Dear Editor, I am writing to draw attention to the remarkable advances in integrating artificial intelligence (AI) and gut microbiome metabolomics for predicting diabetic complications. Despite achieving recommended HbA1c targets, many patients continue to develop diabetic microvascular complications (1).

Dear Editor, I am writing to draw attention to the remarkable advances in integrating artificial intelligence (AI) and gut microbiome metabolomics for predicting diabetic complications. Despite achieving recommended HbA1c targets, many patients continue to develop diabetic microvascular complications (1).

Objective: Type 2 diabetes mellitus (T2DM) is associated with chronic hyperglycemia and systemic inflammation, which contribute to hematological alterations and vascular complications. This study evaluated hematological indices, interleukin-1ß (IL-1ß), and tumor necrosis factor-a (TNF-a) in individuals with T2DM in Port Harcourt, Nigeria, and examined their relationship with glycated hemoglobin (HbA1c). Materials and Methods: This case-control study involved 70 T2DM patients (HbA1c= 6.5%) and 70 age- and sex-matched healthy controls. Fasting blood glucose (FBG) was measured enzymatically, HbA1c by fluorescence immunoassay, complete blood count using an automated hematology analyzer, and cytokines by ELISA. Statistical analysis was performed using GraphPad Prism version 8.0.2, with effect sizes reported and P= 0.05 considered significant. Results: T2DM subjects had significantly higher FBG, HbA1c, WBC, neutrophil percentage, and IL-1ß, and significantly lower RBC, lymphocyte percentage, PLT, and PCT (adjusted P< 0.05). IL-1ß was more than three-fold higher in diabetics, with a very large effect size. FBG increased significantly with longer disease duration (P= 0.008). HbA1c correlated positively with FBG (P< 0.001) WBC (P= 0.044), MPV (P= 0.006), and PDW (P= 0.015), and negatively with MCV (P= 0.019) and Mixed WBC population (P= 0.001). Conclusion: This study simultaneously assessed complete blood count parameters alongside IL-1ß and TNF-a in the same cohort. The findings demonstrate that T2DM in this population is characterized by clinically meaningful hematological and inflammatory alterations linked to poor glycemic control. Integrating routine complete blood count and selected inflammatory markers into diabetes monitoring may enhance early risk stratification, particularly in resource-limited settings.

Objective: Diabetes education is a key component of type 2 diabetes mellitus (T2DM) management. However, evidence from Nigeria on the effectiveness of diabetes education remains limited. This study evaluated the impact of a structured education program on diabetes knowledge, glycemic control, and some metabolic parameters among adults with T2DM. Materials and Methods: This single-group interventional study consecutively recruited T2DM adults attending a tertiary diabetes clinic. The intervention was initially planned with a three months follow-up but was terminated at four weeks due to substantial loss to follow-up. Participants received three structured diabetes self-management education and support (DSMES) sessions at baseline (week 0), week 2 and week 4. Diabetes knowledge was assessed at baseline and at four weeks using the Michigan Brief Diabetes Knowledge Test. Sociodemographic and clinical data were obtained from structured proformas and medical records. Data were analyzed using descriptive and inferential statistics at P< 0.05. Results: A total of 118 participants were enrolled (mean age 58.25± 14.26 years; 63.3% female). At baseline, only 36% achieved good diabetes knowledge (= 65%); this increased significantly to 85% after the education program (P= 0.01). Significant improvements were also observed in fasting blood glucose (P= 0.01) and blood pressure (P= 0.04). Independent predictors of good diabetes knowledge included shorter disease duration (< 10 years), regular exercise, and better short-term glycemic control. Conclusion: Structured diabetes education significantly improved diabetes knowledge and short-term clinical outcomes. Incorporating structured education into routine diabetes care may help reduce the burden of T2DM in Nigeria.

Objective: Adolescents with type 1 diabetes often face psychological challenges that may interfere with effective disease management. This study aimed to examine the structural links between anxiety and diabetes self-management, with perceived stress tested as a potential mediator. Materials and Methods: This descriptive correlational study was conducted among adolescents with type 1 diabetes attending diabetes treatment centers in Tehran, Iran, in 2024. A convenience sample of 310 participants completed the Diabetes Self-Management Questionnaire, the Perceived Stress Scale, and the Beck Anxiety Inventory. Path analysis was conducted using AMOS version 24. The adequacy of the proposed model was evaluated through standard goodness-of-fit indices, and the mediating effect of perceived stress was tested using bootstrap confidence intervals. Results: The structural model showed an acceptable fit to the observed data. Anxiety had a significant positive effect on perceived stress, ß= .33, t= 4.61,P< 0.001, and a significant negative effect on diabetes self-management, ß= -0.28, t= -3.90, P< 0.001. Perceived stress was also negatively associated with diabetes self-management, ß= -0.46, t= -6.20, P< 0.001. Bootstrap analysis confirmed the significant indirect effect of anxiety on diabetes self-management via perceived stress, 95% CI [-0.28, -0.11]. The final model explained 48% of the variance in diabetes self-management. Conclusion: Anxiety appears to compromise diabetes self-management among adolescents with type 1 diabetes, partly through heightened perceived stress. Integrating anxiety- and stress-focused psychological interventions into routine diabetes care may improve self-management outcomes in this vulnerable population.

Objective: The aim of the present study was to investigate the effect of eight weeks of swimming training on Fetuin-A, FGF21, and oxidative stress levels in the liver tissue of type 2 diabetic mice.

Objective: This study aimed to examine the association between depression and quality of life in patients with diabetes at risk of diabulimia, with a particular focus on the mediating role of illness perception. Materials and Methods: This descriptive-correlational study was conducted among patients with diabetes attending specialized diabetes clinics in Shiraz, Iran, between July and October 2025. Using convenience sampling, 161 eligible participants were recruited. Data were collected using the Beck Depression Inventory-II (BDI-II), the Brief Illness Perception Questionnaire (B-IPQ), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). Data were analyzed using SPSS version 27 and SmartPLS version 4. Structural equation modeling was applied to test the hypothesized direct and indirect relationships among depression, illness perception, and quality of life. Results: The findings showed that depression had a significant negative direct effect on illness perception (P< 0.001) and quality of life (P< 0.001). Illness perception had a significant positive effect on quality of life (P< 0.001). In addition, the indirect effect of depression on quality of life through illness perception was significant (P< 0.001), indicating the mediating role of illness perception. Conclusion: Depression was associated with poorer quality of life among patients with diabetes at risk of diabulimia, both directly and indirectly through illness perception. These findings highlight the importance of psychological interventions that address depressive symptoms and illness-related perceptions to improve quality of life in this population.

Objective: Obesity is a chronic inflammatory condition associated with metabolic disorders such as cardiovascular disease, diabetes, and non-alcoholic fatty liver disease. This study aimed to investigate the additive effects of nanocurcumin supplementation combined with exercise training on metabolic and liver function markers in patients after bariatric surgery. Materials and Methods: In this randomized, single-blind, placebo-controlled trial, 60 patients (35-45 years) with a history of bariatric surgery were assigned to two groups: exercise + nanocurcumin or exercise + placebo (n= 30 each). Both groups performed combined aerobic-resistance training (3 sessions/week) for 6 weeks. The intervention group received 40 mg nanocurcumin twice daily. Blood samples were collected before and after the intervention. Data were analyzed using MANCOVA (P= 0.05). Results: A significant multivariate effect of group was observed (Wilks’ Lambda, P< 0.001). Compared with placebo, the intervention group showed significant reductions in LDL, triglycerides (P= 0.001), body fat percentage (P= 0.004), ALT (P= .017), AST (P= .004), and ferritin (P= 0.002) along with increases in HDL (P= 0.023) and albumin (P= 0.017). Conclusion: Nanocurcumin supplementation combined with exercise training may improve lipid profile, liver enzyme levels, and inflammation-related markers in patients after bariatric surgery. However, due to identical exercise protocols in both groups, the findings reflect the additive effect of nanocurcumin rather than its independent effect.

Objective: Ischemic heart disease is one of the most important complications of diabetes mellitus. This study aimed to compare the incidence of cardiovascular events in diabetic patients with inadequate exercise testing and normal myocardial perfusion scans with those who had adequate exercise testing and normal scans. Materials and Methods: This retrospective study was conducted at Shahid Sadoughi Hospital in Yazd, Iran. Medical records of patients referred to the nuclear medicine department were reviewed. Patients were divided into two groups: those with inadequate exercise tests but normal myocardial perfusion scans and those with adequate exercise tests and normal scans. Patients’ contact information was obtained from their medical records, and follow-up was performed by telephone to determine the occurrence of cardiovascular events, including cardiovascular-related death, coronary angiography, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), myocardial infarction, and hospitalization due to cardiovascular disease. Data were analyzed using SPSS version 20, and statistical analyses were performed using the independent t-test and Chi-square test. Results: A total of 210 patients were included in the study, of whom 86 (41%) were male. Dyslipidemia was present in 120 patients (57.1%), hypertension in 89 (42.4%), and smoking in 48 (22.9%). Hypertension and smoking were significantly more common in the study group than in the control group. Cardiovascular events occurred in 18 patients (17.1%) in the study group and 10 patients (9.5%) in the control group; however, this difference was not statistically significant (P= 0.10). Although the risk of cardiovascular events in the study group was 1.35 times higher than in the control group, this difference was not statistically significant (P= 0.60). Conclusion: Although the incidence of cardiovascular events was higher among diabetic patients with inadequate exercise testing and normal myocardial perfusion scans, the difference compared with patients with adequate exercise testing and normal scans was not statistically significant.

As diabetes mellitus evolves into a global health crisis, conventional diagnostic and therapeutic paradigms are no longer sufficient and necessitate innovative treatment approaches that extend beyond traditional pharmacotherapy. Recent advances in epigenetics have uncovered heritable and reversible changes in gene regulation that contribute to the pathogenesis of diabetes. This review provides a comprehensive analysis of various epigenetic mechanisms, including DNA methylation, histone modifications, and the role of non-coding RNAs in diabetes development, and evaluates their integration into a precision medicine framework for early diagnosis, risk stratification, and biomarker-guided therapeutic interventions. Furthermore, we discuss personalized management strategies that leverage epigenetic understanding to optimize therapeutic and preventive outcomes. Finally, we consider the upcoming obstacles and prospective scope of personalized medicine in the field of diabetes management. Incorporating epigenetic profiling into diagnostic and therapeutic workflows enables higher-resolution risk assessment, precision targeting of interventions, and improved pharmacodynamic outcomes. Epigenetically informed strategies, including HDAC inhibitors, DNMT modulators, and microbiota-driven interventions, hold promise for enhancing therapeutic efficacy, optimizing drug selection, and personalizing lifestyle interventions. While translational challenges remain, this review highlights that the integration of epigenetic data with genomics, metabolomics, and microbiomics facilitates next-generation personalized diabetes care and has the potential to reshape both clinical practice and public health strategies in the fight against diabetes.

Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by decreased insulin sensitivity, impaired glucose homeostasis, and progressive pancreatic ß-cell dysfunction. In addition to insulin and glucagon-like peptide-1 (GLP-1), the secretion of other hormones has emerged as a vital regulator of metabolic health, with potential implications for the prevention and treatment of T2DM. One of the hormones in question is irisin. It is a myokine substantially secreted by skeletal muscle during exercise. The aim of this study is to determine the roles of irisin in T2DM, along with its associated mechanisms and therapeutic implications. Irisin levels are declined in T2DM. Irisin enhances insulin secretion and sensitivity in T2DM, which is associated with improved glycemic indices. Medications such as sitagliptin, metformin, and simvastatin stimulate the release of irisin.