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New Insights into the Treatment of Metabolic Syndrome and Diabetes

A special issue of International Journal of Molecular Sciences (ISSN 1422-0067). This special issue belongs to the section "Molecular Pathology, Diagnostics, and Therapeutics".

Deadline for manuscript submissions: 20 January 2026 | Viewed by 6799

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Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
Interests: plant environment interactions; epigenomics; stress memory; medicinal plants; nutraceuticals and pharmaceuticals
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Special Issue Information

Dear Colleagues,

Metabolic dysfunction, also known as metabolic disorder, is the condition characterized by altered ability to metabolize and distribute various nutrients. It is frequently a consequence of high caloric intake and consumption of a diet with high sugar/high fat. Metabolic dysfunction often leads to obesity and contributes to the development of type 2 diabetes (T2D) as well as to hypertension, hypercholesterolemia, and metabolic dysfunction-associated steatotic liver disease (MASLD). Recent studies show that over 300 million people are affected by these diseases. While genetic predisposition to the development of these conditions is evident, the environment, in the form of poor diet choices, lack of exercise, and chronic stress, greatly contributes to these conditions. Treatment of such conditions should start with the changes in lifestyle and an increase in physical activity. Despite that, the drugs are often a treatment of choice because such an approach does not require major efforts from patients. Drugs like statins, controlling the production of cholesterol; metformin, lowering gluconeogenesis by the liver; semaglutide, dulaglutide, and tripeptide, all GLP-1 receptor agonists, are commonly prescribed for T2D and weight loss.

At the same time, there are many other potential molecular targets that can be acted upon to control T2D and metabolic syndrome, including improvement of health and prevention of dedifferentiation and apoptosis in beta cells. Many naturally derived compounds, including complex extracts from plants and fungi, are known to effectively control blood sugar, cholesterol, and metabolic dysfunction.

The aim of this Special Issue is to cover various pharmacological ways of coping with T2D and metabolic syndrome by targeting alternative molecular pathways. Of special interest would be research describing plant- and fungi-derived extracts effective in T2D and metabolic syndrome, with descriptions of molecular targets. We are also interested in papers describing synergistic effects of commonly used drugs and novel treatments of TD2 and metabolic syndrome. Finally, papers describing the role of genetic and epigenetic factors in the development and treatment of metabolic syndrome are also encouraged.

Prof. Dr. Igor Kovalchuk
Guest Editor

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Keywords

  • metabolic dysfunction
  • metabolic disorder
  • diabetes

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Published Papers (5 papers)

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Research

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11 pages, 245 KB  
Article
The Impact of Ketogenic Capacity on Lipid Profile in Individuals with Prediabetes or Newly Diagnosed Type 2 Diabetes
by Jaehyun Bae, Minyoung Lee, Yong-ho Lee, Sang-Guk Lee and Byung-Wan Lee
Int. J. Mol. Sci. 2025, 26(17), 8566; https://doi.org/10.3390/ijms26178566 - 3 Sep 2025
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Abstract
In individuals with non-adipogenic traits and enhanced ketogenic capacity, plasma triglyceride (TG) levels are typically low, while low-density lipoprotein cholesterol (LDL-C) levels often exceed the normal range, complicating cardiovascular risk assessment. We analyzed lipid profiles to better characterize cardiovascular risk in this population. [...] Read more.
In individuals with non-adipogenic traits and enhanced ketogenic capacity, plasma triglyceride (TG) levels are typically low, while low-density lipoprotein cholesterol (LDL-C) levels often exceed the normal range, complicating cardiovascular risk assessment. We analyzed lipid profiles to better characterize cardiovascular risk in this population. Drug-naïve patients newly diagnosed with prediabetes or type 2 diabetes (T2D) were divided into two groups based on serum β-hydroxybutyrate levels: enhanced versus non-enhanced ketogenesis. Among those with enhanced ketogenesis, 27 individuals with high LDL-C (≥100 mg/dL) and low TG (<150 mg/dL) were selected. For comparison, 27 individuals with high TG (>150 mg/dL) from the non-enhanced group were included. The enhanced ketogenesis group demonstrated more favorable lipid characteristics, including a significantly larger average LDL particle size (26.8 ± 0.3 nm vs. 25.9 ± 0.6 nm, p < 0.001), a lower proportion of small dense LDL particles, and reduced oxidized LDL to LDL-C ratio. Importantly, enhanced ketogenesis remained an independent predictor of larger LDL particle size after adjusting for potential confounders including TG. Despite the potential of selection bias intentionally induced by the predefined inclusion criteria, our findings suggest that patients with T2D or prediabetes who exhibit enhanced ketogenesis, even in the presence of elevated LDL-C levels, may have a more favorable atherogenic profile and are not necessarily at increased cardiovascular risk. Full article
(This article belongs to the Special Issue New Insights into the Treatment of Metabolic Syndrome and Diabetes)
10 pages, 825 KB  
Article
Circulating ORM2 as a Biomarker of Metabolic Dysfunction: Evidence from the KADEM Study in Kuwaiti Adults
by Mohamed Abu-Farha, Ahmed N. Albatineh, Bader Alawadh, Loulwa Alsalem, Irina Al-Khairi, Preethi Cherian, Fahad Al-Ajmi, Mohammad Qaddoumi, Muhammad Abdul-Ghani, Fahd Al-Mulla and Jehad Abubaker
Int. J. Mol. Sci. 2025, 26(17), 8326; https://doi.org/10.3390/ijms26178326 - 27 Aug 2025
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Abstract
Metabolic dysfunction-associated fatty liver disease (MAFLD) and type 2 diabetes mellitus (T2DM) share overlapping pathophysiological mechanisms, including insulin resistance and chronic inflammation. Recent evidence suggests that Orosomucoid-2 (ORM2), an acute-phase immunomodulatory protein, may play a role in metabolic regulation; however, its specific involvement [...] Read more.
Metabolic dysfunction-associated fatty liver disease (MAFLD) and type 2 diabetes mellitus (T2DM) share overlapping pathophysiological mechanisms, including insulin resistance and chronic inflammation. Recent evidence suggests that Orosomucoid-2 (ORM2), an acute-phase immunomodulatory protein, may play a role in metabolic regulation; however, its specific involvement in MAFLD remains unclear. This study examined the association between circulating ORM2 levels and the severity of hepatic steatosis, insulin resistance, and T2DM in a cohort of 449 adults. MAFLD was assessed using FibroScan® with hepatic steatosis categorized by Controlled Attenuation Parameter (CAP) scores, while plasma ORM2 levels were measured via ELISA. Statistical analyses using Spearman correlation and multiple logistic regression revealed that elevated ORM2 levels were significantly correlated with greater hepatic steatosis, insulin resistance, triglycerides, ALT, and hip circumference (p < 0.001). Individuals with severe steatosis (CAP > 290 dB/m) had markedly higher ORM2 levels (312.3 ng/mL) compared to those with normal CAP scores (210.4 ng/mL; p < 0.001). ORM2 was identified as an independent predictor of steatosis severity and after adjusting for several metabolic variables (AOR = 1.005; 95% CI: 1.002–1.007). ROC analysis incorporating ORM2 and metabolic variables demonstrated strong predictive capability for MAFLD (AUC = 0.864, 95% CI: 0.825–0.902). These findings support ORM2 as a promising non-invasive diagnosis for MAFLD, involving only blood sampling without direct invasion of the liver and associated metabolic dysfunction. Full article
(This article belongs to the Special Issue New Insights into the Treatment of Metabolic Syndrome and Diabetes)
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Review

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16 pages, 848 KB  
Review
Current Data on the Role of Amino Acids in the Management of Obesity in Children and Adolescents
by Diana Zamosteanu, Nina Filip, Laura Mihaela Trandafir, Elena Ţarcă, Mihaela Pertea, Gabriela Bordeianu, Jana Bernic, Anne Marie Heredea and Elena Cojocaru
Int. J. Mol. Sci. 2025, 26(15), 7129; https://doi.org/10.3390/ijms26157129 - 24 Jul 2025
Viewed by 2649
Abstract
Childhood obesity is a major global health problem, and its management involves a multidisciplinary approach that includes lifestyle changes, dietary interventions, and the use of dietary supplements. In this review, we summarize current findings on the role of amino acids in pediatric obesity, [...] Read more.
Childhood obesity is a major global health problem, and its management involves a multidisciplinary approach that includes lifestyle changes, dietary interventions, and the use of dietary supplements. In this review, we summarize current findings on the role of amino acids in pediatric obesity, with a particular focus on their involvement in metabolic pathways and weight regulation. The involvement of branched-chain and aromatic amino acids in the pathophysiology and potential management of pediatric obesity is highlighted in recent studies. Both experimental and clinical studies have shown that obese children often exhibit altered plasma amino acid profiles, including increased levels of leucine, isoleucine, valine, phenylalanine, and tyrosine, as well as decreased levels of glycine and serine. These imbalances are correlated with insulin resistance, inflammation, and early metabolic dysfunction. One of the mechanisms through which branched-chain amino acids can promote insulin resistance is the activation of the mammalian target of rapamycin (mTOR) signaling pathway. Metabolomic profiling has demonstrated the potential of specific amino acid patterns to predict obesity-related complications before they become clinically evident. Early identification of these biomarkers could be of great help for individualized interventions. Although clinical studies indicate that changes in dietary amino acids could lead to modest weight loss, improved metabolic profiles, and increased satiety, further studies are needed to establish standardized recommendations. Full article
(This article belongs to the Special Issue New Insights into the Treatment of Metabolic Syndrome and Diabetes)
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34 pages, 2372 KB  
Review
SGLT2 Inhibitors: From Structure–Effect Relationship to Pharmacological Response
by Teodora Mateoc, Andrei-Luca Dumitrascu, Corina Flangea, Daniela Puscasiu, Tania Vlad, Roxana Popescu, Cristina Marina and Daliborca-Cristina Vlad
Int. J. Mol. Sci. 2025, 26(14), 6937; https://doi.org/10.3390/ijms26146937 - 19 Jul 2025
Viewed by 2041
Abstract
SGLT2 inhibitors have become increasingly used due to their effectiveness in improving not only type 2 diabetes but also cardiovascular, renal and hepatic diseases, as well as the obesity found in metabolic syndrome. Starting from the structure of gliflozins, modifications of the carbohydrate [...] Read more.
SGLT2 inhibitors have become increasingly used due to their effectiveness in improving not only type 2 diabetes but also cardiovascular, renal and hepatic diseases, as well as the obesity found in metabolic syndrome. Starting from the structure of gliflozins, modifications of the carbohydrate part, aglycone, and also the glycosidic bond between them can determine variations in pharmacokinetic and pharmacodynamic properties. SGLT2 inhibitors, in addition to reducing blood glucose levels, improve alterations in lipid metabolism by diverting excessively accumulated lipids in tissues towards mobilization, lipolysis, β-oxidation, ketogenesis and the utilization of ketone bodies. This enhances anti-inflammatory properties by decreasing the levels of some proinflammatory mediators and by modulating some cell signaling pathways. Thus, in this review, the intimate mechanisms by which SGLT2 inhibitors achieve these therapeutic effects in the various conditions belonging to metabolic syndrome and beyond were described, along with the structure–effect relationship with some specific features of each gliflozin. Starting from these findings, further modeling of these molecules may lead to the creation of new therapeutic uses. Further research is needed to broaden the range of indications and also eliminate adverse effects, such as phenomena leading to lower limb amputations. Full article
(This article belongs to the Special Issue New Insights into the Treatment of Metabolic Syndrome and Diabetes)
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Other

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10 pages, 1057 KB  
Brief Report
Effects of Combined Therapy with SGLT2i and GLP-1RAs on Atrial Fibrillation Recurrence After Catheter Ablation in Diabetic Cohorts: One-Year Outcomes from Continuous Monitoring
by Celestino Sardu and Raffaele Marfella
Int. J. Mol. Sci. 2025, 26(19), 9285; https://doi.org/10.3390/ijms26199285 - 23 Sep 2025
Viewed by 91
Abstract
To evaluate the effect of sodium–glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RAs), and their combination on atrial fibrillation (AF) recurrence after catheter ablation in patients with type 2 diabetes mellitus (T2DM). In a prospective cohort study, patients with T2DM undergoing AF [...] Read more.
To evaluate the effect of sodium–glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RAs), and their combination on atrial fibrillation (AF) recurrence after catheter ablation in patients with type 2 diabetes mellitus (T2DM). In a prospective cohort study, patients with T2DM undergoing AF ablation were stratified into three groups: SGLT2i-users, GLP-1RAs-users, and combined SGLT2i/GLP-1RAs users. Diabetics under SGLT2i/GLP-1RAs therapy had worse glycemic control (HbA1c > 7%). AF recurrence was assessed over 12 months using implantable continuous monitoring (ICM). Secondary outcomes included the inflammatory/oxidative stress markers measured at the 12-month follow-up. At the follow-up end, patients treated with SGLT2i/GLP-1RAs versus monotherapy patients showed significantly lower AF recurrence and serum inflammatory/oxidative stress markers, despite having higher HbA1c levels (p < 0.05). Combined SGLT2i/GLP-1RAs therapy reduced AF recurrence following catheter ablation and inflammatory/oxidative stress in T2DM patients. Full article
(This article belongs to the Special Issue New Insights into the Treatment of Metabolic Syndrome and Diabetes)
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