Background: Type 2 diabetes (T2D) is the leading cause of chronic kidney disease (CKD), responsible for approximately 60% of cases. Diabetic kidney disease (DKD) affects 20–50% of individuals with diabetes, with diabetes-related ESKD cases rising steadily worldwide from 22.1% in 2000 to 31.3% in 2015. Methods: This review examines the literature published up to 25 February 2025, using a systematic search in PubMed and Scopus. Keywords included uremic toxins and diabetic kidney disease and/or gut microbiota, or dysbiosis or gut–kidney axis. Studies were independently assessed by a minimum of three authors, with discrepancies resolved through consensus. Results: Gut microbiota dysbiosis is a key driver of DKD progression, making the gut–kidney axis a promising therapeutic target. A “nuts and fruits” dietary pattern reduces the DKD risk by 43.3%, while an animal protein intake lowers the diabetic peripheral neuropathy risk by 42.8%. High-fiber diets and supplements like resistant starch may reduce uremic toxins through microbiota modulation. Conclusions: Microbiota-targeted interventions, including probiotics, synbiotic, and dietary modifications, show potential in reducing uremic toxin production and inflammation, though DKD-specific evidence remains limited. Lactobacillus and Bifidobacterium strains may help lower urea and creatinine levels, but outcomes vary by disease stage. Further research is needed to confirm the efficacy of dietary and probiotic approaches in DKD management.

Introduction: Obesity is a systemic disease leading to many complications. One of the causes of obesity is excessive energy intake in relation to its expenditure. Assessing portion sizes and estimating caloric intake is crucial in maintaining a healthy body weight and combating obesity. Objectives: To evaluate the impact of BMI on the perception of portion sizes and their estimated caloric content. Patients and methods: The anonymous survey was filled out by 205 patients. The survey contained questions regarding different meals. Pictures of main meals were presented and individually assessed by the study participants. Next, they were divided into groups, individuals with normal weight (BMI < 25 kg/m²), who were overweight (BMI 25–29.9 kg/m²), and with obesity (BMI ≥ 30 kg/m²), to analyze the differences in food perception and caloric estimation. Results: The study did not demonstrate significant differences in the subgroups’ estimated portion sizes of most main meals. No statistical significance was found in the estimated caloric content of the indicated main meal portions across the studied groups. Obese, overweight, and normal-weighted patients assess food portion size similarly. Conclusions: BMI has no significant impact on caloric estimation. The majority of the population estimate the caloric value of the meals inappropriately. Nevertheless, patients with excessive body weight (overweight and obesity) have a tendency (but not statistically significant) to underestimate the caloric value of full meals compared with people with normal BMI. Incorrect calorie estimation may lead to consuming bigger meal portions in patients with overweight and obesity.

Background: Diabetic kidney disease (DKD) affects 20–50% of individuals with diabetes. The aim of this review was to identify interventions that positively influence the gut microbiota in DKD. Methods: Identification of relevant studies was conducted via a systematic search of databases and registers using the PRISMA guidelines. This review examined the relevant literature published up to 5 January 2025, using a systematic search in PubMed and Scopus. The search was conducted with combinations of keywords including DKD and therapy, supplementation and gut microbiota, and supplementation or probiotics or fecal microbiota transplant. The initial search fielded 132 results from PubMed and 72 from Scopus, which was narrowed to 135 relevant studies. The exclusion criteria included non-English language studies, letters to the editor, and conference abstracts. Eligible studies were independently assessed by a minimum of three authors, with discrepancies resolved through consensus. Results: Gut microbiota-targeted interventions, including probiotics, synbiotics, and dietary modifications, show promise in modulating the gut microbiota, but evidence specific to DKD remains limited. Some natural food components such as polyphenols and anthocyanins modulate the composition of the gut microbiota translocation of uremic toxins, which slows down the progression of diabetic kidney disease. In animal models, fecal microbiota transplantation (FMT) has shown positive effects in regulating dysbiosis and beneficial effects in chronic kidney disease, but studies involving humans with DKD are insufficient. Conclusions: Lactobacillus and Bifidobacterium strains, administered at doses ranging from 0.6 to 90 billion CFU, may help lower urea and creatinine levels, but outcomes vary by disease stage, duration of therapy, and amount used. High-fiber diets (>10.1 g/1000 kcal/day) and supplements such as resistant starch and curcumin (400–1500 mg/day) may reduce uremic toxins through gut microbiota modulation and reduction in oxidative stress. The effect of sodium butyrate requires further human studies.

Obesity is a disease which is currently one of the most serious problems affecting approximately 650 million people worldwide. Improper lifestyle is considered the primary cause of the disease; however, many other factors contribute to the problem. In recent years, attention has been drawn to the role of gut microbiota in developing and controlling obesity and overweight. Microorganisms in the gastrointestinal tract are responsible for the fermentation of certain nutrients, causing efficient digestion, stimulation of intestinal transit, vitamin production, and modulation of the host’s immune system. Numerous studies have demonstrated that gut microbiota composition differs between obese individuals and those with a normal body mass index (BMI). It has also been shown that altering gut microbiota can influence the phenotype of the host organism, promoting metabolic changes, including BMI reduction. Recent studies aimed at using probiotics to modify gut microbiota composition to reduce body weight are still inconclusive.

Introduction Prediabetes is a metabolic state that frequently precedes overt type 2 diabetes mellitus (T2DM) and is associated with an increased risk of micro- and macrovascular complications. Lifestyle modification remains the cornerstone of management, and several pharmacological agents, including metformin, pioglitazone, acarbose and glucagon-like peptide−1 receptor agonists (GLP-1 RAs), have demonstrated efficacy in delaying progression to T2DM. Sodium–glucose cotransporter 2 (SGLT2) inhibitors (often referred to as gliflozins) are increasingly being investigated in this context. The aim of this review is to summarise current evidence regarding the use of SGLT2 inhibitors in adults with prediabetes and to discuss the arguments for and against their routine clinical use. Methods A narrative review of publications retrieved from the PubMed database, addressing the role of SGLT2 inhibitors in prediabetes, was performed. Original studies, meta-analyses, systematic reviews and high-quality narrative reviews up to February 2026 were considered for inclusion. Results Multiple studies have demonstrated that SGLT2 inhibitors improve insulin sensitivity, promote modest weight reduction, lower blood pressure and exert favourable effects on hepatic lipid metabolism. Two contemporary meta-analyses confirm that SGLT2 inhibitors reduce the incidence of new-onset T2DM in adults with prediabetes who also have heart failure or chronic kidney disease (CKD), with relative risk reductions of approximately 19–21%. This drug class is generally well tolerated, although it is associated with increased risk of genitourinary infections and rare but serious euglycaemic diabetic ketoacidosis. Conclusions SGLT2 inhibitors appear to be a promising class of drugs for the prevention of T2DM, particularly in high-risk populations with concomitant cardiovascular or renal disease. However, dedicated randomised controlled trials in prediabetes—with adequate follow-up and washout periods—are necessary before routine use can be recommended. Current 2026 guidelines do not yet endorse SGLT2 inhibitors as a preventive therapy for prediabetes outside the indications of heart failure and CKD.