Chronic Kidney Disease is a global health challenge and its early diagnosis is still a challenge, particularly when relying on conventional biomarkers like serum creatinine. In this systematic review, PRISMA guidelines were followed with a comprehensive search on various databases focusing on studies assessing estimated cystatin C levels, and creatinine levels among patients with chronic kidney disease, type 2 diabetes mellitus and hypertension. The Joanna Briggs Institute's critical assessment tool was used to estimate quality and risk bias of included studies. This systematic review included 21 studies with maximum studies demonstrating cystatin C based eGFR may provide more reliable and accurate estimate of kidney function than creatinine based eGFR, specifically for early identification of kidney dysfunction. The findings suggest that serum cystatin C is an early diagnostic and prognostic marker and its incorporation into routine testing will increase the clinical utility by improving risk stratification. In general, this systematic review highlights the diagnostic and prognostic utility of serum cystatin C for early detection of kidney dysfunction.

Delayed healing of diabetic foot ulcers (DFUs) remains a clinical challenge, and the relationships among glycemic control, wound healing progression, and morphological characteristics in DFUs remain systematically unmapped. This scoping review synthesized current evidence on these relationships. Following PRISMA-ScR guidelines, PubMed, Scopus, MEDLINE, and CINAHL were searched on April 2026. Eligible studies included adults with DFUs reporting glycemic parameters alongside wound morphology or healing progression. Twenty-two studies were included. HbA1c was the most frequently evaluated glycemic parameter, followed by fasting and postprandial glucose. Poorer glycemic control was associated with less favorable healing outcomes in several studies, including delayed healing, reduced healing velocity, treatment failure, and amputation; however, the direction and strength of these associations varied across studies. Direct evidence linking glycemic parameters to specific wound morphological characteristics was limited and heterogeneous, with reported associations involving wound size and depth, while other studies found no significant associations. Dynamic glycemic monitoring was rarely assessed, with glycemic variability evaluated in only one study. Current evidence does not establish a unidirectional causal relationship between glycemic control and wound morphological changes or specific glycemic targets for individual healing progression. Prospective longitudinal studies integrating repeated dynamic glycemic monitoring with standardized serial wound morphology assessment are needed.

Type 2 diabetes remission may reduce the long-term burden of vascular complications, but the magnitude and consistency of this association remain uncertain. We systematically evaluated whether remission was associated with lower subsequent microvascular and macrovascular or cardiovascular risk compared with non-remission. PubMed/MEDLINE and Europe PMC were searched through 31 August 2026 for longitudinal cohorts comparing adults with and without biochemical remission. Eight reports from seven independent cohorts were included, with five cohorts contributing to quantitative vascular synthesis. Remission was associated with lower microvascular risk (pooled HR 0.68, 95% CI 0.59-0.77; I[2] = 4.1%) and lower macrovascular or cardiovascular risk (pooled HR 0.73, 95% CI 0.61-0.87; I[2] = 8.7%). Findings were consistent across lifestyle, routine-care, and metabolic-surgery settings. Additional cohorts associated remission with lower all-cause and cardiovascular mortality. However, risk of bias was moderate or serious because remission was not randomized and may reflect favorable post-baseline risk-factor changes. Type 2 diabetes remission is associated with substantially fewer subsequent vascular events, but causal attribution remains uncertain. Remission should complement, rather than replace, continued complication surveillance and multifactorial risk management.

Clinical guidelines relax glycaemic targets for older adults with diabetes on the assumption that ageing increases vulnerability to hypoglycaemia, an evidence base not formally appraised. We assessed whether ageing alters physiological, cognitive and behavioural responses to experimentally induced hypoglycaemia and hyperglycaemia. We searched PubMed, Embase and Web of Science from inception to 15 February 2025, updated to 15 September 2026, for studies comparing an older with a younger adult group as designated by the study authors, and reporting awareness, counter-regulatory hormone, cognitive or glucose-handling outcomes. Risk of bias was assessed with ROBINS-E, certainty with GRADE, and findings synthesised narratively. Fourteen studies (1985-2009; nine hypoglycaemia, five hyperglycaemia) met criteria; eleven enrolled healthy adults without diabetes, none at low risk of bias. Four of five awareness studies found reduced symptom perception in older adults; three of six glucagon studies showed attenuation; catecholamine findings were mixed; three of four cognition studies found comparable impairment. Each hyperglycaemia study identified a different impaired mechanism, none replicated; certainty was very low throughout. Very-low-certainty evidence suggests reduced symptom perception in older adults, with heterogeneous findings for counter-regulation and hyperglycaemia. This evidence base is too limited to determine appropriate glycaemic targets. PROSPERO: CRD420250654327.

Corn-derived dietary fibers have been increasingly recognized for their potential cardiometabolic benefits; however, evidence regarding their effects on cardiometabolic markers remains inconsistent. This systematic review and meta-analysis aimed to evaluate the effects of corn-derived dietary fiber supplementation on cardiometabolic outcomes in adults. A systematic search of original databases was conducted from database inception to May 2026 to identify randomized controlled trials investigating the effects of corn-derived dietary fibers. Weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Corn-derived dietary fiber supplementation significantly reduced total cholesterol (TC) (WMD: -7.93 mg/dL; 95% CI: -14.00 to -1.86) and low-density lipoprotein- cholesterol (LDL-C) (WMD: -8.82 mg/dL; 95% CI: -14.31 to -3.33). No significant effects were observed for glycemic control, other lipid profile, anthropometric indices, blood pressure, and C-reactive protein (all P > 0.05). Subgroup analyses showed that the lipid-lowering effects remained generally consistent across intervention durations and fiber dosages. Corn-derived dietary fiber supplementation significantly improves TC and LDL-C concentrations but has no significant effects on other cardiometabolic outcomes. These findings support the potential role of corn-derived dietary fibers as an adjunct nutritional strategy for improving lipid profile and reducing cardiovascular risk.

Subclinical myocardial dysfunction may precede overt heart failure in type 2 diabetes mellitus (T2DM), while conventional cardiac biomarkers largely reflect myocardial wall stress or cardiomyocyte injury. We systematically reviewed circulating fibroblast growth factor 21 (FGF21) and growth differentiation factor 15 (GDF15) across two distinct evidence domains: direct diagnostic or associative evidence for early myocardial dysfunction and longitudinal prognostic evidence for subsequent cardiovascular outcomes in T2DM. MEDLINE/PubMed, Embase, Scopus and Web of Science were searched from inception, and eligible studies related FGF21 and/or GDF15 to objective cardiac phenotypes or cardiovascular outcomes. Four GDF15 cohorts harmonised to a per-1-SD increase in log-transformed GDF15 showed higher cardiovascular risk (pooled HR 1.23, 95% CI 1.10-1.37; I[2] = 16.2%), with stable leave-one-out analyses. Three FGF21 cohorts yielded a pooled HR of 1.60 (95% CI 1.08-2.39; I[2] = 69.9%). In an exploratory leave-one-out analysis, omission of the Lenart-Lipińska 2013 cohort yielded HR 1.32 (95% CI 1.15-1.52; I[2] = 0%); this was interpreted as an influence analysis rather than an alternative primary estimate. Diagnostic evidence remained limited: FGF21 AUC ranged from 0.70 to 0.88, whereas one GDF15 study reported AUC 0.83 for asymptomatic diabetic cardiomyopathy. The current evidence therefore supports prognostic association rather than validated early diagnostic performance or demonstrated incremental predictive utility beyond established biomarkers; prospective head-to-head validation in subclinical disease is required.

Non-pharmacological interventions may provide a safe and practical approach to improving sleep among persons with T2DM. The systematic review aimed to evaluate the effectiveness of nonpharmacological interventions for improving sleep quality among persons with T2DM. This systematic review was registered in PROSPERO (CRD420251154335) and followed the PRISMA guideline. PubMed, ScienceDirect, Scopus, Google Scholar, and Wiley Online Library were systematically searched for relevant articles published from inceptions up to 30 October 2025. The quality of studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal tools. A narrative synthesis was applied to this study. A total of 16 studies involving approximately 1,300 participants with T2DM met the inclusion criteria, demonstrating improvements in sleep quality among persons with T2DM. Five categories of non-pharmacological interventions were effective in improving sleep quality among persons with T2DM, including exercise, diabetes knowledge, sleep hygiene training, diabetes sleep education and psychological and behavioural therapies. Characteristics of interventions were face to face interventions and combination face to face and telephone/online intervention. Evidence from this review indicates that non-pharmacological interventions were effective in improving sleep quality among persons with T2DM. Personal condition should be taken into consideration when implementing these interventions.

Scoparia dulcis L. is a pantropical medicinal plant traditionally used in Brazil, Asia, and Africa to manage diabetes. This study systematically reviewed and meta-analyzed the effects of S. dulcis extracts and isolated compounds on glycemic outcomes in animal models of diabetes. PubMed, Embase, and Scopus were searched through February 2026 in accordance with PRISMA guidelines. In vivo preclinical studies evaluating glycemic outcomes after treatment with S. dulcis were included. Risk of bias was assessed using a modified CAMARADES checklist, and treatment effects were pooled as standardized mean differences (SMDs) with 95% confidence intervals. Fourteen studies met the inclusion criteria. Aqueous, ethanolic, and methanolic extracts, as well as the isolated alkaloid coixol, significantly reduced blood glucose at 60 min (SMD = - 4.15; 95% CI: -6.03 to - 2.27), 120 min (SMD = - 3.59; 95% CI: -5.07 to - 2.11), 1 week (SMD = - 3.47; 95% CI: -4.45 to - 2.48), and 2 weeks (SMD = - 5.61; 95% CI: -7.15 to - 4.06) (all p < 0.0001). Heterogeneity was substantial (I[2] = 61-73%). The aqueous extract consistently showed the greatest effect. These findings support the traditional use of S. dulcis and provide a rationale for future clinical trials evaluating its antidiabetic potential.