{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T04:30:21Z","timestamp":1786509021098,"version":"build-2736575974"},"reference-count":5,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e0 degli Studi di Bari Aldo Moro"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Diabetol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Phenylketonuria and type 1 diabetes are lifelong metabolic disorders requiring complex and potentially conflicting nutritional strategies. Their coexistence is rare, yet management may become particularly challenging during transition from pediatric to adult care. We describe the case of a young adult with phenylketonuria who developed type 1 diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 27-year-old man with longstanding phenylketonuria was referred to an adult metabolic-diabetes center after the diagnosis of type 1 diabetes. Clinical, biochemical, nutritional, and continuous glucose monitoring data were reviewed. The intervention included structured therapeutic education, transition from fixed insulin doses to a dynamic regimen based on carbohydrate counting, and revision of medical nutrition therapy using phenylketonuria-adapted low-protein foods and sugar-free phenylalanine-free amino acid supplements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At diagnosis, HbA1c was 11.5%, with markedly reduced C-peptide levels and high titer anti-GAD antibodies. Initial diabetes management was associated with poor adherence to the phenylketonuria diet, increased intake of conventional protein sources, and elevated phenylalanine levels. After individualized insulin titration and nutritional intervention, HbA1c improved from 11.5% to 7.8%, phenylalanine levels decreased from 842 to 705 \u03bcmol\/L, insulin requirement declined from 0.55 to 0.3 IU\/kg\/day, and continuous glucose monitoring showed improved glycemic control without increased hypoglycemia. The Glycemia Risk Index improved from high-risk Zone E to low-intermediate-risk Zone B.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case highlights the need for personalized multidisciplinary care integrating continuous glucose monitoring, carbohydrate counting, and phenylketonuria specific nutrition to optimize both metabolic conditions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00592-026-02685-6","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T08:26:04Z","timestamp":1781857564000},"page":"1405-1409","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Phenylketonuria and type 1 diabetes: a clinical and nutritional challenge in a young adult\u2014a case report"],"prefix":"10.1007","volume":"63","author":[{"given":"Carmine","family":"Piccolo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"de Candia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Natalicchio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Di Molfetta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Caruso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Laviola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7372-2678","authenticated-orcid":false,"given":"Francesco","family":"Giorgino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Pio","family":"Sorice","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"issue":"1","key":"2685_CR1","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1186\/s13023-019-1131-4","volume":"14","author":"KF Trefz","year":"2019","unstructured":"Trefz KF, Muntau AC, Kohlscheen K et al (2019) Clinical burden of illness in patients with phenylketonuria (PKU) and associated comorbidities: a retrospective study of German health insurance claims data. Orphanet J Rare Dis 14(1):170. https:\/\/doi.org\/10.1186\/s13023-019-1131-4","journal-title":"Orphanet J Rare Dis"},{"issue":"2","key":"2685_CR2","doi-asserted-by":"publisher","first-page":"221","DOI":"10.17306\/J.ABP.2016.2.26","volume":"15","author":"R Mozrzymas","year":"2016","unstructured":"Mozrzymas R, Du\u015b-\u017buchowska M, Ka\u0142u\u017cny \u0141, Wenska-Chy\u017cy E, Walkowiak J (2016) Phenylketonuria is not a risk factor for changes of inflammation status as assessed by interleukin 6 and interleukin 8 concentrations. Acta Sci Pol Technol Aliment 15(2):221\u2013225. https:\/\/doi.org\/10.17306\/J.ABP.2016.2.26","journal-title":"Acta Sci Pol Technol Aliment"},{"issue":"4","key":"2685_CR3","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1016\/j.ymgme.2015.10.001","volume":"116","author":"A MacDonald","year":"2015","unstructured":"MacDonald A, Ahring K, Almeida MF et al (2015) The challenges of managing coexistent disorders with phenylketonuria: 30 cases. Mol Genet Metab 116(4):242\u2013251. https:\/\/doi.org\/10.1016\/j.ymgme.2015.10.001","journal-title":"Mol Genet Metab"},{"issue":"Suppl 3","key":"2685_CR4","doi-asserted-by":"publisher","first-page":"S283","DOI":"10.1007\/s10545-010-9149-8","volume":"33","author":"M Albersen","year":"2010","unstructured":"Albersen M, Bonthuis M, de Roos NM et al (2010) Whole body composition analysis by the BodPod air-displacement plethysmography method in children with phenylketonuria shows a higher body fat percentage. J Inherit Metab Dis 33(Suppl 3):S283\u2013S288. https:\/\/doi.org\/10.1007\/s10545-010-9149-8","journal-title":"J Inherit Metab Dis"},{"issue":"6","key":"2685_CR5","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1002\/jmd2.12379","volume":"64","author":"C Giret","year":"2023","unstructured":"Giret C, Dos Santos Y, Blasco H et al (2023) No evidence for systemic low-grade inflammation in adult patients with early-treated phenylketonuria: The INGRAPH study. JIMD Rep 64(6):446\u2013452. https:\/\/doi.org\/10.1002\/jmd2.12379","journal-title":"JIMD Rep"}],"container-title":["Acta Diabetologica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00592-026-02685-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00592-026-02685-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00592-026-02685-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T04:03:01Z","timestamp":1786507381000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00592-026-02685-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,19]]},"references-count":5,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["2685"],"URL":"https:\/\/doi.org\/10.1007\/s00592-026-02685-6","relation":{},"ISSN":["1432-5233"],"issn-type":[{"value":"1432-5233","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,19]]},"assertion":[{"value":"16 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that they have no conflict of interest.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}