Search Results (117)

Diabetes mellitus constitutes a significant global public health problem. It is a chronic disease characterized by persistent hyperglycemia, which is a consequence of inadequate insulin secretion, deficient insulin action, or a combination of both factors. A crucial component in the effective management of this pathology is therapeutic adherence, as it helps prevent complications, improve patient quality of life, reduce associated mortality, and decrease the need for hospitalization. In this context, it is crucial to implement a comprehensive care model that offers continuous support and a multidisciplinary approach. Primary care should be central, coordinating the entire care process. Understanding the clinical and social characteristics of people with diabetes is key to guiding more effective interventions. Objective: The objective of this study was to describe the sociodemographic and anthropometric characteristics, degree of metabolic control, and treatment adherence in patients with diabetes mellitus enrolled in primary care programs in Ceuta. Materials and Methods: This was a descriptive, observational, and cross-sectional study conducted during the second half of 2024. The study population included individuals enrolled in the primary care diabetes program in Ceuta. We analyzed sociodemographic variables with a self-administered questionnaire, the level of therapeutic adherence using the MMAS-8 scale, and glycemic control through glycosylated hemoglobin (HbA1c) values. Results: The sample consisted of 370 individuals, with 50.3% being men. The average age was 62.82 years (SD = 13.46). A significant portion of participants, 61.07%, had no formal education or had only received primary education. Additionally, 84.9% of the participants had at least one other associated chronic pathology. Regarding adherence, 36.8% of the patients showed a high level, and for all patients, the mean HbA1c value was 7.5% (SD = 1.55). Furthermore, our analysis revealed statistically significant associations between cultural background and both therapeutic adherence (weak positive correlation: r = 0.213, p ≤ 0.001; multivariate significance: sig: <0.001; Exp(B) = 2.448) and glycemic control (multivariate significance: sig: <0.001; Exp(B) = 2.686). Conclusions: We observed high treatment adherence in the study population, with HbA1c values within the limits recommended by the World Health Organization for older adults. Furthermore, a relationship between cultural background and both treatment adherence and glycemic control was identified. This suggests a need for further research into these and other social determinants, like study level or monthly income, in future studies. Full article

Background: Diabetic cardiomyopathy is a major contributor to cardiovascular morbidity, often progressing silently before overt heart failure. Left atrial (LA) strain, assessed via speckle-tracking echocardiography, could serve as an early indicator of subclinical myocardial dysfunction in patients with type 2 diabetes mellitus (T2DM). Objectives: The objectives of this study were to evaluate LA strain parameters in patients with T2DM versus non-diabetic controls and investigate their association with glycemic control and diabetes duration. Methods: This cross-sectional study, designed according to STROBE reporting guidelines, included 47 participants (25 with T2DM and 22 controls) undergoing comprehensive echocardiographic and biochemical evaluation. LA reservoir (LASr), conduit (LAScd), and booster-pump (LASbp) strain values were measured. Associations with glycosylated hemoglobin (HbA1c) and diabetes duration were assessed via multivariate analysis. ROC curves were used to evaluate predictive performance. Results: Diabetic patients had significantly lower LASr (20.4 ± 7.25% vs. 26.7 ± 8.0%, p = 0.007), LAScd (−10.9 ± 5.4% vs. −15.6 ± 6.5%, p = 0.010), and LASbp (−9.9 ± 4.2% vs. −12.9 ± 5.0%, p = 0.034). LASr and LAScd remained independent predictors in multivariate models. ROC analysis showed good discrimination (AUC: LAScd = 0.78; LASr = 0.73). Conclusions: This study demonstrates that LASr and LAScd are independently associated with type 2 diabetes mellitus and can reliably identify subclinical atrial dysfunction before the onset of structural or symptomatic heart disease. Full article

Background and Aims: Numerous clinical and observational studies have examined the role of vitamin D in glycemic control and metabolic regulation among diabetic patients, but findings remain inconsistent. This meta-analysis aimed to assess the effects of vitamin D supplementation on glycosylated hemoglobin (HbA1c%), HOMA-IR, HOMA-β, LDL cholesterol, total cholesterol, triglycerides, fasting insulin, fasting plasma glucose, C-reactive protein, and the likelihood of reversion to normoglycemia in prediabetic individuals. Methods: A comprehensive search of multiple databases was performed using keywords including “diabetes mellitus,” “type 2 diabetes,” “vitamin D supplementation,” and “VD supplementation.” Twenty studies met the inclusion criteria. Results: Vitamin D supplementation was associated with significant improvements across several parameters, including HOMA-β (SMD = 0.71; 95% CI: 0.63–0.80; p < 0.00001), HDL cholesterol (SMD = 0.07; 95% CI: 0.05–0.09; p < 0.00001), and others (SMD = −0.40; 95% CI: −0.45 to −0.34; p < 0.00001). Conclusions: Vitamin D supplementation appears to provide beneficial effects on glycemic, lipid, and inflammatory markers in patients with diabetes and prediabetes. Specifically, supplementation significantly reduced HbA1c%, HOMA-IR, LDL cholesterol, total cholesterol, triglycerides, fasting insulin, fasting glucose, and C-reactive protein while increasing the rate of normoglycemia among prediabetic individuals. Further research is needed to strengthen the evidence base regarding vitamin D’s role in diabetes management. Full article

Background/Objectives: The objective of this study is to investigate pregnancy and neonatal outcomes in women with pre-gestational diabetes (PGDM) in the Korean population and compare outcomes according to glycosylated hemoglobin (HbA1c) levels in the third trimester. Methods: Singleton pregnant women with PGDM, with follow-up data, and who delivered at 16 Korean tertiary institutions between 2010 and 2023 were included for analysis. Eligible patients were divided into two groups according to HbA1c levels (47.5 mmol/mol, 6.5%) in the third trimester (well-controlled and poorly controlled group). Adverse pregnancy and neonatal outcomes between the two groups were compared. The primary outcome was the composite neonatal adverse outcome and the secondary outcome was pregnancy-related hypertension. Results: In 416 pregnancies, the mean HbA1c in the third trimester was 45 mmol/mol (6.26%). Of these, 296 (71.2%) women were included in the well-controlled group and 120 (28.8%) in the poorly controlled group. Between these, the poorly controlled group showed a significantly higher risk of composite neonatal adverse outcome (57.8% vs. 79.2%, p < 0.001) and pregnancy-related hypertension (14.5% vs. 24.2%, p = 0.022). In multivariate analysis, HbA1c > 6.5% in the third trimester was associated with higher risk of composite neonatal adverse outcome and pregnancy-related hypertension. HbA1c ROC curves for the third trimester that predicted composite neonatal adverse outcomes had an AUC of 0.66; HbA1c of 43.7 mmol/mol (6.15%) had a sensitivity of 52.3% and specificity of 73.5% (p < 0.001). Conclusions: In PGDM, HbA1c > 47.5 mmol/mol (6.5%) in the third trimester was significantly associated with a higher risk of adverse neonatal and pregnancy outcomes and could be a predictive factor for composite neonatal adverse outcomes and pregnancy-related hypertension. Maintenance of HbA1c levels below 43.7 mmol/mol (6.15%) in the third trimester might decrease the risk of adverse neonatal outcomes. Full article

Diabetes mellitus (DM) is a chronic metabolic disorder that can induce systemic and ocular complications. Among the latter, an increase in central corneal thickness (CCT) has been reported, potentially affecting endothelial function and increasing the risk of ocular disease. This study aimed to determine the impact of DM on CCT and to assess its correlation with diabetes duration and glycosylated hemoglobin (HbA1c) levels. A systematic literature search was conducted in Web of Science (1980–2025) following a PICO-based strategy. Observational studies evaluating CCT in diabetic patients were included. Data were analyzed using a random-effects model. Statistical heterogeneity was assessed with χ² test, p values, and I² index. Publication bias was evaluated using Begg’s funnel plot and Egger’s regression test. Twenty-nine studies were included in the meta-analysis. Diabetic patients showed significantly higher CCT values compared to controls, particularly in those with long-standing DM (p < 0.001) and poor glycemic control (HbA1c, p < 0.001). Egger’s regression suggested an association between increasing CCT, disease duration, and HbA1c levels, while funnel plot asymmetry indicated potential publication bias. CCT appears to increase in patients with long-term DM and inadequate glycemic control. These findings highlight the relevance of CCT assessment as a potential indicator of corneal changes in diabetic patients. Full article

Metabolic syndrome refers to a group of conditions that commonly occur together, including abdominal obesity, high blood pressure, elevated blood sugar, high triglyceride levels, and low high-density lipoprotein cholesterol (HDL). These factors collectively increase the risk of cardiovascular disease, diabetes, and cognitive impairment. Recent research has identified a connection between metabolic syndrome and cognitive disorders such as mild cognitive impairment and vascular dementia (VaD). Mulberry (Morus alba L.) is a natural source of bioactive compounds with antioxidant, anti-inflammatory, and lipid-regulating properties. This meta-analysis assessed the potential of mulberry extract as an adjunctive treatment for metabolic risk factors linked to vascular dementia. We systematically reviewed randomized controlled trials (RCTs) published up to May 2025 that compared mulberry extract to placebo or standard care in adults with metabolic disorders. Fifteen trials including 1202 participants met the inclusion criteria. The primary outcomes were fasting glucose, fasting insulin, liver enzyme levels, lipid profiles, and inflammatory markers such as tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP). The pooled results indicated that mulberry supplementation improved blood sugar control and lowered total cholesterol, low-density lipoprotein cholesterol (LDL), triglycerides, fasting blood glucose, glycosylated hemoglobin (HbA1c), homeostasis model assessment for insulin resistance (HOMA-IR), and inflammatory markers. Aspartate aminotransferase (AST) improved, whereas alanine aminotransferase (ALT) showed no significant change. Subgroup analyses revealed that greater benefits were associated with shorter treatment durations and doses below 500 milligrams per day. Furthermore, extracts from different parts of the mulberry plant showed varying effects on lipid and glucose metabolism. None of the included trials directly measured cognitive or neurovascular outcomes, so any potential neurovascular protection is inferred from changes in metabolic and inflammatory markers rather than demonstrated. In summary, these findings suggest that mulberry extract may be a promising complementary approach for managing metabolic risk factors in people at risk for VaD. However, further large-scale and rigorously designed studies are required to confirm its clinical benefits and to identify the most effective preparations. Full article

Background and Objectives: Type 2 diabetes (T2DM) substantially increases cardiovascular risk; beyond the well-recognized left-ventricular involvement in diabetic cardiomyopathy, emerging data indicate subclinical right-ventricular (RV) dysfunction may also be present. This study aimed to evaluate whether speckle-tracking echocardiography identifies subclinical right-ventricular systolic dysfunction in type 2 diabetes, despite normal conventional indices and preserved global systolic function. Materials and Methods: We conducted a cross-sectional, single-center study in accordance with STROBE recommendations, enrolling 77 participants, 36 adults with T2DM, and 41 non-diabetic controls, between December 2024 and July 2025. All participants underwent comprehensive transthoracic echocardiography, including conventional parameters (tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (TV S’), right ventricular fractional area change (RVFAC)) and deformation imaging (right ventricular global longitudinal strain (RV GLS), right ventricular free wall longitudinal strain (RVFWS)) using speckle-tracking echocardiography. Biochemical and clinical data, including glycosylated hemoglobin (HbA1c), were recorded. Correlation and ROC curve analyses were performed to explore associations and predictive value. Results: The mean age was comparable between the two groups (62.08 ± 9.54 years vs. 60.22 ± 13.39 years; p = 0.480). While conventional RV parameters did not differ significantly between groups, diabetic patients had significantly lower RV GLS (−13.86 ± 6.07% vs. −18.59 ± 2.27%, p < 0.001) and RVFWS (−15.64 ± 4.30% vs. −19.03 ± 3.53%, p < 0.001). HbA1c levels correlated positively with RV strain impairment (RVFWS r = 0.41, p < 0.001). Both RV GLS and RVFWS were independent predictors of RV dysfunction in logistic regression analysis. ROC analysis showed good diagnostic performance for RV GLS, AUC = 0.84 with an optimal cut-off −17.2% (sensitivity 86.1% and specificity 80.5%) and RVFWS, AUC = 0.76 with cut-off −17.6% (sensitivity 77.8; specificity 80.5%) in identifying early myocardial involvement. Conclusions: RV systolic dysfunction may occur early in T2DM, even when traditional echocardiographic indices remain within normal limits. Speckle-tracking echocardiography, particularly RV GLS and RVFWS, offers sensitive detection of subclinical myocardial impairment, reinforcing its value in early cardiovascular risk stratification among diabetic patients. Full article

Type 2 diabetes mellitus (T2DM) and metabolic syndrome (MS) are chronic disorders characterized by hyperglycemia. Sechium edule (S. edule) has emerged as a complementary option due to its bioactive compounds. A systematic review of preclinical and clinical studies was carried out until 25 May 2025 in the databases PubMed, Scopus, Web of Science, SciELO, and TESIUNAM. The keywords were “diabetes mellitus”, “Sechium edule”, “Squash”, “Chayote”, “hypoglycemic effect”, and “Older adults”. A total of 110 articles were found; 11 met eligibility criteria (six clinical trials and five preclinical trials). Three clinical trials met the requirements for meta-analysis. The mean difference (MD) was calculated, and data were analyzed using RevMan 5.4 software. The meta-analysis showed a statistically significant decrease in serum glucose after three months (MD = −20.56, 95% CI −29.35 to −11.77, p < 0.0001) and six months after intervention (MD = −12.96, 95% CI = −21.90 to −4.02, p = 0.004). Likewise, there was a significant decrease in glycosylated hemoglobin (HbA1c) after three months (MD = −1.12, 95% CI = −1.45, −0.78, p < 0.0001) and after six months of intervention (MD = −0.92, 95% CI = −1.13, −0.25, p = 0.002). Our findings showed that S. edule intake has a statistically significant hypoglycemic effect in older adults with T2DM or MS by decreasing serum glucose and HbA1c levels. However, the magnitude of the decrease is clinically modest, so it cannot be a substitute for pharmacological treatment. For this reason, the intake of S. edule can only be considered as a complement to pharmacological treatment. Full article

Background/Objectives: After diagnosis, it is common for women with breast cancer to gain weight, which is associated with worse clinical outcomes. However, traditional measures such as body weight, BMI, and waist circumference do not detect key changes in body composition, such as fat redistribution or muscle loss. The objective of this exploratory study was to assess the evolution of body composition and muscle strength after one year of treatment, and their relationship with metabolic biomarkers. Methods: Prospective observational study in newly diagnosed breast cancer patients. Body composition was assessed using bioelectrical impedance analysis (BIA) and ultrasound (US); muscle strength was measured by handgrip dynamometry. Biomarkers analyzed included glucose, insulin, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), glycosylated hemoglobin (HbA1c), total cholesterol (and its fractions), triglycerides, C-reactive protein (CRP), 6-interleukin (IL-6), vitamin D, myostatin, and fibroblast growth factor 21 (FGF-21). Results: Sixty-one women (mean age 58 years) were included. After one year, fat mass and related parameters significantly increased, while skeletal muscle mass and muscle strength decreased. Sarcopenic obesity prevalence rose from 1.16% to 4.9%. No significant changes were found in biomarkers, but positive correlations were observed between fat parameters and insulin, HOMA-IR, and triglycerides, and negative correlations with HDL-cholesterol. Conclusions: BIA and US can detect unfavorable changes in body composition that are not reflected in conventional measurements. At one year post-diagnosis, women showed increased fat accumulation, muscle loss, and reduced strength, even without significant metabolic biomarker changes. Further research is warranted to elucidate the long-term clinical implications of these findings and the external validity in larger cohorts. Full article

Background: Type 2 diabetes (T2D) and overweight or obesity are strongly associated, with a high prevalence of these concomitant conditions contributing significantly to global healthcare costs. Given this burden, there is an urgent need for effective interventions. Mobile health (mHealth) technologies represent a promising strategy to address both conditions simultaneously. Objectives: This systematic review and meta-analysis aimed to evaluate the effectiveness of mHealth-based interventions for the management of adults with T2D and overweight/obesity. Specifically, it assessed the quantitative impact of these interventions on glycosylated hemoglobin (HbA1c), body weight, triglycerides, total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels. Methods: A systematic search was conducted in PubMed, Web of Science, and Scopus databases from inception to 9 July 2025. The inclusion criteria focused on randomized controlled trials (RCTs) using mHealth interventions in adults with T2D and overweight/obesity, reporting HbA1c or weight as primary or secondary outcomes. The risk of bias was assessed using the Cochrane Risk of Bias tool 2. A total of 13 RCTs met the inclusion criteria. Results: Meta-analysis indicated significant improvements after 6–12 months of intervention in HbA1c (MD −0.23; 95% CI −0.36 to −0.10; p < 0.001; I² = 72%), body weight (MD −2.47 kg; 95% CI −3.69 to −1.24; p < 0.001; I² = 79%), total cholesterol (MD −0.23; 95% CI −0.39 to −0.07; p = 0.004; I² = 0%), and LDL (MD −0.27; 95% CI −0.42 to −0.12; p < 0.001; I² = 0%). Conclusions: mHealth interventions are effective and scalable for managing T2D and obesity, particularly when incorporating wearable technologies to improve adherence. Future research should focus on optimizing personalization, engagement strategies, and long-term implementation. Full article

Background/Objectives: Diabetes mellitus is associated with significant health complications, including challenges in periodontal health. Gingival inflammation is especially common among diabetic patients and can significantly impact overall diabetes management. This study aims to investigate the correlation between glycosylated hemoglobin (HbA1c) levels, an established marker of glycemic control, and gingival inflammation using the Quantitative Gingival Bleeding Index (QGBI) among hospitalized diabetic patients, thereby placing the question within a broader clinical context. Methods: The study enrolled 671 hospitalized patients with diabetes complications at “Mother Theresa University Hospital” in Tirana, AL, USA. Glycemic control was assessed through glycosylated hemoglobin (HbA1c) levels, and gingival health was evaluated using the Quantitative Gingival Bleeding Index (QGBI). Behavioral variables were also documented, including smoking habits and routine oral care practices. Spearman’s correlation coefficient (r_s) was applied to determine the relationship between HbA1c levels and QGBI scores. Results: Our findings revealed a strong positive correlation between glycemic control (HbA1c) and gingival inflammation (QGBI) among the participants (Spearman’s coefficient r_s = 0.868, p < 0.001). Additionally, significant positive associations were observed between behavioral factors, such as smoking habits and regular oral care practices, further underscoring their role in periodontal health in diabetic patients. Conclusions: The study highlights a significant positive relationship between poor glycemic control and increased gingival inflammation, emphasizing the importance of periodontal health in the comprehensive management of diabetes mellitus. Our results support integrating periodontal evaluation and management into standard diabetes care, which could improve patient outcomes and overall well-being. Full article

Background: SGLT2 inhibitors (SGLT-2i) and GLP1 receptor agonists (GLP-1 RA) are recommended as the first line therapy for the management of type 2 diabetes mellitus (T2DM), particularly in patients with chronic kidney disease (CKD), cardiovascular disease (CVD), and heart failure (HF). Despite their established efficacy, there is limited evidence available to predict which subset of patients will respond favorably to them. We conducted this study to identify baseline characteristics to predict the response to therapy with SGLT-2i and GLP-1 RA. Methods: A retrospective analysis of the medical records was conducted at the Veteran Affairs Medical Center (VAMC) in Omaha, Nebraska, USA. Veterans who had completed 6–12 months of treatment with SGLT-2i or GLP-1 RA were included. Favorable treatment outcomes were a ≥0.5% reduction in glycosylated hemoglobin (HbA1c) or a ≥5% reduction in body weight; and those who achieved both outcomes were classified as adequate responders. Results: Patients in the GLP-1 RA group had 2.11 (95% CI: 1.45, 3.07) times the odds of achieving an adequate response as compared to patients in the SGLT-2i group in the unadjusted analysis, p < 0.001. HbA1c > 8% and older age was significantly associated with achieving an adequate response. Conclusions: Treatment with GLP-1 RA should be considered in Veterans with these characteristics. Full article

Background/Aims: Diabetes mellitus is a major cause of atherosclerotic cardiovascular disease (ASCVD). We examined a large population and tested the efficacy of a voluntary lifestyle program in prediabetic and diabetic subjects. Methods: Of 133,764 subjects, 56.3% were healthy, 36.2% were prediabetic, and 7.5% were diabetic. Fasting serum measurements of glucose, insulin, adiponectin, glycosylated hemoglobin (HbA1c), high-sensitivity C-reactive protein (hs-CRP), glycated serum protein (GSP), fibrinogen, myeloperoxidase (MPO), lipoprotein-associated phospholipase A₂ (LpPLA₂), as well as standard lipids, direct low-density lipoprotein cholesterol (LDL-C), and small dense LDL-C (sdLDL-C) were performed using standard automated assays. Follow-up sampling at 6–12 months occurred in 20.1% of the prediabetic and 22.2% of the diabetic subjects; of these, 12.2% of the prediabetic and 9.7% of the diabetic subjects participated in a voluntary, real-world, digital dietitian-directed lifestyle-modification program with a 10-year diabetes risk being calculated using a biochemical model (Framingham). Results: Prediabetic and diabetic subjects had significantly elevated triglycerides, sdLDL-C, and hs-CRP and decreased HDL-C. They were insulin resistant as compared to healthy subjects, but only diabetics had significant reductions in insulin production. Lifestyle modification significantly reduced diabetes risk by 45.6% in prediabetics and significantly increased (2.4-fold) the percentage of diabetics that were in remission at follow-up (8.2% versus 3.4%) with increased weight loss (6.5 versus 2.0 pounds). Lifestyle intervention resulted in significant favorable effects on many metabolic markers. Conclusions: The measurement of fasting glucose and insulin is essential for the detection of decreased insulin production in diabetics. A digital lifestyle program can have favorable effects on ASCVD risk factors and diabetic status. Full article

Background: Diabetic kidney disease (DKD), a severe chronic complication of diabetes, significantly impacts the quality of life and life expectancy of affected individuals. Meanwhile, advanced glycation end products (AGEs) are believed to play a central role in the pathogenesis of DKD. Skin autofluorescence (SAF) is a well-validated, noninvasive technique for the estimation of AGE levels in the dermis. Aims: This study aims to evaluate the correlation between SAF and DKD prevalence, as well as the association between SAF and renal function parameters, in patients with Type 2 Diabetes Mellitus (T2DM). Methods: This cross-sectional analysis included 1259 hospitalized T2DM patients. SAF was measured using a spectroscopy device. Logistic regression analysis, p-trend analysis, and restricted cubic spline were performed with the prevalence of DKD as the dependent variable. Multiple linear regression analyses were conducted to investigate the associations of SAF with renal function parameters, specifically the estimated glomerular filtration rate (eGFR) and the log-transformed albumin-to-creatinine ratio (ln(ACR)). Results: The prevalence of DKD was strongly associated with SAF rather than with glycosylated hemoglobin (HbA1c). For each arbitrary unit (AU) increase in SAF, DKD incidence rose by 1.6%. A significant stepwise increase in the odds ratio (OR) of DKD was observed across SAF quartiles. A dose-response relationship existed between SAF and the OR value of DKD. Additionally, SAF showed a linear correlation with eGFR and ln(UACR). For each AU increase in SAF, eGFR decreased by 0.14 mL/min/1.73 m², while UACR increased by 1.2%. Conclusions: Elevated SAF, rather than HbA1c, is independently associated with increased DKD prevalence and impaired renal function. Full article

Background/Objectives: No previous study has provided a comprehensive evaluation of all biventricular and biatrial myocardial strain parameters in women with previous gestational diabetes mellitus (pGDM). Accordingly, we aimed at investigating the structural and myocardial deformation properties of all cardiac chambers in a cohort of pGDM women at 4 years postpartum. Methods: A consecutive cohort of pGDM women was compared to a control group of healthy women with previous uncomplicated pregnancy, matched by age, ethnicity and gestational week, at 4 years postpartum. Both groups of women underwent transthoracic echocardiography (TTE) implemented with speckle-tracking echocardiography (STE) and subsequent carotid ultrasonography. The primary endpoint was subclinical myocardial dysfunction, defined as left-ventricular (LV) global longitudinal strain (GLS) < 20%, whereas the secondary endpoint was early carotid atherosclerosis, defined as common carotid artery (CCA) intima-media thickness (IMT) ≥ 0.7 mm. Results: A total of 32 pGDM women (39.1 ± 6.5 yrs) and 30 matched healthy controls (40.8 ± 5.0 yrs) were analyzed. Despite normal and similar systolic function on conventional TTE, all biventricular and biatrial strain parameters were significantly lower in pGDM women than controls. Mean follow-up period was 4.0 ± 1.9 yrs. During follow-up, 62.5% of pGDM women developed subclinical myocardial dysfunction, and 78.1% of them were diagnosed with early carotid atherosclerosis. Third-trimester BMI (OR 1.88, 95% CI 1.19–2.98) and third-trimester glycosylated hemoglobin (HbA1C) (OR 2.34, 95% CI 1.08–5.04) were independently associated with the primary endpoint. Third-trimester BMI and HbA1C also independently predicted the secondary endpoint. Third-trimester BMI > 27 kg/m² and HbA1C > 33 mmol/mol showed the best sensitivity and specificity for predicting both endpoints. Conclusions: Women with a previous history of GDM complicated by overweight/obesity and uncontrolled diabetes have a significantly increased risk of subclinical myocardial dysfunction and early carotid atherosclerosis at 4 years postpartum. Full article