Nabila Rekik

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.

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.

This article delves into the intricate relationships between Type 1 Diabetes Mellitus (T1DM), thyroid function, and hepatic metabolism, shedding light on the complex interplay that influences insulin sensitivity, glucose homeostasis, and liver health. The study, conducted at Al-Qadisiyah Teaching Hospital in Iraq from January 2021 to July 2021, involved 60 T1DM patients and 40 healthy controls aged 1 to 16 years. Results from the investigation revealed significant elevations in thyroid-stimulating hormone (TSH) levels among individuals with diabetes, emphasizing the intricate interplay between T1DM and thyroid function. Moreover, T1DM patients exhibited marked increases in liver enzymes and bilirubin levels, underscoring the potential hepatocellular implications associated with metabolic dysregulation. Our findings highlight the augmented production of TSH in individuals with diabetes as a potential defensive mechanism to mitigate the consequences of elevated blood glucose. The crucial role of triiodothyronine (T3) in enhancing insulin sensitivity and reducing serum blood glucose levels is emphasized, reinforcing its position as a key player in glucose metabolism. On hepatic level, the presence of advanced glycation end-products (AGEs) in diabetes amplifies oxidative stress, potentially leading to inflammation and tissue damage in the liver. The study illustrates a model of interaction between hepatic metabolism and T1DM, highlighting the impact of diabetes on liver apoptosis, bilirubin metabolism, and the intricate interplay between high blood sugar levels, AGEs, and red blood cell (RBC) membranes. Our findings provide comprehensive insights into the interconnected dynamics of T1DM, thyroid function, and hepatic metabolism, contributing to a deeper understanding of the complex physiological interactions within the context of diabetes mellitus.