Health literacy (HL) plays a crucial role in the self-management and clinical outcomes of individuals with Type 1 Diabetes Mellitus (T1DM). Despite its significance, research on HL in this population remains fragmented. This scoping review aims to map the existing literature on HL in T1DM and assess its impact on disease management. A systematic search was conducted in PubMed, Embase, Scopus, Web of Science, and Google Scholar, covering studies up to January 2025. The review included 55 studies, primarily focusing on adolescents and young adults, examining key HL dimensions such as numeracy, self-efficacy, nutrition literacy, and the use of digital health technologies. Findings highlight that adequate HL levels are associated with improved diabetes self-care, glycemic control, and quality of life, while barriers such as low numeracy, social anxiety, and socioeconomic disparities hinder disease management. Limited research exists on HL interventions tailored to T1DM, underscoring the need for targeted strategies to enhance patient education and engagement. Given the complex interplay between HL and diabetes outcomes, integrating HL assessments into routine care and developing tailored interventions may improve long-term disease management and quality of life for individuals with T1DM.

Gestational diabetes mellitus (GDM) is an increasingly prevalent global health condition, driven by rising maternal age and the obesogenic environment, currently affecting approximately 14% of pregnancies worldwide. GDM is associated with adverse perinatal outcomes as well as a substantial increase in long-term cardiometabolic risk. Women with a history of GDM exhibit a markedly elevated risk of developing type 2 diabetes (T2D) within the first decade postpartum, together with an approximately twofold higher risk of major cardiovascular events. Importantly, offspring of mothers with GDM are also predisposed to obesity and T2D later in life, underscoring the role of GDM as a major intergenerational determinant of cardiometabolic disease. Physical activity is recommended as an effective non-pharmacological strategy for the prevention and management of GDM; however, the molecular mechanisms underlying its benefits remain only partially understood. Exerkines, bioactive molecules modulated by exercise, have emerged as important regulators of systemic metabolic and cardiovascular adaptations. In addition to the well-characterised exerkines such as leptin, adiponectin, and irisin, emerging evidence supports the relevance of additional mediators, including chemerin, members of the FGF19 subfamily, and adipsin, as contributors to the pathophysiology of GDM and cardiovascular risk. This narrative review summarises the current evidence on these emerging exerkines, focusing on their biological mechanisms and clinical relevance in GDM. A deeper understanding of the exerkine network may provide novel insights into the interplay between exercise, metabolic regulation, and pregnancy, ultimately supporting improved GDM management and long-term cardiometabolic risk stratification across generations.

Insulin resistance (IR) in type 1 diabetes mellitus (T1D) has significant cardiovascular and metabolic implications. Hypovitaminosis D has been linked to IR in various populations; however, its relationship with insulin sensitivity in T1D remains unclear. This review aimed to investigate the association between hypovitaminosis D and IR in individuals with T1D. Vitamin D may enhance glucose metabolism by protecting pancreatic β-cells, and therefore, insulin secretion. Animal studies and clinical trials have suggested that vitamin D supplementation improves β-cell survival and can slow disease progression when initiated soon after T1D diagnosis. Nevertheless, its impact on insulin secretion in established T1D is limited because of significant β-cell loss at diagnosis. Moreover, vitamin D can improve insulin sensitivity by attenuating renin-angiotensin system activity, enhancing insulin receptor expression, activating metabolic pathways such as peroxisome proliferator-activated receptor delta, and reducing inflammation by downregulating proinflammatory cytokines associated with IR. Studies have demonstrated an inverse relationship between serum 25-hydroxyvitamin D (25[OH]D) levels and IR in T1D, with higher vitamin D levels being associated with reduced IR odds across various age groups. However, factors such as the body mass index may influence this relationship, particularly in younger populations, indicating complex interactions. Despite preliminary evidence, the link between hypovitaminosis D and IR in T1D remains underexplored. The evidence reviewed in this work underscores the need for further research to clarify this relationship and explore the detailed mechanisms involved.

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