Franco Arturi

It is well-established that individuals with type 2 diabetes mellitus (T2DM) have an increased risk of developing cognitive impairment and dementia, suggesting a close relation between hyperglycemia, insulin resistance, and chronic inflammation. This decline is characterized by a large variety of symptoms going from mild to major form of cognitive impairment characterized of loss of memory, attention, processing speed, and executive function. Preserving the physiological level of glycemia improves cognitive performance, but untreated or inadequately diabetes therapy facilitates the risk of dementia. Some experimental studies have disclosed that drug for diabetes can have protective outcomes on cognitive impairment. In this context, incretin hormone glucagon-like peptide-1 (GLP-1) can reduce blood glucose, improve glucose transport through cell membranes, and to improve brain insulin resistance modulating neuroinflammation. In fact, GLP-1 acts as a neurotransmitter and neuromodulator activating central GLP-1 receptors located in the neurons determining its neurotropic and neuroprotective role in central nervous system. Preclinical and clinical studies suggest the potential role of dipeptidyl peptidase-4 inhibitors (DPP4-i) as therapy for the treatment and prevention of cognitive impairment and dementia. Similarly, several evidences demonstrated that treatment with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) reduces the risk of cognitive impairment and dementia in T2DM patients by improving learning, memory, attention and executive functions. In addition, preclinical studies suggest a possible neuroprotective effect of GLP-1/GIP dual receptor agonist in animal models. The current narrative review, including studies published from September 1987 to September 2025, summarized the recent improvements regarding to the incretin-based therapy for cognitive impairment associated to the type 2 diabetes mellitus.

Objective: Disturbances of glucose homoeostasis are claimed to act as both a consequence and maintaining factor in eating disorders (EDs). This study explored glucose trends and their association with real‐time food intake and self‐report eating psychopathology in a sample of patients with anorexia nervosa (AN) and binge‐eating disorder (BED). Method: 30 patients (AN, 15; BED, 15) wore continuous glucose monitoring (CGM) sensors while synchronously collecting data on daily food intake. CGM outputs were extracted and correlated with nutritional intake, daily meals composition and self‐report eating psychopathology (BES, NEQ, GQ, Y‐FAS). Results: Up to 74% of participants experienced hypoglycaemia in the study period, with unique trends by diagnosis (prolonged, interprandial, nocturnal episodes in AN; brief, postprandial, daytime episodes in BED). Significant association between the average number of daily meals, glucose coefficient of variation, and symptomatic events was evident in AN. Self‐report night eating and food addiction symptoms in AN, and self‐report grazing in BED, associated, respectively, with daytime and symptomatic hypoglycaemia. Conclusions: Hypoglycaemia is a frequent finding in patients with AN and BED and is associated with daily meals composition and dysfunctional eating behaviours. Theoretical explanations are provided for a diagnosis‐specific effect on hypoglycemia events. CGM could valuably contribute to understanding, clinical staging, and customised treatments of EDs.

Obesity, insulin resistance, type 2 diabetes mellitus (T2DM) and metabolic syndrome have been largely correlated to a reduction in bacterial load and diversity, resulting in a condition known as intestinal dysbiosis. The recent emergence of novel antidiabetic medications has been demonstrated to exert a favourable influence on the composition of the intestinal microbiota. Incretin-based therapy exerts a multifaceted influence on the composition of the gut microbiota, leading to alterations in bacterial flora. Of particular significance is the capacity of numerous metabolites produced by the gut microbiota to modulate the activity and hormonal secretion of enteroendocrine cells. This review examines the effects of dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists and GLP-1/gastric inhibitory polypeptide (GIP) receptor dual agonists on the composition of the gut microbiota in both mice and human subjects. The nature of this interaction is complex and bidirectional. The present study demonstrates the involvement of the incretinic axis in modulating the microbial composition, with the objective of providing novel preventative strategies and potential personalised therapeutic targets for obesity and T2DM.

Binge eating disorder (BED) carries a 6 times higher risk for obesity and accounts for roughly 30% of type 2 diabetes cases. Timely identification of early glycemic disturbances and comprehensive treatment can impact on the likelihood of associated metabolic complications and the overall outcome. In this study, machine learning techniques were applied to static and dynamic glucose-derived measures to detect BED among 281 individuals with high weight. Data from the classic (2 h) and the extended (5 h) glucose load were computed by multiple algorithms and two models with the most relevant features were trained to detect BED within the sample. The models were then tested on an independent cohort (N = 21). The model based on the 5 h-long glucose load exhibited the best performance (sensitivity = 0.75, specificity = 0.67, F score = 0.71) diagnosing BED in 7 out of 10 cases. Sex, HOMA-IR, HbA1c and plasma glucose in different times, and hypoglycemia events were the most sensitive features for BED diagnosis. This study is the first to use metabolic hallmarks to train ML algorithms for detecting BED in individuals at high risk for metabolic complications. ML techniques applied to objective and reliable glycemic features might prompt the identification of BED among individuals at high risk for metabolic complications, enabling timely and tailored multidisciplinary treatment.

Background. Adipose tissue macrophages (ATMs) and mast cells (MCs) play a role in immune responses. More recently, their involvement in tumor angiogenesis and chronic inflammatory conditions in patients with obesity has been discovered. Furthermore, a higher BMI (Body Mass Index) value corresponds to a higher inflammatory state. In particular, gastric tissue in obesity (GTO) is characterized by Macrophages, Mast Cells Positive to Triptase (MCPT), and neo-formed microvessels (MVD). Materials and Methods. We collected gastric tissue samples from December 2021 to December 2022. The patients selected had a BMI > 35 kg/m² with different comorbidities. Regarding the surgery, surgeons executed a Laparoscopic Sleeve Gastrectomy (LapSG). Gastric tissue was analyzed by immunohistochemistry and morphometrical assay, comparing “obese-related” gastric tissue to normal gastric tissue. Furthermore, tissue parameters were correlated with important clinicopathological features. Results. We collected thirty gastric tissue samples from thirty patients with obesity. Blood tests, Electrocardiogram (ECG), esophagogastroduodenoscopy (EGDS) associated with a urea breath test, and chest X.R. were performed. A significant correlation between ATMs, MCPT, MVD, and BMI was found in GTO. Pearson t-test analysis was conducted (r ranged from 0.67 to 0.71; p-value < 0.05). Conclusions. These preliminary data suggest that ATMs, MCPT, and MVD related to BMI can play a role in both gastric tissue angiogenesis and inflammation inducing a tissue change that could lead to gastric inflammation or cancer diseases.

Background and Objectives: The NUCB2 gene and its polymorphisms were identified as novel players in the regulation of food intake, potentially leading to obesity (OBE) and altered eating behaviors. Naltrexone/bupropion SR (NB) showed good efficacy and tolerability for treating OBE and altered eating behaviors associated with binge eating disorder (BED). This prospective study investigates the influence of NUCB2 gene polymorphism on NB treatment response in OBE and BED. Materials and Methods: Body mass index (BMI), eating (EDE-Q, BES, NEQ, GQ, Y-FAS 2.0) and general psychopathology (BDI, STAI-S) were evaluated at baseline (t0) and after 16 weeks (t1) of NB treatment in patients with OBE and BED (Group 1; N = 22) vs. patients with OBE without BED (Group 2; N = 20). Differences were evaluated according to the rs757081 NUCB2 gene polymorphism. Results: NUCB2 polymorphism was equally distributed between groups. Although weight at t0 was higher in Group 1, weight loss was similar at t1 in both groups. BMI was not influenced by NUCB2 polymorphism. In Group 1, the CG-genotype reported significant improvement in eating psychopathology while the GG-genotype reported improvement only for FA. No differences were observed in Group 2. Conclusions: Patients diagnosed with BED and treated with NB exhibited a more favorable treatment response within the CG-genotype of the NUCB2 polymorphism.

Background: Non-alcoholic fatty liver disease (NAFLD) and the presence of low muscle mass (sarcopenia) represent noteworthy health issues. Handgrip strength, a muscle function indicator, is vital for sarcopenia diagnosis. We investigated the link between handgrip strength and hepatic steatosis in Italian adults. Methods: We retrospectively assessed 388 adults (≥50 years), measuring muscle function and hepatic steatosis using a dynamometer and transient elastography. We divided participants into handgrip strength tertiles. Results: 207 had NAFLD. The lowest handgrip strength tertile had a higher NAFLD prevalence (64% vs. 46%, p = 0.02). Tertiles I and II exhibited increased odds of NAFLD in comparison to tertile III, with an odds ratio of 5.30 (95% confidence interval: 2.24–12.57, p < 0.001) and 2.56 (95% confidence interval: 1.17–5.59, p = 0.01), respectively. rHGS predicted NAFLD with an AUC of 0.41 (SE = 0.029, p = 0.003). An rHGS of 1.22 achieved 18% sensitivity and 80% specificity for hepatic steatosis prediction. Conclusion: Low handgrip strength is linked to an increased susceptibility to NAFLD among the Italian population, implying its potential utility in the identification of risk for hepatic steatosis.

Background: Impaired metabolic response such as blood glucose fast fluctuations may be hypothesized in binge eating disorder (BED) and food addiction (FA) by virtue of the repetitive consumption of highly processed food. Conversely, rapid changes in plasma glucose (i.e., hypoglycemia) may trigger craving for the same food products. The investigation of early glycemic disturbances in BED and FA could enhance the understanding of the metabolic mechanisms involved in the maintenance of the disorders. Present study investigated hypoglycemia events during a 5-h-long oral glucose tolerance test (OGTT) in people with BED, FA, and the comorbid phenotype. Further, the association between the severity of eating psychopathology and the variability in hypoglycaemia events was explored. Methods: Two-hundred participants with high weight and no diabetes completed the extended OGTT and were screened for BED, FA, BED-FA, or no-BED/FA. The four groups were compared in hypoglycemia events, OGTT-derived measures, and eating psychopathology. The association between predictors (eating psychopathology), confounders (demographics, metabolic features), and the outcomes (hypoglycemia, early/late hypoglycemia, severe hypoglycemia, reactive hypoglycemia) was examined through logistic regression. Results: Hypoglycemia in general, and reactive hypoglycemia were highly frequent (79% and 28% of the sample, respectively). Hypoglycemia events (< 70 mg/dL) were equally experienced among groups, whilst severe hypoglycemia (< 54 mg/dL) was more frequent in BED at the late stage of OGTT (5 h; χ² = 1.120, p = .011). The FA and BED groups exhibited significantly higher number of reactive hypoglycemia (χ² = 13.898, p = .003), in different times by diagnosis (FA: 210′–240′; BED: at the 270′). FA severity was the only predictor of early and reactive hypoglycemia. Conclusions: People with BED or FA are prone to experiencing reactive hypoglycemia; FA severity may predict early and symptomatic hypoglycemia events. This can further reinforce disordered eating behaviours by promoting addictive responses, both biologically and behaviourally. These results inform professionals dealing with eating disorders about the need to refer patients for metabolic evaluation. On the other hand, clinicians dealing with obesity should screen for and address BED and FA in patients seeking care for weight loss.

Dementia is a permanent illness characterized by mental instability, memory loss, and cognitive decline. Many studies have demonstrated an association between diabetes and cognitive dysfunction that proceeds in three steps, namely, diabetes-associated cognitive decrements, mild cognitive impairment (MCI; both non-amnesic MCI and amnesic MCI), and dementia [both vascular dementia and Alzheimer’s disease (AD)]. Based on this association, this disease has been designated as type 3 diabetes mellitus. The underlying mechanisms comprise insulin resistance, inflammation, lipid abnormalities, oxidative stress, mitochondrial dysfunction, glycated end-products and autophagy. Moreover, insulin and insulin-like growth factor-1 (IGF-1) have been demonstrated to be involved. Insulin in the brain has a neuroprotective role that alters cognitive skills and alteration of insulin signaling determines beta-amyloid (Aβ) accumulation, in turn promoting brain insulin resistance. In this complex mechanism, other triggers include hyperglycemia-induced overproduction of reactive oxygen species (ROS) and inflammatory cytokines, which result in neuroinflammation, suggesting that antidiabetic drugs may be potential treatments to protect against AD. Among these, glucagon-like peptide-1 receptor agonists (GLP-1RAs) are the most attractive antidiabetic drugs due to their actions on synaptic plasticity, cognition and cell survival. The present review summarizes the significant data concerning the underlying pathophysiological and pharmacological mechanisms between diabetes and dementia.