Summary: In trained adult athletes participating in a controlled energy availability study, short-term low energy availability (LEA) at 15 kcal·kg FFM⁻¹·day⁻¹, achieved with or without exercise manipulation demonstrated significant alterations in serum metabolome with shifts toward increased fat utilization, enhanced ketogenesis, reduced circulating triglycerides, and decreased amino acid concentrations compared to high energy availability (HEA) at 40 kcal·kg FFM⁻¹·day⁻¹, with metabolic changes occurring regardless of whether LEA was achieved through reduced intake or increased exercise. PICO Description Population Trained adult athletes participating in a controlled energy availability study. Intervention Short-term low energy availability (LEA) at 15 kcal·kg FFM⁻¹·day⁻¹, achieved with…
Author: FWA
Clinical Context Diabetic foot ulcers remain a major clinical challenge, with healing rates of only 30-50% at 12 weeks using standard care. The impaired healing environment in diabetes—characterized by hyperglycemia, neuropathy, microvascular disease, chronic inflammation, and deficient growth factor signaling—creates wounds that resist closure. When standard care fails, clinicians seek advanced wound therapies that can shift the wound toward a healing trajectory. Bioactive glasses are synthetic inorganic materials that interact with biological tissues to promote regeneration. Originally developed for bone repair, bioactive glasses have shown wound healing properties through multiple mechanisms: they release ions (boron, calcium, sodium) that stimulate angiogenesis,…
Clinical Context Digital health technologies—smartphone apps, wearables, telehealth platforms—promise to transform chronic disease management by extending care beyond clinic visits into patients’ daily lives. Type 2 diabetes, with its need for ongoing self-management (diet, exercise, medication adherence, glucose monitoring), seems ideally suited for digital support. Patients make dozens of diabetes-relevant decisions daily, and real-time feedback and coaching could theoretically improve each one. The challenge lies in translating technological potential into sustained behavioral change. Many digital health interventions show short-term benefits in controlled studies but struggle with real-world implementation. User engagement typically follows a pattern: initial enthusiasm, gradual decline in app…
Clinical Context Dexamethasone is widely used perioperatively for prevention of postoperative nausea and vomiting (PONV), reduction of inflammation and edema, and potential analgesic benefits. Standard PONV prophylaxis protocols often include dexamethasone 4-8 mg as a single intraoperative dose. The drug is highly effective—reducing PONV by approximately 25%—and has become near-ubiquitous in anesthetic practice for procedures with moderate-to-high PONV risk. However, glucocorticoids are known to raise blood glucose through multiple mechanisms: they increase hepatic gluconeogenesis, induce insulin resistance, and impair peripheral glucose uptake. For patients with diabetes, there has been longstanding concern that even a single dose of dexamethasone might cause…
Clinical Context Dexamethasone is a cornerstone of modern anesthetic practice, widely used for prevention of postoperative nausea and vomiting (PONV). Standard PONV prophylaxis protocols typically include dexamethasone 4-8 mg as a single intraoperative dose, which reduces PONV by approximately 25%. The drug also provides anti-inflammatory benefits that may reduce surgical swelling and improve early recovery. However, glucocorticoids predictably elevate blood glucose through multiple mechanisms: increased hepatic gluconeogenesis, peripheral insulin resistance, and direct pancreatic effects. For patients with diabetes, this hyperglycemic effect raises concerns about perioperative glucose management, wound healing, and infection risk. The question of whether a single prophylactic dexamethasone…
Summary: In adults diagnosed with type 2 diabetes receiving standard medical treatment in China, Sanxiao Jiuzhi Gong (SJG) exercise therapy practiced 30-60 minutes daily for 12-24 weeks added to standard diabetes care demonstrated significantly reduced blood glucose levels and enhanced exercise self-efficacy compared to standard diabetes care alone without structured SJG practice, with only minor exercise-related discomforts (muscle soreness, fatigue) and no serious adverse events. PICO Description Population Adults diagnosed with type 2 diabetes receiving standard medical treatment in China. Intervention Sanxiao Jiuzhi Gong (SJG) exercise therapy added to standard diabetes care, typically practiced 30-60 minutes daily for 12-24 weeks.…
Clinical Context Exercise interventions for type 2 diabetes must balance efficacy with accessibility and sustainability. While high-intensity aerobic and resistance training produce robust metabolic benefits, many patients—particularly older adults or those with comorbidities—cannot perform or maintain such programs. Traditional Chinese exercises like Qigong offer an alternative approach: low-impact movements combined with breathing techniques and mental focus that are accessible to patients across fitness levels. Sanxiao Jiuzhi Gong (SJG) is a Qigong form specifically developed within traditional Chinese medicine for diabetes management. Unlike general Qigong or Tai Chi, SJG was designed with metabolic regulation as its primary goal, incorporating movements and…
Clinical Context Extreme endurance exercise places remarkable stress on the skeletal system. Ultramarathons—typically defined as races exceeding 42.2 km—impose hours of repetitive loading on bones, triggering acute changes in bone turnover markers. Studies consistently show that prolonged endurance exercise acutely increases bone resorption markers while bone formation markers show variable responses. Over time, this pattern could contribute to stress fractures and bone loss if not adequately counterbalanced during recovery. Vitamin D plays critical roles in bone metabolism: it enhances intestinal calcium absorption, regulates parathyroid hormone (PTH), and influences osteoblast and osteoclast function. Vitamin D deficiency is common in athletes, particularly…
Summary: In patients with type 2 diabetes exhibiting reduced salivary gland function and associated oral symptoms, low-level laser therapy combined with transcutaneous electrical nerve stimulation (TENS) applied to major salivary glands (parotid, submandibular) demonstrated significantly increased stimulated salivary flow rate and shifts in oral microbiome composition with reduction in certain bacterial taxa compared to sham treatment with inactive devices, with good tolerability and minimal side effects. PICO Description Population Patients with type 2 diabetes mellitus exhibiting reduced salivary gland function and associated oral symptoms. Intervention Low-level laser therapy combined with transcutaneous electrical nerve stimulation (TENS) applied to major salivary glands…
Clinical Context Salivary gland dysfunction in type 2 diabetes creates a cascade of oral health problems. Beyond the discomfort of dry mouth, reduced saliva impairs the mouth’s natural defense system: salivary immunoglobulins, antimicrobial peptides, and mechanical flushing all decline. The resulting oral environment favors pathogenic bacteria, promoting caries, periodontitis, and candidiasis. These oral complications, in turn, may worsen systemic inflammation and glycemic control. The oral microbiome in diabetes differs from healthy individuals, with increased abundance of periodontal pathogens and reduced beneficial commensals. Whether restoring salivary flow can normalize the oral microbiome—rather than just providing symptomatic relief—has important implications for breaking…