Background/Objectives: Regular physical activity is an important component of healthy development and diabetes management for children with type 1 diabetes (T1D). However, concerns about hypoglycemia, limited knowledge of T1D-related physical activity and glucose management, inadequate school support, and other contextual factors may restrict participation. This qualitative study explored barriers and facilitators influencing physical activity among children with T1D from the perspectives of parents and healthcare providers in Saudi Arabia. Methods: One-to-one semi-structured interviews were conducted with parents of children with T1D and healthcare providers involved in pediatric diabetes care. Participants were purposively recruited at King Saud Medical City Pediatric Hospital. Interviews were conducted in February 2025 and analyzed using thematic analysis, with the Social Ecological Model guiding the interview domains and interpretation. Twenty-three participants were included: 13 parents and 10 healthcare providers. Results: Six themes were identified: (1) physical activity practices and preferences; (2) barriers to physical activity; (3) strategies for managing blood glucose during activity; (4) parental and professional support systems; (5) need for structured programs; and (6) societal awareness and stigma. Fear of hypoglycemia, limited school preparedness, lack of awareness, and limited routine activity were important barriers, while glucose monitoring, family and professional guidance, and structured support were described as facilitators. Conclusions: The findings support the need for practical education, trained school personnel, structured physical activity opportunities, and coordinated support across families, healthcare services, schools, and communities.
Background/Objectives: Infusion sets are essential for continuous subcutaneous insulin infusion. Conventional sets require replacement every 2–3 days, while recent research has focused on extending wear time to reduce treatment burden and support automated insulin delivery. We aimed to characterize evidence on extended-wear infusion sets (>3 and ≤7 days) in people with type 1 diabetes (T1D), focusing on survival, safety, insulin delivery, glycemic outcomes, pharmacokinetic/pharmacodynamic parameters, and user experience. Methods: A scoping review was conducted according to PRISMA-ScR. The protocol was registered in the Open Science Framework (OSF; DOI: 10.17605/OSF.IO/TNKJ5). MEDLINE/PubMed, Embase, Scopus, Web of Science Core Collection, and Cochrane CENTRAL were searched for studies published from 1 January 2020 to 4 September 2026. Eligible studies evaluated infusion sets worn for >3 days in people with T1D and reported extended-wear outcomes. Results: Of 229 records identified, 103 unique references were screened and 11 underwent full-text assessment. Ten publications met the inclusion criteria, representing 9 independent sources of evidence. In the largest studies, 7-day set survival ranged from 77.8% to 95%, depending on device and failure criteria. Some studies reported deterioration in glycemic or pharmacodynamic measures with prolonged wear, whereas others showed good tolerability and reduced burden from set changes. Conclusions: Extended-wear infusion sets can remain functional for 4–7 days in a substantial proportion of people with T1D, although performance may decline with increasing wear time. Evidence is limited by heterogeneity in devices and study designs, small samples, few direct comparisons, and difficulty isolating the infusion set effect from other technological components. Independent comparative studies are needed to establish safety, insulin delivery stability, and clinical benefit.
Background/Objectives: Although dietary therapy forms the cornerstone of type 2 diabetes management, strict regimens frequently impose significant cognitive and psychosocial burdens, reducing adherence. This cross-sectional study investigated patient acceptability of individual dietary advice commonly used in nutritional counseling and its clinical associations, aiming to identify a practical screening method for potentially poor adherence. Methods: Among 128 outpatients with type 2 diabetes receiving regular nutritional counseling, patients evaluated their acceptability of 13 standard dietary advice items using a 4-point scale (0 points = Cannot do, 3 points = Can do). We comprehensively analyzed correlations between item-specific acceptability scores and clinical characteristics, including hemoglobin A1c (HbA1c), dietary adherence, and complications. Results: While acceptability for eating vegetables before carbohydrates was extremely high (98%), weighing staple foods and seasonings yielded the highest proportion of 0-point responses (17%, 22 patients). The acceptability score for weighing correlated positively with the nutritional counseling adherence rate (ρ = 0.25) and negatively with HbA1c (ρ = −0.19), estimated salt intake (ρ = −0.28), and diabetic retinopathy (ρ = −0.28) (all p < 0.05). In multivariate logistic regression, the 0-point response to weighing remained significantly associated with lower nutritional adherence (odds ratio [OR] = 0.36, p = 0.02), higher salt intake (OR = 1.96, p < 0.01), and elevated HbA1c (OR = 1.53, p = 0.04), even after adjusting for covariates. Conclusions: Low acceptability of weighing staple foods and seasonings was associated with poorer dietary adherence and worse glycemic control in patients with type 2 diabetes. Assessing this item may help identify patients who could benefit from individualized nutritional counseling. Further prospective studies are needed to validate its utility as a screening indicator.
Mitochondrial quality control (MQC) is essential for maintaining mitochondrial integrity, metabolic flexibility, and cellular homeostasis. Rather than functioning as isolated pathways, molecular repair and proteostasis, mitochondrial dynamics, mitophagy, and mitochondrial biogenesis form an interconnected network that continuously detects, compensates for, removes, and replaces damaged mitochondrial components. In type 2 diabetes (T2D), chronic nutrient excess, metabolic stress, and low-grade inflammation disrupt this network. Increased metabolic flux and electron pressure within the respiratory chain promote excessive reactive oxygen species (ROS) production and oxidative damage to mitochondrial proteins, lipids, and mitochondrial DNA (mtDNA). Persistent stress challenges molecular repair capacity, alters the balance of mitochondrial fusion and fission, impairs mitophagic clearance, and compromises mitochondrial renewal. These abnormalities interact with one another, promoting the accumulation of dysfunctional mitochondria and establishing a self-reinforcing cycle of oxidative stress, inflammation, insulin resistance, and pancreatic β-cell dysfunction. This review examines the molecular mechanisms through which metabolic stress disrupts the MQC network in T2D and considers the tissue-specific consequences of impaired MQC. This further discusses established antidiabetic therapies and emerging mitochondria-targeted interventions that may modulate different components of the MQC network, including oxidative stress, molecular repair, mitochondrial dynamics, mitophagy, and biogenesis. By framing MQC as an integrated and interconnected network rather than a series of strictly sequential or hierarchical defenses, this review provides a framework for understanding how impaired MQC contributes to T2D pathogenesis and for identifying therapeutic strategies aimed at restoring mitochondrial and metabolic homeostasis.
Objective: This study aimed to investigate telomere length characteristics in patients with type 2 diabetes mellitus (T2DM) according to the presence of chronic kidney disease (CKD) and the use of sodium–glucose cotransporter 2 (SGLT2) inhibitors. Materials and Methods: The study included 100 patients with T2DM, who were divided into groups according to the presence of CKD (50 patients in each group). Renal function parameters, urinary albumin-to-creatinine ratio, the presence of cardiovascular disease, and leukocyte telomere length were assessed. Telomere length was measured by monochrome multiplex quantitative polymerase chain reaction, with determination of the T/S ratio and residual telomere length (ΔT/S). The association between SGLT2 inhibitor therapy and telomere length parameters was additionally analyzed. Results: After adjustment for age, patients with CKD had significantly lower residual telomere length (ΔT/S; p = 0.035), while pathologically short telomeres were observed more frequently (20.8% vs. 2.1%; p = 0.0076). SGLT2 inhibitor use was associated with greater telomere length irrespective of CKD status. In multivariable regression analysis restricted to patients with CKD, SGLT2 inhibitor use was independently associated with greater leukocyte telomere length (B = 0.434; 95% CI: 0.227–0.642; p < 0.001). Conclusions: Patients with T2DM and CKD demonstrate more pronounced age-adjusted telomere shortening, suggesting accelerated biological aging. SGLT2 inhibitor use is associated with preservation of telomere length irrespective of CKD status, which may indicate a potential effect of this drug class on cellular senescence.
