The increased availability and use of automated insulin delivery (AID) systems in recent years have shown that individuals using AID systems can more easily and consistently achieve glycemic targets and that this is associated with improvements in quality of life. Alongside this technological progress, regular physical activity and exercise remain cornerstones of diabetes management for individuals with type 1 diabetes, owing to the numerous well-documented health benefits of an active lifestyle. Despite the clear evidence supporting the positive effects of physical activity and exercise, glucose fluctuations frequently occur around physical activity and exercise, posing challenges for AID systems and simultaneously deterring people with type 1 diabetes from maintaining a physically active lifestyle. Given the growing number of clinical trials and reviews on AID systems in the context of physical activity and exercise, there is a clear need to consolidate this knowledge and develop joint guidelines by the German Diabetes Association (DDG) and the Austrian Diabetes Association (ÖDG). This German-language guideline is based on the current position statements of the European Association for the Study of Diabetes (EASD) and the International Society for Pediatric and Adolescent Diabetes (ISPAD). They summarize the evidence on AID systems and provide practical recommendations for the management of physical activity and exercise in children, adolescents and adults with type 1 diabetes using AID systems. Within the guidelines we detail each AID system available in Germany and Austria and give specific guidance for their use around physical activity and exercise. Furthermore, we discuss glycemic responses to physical activity and exercise and outline therapeutic strategies to maintain glycemia within target ranges.

Sedentary behavior is associated with higher all-cause mortality and increased cardiometabolic risk, while lack of time remains a major barrier to regular physical activity (PA). Exercise snacks are a daily-life PA strategy characterized by short, repeatable bouts of activity distributed across multiple time points throughout the day. This format may help interrupt prolonged sitting and increase overall PA exposure with minimal reliance on dedicated facilities or equipment. This narrative review, informed by a structured literature search, aimed to (i) clarify the conceptual boundaries between exercise snacks and related approaches, (ii) summarize key prescription elements-frequency, intensity, time, type, and timing (FITT+T)-and their physiological and behavioral rationale, and (iii) synthesize evidence on applications across populations and settings, associated health effects, and implementation considerations. Relevant literature was searched in PubMed (MEDLINE) and Scopus from database inception to September 30, 2025, supplemented by reference-list screening and iterative manual searches. Evidence was synthesized thematically. For health-related outcomes, systematic reviews and meta-analyses were prioritized where available, with individual randomized controlled trials and other primary studies cited selectively when needed for specific populations, outcomes, protocols, or newer evidence. Overall, current evidence suggests that exercise snacks can improve sedentary patterns and may increase activity levels in some contexts. Favorable effects have been reported for postprandial glucose and insulin responses, and some protocols sustained over several weeks have also been associated with improvements in cardiorespiratory fitness and physical function. However, evidence remains limited or inconsistent for blood lipids, body composition, psychological outcomes, and several longer-term clinical endpoints. Most studies report high acceptability and adherence, but real-world implementation may be hindered by forgetting, contextual constraints, and variability in individual capacity. Future research should establish greater consistency in terminology and FITT+T reporting, clarify dose-response relationships across outcomes and populations, leverage wearable and mobile health technologies to support detection and prompting of brief activity bouts, and conduct stratified trials with longer follow-up in high-risk and special populations to support scalable translation into public health and clinical practice.

Type 2 diabetes mellitus (T2DM) is developed through the coexistence of β-cell dysfunction and insulin resistance. T2DM causes multiple complications, increase mortality and morbidity that make huge social and economic burden. Bangladesh is experiencing a rising prevalence of the disease, posing major challenges for health policy planners. Circulating ferritin concentrations may be related with the advanced risk of T2DM, regardless of iron status. Dysregulation of ferritin and glucose level may exert reciprocal effects. The goal of this study was conducted to evaluate and compare serum ferritin between type 2 diabetic patients and non diabetic apparently healthy groups. This cross-sectional analytical type of study was completed in the Biochemistry department of Mymensingh Medical College and samples were collected from the Endocrinology department of Mymensingh Medical College Hospital, Mymensingh, from July 2023 to June 2024. Through the purposive non-random sampling approach, total 132 study subjects were selected according to inclusion and exclusion criteria. Among them, 66 patients with type 2 diabetes mellitus, diagnosed according to ADA criteria, aged from 30 to 65 years of both male and female, were selected as Group I (Case). Another 66 non diabetic apparently healthy individuals of the same age and sex matched, were selected as Group II (Control). Informed written consents were taken. Baseline parameters were accumulated and recorded in pre-designed data collection sheets. Fasting serum glucose and serum ferritin levels were analysed, Mean±SD was used to express all values. Statistical analysis was done by using SPSS (statistical product and service solutions) version 26.0 windows package. By using Student's unpaired 't' test, quantitative continuous variables were compared between groups of study subjects and qualitative variables by Chi-square test. By using Pearson's correlation coefficient test correlations were done. Following comprehensive analysis, it was revealed that highly significant (p<0.001) raised of serum ferritin level in patient with T2DM (185.83±57.19μg/L) case group when compared with non diabetic (102.59±40.56μg/L) control group. Also showed that, highly significant positive correlations of fasting serum glucose with serum ferritin level in patients with T2DM (r=0.542, p<0.001). This study will provide fruitful information to the clinicians to advance their knowledge to overall management of T2DM. So, it is suggested timely evaluation and regular monitoring of serum ferritin in T2DM.

Obesity is recognized as a systemic disease characterized by chronic, low-grade inflammation. The persistent inflammatory state can be driven by secretion of cytokines from adipose tissue, also known as adipokines. In patients with obesity, adipose tissue releases elevated levels of pro-inflammatory cytokines that can have an autocrine and paracrine function. The main cytokines involved in this process include tumor necrosis factor alpha (TNF-α), interleukin-6, and interleukin-1 beta (IL-1β). These molecules actively contribute to metabolic dysregulation by interfering with insulin signaling pathways and facilitating the infiltration of immune cells into adipose tissue. Thus, a vicious cycle can be established in which inflammation perpetuates metabolic disturbances, increasing the risk of developing cardiovascular disease, type II diabetes mellitus, and other chronic conditions. On the other hand, physical exercise can release myokines with anti-inflammatory properties, such as interleukin-6 and irisin, which can positively modulate immune response. Regular physical activity and healthy eating patterns emerge as essential tools to counteract low-grade inflammation. A diet rich in bioactive compounds, such as antioxidants and polyunsaturated fatty acids, may also regulate cytokine expression, reinforcing the role of nutrition as a therapeutic strategy for obesity management. In conclusion, the role of inflammatory cytokines in obesity is central and managing their activity through non-pharmacological interventions, combining exercise and nutrition, represents a powerful tool to prevent long-term complications. However, more studies are needed to elucidate the exact molecular mechanisms by which nutrition and exercise modulate inflammation in obesity, in order to develop more effective interventions.

Despite the well-acknowledged benefits of physical activity for type 2 diabetes (T2D) prevention, the literature lacks validated models able to predict the long-term benefits of exercise on T2D progression and that could be used to support personalized risk prediction and prevention. To bridge this gap, we developed a novel mathematical model that formalizes the link between exercise and short- and long-termglucose-insulin dynamics to predict the benefits of regular exercise on T2D progression. Specifically, we combine a well-known T2D progression model that describes a fast dynamics of physical activity with a slow dynamics that accounts for the cumulative effects of regular physical activity on pancreatic beta-cell mass and on individual insulin sensitivity, mediated by the integral effect of interleukin-6 produced during exercise. The model was used to estimate the benefits of physical activity in four conditions: (i) regular exercise of varying intensity; (ii) regular exercise following the World Health Organization (WHO) recommendations for chronic disease prevention; (iii) discontinuation of a regular exercise program; and (iv) assessment of the inter-individual variability in a wide range of simulated scenarios. These results are encouraging and can set the basis for future development of decision support tools able to assist patients and clinicians in tailoring preventive lifestyle interventions. Results showed that the model quantitatively captured the dose-response relationship (larger benefits with increasing intensity and/or duration of exercise), it consistently reproduced the benefits of clinical guidelines for diabetes prevention, and it accurately predicted persistent benefits following interruption of physical activity, in line with real-world evidence from the literature.

Introduction Lifestyle management plays a vital role in the care of patients with type 2 diabetes mellitus (T2DM). Empowering individuals through education on lifestyle and behavior can be effectively supported by technology. This study aimed to evaluate the impact of telemedicine services on glycemic control, medication adherence, and insulin resistance among patients with T2DM. Materials and methods This two-arm, double-blinded, randomized controlled trial was conducted at a diabetes clinic in a tertiary care hospital. A total of 200 patients were enrolled and randomly assigned to either the intervention or control group. A total of 100 patients were enrolled in each of the intervention and control arms. The intervention group received weekly interactive voice calls for one year, focusing on medication adherence and lifestyle modifications, including dietary changes and physical activity. Primary outcomes included changes in HbA1c levels, medication compliance, lifestyle behaviors, and insulin resistance. An intention-to-treat analysis was performed, with a p-value of <0.05 considered statistically significant. Results At baseline, the mean HbA1c was 7.3% (±0.25) in the intervention group and 7.1% (±0.17) in the control group. Insulin resistance, measured by Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), was 5.4 (±0.26) and 5.4 (±0.22), respectively. At 12 months, 91 participants were followed up in the intervention group, whereas 82 participants were followed up in the control group. The intervention group showed a significant reduction in HbA1c to 6.7% (±0.21), compared to 7.0% (±0.15) in the control group (p = 0.035). Fasting blood glucose and postprandial blood glucose levels also improved significantly in the intervention group (113 vs. 134 mg/dL, p = 0.046; and 142 vs. 163 mg/dL, p = 0.032, respectively). HOMA-IR was notably lower in the intervention group at 3.4 compared to 4.6 in the control group (p = 0.04). Conclusion Telemedicine interventions, in the form of regular health education and support, significantly improved glycemic control, lifestyle behaviors, and insulin resistance in patients with T2DM. These findings suggest that such an intervention could be further evaluated in community settings to determine its effectiveness in real-world conditions.

Diabetes mellitus (DM) and multiple sclerosis (MS), while affecting metabolic and neurological systems respectively, share convergent immunometabolic pathways. This review synthesizes recent evidence elucidating overlapping mechanisms linking DM and MS, emphasizing metabolic dysfunction and systemic inflammation, with therapeutic potential of lifestyle interventions alongside pharmacotherapy. A comprehensive literature analysis examined shared pathogenesis through recent studies. We propose a novel conceptual framework integrating behavioral drivers, metabolic dysregulation, and central nervous system (CNS) pathological outcomes, demonstrating how DM-related immunometabolic stressors promote MS development. Key findings reveal that diabetic metabolic disturbances, including hyperinsulinemia, insulin resistance, and chronic inflammation, potentiate neurodegenerative processes in MS through shared pathways such as nuclear factor kappa B (NF-κB), NOD-, LRR- and pyrin domain-containing 3 (NLRP3) inflammasome, and blood-brain barrier (BBB) dysfunction. Sedentary behavior, excessive adiposity, and Western dietary patterns emerge as modifiable risk factors promoting pro-inflammatory states. Evidence supports that lifestyle interventions, particularly Mediterranean-style diets and regular physical activity, attenuate inflammation, enhance insulin sensitivity, and preserve neurological function in both diseases. DM and MS are united by shared inflammatory and metabolic mechanisms that accelerate disease progression. Beyond pharmacological management, lifestyle modifications represent clinically impactful, sustainable strategies. Integrating dietary and exercise interventions into standard care models signifies a paradigm shift toward proactive, personalized disease modulation.

Background/Objectives: We evaluated the efficacy of a good lifestyle intervention on the severity of metabolic dysfunction-associated steatotic liver disease (MASLD) in children with Down syndrome (DS). Methods: This retrospective longitudinal study included 31 children with Down syndrome (DS) who were affected by MASLD and attended nutritional counseling based on a nutritional approach (e.g., Mediterranean diet and antioxidant supplements), as well as physical exercise. Clinical parameters, markers of low-grade systemic inflammation, and hepatic steatosis, as assessed by ultrasound, were evaluated at baseline (T0) and after 6 months (T1). Results: Several anthropometric and biochemical parameters, including body mass index, waist circumference, diastolic and systolic blood pressure, aspartate aminotransferase, basal insulin, insulin resistance, pro-inflammatory interleukin-1β, and anti-inflammatory interleukin-10, showed significant improvement after 6 months of a nutritional approach. This study also found a regression of at least one grade of hepatic steatosis in a significant portion of patients, especially in those who received antioxidant supplements. Conclusions: Our study further supports the hypothesis that a healthy lifestyle intervention, based on adherence to the Mediterranean diet, natural supplements with antioxidant properties, and regular physical activity, can be considered a safe therapeutic approach for reducing the risk and severity of MASLD in children with DS.