Current Issue
Volume 3, Issue 2 - 2026 (July - December 2026 )
Issue Details:
Volume 3 Issue 2 (July - December 2026)Issue Description:
Welcome to the 2026 issue of Advances in Obesity, Endocrinology, and Diabetes. This issue showcases the remarkable breadth and depth of contemporary research across multiple disciplines. From cutting-edge applications of machine learning in climate science to the revolutionary potential of quantum computing in drug discovery, our featured articles demonstrate the power of interdisciplinary collaboration in addressing global challenges.
We are particularly excited to present research that bridges traditional academic boundaries, reflecting our journal's commitment to fostering innovation through cross-disciplinary dialogue. The integration of artificial intelligence with environmental science, the application of blockchain technology to supply chain management, and the convergence of urban planning with smart city technologies exemplify the transformative potential of collaborative research.
As we continue to navigate an era of rapid technological advancement and global challenges, the research presented in this issue offers both insights and solutions that will shape our future. We thank our authors, reviewers, and editorial board members for their continued dedication to advancing knowledge and promoting scientific excellence.
Dr Lakshmi Nagendra
Editor-in-Chief
Advances in Obesity, Endocrinology, and Diabetes
Articles in This Issue
Genotype phenotype correlation of a homozygous DDX11 variant of uncertain significance in a 21-year-old Sudanese woman with a Warsaw Breakage Syndrome phenotype
Warsaw Breakage Syndrome (WABS) is a rare autosomal recessive chromosome instability disorder caused by biallelic pathogenic variants in DDX11 [1]. It is characterised by growth restriction, microcephaly, intellectual disability and sensorineural hearing loss [1,4,5]. We report a 21-year-old Sudanese woman with severe proportionate short stature, microcephaly, intellectual disability, hearing loss and pigmentary skin changes. Genetic testing identified a homozygous DDX11 missense variant (c.707A>G; p.His236Arg), classified as a variant of uncertain significance (VUS). Despite uncertain classification, the phenotype is highly suggestive of WABS. This case highlights the importance of clinical correlation in interpreting VUS findings in rare cohesinopathies [5,8].
Contributors:
SGLT2 Inhibitor-Associated Erythrocytosis in Patients with Type 2 Diabetes Mellitus: A Three-Patient Case Series and practical approach to evaluation and management.
Background Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have become a cornerstone in the management of type 2 diabetes mellitus (T2DM) because of their established cardiovascular and renal benefits. In addition to improving glycemic control, these agents are associated with increases in hemoglobin and hematocrit levels. While mild hematological changes are commonly observed, clinically significant erythrocytosis remains underrecognized and may prompt investigation for myeloproliferative or secondary causes.(1-2 ) Case Presentations We describe three male patients with T2DM who developed erythrocytosis while receiving dapagliflozin or empagliflozin. All patients were overweight active smokers and demonstrated elevated hemoglobin and hematocrit levels, preserved renal function, normal oxygen saturation, elevated or upper-normal erythropoietin concentrations, and negative JAK2 mutation testing. No patient demonstrated splenomegaly, hyperviscosity symptoms, or thrombotic complications. One patient developed erythrocytosis within six months of dapagliflozin initiation, whereas two patients developed erythrocytosis during long-term SGLT2 inhibitor therapy. Dose reduction in the latter two cases resulted in stabilization or reduction of hemoglobin levels without treatment discontinuation. Conclusion SGLT2 inhibitor-associated erythrocytosis is an increasingly recognized clinical entity that may mimic primary or secondary hematologic disorders. Careful evaluation and individualized management may allow continuation of therapy while preserving its established cardiometabolic benefits.
Contributors:
GLP-1 receptor agonists and the immune microbiome infection axis: a narrative review
Background: Obesity and type 2 diabetes mellitus (T2DM) are associated with chronic inflammation, immune dysfunction, and as a result increased risk of infections. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as key therapeutic agents with potential pleiotropic effects beyond glycemic control. Objective: This narrative review summarizes current evidence on the role of GLP-1 receptor agonists in modulating the immune–microbiome–infection axis and their potential impact on infection risk. Methods: A narrative review of recent experimental, clinical, and meta-analytic studies was performed focusing on immune regulation, inflammatory biomarkers, gut microbiota, and infectious outcomes. Results: GLP-1 RAs are associated with reduced systemic inflammation and oxidative stress, along with immunomodulatory effects including macrophage polarization and cytokine regulation. Emerging evidence suggests beneficial modulation of gut microbiota composition and improved intestinal barrier function. Studies have shown a reduction in infections, especially respiratory and systemic infections. Conclusion: GLP-1 receptor agonists may act as immunometabolic modulators linking metabolic health with immune and microbial homeostasis. Further mechanistic studies are required to clarify their role in infection susceptibility.
Contributors:
Editorial: Enhanced External Counterpulsation (EECP) Therapy: An Underutilized tool in diabetic patients
An underutilized tool in the cardiovascular armamentarium, for Cardiologists and Endocrinologists in particular to be aware of, is Enhanced External Counterpulsation (EECP) Therapy. EECP is recognized as a valuable therapeutic option for patients with Coronary Artery Disease and Diabetes Mellitus. The mechanism by which this technique exerts favorable results may also offer the "over-30" generation a viable option for the prevention and treatment of endothelial dysfunction, particularly in early insulin resistance, thereby helping diminish vascular aging. EECP may also improve athletic performance and can serve as a valuable component of cardiovascular fitness programs for competitive sports teams and individual athletes. Developed at Harvard in the early 1950s to enhance the development of coronary collateral circulation, EECP has since been shown in multiple clinical trials to provide benefits not only to patients with vascular disease but also to healthy individuals, including athletes, particularly in exercise recovery.
Contributors:
Effect of Ceylon Cinnamon on Anthropometric Parameters and Insulin Resistance Profile in Women with Polycystic Ovary Syndrome: A Pilot Study and Literature Review
Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder frequently associated with insulin resistance, obesity, and increased cardiometabolic risk. Ceylon cinnamon (Cinnamomum verum) has demonstrated insulin-sensitizing, antioxidant, and anti-inflammatory properties that may improve metabolic outcomes in women with PCOS. Objective: To evaluate the effects of Ceylon cinnamon supplementation on anthropometric parameters and insulin resistance in Tunisian women with PCOS. Methods: A prospective interventional pilot study was conducted in the Endocrinology Department of the National Institute of Nutrition and Food Technology (INNTA). Women diagnosed with PCOS according to the Rotterdam 2003 criteria received Ceylon cinnamon capsules (500 mg three times daily; total 1500 mg/day) for eight weeks without changes in diet or physical activity. Anthropometric measurements, body composition, fasting glucose, fasting insulin, and the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) were assessed at baseline and after intervention. Results: Fifteen women were enrolled, and thirteen completed the study. The mean age was 25.38 ± 5.12 years. After eight weeks of supplementation, waist circumference and waist-to-height ratio decreased significantly (both p = 0.02). Although reductions were observed in fasting glucose, fasting insulin, and HOMA-IR (from 4.96 ± 3.22 to 2.75 ± 1.88), these changes did not reach statistical significance. No significant changes were found in body weight or body mass index. Conclusion: Short-term Ceylon cinnamon supplementation was associated with significant improvements in abdominal anthropometric measures in women with PCOS and showed a favorable trend toward improved insulin resistance. These findings suggest that Ceylon cinnamon may serve as a promising adjunctive nutritional therapy for metabolic dysfunction in PCOS. Larger randomized controlled trials with longer follow-up are warranted to confirm these preliminary results.
Contributors:
Effectiveness of Laser Therapy in the Treatment of Diabetic Foot Ulcers: A Systematic Review
Background: Diabetic foot ulcers (DFUs) are among the most serious and costly complications of diabetes mellitus, often leading to infection, amputation, and a significant decline in quality of life. Despite conventional treatment strategies, many DFUs remain slow to heal or unresponsive, prompting interest in complementary therapies. Low-Level Laser Therapy (LLLT) has emerged as a non- invasive, painless, and potentially effective modality to enhance ulcer healing through mechanisms like improved microcirculation and tissue regeneration. Objective: This systematic review aims to evaluate the effectiveness of Low-Level Laser Therapy (LLLT) in promoting the healing of diabetic foot ulcers in patients with type 2 diabetes. Methods: A systematic literature search was conducted using PubMed and Elsevier databases up to April 2025. Studies were included if they investigated the use of LLLT in treating DFUs in type 2 diabetic patients. Inclusion criteria focused on randomized controlled trials and clinical studies available in English or French. Study selection followed the PRISMA 2020 guidelines, and a narrative synthesis of outcomes was performed. Risk of bias was assessed using the Cochrane Collaboration’s tool. Results: Eight studies met the inclusion criteria, including randomized controlled trials, systematic reviews, and clinical studies, with sample sizes ranging from 7 to 413 participants. The findings consistently demonstrated that LLLT significantly reduced ulcer size, accelerated healing time, improved pain management, and enhanced granulation without reported adverse effects. While heterogeneity existed in laser parameters and treatment protocols, the overall quality of evidence was considered high. Conclusion: LLLT appears to be a safe, effective, and well-tolerated adjunctive treatment for diabetic foot ulcers. Its ability to promote wound healing and reduce complications offers promising implications for clinical practice. However, further large-scale and standardized trials are needed to confirm these findings and establish optimal treatment guidelines.
Contributors:
Gut Microbiota as a Determinant of Interindividual Variability in Response to Dietary Interventions: Mechanistic Insights and Clinical Implications Running head: Microbiota and Dietary Response
Introduction: Dietary interventions are central to the management of obesity, insulin resistance, type 2 diabetes and related cardiometabolic disorders, yet clinical responses vary substantially between individuals exposed to apparently similar nutritional prescriptions. The gut microbiota may explain part of this variability because it transforms dietary substrates into bioactive metabolites and influences intestinal, immune and endocrine pathways. Methods: A narrative review informed by a structured literature search was conducted using PubMed, ScienceDirect and Google Scholar. Search terms combined concepts related to gut microbiota, intestinal microbiota, dietary intervention, nutrition, fiber, prebiotics, probiotics, metabolic response, obesity, insulin sensitivity and glycemic response. Forty records were initially identified, and 21 references were retained for qualitative synthesis after duplicate removal, screening and full-text eligibility assessment. Results: The reviewed literature indicates that baseline microbial diversity, community structure and functional capacity are associated with differential metabolic responses to calorie restriction, fiber-rich dietary patterns, probiotics, prebiotics and glycemia-oriented personalized nutrition. Key taxa and communities discussed in the evidence include Bacteroides, Prevotella, Akkermansia muciniphila, Bifidobacterium, Lactobacillus and Christensenella-associated communities. Mechanistic pathways include short-chain fatty acid generation, bile acid transformation, tryptophan-derived signaling, incretin-related pathways, epithelial barrier integrity and low-grade inflammation. Conclusion: The gut microbiota should be regarded as both a biomarker and a potential mediator of response to dietary interventions. Microbiota-informed nutrition is promising for precision diabetes and endocrinology care, but standardized prospective studies integrating microbiome profiling with robust metabolic outcomes remain necessary before routine clinical implementation.
Contributors:
Gut Microbiota in Type 2 Diabetes: Dysbiosis Signatures, Metabolic Signalling, and Microbiome-Targeted Therapeutics
Introduction: Type 2 diabetes is a complex endocrine-metabolic disorder in which insulin resistance, beta-cell dysfunction, chronic low-grade inflammation and environmental exposures interact. The gut microbiota has emerged as a biologically plausible determinant of this process because it regulates nutrient fermentation, microbial metabolite production, gut barrier integrity, immune tone and endocrine-metabolic signalling. Methods: A structured review of the literature was conducted using PubMed/MEDLINE, ScienceDirect and Google Scholar. English and French publications were screened using terms related to gut microbiota, type 2 diabetes, dysbiosis, insulin resistance, inflammation, probiotics, prebiotics, microbiota-targeted therapy and fecal microbiota transplantation. Forty-two records were identified, and 32 references were retained for qualitative synthesis after screening and full-text eligibility assessment. Results: The evidence consistently indicates that type 2 diabetes is associated with dysbiosis, reduced microbial diversity, depletion of butyrate-producing or metabolically favorable taxa and enrichment of opportunistic or pro-inflammatory communities. Recurrent mechanisms include intestinal barrier dysfunction, lipopolysaccharide-mediated metabolic endotoxemia, impaired short-chain fatty acid signalling, bile acid dysregulation, excessive imidazole propionate, branched-chain amino acid metabolism, altered incretin responses and immune-metabolic activation. Microbiota-targeted interventions, including fermented foods, probiotics, prebiotics, synbiotics, resistant starch and fecal microbiota transplantation, show promise but remain clinically heterogeneous. Conclusion: The gut microbiota is best understood as a dynamic metabolic interface rather than a passive marker of type 2 diabetes. Microbiome-informed strategies may enrich future precision endocrinology, but standardised human trials integrating taxonomic, functional and clinical endpoints are required before routine implementation.
Contributors:
VITAMIN D AND THE HUMAN GUT MICROBIOTA: A NARRATIVE REVIEW Review Article
Background: Vitamin D is an endocrine secosteroid with recognized extra-skeletal functions, including modulation of immune responses, epithelial barrier integrity, antimicrobial peptide expression, and inflammatory signaling. In parallel, the intestinal microbiota is increasingly recognized as a metabolic and immunological interface relevant to obesity, diabetes, inflammatory bowel disease, and systemic health. This review evaluates the evidence linking vitamin D status or supplementation to the composition and diversity of the human gut microbiota. Methods: A systematic narrative review was conducted using PubMed, ScienceDirect, and Google Scholar for studies published from 2010 to 2025. Human interventional and observational studies, systematic reviews, and mechanistic reports addressing vitamin D status or supplementation and gut microbiota outcomes were considered. The search and selection process was summarized using a PRISMA-style flow diagram. Findings were synthesized qualitatively because of substantial heterogeneity in populations, vitamin D regimens, microbiome sequencing methods, and reported endpoints. Results: Seventy-four records were identified; after duplicate removal and screening, 25 full-text reports were assessed and 11 evidence sources were retained for detailed synthesis. Higher serum 25-hydroxyvitamin D was generally associated with a more favorable microbiota profile, including greater microbial diversity and enrichment of taxa such as Bifidobacterium, Lactobacillus, Akkermansia, Bacteroides, and butyrate-associated organisms. Randomized supplementation studies showed biologically plausible but inconsistent effects on alpha diversity, beta diversity, and phylum-level changes, particularly the Bacteroidetes/Firmicutes balance. Conclusions: Current evidence supports a plausible vitamin D-gut microbiota axis, but causality remains unproven. Vitamin D supplementation should not yet be considered a targeted microbiota- modifying therapy outside correction of deficiency. Larger standardized randomized trials with integrated metabolomic, endocrine, and clinical endpoints are required.
Contributors:
Gut Microbiota in Obesity: From Dysbiosis and Metabolic Inflammation to Microbiome- Targeted Therapy Running title: Gut microbiota and obesity
Background: Obesity is a chronic endocrine-metabolic disease characterized by excess adiposity, metabolic inflammation and a high burden of cardiometabolic complications. The gut microbiota has emerged as a biologically plausible determinant of obesity because it regulates energy harvest, gut barrier integrity, immune signaling, bile acid metabolism and appetite-related neuroendocrine pathways. Methods: A structured literature search was conducted in PubMed/MEDLINE, ScienceDirect and Google Scholar for publications from 2000 to 2024 using English and French terms related to obesity, gut microbiota, dysbiosis, inflammation, probiotics, prebiotics, fecal microbiota transplantation, microbiota-targeted therapy and energy metabolism. Systematic reviews, meta- analyses, randomized trials, observational studies and mechanistic investigations were eligible when they addressed microbiota composition, obesity-related mechanisms or microbiome-based therapeutic strategies. Results: Seventy-two records were initially identified. After duplicate removal, 40 records were screened and 26 full-text publications were retained for qualitative synthesis. Obesity was frequently associated with reduced microbial richness, altered Firmicutes and Bacteroidetes profiles, enrichment of inflammatory taxa and depletion of potentially beneficial organisms such as Akkermansia muciniphila, Bifidobacterium and Faecalibacterium prausnitzii. The principal mechanisms involve short-chain fatty acid signaling, bile acid transformation, metabolic endotoxemia, low-grade inflammation, altered intestinal permeability, adipose-tissue dysfunction and gut-brain axis dysregulation. Dietary strategies, probiotics, prebiotics, next-generation probiotics and fecal microbiota transplantation show therapeutic potential, although clinical efficacy remains heterogeneous. Conclusion: The gut microbiota is not merely an associated biomarker of obesity but a dynamic metabolic interface that may influence disease expression and therapeutic response. Microbiome- targeted approaches are promising for future precision obesity care, but routine clinical implementation requires standardized, adequately powered and mechanistically informed human trials.
Contributors:
Eating Disorder Risk among Young Physicians in a Tunisian University Hospital: A Cross- sectional Screening Study Running head: Eating Disorder Risk in Young Physicians
Background: Eating disorders and disordered eating behaviors are increasingly recognized among medical trainees, but data in young physicians remain limited. Screening in this population is clinically relevant because eating disorder risk may coexist with anxiety, depressive symptoms, weight-control behaviors, and occupational stress. Objective: To estimate the prevalence of a positive SCOFF-F screen for eating disorder risk among interns and residents at a Tunisian university hospital and to describe associated sociodemographic, psychological, and weight-control factors. Methods: This cross-sectional descriptive and analytical study was conducted at Fattouma Bourguiba University Hospital, Monastir, during the 2022-2023 academic year. Interns and residents completed an anonymous self-administered questionnaire assessing sociodemographic characteristics, clinical history, substance use, body mass index, weight-control behaviors, gastrointestinal symptoms, the French SCOFF questionnaire, and the Hospital Anxiety and Depression Scale. Categorical variables were summarized as counts and percentages. Exploratory comparisons used the chi-square test or Fisher exact test when appropriate. Results: Of 55 returned questionnaires, 50 were analyzable. The mean age was 26 years, 28 participants (56%) were women, and 33 (66%) were residents. Twelve participants (24%) screened positive for eating disorder risk. Underweight, overweight, and obesity were observed in 12%, 16%, and 2% of participants, respectively. Anxiety symptoms were common, and depressive symptoms were present in approximately one quarter of participants. In exploratory analyses based on the available tabulated counts, SCOFF positivity was associated with anxiety category, depression category, dieting, and exercise used as a weight-control behavior, whereas sex and training status were not statistically significant. Conclusion: One in four young physicians screened positive for eating disorder risk in this single-center cohort. The findings support systematic awareness, early screening, and institutional wellness strategies targeting disordered eating, psychological distress, and potentially harmful weight-control behaviors among medical trainees.