While many studies compared multiple daily injections (MDI) and insulin pump therapy on various clinical outcomes, the results remain inconclusive. This multicenter retrospective cohort study included 175 patients and aimed to evaluate the effects of different insulin therapy methods on various clinical outcomes, including hemoglobin A1c (HbA1c), total daily insulin dosage, body mass index, glomerular filtration rate, in pediatric patients with type 1 diabetes. In a linear mixed-effects regression analysis, a statistically significant interaction between time and treatment type on HbA1c was found. It suggested significantly higher reduction of HbA1c values between 12-month visit and baseline in the group receiving MDIs compared to insulin pump therapy. Patients using MDIs observed higher reduction of HbA1c levels and lower total daily insulin dose relative to insulin pump therapy group. Other changes of clinical indicators were the same for group of patients. Various studies report controversial results on long term effects of these treatments on HbA1c values necessitating large population-based cohort studies in this field.

Background: The comparative effects of pharmacological treatment, bariatric surgery, and diet on insulin resistance (IR) remain unclear. Aim: To study the comparative effects of the methods on IR: pharmacologic, bariatric surgery, and very-low-calorie diet (VLCD) in patients with type 2 diabetes mellitus (T2DM) and hypertension. Methods: Design: a 90-day prospective, multicenter, comparative clinical trial including 130 adult patients divided into three groups: Drug, Surgery, and VLCD. Endpoints: HOMA-IR; weight loss; and HbA1c, systolic/diastolic blood pressure (SBP/DBP). Results: At 90 days, weight loss in the Surgery (−19.8%) and VLCD groups (−17.4%) was significant (p < 0.0001), while in the Drug group, the loss was insignificant (−6.5%; p = 0.06). SBP/DBP in the Drug group decreased by −9.5% (p = 0.0002) and −4.1% (p = 0.09), respectively. SBP/DBP in the Surgery group decreased by −13.6% and −10.6%, respectively (p < 0.001), and in the VLCD group, by −23.3% and 21.3%, respectively (p < 0.0001). HOMA-IR in Drug, Surgery, and VLCD groups decreased by −42.2% (p = 0.004), −87.6% (p < 0.0001), and −88.7% (p < 0.0001), respectively. In the Drug group, HOMA-IR did not reach the normal level. Correlation-regression analysis revealed a direct correlation between weight loss and a decrease in HOMA-IR (r = 0.526; F = 33.2, p < 0.0001). HOMA-IR decreases by 65% if weight decreases by 10%; if weight decreases by 25%, then HOMA-IR decreases by 83%. Conclusions: HOMA-IR was associated with weight loss: the greater the weight loss, the lower the HOMA-IR. Weight loss leads to a reduction in the need for antidiabetic/antihypertensive drugs in patients with T2DM and hypertension.

Background: The coexistence of type two diabetes (T2D) and cardiovascular diseases (CVD) in patients with overweight increases the risk of macro-vascular complications. Some studies are controversial of the results of Ramadan fasting (RF) in patients T2D+CVD. Objective: To compare different RF (antique and modern) on anthropometric, glycemic, blood pressure (BP), lipids, heel bone mineral density (HBMD), and ejection fraction (EF) in patients with T2D+CVD. Methods: An open, 60-day, controlled, single-center, randomized clinical trial included 51 patients (29 women) with T2D+CVD: 26 in Main (antique RF); 25 in Controls (modern RF). Primary endpoints: weight loss, fasting blood glucose and, blood insulin, BP. Secondary endpoints: blood lipids, HBMD, and EF. Results: Patients in Main lost weight –8.02 kg ( P <0.0001), in Controls lost weight –2.67 kg ( P <0.025); BMI in Main significantly decreased ( P <0.0001), but in Controls did not significantly decrease ( P> 0.025). During a 30-day follow-up, Main did not regain weight and WC; but Controls regained weight and WC. In Main BP, all glycemic parameters (fasting glucose, immunoassay insulin, HOMA-IR), lipids (cholesterol, triglyceride, HDL), HBMD, and EF in patients with and without heart failure (HF) were significantly normalized at 30-day RF ( P 0.025). In Controls HBMD and EF in patients with HF did not change ( P >0.025). At 30-day follow-up, glycemic, BP, lipids, HBMD, and EF parameters did not significantly change in Main; but in Controls they worsened as weight regained. Conclusion: Both the RF methods allowed weight loss, but antique RF led to markedly weight loss and significant positive change in glycemic, BP, lipids, bone mineralization, and EF in patients with T2D+CVD; the antique RF allowed patients to stop taking medications. The duration of the positive results depended on the maintenance of the achieved weight loss on RF. Trial Registration: ClinicalTrials.gov NCT06410352 (05/08/2024): https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000EG8K&selectaction=Edit&uid=U0006MBT&ts=139&cx=bhsvd1

Background: The impact of overweight and adipocyte size on the development of type 2 diabetes mellitus (T2DM) even remains unclear. Aim: To study: 1) the relationship between the state of adipocytes and/or overweight/obesity, the development of T2DM and its clinical and laboratory signs; 2) the effect of weight loss on glycemic level, hyperinsulinemia (HI), insulin resistance (IR), and T2DM status. Methods. Design: a systematic review. Settings: Web of Science, EBSCO, Scopus/ Science-Direct, Google Scholar, PubMed, Cochrane, и Wolter Kluwer were searched for articles published for 26 years (2000-2026). The study bases on a systematic review of 3853 articles published worldwide. Results. In total, 142 full-text articles were assessed for eligibility. With an increase in overweight, the size of adipose tissue increases, adipocytes increase, the cell radius increase. All it leads to an overload of intracellular transport and internal organs. Increase in cell size triggers intracellular mechanisms to limit further nutrient supply. When cell size increases excessively, conformational changes in cellular receptors are activated, resulting in the development of IR. The increase in cell size and the maximum accumulation of overweight, as parallel processes, lead to hyperglycemia and HI with gradual development of IR and T2DM. Any type of i ntentional weight loss leads to a decrease in IR, HI and the disappearance of T2DM. Targeted weight loss in patients with T2DM improves metabolic and cardiovascular health, reduces blood pressure and blood sugar, reduces doctor visits, normalization of HbA1c, HI, IR. Conclusions. IR is a protective reaction of the cells, preventing its oversaturation and overflow. Overweight is an independent risk factor for the development of T2DM and its clinical and laboratory manifestations. Targeted weight loss leads to disappearance of symptoms of HI, IR and T2DM.

Background: COVID and Influenza with non-communicable chronic diseases (NCDs) complicate the diagnosis, treatment, prognosis, and increase mortality rate. The aim: to evaluate the effects of the fast weight loss on clinic and laboratory inflammation profile, metabolic profile, reactive oxygen species (ROS) and body composition in patients with COVID and Influenza in comorbidity with NCDs. Methods: A 6-week open, pilot prospective clinical trial including 62 adult patients with COVID (n=27) and influenza (n=35) in comorbidity with T2D, hypertension, and NASH. Overweight in 33 patients (53.2%) with BMI 28.14±0.39 kg/m ² , and 29 patients without overweight with BMI 23.37 ± 0.38 kg/m ² . T2D in 26 (41.9%); Hypertension in 38 (61.3%) (incl. 12 patients with T2D); NASH in 51 patients (82.2%) (incl. 8 patients with NASH, T2D and Hypertension; 6 patients with NASH and T2D; 18 patients with NASH and Hypertension; 19 patients with only NASH). Primary endpoints: Clinic/infectious/inflammation tests for COVID and Influenza; weight loss during 14 days. Secondary endpoints: fasting blood glucose, HbA1c, blood insulin; systolic/diastolic BP; blood lipids; ALT, AST, chest CT-scan. Results: The patients with overweight lost -12,4% from baseline or BMI= -4.2 kg/m ² , and patients without overweight lost -9,14% from baseline or BMI= -2.2 kg/m ² (−9.7±0.7 kg vs. - 6.4±0.6 kg, respectively; P <0.001) at 14-day of the treatment. Weight loss in both groups was due to reduction of fat mass ( P <0.0001). Sputum production increased in 1.0-1.5 liter/day on 2-3 days, decreased in 7-9 days. Body temperature normalized in 6-9 days. On 3-5 days, in most patients their urine became turbid/muddy/intensively colored. Urine microscopy showed organic and non-organic salts, and leukocyturia (20-35/sight). White blood cells, lymphocytes, NLR normalized at 14 days (P<0.0001). Total-fibrinogen, C-reactive-protein, and Erythrocyte-sedimentation-rate, ROS normalized at 14-day of treatment ( P 96.3% patients at 14-day. Systolic/diastolic BP decreased (161.3±1.31/101.6±0.85 vs. 118.3±0.46/80.89±0.66, P <0.0001), glucose and lipids metabolism in patients with T2D (n=26) (P<0.0001); ALT and AST in patients with NASH (n=51) were significantly normalized (from baseline 134.3±5.4 and 166.5±5.5 U/L, respectively, and at 14-day to 78.4±4.2 and 92.4±4.9 U/L, respectively (P<0.0001)), platelets increased from baseline (186.5±4.6, ×10 ⁹ /L) at 14-day of treatment (238.5±5.8, ×10 ⁹ /L) ( P <0.0001), and at 6-week follow-up (278.3±6.9, ×10 ⁹ /L) ( P <0.0001). The mean score of chest-CT for the patients (n=44) was 13.12±0.38 from baseline, and at 14-day the score was 1.72±0.12 ( P <0.0001). ROS level normalized at 14-day treatment and 6-week follow-up from baseline ( P <0.0001). The previous antidiabetic, antihypertensive, anti-inflammatory and hepatoprotective, and other symptomatic medications were adequately decreased in 2-5 days to completely stopping by 5-8 days treatment. Conclusions: The fast weight loss is clinical/laboratory benefit in treatment of patients with COVID-19 and Influenza in comorbidity with T2D, hypertension, and NASH. Trial Registration: ClinicalTrials.gov NCT05635539 . Registered 1 December 2022.