Current strategies and priorities for diabetic footwear design and production: a cross-European exploratory survey of clinicians and shoemakers

Hadi Sarlak1,2  · Kamran Shakir1,2  · Giulia Rogati2  · Alberto Leardini2  · Lisa Berti1,3 · Paolo Caravaggi2

Received: 11 December 2025 / Accepted: 5 February 2026 © The Author(s) 2026

Abstract

Background Therapeutic footwear plays an important role in preventing ulceration in people with diabetes. Despite guide-lines recommending offloading footwear for individuals at risk of ulceration, limited data are available on the alignment between current industrial practices, clinical expectations, and evidence. This study explored current practices, priorities and challenges associated with diabetic footwear from manufacturers’ and clinicians’ perspectives across Europe.

Methods An exploratory cross-sectional survey was conducted between May and October 2025 to gather insights from diabetic footwear manufacturers and clinicians involved in diabetic foot care across Europe. A 26-item questionnaire was developed to explore product design, materials, innovation, and adherence to guidelines among manufacturers. Additionally, a separate 14-item questionnaire for clinicians examined footwear prescription, patient barriers, and industry communica-tion. Quantitative data were analysed descriptively, and open-text responses underwent thematic analysis.

Results Nine manufacturers and twelve clinicians participated in the survey. While only half of the Manufacturers that completed the survey reported having a research and development department, most reported adopting data-driven design approaches (n=8) and scientific literature (n=7). Offloading, internal volume, and toe protection were the highest-ranking priorities for manufacturers, whereas aesthetics ranked lowest. Clinicians, conversely, prioritised accommodation of defor-mities, offloading, and comfort, and highlighted poor aesthetics and shoe weight as major limitations to adherence.

Conclusions This exploratory study suggests partial alignment between diabetic footwear manufacturers and clinicians on functional and offloading features but highlights gaps in aesthetics, materials, and sustainability. Better collaboration, data-driven innovation, and clearer product specifications could improve user adherence, prescription efficacy, and the preventive role of therapeutic footwear in diabetes care.

Keywords Diabetic foot ulcers · Therapeutic footwear · Offloading · Survey · Footwear design

Communicated by Massimo Federici.

Kamran Shakir

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Hadi Sarlak

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Giulia Rogati

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Alberto Leardini

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Lisa Berti

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Paolo Caravaggi

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1 Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - Università di Bologna, Via Zamboni,33, Bologna 40126, Italy

2 Movement Analysis Laboratory and Functional Evaluation of Prostheses, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna 40136, Italy

3 Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy

The erythropoietin gene polymorphism (rs1617640) is associated with retinopathy in type 2 diabetes patients

Jolanta Szeliga-Krol1  · Agata Betlejewska1  · Monika Buraczynska1  · Wojciech Zaluska1

Received: 29 September 2025 / Accepted: 25 January 2026 © The Author(s) 2026

Abstract

Aims Our study aimed to evaluate the association between the erythropoietin gene rs1617640 polymorphism and diabetic retinopathy (DR) in diabetes patients.

Methods In this preliminary retrospective study the genotyping was performed on 860 DNA samples from Caucasian patients with type 2 diabetes mellitus (T2DM). For analyzing the effect of the polymorphism, patients were assigned into three phenotypic subgroups: non-DR (without retinopathy), NPDR (with non-proliferative diabetic retinopathy) and PDR (with proliferative diabetic retinopathy). The rs1617640 polymorphism was analyzed using polymerase chain reaction (PCR)–restriction fragment length polymorphism (RFLP) and direct DNA sequencing procedures.

Results A statistically significant difference in the polymorphism distribution was observed between T2DM patients with DR (both NPDR and PDR) and those without DR. The minor G allele was associated with the increased risk of DR. In the NPDR subgroup subjects carrying the G allele had 1.53-fold higher risk of developing retinopathy. Similarly, in the PDR subgroup patients carrying the G allele showed almost twofold increased risk of PDR in a dominant model of inheritance.

Conclusion Our results demonstrate that in T2DM patients the EPO rs1617460 polymorphism is associated with signifi-cantly increased risk of developing DR. This finding can provide a new insight into the role of EPO gene in the pathophysi-ology of microvascular complications of diabetes.

Keywords EPO gene · Type 2 diabetes mellitus · Diabetic retinopathy · Single nucleotide polymorphism · Risk allele

Communicated by Marta Letizia Hribal.

 Monika Buraczynska 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

1 Department of Nephrology, Medical University of Lublin, Jaczewskiego 8, 20-950 Lublin, Poland

Type 2 diabetes mellitus is associated with asymptomatic acute abdomen among elderly patients admitted to acute tertiary care hospital wards

Andrea Tumminia1  · Raffaella Romano2  · Francesco Frasca1,3  · Francesco Galeano3  · Roberto Baratta1  · Vittorio Oteri3  · Alessia Longo3  · Lucia Frittitta3,4  · Rosario Le Moli5  · Tommaso Piticchio6  · Antonino Di Pino7  · Maurizio Di Marco7  · Luigi Piazza8  · Maria Carolina Picardo9  · Paola Magnano San Lio10 · Filippo Luca Fimognari11  · Marcello Romano2

Received: 13 November 2025 / Accepted: 5 February 2026 © The Author(s) 2026

Abstract

Background Pain may be absent in a substantial proportion of elderly patients with acute abdominal conditions. This study explored the association between type 2 diabetes mellitus (T2DM) and asymptomatic presentation.

Methods We conducted a cross-sectional analysis of 215 patients aged≥65 years admitted with acute abdominal conditions. Demographic, clinical, and laboratory data were extracted from medical records. Descriptive statistics and multivariable logistic regression were used to identify associative predictors of asymptomatic acute abdomen (AAA).

Results The median age was 82 years [77–86]; 54.4% (n=117) were female; 31.2% (n=67) had T2DM. Overall, 33.5% (n=72) presented without abdominal pain. T2DM prevalence was higher in AAA than symptomatic patients (44.4% vs. 24.5%, p<0.01). In multivariable analysis, T2DM (OR 1.95, 95% CI 1.10–3.45, p=0.02), lower heart rate (OR 0.83, 95% CI 0.71–0.96, p=0.01), and absence of fever (OR 0.50, 95% CI 0.26–0.95, p=0.03) were associated with AAA. Among patients with T2DM, longer diabetes duration (12.5 years [10.5–14.5] vs. 8.8 years [5.0–11.0]; p<0.01) and higher HbA1c (8.2% [7.2–8.7] vs. 7.5% [6.8–7.6]; p=0.02) were associated with asymptomatic presentation.

Conclusions Asymptomatic acute abdomen is common among elderly patients. Long-standing and poorly controlled T2DM is associated with absent pain. Prospective studies are needed to clarify causal mechanisms, and early glyco-metabolic assessment may aid recognition of at-risk patients.

Keywords Type 2 diabetes · Acute abdomen · Elderly · Pain perception · Emergency medicine · Predictors

Medical nutrition therapy in physiological pregnancy and in pregnancy complicated by obesity and/or diabetes: SID-AMD recommendations

Annunziata Lapolla1  · Maria Grazia Dalfrà1  · Giuseppe Marelli2  · Mario Parrillo3  · Laura Sciacca4  · Maria Angela Sculli5  · Elena Succurro6  · Elisabetta Torlone7  · Ester Vitacolonna8

Received: 18 September 2024 / Accepted: 27 December 2024 / Published online: 22 January 2025 © Springer-Verlag Italia S.r.l., part of Springer Nature 2025

Abstract

Proper nutrition is essential during pregnancy to ensure an adequate supply of nutrients to the foetus and adequate maternal weight gain. In pregnancy complicated by diabetes (both gestational and pre-gestational), diet in terms of both the intake and quality of carbohydrates is an essential factor in glycaemic control. Maternal BMI at conception defines the correct weight increase during gestation in order to reduce maternal-foetal complications related to hypo- or hyper-nutrition. The recommendations presented here, which are based on national and international guidelines and the most recently published data on nutrition in physiological pregnancy and pregnancy complicated by hyperglycaemia and/or obesity, are designed to help healthcare professionals prescribe suitable eating patterns to safeguard the health of the mother and the foetus.

Communicated by Massimo Federici, M.D.

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1 UO Diabetologia, DIMED, Università di Padova, Padova, Italy

2 Ordine Ospedaliero San Giovanni di Dio Fatebenefratelli, Erba, CO, Italy

3 UOSD Endocrinologia e Malattie del Ricambio, AO Sant’Anna e San Sebastiano, Caserta, Italy

4 Dipartimento Medicina Clinica e Sperimentale, Università degli Studi di Catania, Catania, Italy

5 UOC Diabetologia e Endocrinologia, GOM Bianchi-Melacrino-Morelli, Reggio Calabria, Italy

6 DPT Scienze Mediche Chirurgiche, Università Magna Grecia, Catanzaro, Italy

7 AOS Maria della Misericordia SC Endocrinologia e Metabolismo, Università di Perugia, Perugia, Italy

8 Dipartimento di Medicina e Scienza dell’Invecchiamento, Università di Chieti, Chieti, Italy

Exploring metabolomic clues in diabetic retinopathy: a pilot study

Matthew Simonson1  · Yanliang Li2  · J. Jason McAnany2  · Jason C. Park2  · Felix Y. Chau2  · Bharati Prasad3,4 · Silvana Pannain5  · Erin C. Hanlon5  · Eve Van Cauter5  · Kirstie K. Danielson6  · Brian T. Layden6  · Hui Chen7  · George E. Chlipala8  · Carlos Martinez8  · Stephanie J. Crowley9  · Sirimon Reutrakul6

Received: 23 August 2025 / Accepted: 23 February 2026 © The Author(s) 2026

Keywords Metabolomics · Diabetic retinopathy · Diabetes Mellitus · Retina

Communicated by Massimo Federici, M.D Matthew Simonson 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

1 College of Medicine, University of Illinois Chicago, Chicago, IL 60612, USA

2 Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago, Chicago, IL, USA

3 Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA

4 Jesse Brown Department of Veterans Affairs Hospital, Chicago, IL, USA

5 Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Chicago, Chicago, IL, USA

6 Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA

7 Mass Spectrometry Core, Research Resource Center, Office of Vice Chancellor for Research, University of Illinois at Chicago, Chicago, IL, USA

8 Research Informatics Core, Research Resources Center, University of Illinois at Chicago, Chicago, IL, USA

9 Biological Rhythms Research Laboratory, Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA

The close relationship between inflammation and insulin resistance: a comparative perspective from a new angle

Xiaoyan Wang1  · Run Yang1  · Jingxiang Li1  · Yongqi Liang2  · Chenxi Jin1  · Yining Xu1  · Xianbo Wu2  · Mengchen Zou1

Received: 4 July 2025 / Accepted: 30 September 2025 / Published online: 15 October 2025 © The Author(s) 2025

Abstract

    Background Excess weight is a progressive metabolic epidemic, and inflammation plays an important role in the progres-sion of disease. Insulin resistance (IR) is an important feature of obesity, but it does not reflect systemic inflammation. Cur-rently, there is a lack of effective clinical tools for early risk stratification and intervention in physically active people.

    Methods This was a prospective cohort of 72,262 overweight but physically active persons in the UK Biobank. The TyG was combined with hsCRP, waist circumference (WC), or body mass index (BMI) as indices of IR. Adjusted Cox regression, interaction tests, restricted cubic splines (RCS) analysis, Kaplan-Meier analysis, and Harrell’s C-index were used to examine the relations and time-dependent predictive power.

    Results During 12.7 years of follow-up, 1,477 participants developed metabolic dysfunction-associated fatty liver disease (MAFLD). RCS analysis suggested TyG-hsCRP had a nonlinear positive correlations with all-cause mortality. Compared to the lowest quartile group, the corrected hazard ratio (HR) (95% confidence interval [CI]) of new-onset MAFLD in maximum quartile groups for TyG-hsCRP was 1.94(1.62–2.32), for TyG-WC was 1.78(1.44–2.18), for TyG-BMI was 1.36(1.12–1.65), and for TyG was 1.41(1.15–1.72). The relation between C-index of TyG-hsCRP and MAFLD was higher than that of other TyG indices. Similar results were observed in all-cause mortality.

    Conclusion TyG-hsCRP is superior to other indices for identifying risk of MAFLD and all-cause mortality in overweight but physically active people. Our findings suggest the importance of inflammatory metabolism and provide evidence for effectively early anti-inflammatory treatments.

    Keywords Excess weight · Inflammation · Insulin resistance · Physically active

Communicated by Salvatore Corrao, M.D

    Mengchen Zou

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    Xianbo Wu

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1 Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Road North, Guangzhou 510515, China

2 Department of Occupational Health and Medicine, School of Public Health, Southern Medical University, Guangzhou, China