Khouloud Boujelben

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.

INTRODUCTION: The coronavirus 2019 (COVID-19) pandemic has represented a major global health emergency and It is now recognized as a multisystemic disease, with potential repercussions on various organs. Diabetes mellitus is a common comorbidity associated with COVID-19. Its first-time diagnosis during the course of COVID-19 infection has been frequently reported, often with specific clinical, biological, and prognostic profiles. A better understanding of this association could shed light on the interplay between these two conditions. PATIENTS AND METHODS : This retrospective, descriptive, and analytical study included non-diabetic patients hospitalized for COVID-19 between 2021 and 2022 in the Pulmonology Department of the University Hospital of Sfax. Patients who developed newly diagnosed diabetes during hospitalization were identified and formed the basis of our analysis. RESULTS: New-onset diabetes was identified in 108 patients (12.9%) during hospitalization for COVID-19 with a mean age of 64.4 years and a male-to-female ratio of 1.34. Hypertension was the most common associated comorbidity, reported in 35.2% of cases. Clinically, the most frequent symptoms were dyspnea (60%), fever (55.6%), and cough (52.8%). On physical examination, hypoxia was observed in 65% of patients at admission. Laboratory findings revealed a mean random blood glucose level of 14.8 mmol/L. Chest CT scans showed extensive pulmonary involvement in 58% of cases. Systemic corticosteroids were prescribed in 70.6%. Diabetic ketoacidosis occurred in 4.6% of cases. Nine percent of patients with newly diagnosed diabetes required transfer to an intensive care unit. The mortality rate in this group was 14.7%. At a mean follow-up of 24 months, glycemic status was reassessed. Among reachable patients, 60% remained diabetic. Diarrhea and the severity of radiological lung involvement were identified as independent predictors of new-onset diabetes during COVID-19 infection. CONCLUSION: New-onset diabetes during COVID-19 infection is not uncommon. It is associated with distinct clinical and paraclinical features. Early identification of diabetes in this context is essential for timely and appropriate management to prevent complications.

Background: The coexistence of type 2 diabetes (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD) accelerates the progression of cardiovascular and metabolic disorders. To mitigate the medical and economic burden associated with these comorbidities, identifying their risk factors is essential. Aim: to assess the prevalence of MASLD and identify its associated risk factors in T2D patients in Tunisia. Methods: This descriptive and analytical study included 202 T2D patients followed over a 12-year period at the Endocrinology Department in Sfax, Tunisia. Patients were divided into two groups: 101 patients with confirmed MASLD (G1) and 101 patients without MASLD (G2). Results: The prevalence of MASLD was 17.03%. A family history of autoimmunity was significantly associated with MASLD. Glycemic control indicators, including HbA1C levels (p=0.943) and blood glucose levels (p=0.627), did not differ between groups. Insulin therapy was significantly less common in G1 (p=0.027). Abdominal obesity and elevated triglyceride levels were strongly associated with MASLD. Additionally, carbohydrate intake was higher in G1 compared to G2 (p=0.041). Multivariate analysis identified non-HDL cholesterol as the most significant independent risk factor for MASLD (odds ratio [OR]: 4.07 × 10⁵), followed by uric acid levels (OR: 1.03, p=0.024) in a 95% confidence interval of [1.004–1.058]. Conclusion: The findings reveal a notable prevalence of MASLD among T2D patients in Tunisia, with non-HDL cholesterol, uric acid levels, abdominal obesity, and dietary patterns emerging as key contributors. These results emphasize the need for targeted screening and management strategies of MASLD.