Chronic exogenous insulin administration,genetic and epigenetic factors,and psy-chosocial and behavioral parameters,along with the modern way of life that incorporates unhealthy eating patterns and physical inactivity,set the stage for the increasing obesity rates in T1DM.As our knowledge of the underlying mechanisms that lead to the development of obesity and hyperglycemia expands,it becomes clear that there are overlap zones in the pathophysiology of the two main types of diabetes.Stereotypes regarding strict dividing lines between“autoimmune”and“metabolic”phenotypes increase the risk of trapping physicians into ineffective therapeutic approaches,instead of individualized diabetes care.In this context,the use of adjuncts to insulin therapy that have the potential to alleviate cardiorenal risk and decrease body weight can reduce the burden of obesity in patients with T1DM.

Continuous positive airway pressure to improve insulin resistance and glucose homeostasis in sleep apnea

Obstructive sleep apnea syndrome(OSAS)is a relatively common disorder in the adult population.It is associated with alterations in glucose metabolism and increases the risk for diabetes mellitus.Continuous positive airway pressure(CPAP)is the treatment of choice for OSAS.It may also have a favorable effect on insulin resistance and glucose metabolism,although relevant data is conflicting.Additional research is still needed to fully establish the effect of CPAP on glucose homeostasis.It should ascertain which patients may benefit most and how long treatment takes to induce favorable changes.Finally,patient compliance is being appreciated as a major factor influencing therapeutic outcomes,and this needs to be further examined.

Charcot osteoarthropathy in diabetes: A brief review with an emphasis on clinical practice

Charcot osteoarthropathy (COA) is a potentially limbthreatening condition that mainly affects diabetic patients with neuropathy. In everyday practice, it presents as a red, hot, swollen foot, usually painless, and is frequently trig gered by trivial injury. Its etiology is traditionally attributed to impairment of either the autonomic nervous system, leading to increased blood flow and bone resorption, or of the peripheral nervous system, whereby loss of pain and protective sensation render the foot susceptible to repeated injury. More recently, excessive local inflammation is thought to play a decisive role. Diagnosis is based on clinical manifestation and imaging studies (plain X-rays, bone scan, Magnetic Resonance Imaging). The mainstay of management is immediate off-loading, while surgery is usually reserved for chronic cases with irreversible deformities and/or joint instability. The aim of this review is to provide an overview of COA in terms of pathogenesis, classification and clinical presentation, diagnosis and treatment, with an emphasis on the high suspicion required by clinicians for timely recognition to avoid further complications.

A fairy tale of modern insulin therapy in type 1 diabetes

In type 1 diabetes,flexible,intensive insulin management improves not only glycemic control but also dietary freedom and treatment satisfaction.Such flexibility has been made possible with the new insulin analogues(as part of a basal-bolus regime) and is now gaining wide applicability,especially among children and adolescents.This approach requires appropriate individualized patient education.Especially for adolescents,the clinician should be able to guarantee insightful participation in direct response to their attitudes,wishes and needs.This patient-and-doctor collaboration is an ever-challenging duty and has the potential to change the future of the individual diabetic patient.

Antidiabetic treatment:Though lovers be lost,love shall not

The new position statement of the American Diabetes Association and the European Association for the Study of Diabetes on the management of type 2 diabetes mellitus represents a paradigm shift in our understanding of antidiabetic treatment.It emphasises the necessity to individualise management based on patient needs.Glycaemic targets should also be pursued on an individualised basis.New therapeutic combinations are discussed,and the uncertainty surrounding the ideal choice is acknowledged.Above all,it is the mindful and experienced clinician who will implement the best available evidence towards flexible and efficacious treatment.Some areas of uncertainty may ensue,but it is expected that the new position statement will improve patient healthcare and treatment satisfaction.This now remains to be seen in practice.

All journals should include a correspondence section

Letters to the editor can provide useful scientific information and evaluation of published work as well as acting as an additional level of peer review.Furthermore,letters are good reading material,especially if they involve a debate between authors.Finally,letters are relatively short.Therefore,inexperienced career researchers can use such an opportunity to practice putting together a cogent argument.However,it is far from an ideal situation if letters are the only(or main)type of article on which to base an academic career.

Effect of Exercise on Gait Mechanics in a Patient with Severe Gait Disorder Due to Chronic Ischaemic Stroke: A Case Study

We describe the effects of an exercise programme based on the American Heart Association and American Stroke Association guidelines for stroke patients on gait mechanics in a patient with severe gait disorder due to chronic ischaemic stroke. A 74-year-old female patient, with right hemiparesis as a result of a stroke attack before 18 months followed an 8-week exercise programme, consisting of three hourly sessions per week. Patient’s gait mechanics were evaluated before and after the intervention using a three-dimensional gait analysis system, with six infrared cameras, two force plates, and an electronic timing system. Exercise led to increase of spatial and decrease of temporal gait parameters, increase of joint range of motion and lower limb muscle powers during the entire gait cycle and increase of the moments in the support phase. In conclusion, exercise had a positive effect on this patient’s gait pattern and improved her functionality.

Effect of Exercise on Gait Kinematics and Kinetics in Patients with Chronic Ischaemic Stroke

Introduction :?In 2014, American Heart Association and American Stroke Association (AHA/ASA) issued exercise guidelines for stroke patients. Aim of the Study: To study the effects of an exercise programme based on AHA/ ASA guidelines, on gait kinematics and kinetics in patients with chronic ischemic stroke. Materials and Methods: Twelve stroke patients, 67.33 ± 9.14 years old, followed an 8-week exercise programme, with 3 hourly sessions per week, consisting of strength, endurance and flexibility training, as well as neuromuscular activities. Patients’ gait kinematics and kinetics were evaluated before and after the intervention using a 3-dimensional gait analysis system. Results: In most cases, patients in the intervention group showed significant increase or no change in gait kinematics, significant increase in joint moments at the anterior-posterior plane during support phase, and non-signi- ficant change in the frontal and transverse planes kinetics. Conclusions: Exercise prevented further deterioration and/or led to improved walking pattern.

Remission of type 2 diabetes depends on prompt comprehensive lifestyle changes upon diagnosis: How can this“Road to Damascus” experience be supported?

Theoretically, a new diagnosis of type 2 diabetes mellitus(T2DM) requires a dramatic change in an individual’s way of life. Weight loss and physical activity can lead to remission of diabetes, which has been associated with a lower risk of developing complications. Today, the importance of a healthy lifestyle is further highlighted by data showing that obesity and diabetes increase the risk of severe complications from coronavirus disease 2019. However, remission rarely occurs in reality, probably due to the inability of people with T2DM to adhere to the intensive lifestyle interventions that are necessary. The complexity of contributing factors may explain why making these changes is so challenging and underscore the fact that there is no magical solution for T2DM. Instead, hard work from both patients and health care providers is needed for the conversion to be achieved. This article calls for more research on the underlying reasons why adhering to a healthy way of life is so difficult for people with diabetes and obesity. Clearly defining these barriers would facilitate the planning of effective policies to promote the adoption of appropriate lifestyle changes early in the course of the disease.