{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T19:48:05Z","timestamp":1793303285870,"version":"4.5.0"},"reference-count":97,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biology"],"abstract":"<jats:p>Background: Glycemic control influences a wide range of psychiatric and physiological symptoms. Many psychiatric conditions are linked to poor glucose regulation. Anti-nuclear antibodies (ANAs), widely used to screen for autoimmune disease, may sometimes reflect transient metabolic immune activation rather than chronic pathology. Evidence suggests that glucose dysregulation, including glycemic variability, reactive hypoglycemia, and postprandial spikes, can trigger systemic inflammation, neuropsychiatric symptoms, and temporary autoantibody production. This review explores how these metabolic phenomena complicate diagnosis and may contribute to misclassification or overtreatment. Methods: We conducted a narrative literature review prioritizing studies on immune activation, psychiatric outcomes, metabolic measures (including continuous glucose monitoring), and therapeutic interventions. Articles from the last ten years were emphasized, with older foundational studies included when relevant. Results: Metabolic instability drives immune dysregulation through macrophage polarization, mitochondrial dysfunction, oxidative stress, and impaired clearance of apoptotic debris. Glycemic variability correlates with increased inflammatory cytokines, autonomic dysfunction, and psychiatric symptoms such as anxiety, depression, and cognitive impairment. Emerging evidence from small studies suggests that correcting glucose abnormalities may reduce metabolic dysfunction and improve neuropsychiatric symptoms. Conclusions: Recognizing glucose dysregulation as a contributor to autoimmune-like and psychiatric symptoms may refine diagnostic and therapeutic approaches. Incorporating a dynamic holistic approach, which in practice includes metabolic assessments, dietary interventions, use of continuous glucose monitoring, and history of blood sugar instability, into rheumatologic and psychiatric evaluations could improve diagnostic precision, reduce unnecessary immunosuppression, and enhance patient outcomes.<\/jats:p>","DOI":"10.3390\/biology15131094","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T14:27:23Z","timestamp":1783520843000},"page":"1094","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Glucose Dysregulation as a Driver of Autoimmune Mimicry, Inflammation, and Psychiatric Symptoms: A Narrative Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3936-7064","authenticated-orcid":false,"given":"Jacob","family":"Warner-Palacio","sequence":"first","affiliation":[{"name":"Department of Research, Noorda College of Osteopathic Medicine, 2162 S 180 E, Provo, UT 84606, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Hunsaker","sequence":"additional","affiliation":[{"name":"Department of Research, Noorda College of Osteopathic Medicine, 2162 S 180 E, Provo, UT 84606, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"McKenna","sequence":"additional","affiliation":[{"name":"Department of Research, Noorda College of Osteopathic Medicine, 2162 S 180 E, Provo, UT 84606, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4680-8251","authenticated-orcid":false,"given":"Brigita","family":"Budginas","sequence":"additional","affiliation":[{"name":"Department of Research, Noorda College of Osteopathic Medicine, 2162 S 180 E, Provo, UT 84606, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Levi","family":"Fridriksson","sequence":"additional","affiliation":[{"name":"Department of Research, Noorda College of Osteopathic Medicine, 2162 S 180 E, Provo, UT 84606, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9518-6503","authenticated-orcid":false,"given":"Alexander","family":"Tam","sequence":"additional","affiliation":[{"name":"Department of Research, Noorda College of Osteopathic Medicine, 2162 S 180 E, Provo, UT 84606, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5258-9126","authenticated-orcid":false,"given":"Christina","family":"Nelson","sequence":"additional","affiliation":[{"name":"Department of Research, Noorda College of Osteopathic Medicine, 2162 S 180 E, Provo, UT 84606, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7372-9896","authenticated-orcid":false,"given":"David","family":"Sant","sequence":"additional","affiliation":[{"name":"Department of Research, Noorda College of Osteopathic Medicine, 2162 S 180 E, Provo, UT 84606, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle B.","family":"Bills","sequence":"additional","affiliation":[{"name":"Department of Research, Noorda College of Osteopathic Medicine, 2162 S 180 E, Provo, UT 84606, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1002\/art.10561","article-title":"Evidence-based guidelines for the use of immunologic tests: Antinuclear antibody testing","volume":"47","author":"Solomon","year":"2002","journal-title":"Arthritis Rheum."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"109292","DOI":"10.1016\/j.intimp.2022.109292","article-title":"Antinuclear antibodies in healthy population: Positive association with abnormal tissue metabolism, inflammation and immune dysfunction","volume":"113","author":"Ge","year":"2022","journal-title":"Int. Immunopharmacol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s10067-005-0059-3","article-title":"Circulating auto-antibodies against nuclear and non-nuclear antigens in primary Sjogren\u2019s syndrome: Prevalence and clinical significance in 335 patients","volume":"25","author":"Nardi","year":"2006","journal-title":"Clin. Rheumatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1002\/acr.23292","article-title":"Performance of Antinuclear Antibodies for Classifying Systemic Lupus Erythematosus: A Systematic Literature Review and Meta-Regression of Diagnostic Data","volume":"70","author":"Leuchten","year":"2018","journal-title":"Arthritis Care Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1038\/s41584-020-00522-w","article-title":"Understanding and interpreting antinuclear antibody tests in systemic rheumatic diseases","volume":"16","author":"Bossuyt","year":"2020","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1089\/ars.2017.7060","article-title":"Metabolic Regulation of Adipose Tissue Macrophage Function in Obesity and Diabetes","volume":"29","author":"Appari","year":"2018","journal-title":"Antioxid. Redox Signal."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1002\/art.42330","article-title":"Increasing Prevalence of Antinuclear Antibodies in the United States","volume":"74","author":"Dinse","year":"2022","journal-title":"Arthritis Rheumatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"28","DOI":"10.5604\/18982395.1208185","article-title":"Autoimmunity markers in subjects with diabetes","volume":"10","author":"Kowrach","year":"2016","journal-title":"J. Pre-Clin. Clin. Res."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Xu, L., Yan, X., Zhao, Y., Wang, J., Liu, B., Yu, S., Fu, J., Liu, Y., and Su, J. (2022). Macrophage Polarization Mediated by Mitochondrial Dysfunction Induces Adipose Tissue Inflammation in Obesity. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23169252"},{"key":"ref_10","first-page":"110515","article-title":"Macrophage and inflammation in diabetes and metabolic dysfunction-associated steatotic liver disease: From mechanisms to therapeutic strategies","volume":"16","author":"Zhang","year":"2025","journal-title":"World J. Diabetes"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"682","DOI":"10.2337\/dc14-0654","article-title":"Glycemic Variability Is Associated with Reduced Cardiac Autonomic Modulation in Women with Type 2 Diabetes","volume":"38","author":"Fleischer","year":"2015","journal-title":"Diabetes Care"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Watt, C., Sanchez-Rangel, E., and Hwang, J.J. (2020). Glycemic Variability and CNS Inflammation: Reviewing the Connection. Nutrients, 12.","DOI":"10.3390\/nu12123906"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.jad.2023.09.017","article-title":"Risk of depression and anxiety disorders according to long-term glycemic variability","volume":"343","author":"Kwon","year":"2023","journal-title":"J. Affect. Disord."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"5053","DOI":"10.2147\/PRBM.S441058","article-title":"Association of Long-Term HbA1c Variability with Anxiety and Depression in Patients with Type 2 Diabetes: A Cross-Sectional Retrospective Study","volume":"16","author":"Shi","year":"2023","journal-title":"Psychol. Res. Behav. Manag."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"120606","DOI":"10.1016\/j.jad.2025.120606","article-title":"Glucose biomarkers and antidepressant response: A scoping review of interventions targeting major depressive disorder and metabolic dysfunction","volume":"395","author":"Silver","year":"2026","journal-title":"J. Affect. Disord."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1177\/09727531241255492","article-title":"Integrative Functions of the Hypothalamus: Linking Cognition, Emotion and Physiology for Well-being and Adaptability","volume":"32","author":"Goel","year":"2025","journal-title":"Ann. Neurosci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1089\/ars.2012.4569","article-title":"Neuroendocrine profile in a rat model of psychosocial stress: Relation to oxidative stress","volume":"18","author":"Colaianna","year":"2013","journal-title":"Antioxid. Redox Signal."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1515\/hmbci-2024-0017","article-title":"Hypothalamus-pituitary-adrenal axis in patients with post-traumatic stress disorders and related to oxidative stress","volume":"45","year":"2024","journal-title":"Horm. Mol. Biol. Clin. Investig."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1002\/acr.23237","article-title":"Increased Insulin Resistance and Glucagon Levels in Mild\/Inactive Systemic Lupus Erythematosus Patients Despite Normal Glucose Tolerance","volume":"70","author":"Miyake","year":"2018","journal-title":"Arthritis Care Res."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ciaffi, J., Ruscitti, P., Di Cola, I., Pavlych, V., Italiano, N., Gentile, M., Huizinga, T., de Vries-Bouwstra, J.K., Ursini, F., and Cipriani, P. (2023). Whole body insulin sensitivity is increased in systemic sclerosis. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0283283"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"T25","DOI":"10.1530\/JOE-13-0398","article-title":"Hypothalamic and brainstem neuronal circuits controlling homeostatic energy balance","volume":"220","author":"Schneeberger","year":"2014","journal-title":"J. Endocrinol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1002\/gps.4267","article-title":"Glycemic control, inflammation, and cognitive function in older patients with type 2 diabetes","volume":"30","author":"Akrivos","year":"2015","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_23","unstructured":"Bermingham, K.M., Smith, H.A., Gonzalez, J.T., Duncan, E.L., Valdes, A.M., Franks, P.W., Delahanty, L., Dashti, H.S., Davies, R., and Hadjigeorgiou, G. (2023). Glycaemic variability, assessed with continuous glucose monitors, is associated with diet, lifestyle and health in people without diabetes. Res. Sq., preprint."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s00592-008-0061-8","article-title":"Glycaemic variability and inflammation in subjects with metabolic syndrome","volume":"46","author":"Buscemi","year":"2009","journal-title":"Acta Diabetol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Sousa, E.S.A., Queiroz, L.A.D., Guimar\u00e3es, J.P.T., Pantoja, K.C., Barros, R.S., Epiphanio, S., and Martins, J.O. (2023). The influence of high glucose conditions on macrophages and its effect on the autophagy pathway. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1130662"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.bbi.2024.11.033","article-title":"Depression with immuno-metabolic dysregulation: Testing pragmatic criteria to stratify patients","volume":"124","author":"Zwiep","year":"2025","journal-title":"Brain Behav. Immun."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Nelson, C.A., Reavely, K.W., Jennings, M.R., Burger, B.J., Kim, A.C., Sant, D.W., and Bills, K.B. (2025). Glucose dysregulation and glycemic phenotyping in chronic migraine. Front. Neurol., 16.","DOI":"10.3389\/fneur.2025.1719724"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Cavestro, C. (2025). Metabolic Dysfunction and Dietary Interventions in Migraine Management: The Role of Insulin Resistance and Neuroinflammation-A Narrative and Scoping Review. Brain Sci., 15.","DOI":"10.3390\/brainsci15050474"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.bbi.2018.05.003","article-title":"The effect of insulin-induced hypoglycemia on inflammatory markers: A systematic review","volume":"73","author":"Drummond","year":"2018","journal-title":"Brain Behav. Immun."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"4750","DOI":"10.1038\/s41598-020-61531-z","article-title":"Effect of induced hypoglycemia on inflammation and oxidative stress in type 2 diabetes and control subjects","volume":"10","author":"Kahal","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2716","DOI":"10.2337\/db22-0246","article-title":"Sustained Proinflammatory Effects of Hypoglycemia in People With Type 2 Diabetes and in People Without Diabetes","volume":"71","author":"Verhulst","year":"2022","journal-title":"Diabetes"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"102983","DOI":"10.1016\/j.autneu.2022.102983","article-title":"Stress, hypoglycemia, and the autonomic nervous system","volume":"240","author":"Haas","year":"2022","journal-title":"Auton. Neurosci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1111\/head.12725","article-title":"Migraine Triggers and Oxidative Stress: A Narrative Review and Synthesis","volume":"56","author":"Borkum","year":"2016","journal-title":"Headache"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Mahajan, A., Herrmann, M., and Mu\u00f1oz, L.E. (2016). Clearance Deficiency and Cell Death Pathways: A Model for the Pathogenesis of SLE. Front. Immunol., 7.","DOI":"10.3389\/fimmu.2016.00035"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2888","DOI":"10.1002\/art.11237","article-title":"Increased apoptotic neutrophils and macrophages and impaired macrophage phagocytic clearance of apoptotic neutrophils in systemic lupus erythematosus","volume":"48","author":"Ren","year":"2003","journal-title":"Arthritis Rheum."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1242\/dmm.026609","article-title":"Hypothalamic circuits regulating appetite and energy homeostasis: Pathways to obesity","volume":"10","author":"Timper","year":"2017","journal-title":"Dis. Model. Mech."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1210\/en.2017-00486","article-title":"Dietary Manipulations That Induce Ketosis Activate the HPA Axis in Male Rats and Mice: A Potential Role for Fibroblast Growth Factor-21","volume":"159","author":"Ryan","year":"2017","journal-title":"Endocrinology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1177\/2045125316675579","article-title":"Lactate in the brain: An update on its relevance to brain energy, neurons, glia and panic disorder","volume":"7","author":"Riske","year":"2017","journal-title":"Ther. Adv. Psychopharmacol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Pavlou, S., Lindsay, J., Ingram, R., Xu, H., and Chen, M. (2018). Sustained high glucose exposure sensitizes macrophage responses to cytokine stimuli but reduces their phagocytic activity. BMC Immunol., 19.","DOI":"10.1186\/s12865-018-0261-0"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Pashnina, I.A., Krivolapova, I.M., Fedotkina, T.V., Ryabkova, V.A., Chereshneva, M.V., Churilov, L.P., and Chereshnev, V.A. (2021). Antinuclear Autoantibodies in Health: Autoimmunity Is Not a Synonym of Autoimmune Disease. Antibodies, 10.","DOI":"10.3390\/antib10010009"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3631","DOI":"10.1097\/MS9.0000000000001993","article-title":"Diabetic cheiroarthropathy in uncontrolled type 2 diabetes with positive anti-nuclear antibodies: A case report from Sudan","volume":"86","author":"Abdalla","year":"2024","journal-title":"Ann. Med. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1084\/jem.20012094","article-title":"Delayed Apoptotic Cell Clearance and Lupus-like Autoimmunity in Mice Lacking the c-mer Membrane Tyrosine Kinase","volume":"196","author":"Cohen","year":"2002","journal-title":"J. Exp. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1507\/endocrj1954.30.469","article-title":"Antinuclear Antibodies in Childhood Diabetics","volume":"30","author":"Notsu","year":"1983","journal-title":"Endocrinol. Jpn."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"243","DOI":"10.5114\/reum.2018.77976","article-title":"Antinuclear antibodies in healthy people and non-rheumatic diseases\u2014Diagnostic and clinical implications","volume":"56","author":"Rogacka","year":"2018","journal-title":"Reumatologia"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Knezevic, E., Nenic, K., Milanovic, V., and Knezevic, N.N. (2023). The Role of Cortisol in Chronic Stress, Neurodegenerative Diseases, and Psychological Disorders. Cells, 12.","DOI":"10.3390\/cells12232726"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"5305","DOI":"10.1113\/jphysiol.2009.179192","article-title":"Hormone and glucose signalling in POMC and AgRP neurons","volume":"587","author":"Belgardt","year":"2009","journal-title":"J. Physiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1212\/WNL.0b013e3181df0a3f","article-title":"Neural control of feeding behavior","volume":"74","author":"Benarroch","year":"2010","journal-title":"Neurology"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.cell.2016.02.044","article-title":"AgRP Neurons Control Systemic Insulin Sensitivity via Myostatin Expression in Brown Adipose Tissue","volume":"165","author":"Steculorum","year":"2016","journal-title":"Cell"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1038\/nature06098","article-title":"Glucose sensing by POMC neurons regulates glucose homeostasis and is impaired in obesity","volume":"449","author":"Parton","year":"2007","journal-title":"Nature"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.npep.2018.02.001","article-title":"Weaning stage hyperglycemia induces glucose-insensitivity in arcuate POMC neurons and hyperphagia in type 2 diabetic GK rats","volume":"68","author":"Ando","year":"2018","journal-title":"Neuropeptides"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1001\/jamapsychiatry.2025.2240","article-title":"Antipsychotic Drugs and Dysregulated Glucose Homeostasis: A Systematic Review and Meta-Analysis","volume":"82","author":"Smith","year":"2025","journal-title":"JAMA Psychiatry"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.1016\/S0140-6736(25)01293-0","article-title":"The effects of antidepressants on cardiometabolic and other physiological parameters: A systematic review and network meta-analysis","volume":"406","author":"Pillinger","year":"2025","journal-title":"Lancet"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2162","DOI":"10.1002\/art.40222","article-title":"Association of Trauma and Posttraumatic Stress Disorder With Incident Systemic Lupus Erythematosus in a Longitudinal Cohort of Women","volume":"69","author":"Roberts","year":"2017","journal-title":"Arthritis Rheumatol."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Alzahrani, M.S., Alabbasi, A., Alzahrani, Z., and Alsafrani, T. (2026). Prevalence and patterns of psychiatric comorbidities in type 2 diabetes mellitus: A systematic review and meta-analysis. Front. Public Health, 14.","DOI":"10.3389\/fpubh.2026.1697079"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1002\/glia.23283","article-title":"Brain metabolic sensing and metabolic signaling at the level of an astrocyte","volume":"66","author":"Marina","year":"2018","journal-title":"Glia"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1186\/s12974-024-03136-1","article-title":"Hyperglycemia enhances brain susceptibility to lipopolysaccharide-induced neuroinflammation via astrocyte reprogramming","volume":"21","author":"Lee","year":"2024","journal-title":"J. Neuroinflamm."},{"key":"ref_57","first-page":"234572","article-title":"Reevaluating Metabolism in Alzheimer\u2019s Disease from the Perspective of the Astrocyte-Neuron Lactate Shuttle Model","volume":"2013","author":"Newington","year":"2013","journal-title":"J. Neurodegener. Dis."},{"key":"ref_58","first-page":"4","article-title":"Astrocytic Glucose Sensing Drives Synaptic Depression under Metabolic Stress","volume":"17","author":"Baraibar","year":"2025","journal-title":"Aging Dis."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.1016\/S2213-8587(19)30074-9","article-title":"Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: A prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial","volume":"7","author":"Estruch","year":"2019","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.brainresrev.2008.09.002","article-title":"The neuroprotective properties of calorie restriction, the ketogenic diet, and ketone bodies","volume":"59","author":"Maalouf","year":"2009","journal-title":"Brain Res. Rev."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"528","DOI":"10.2337\/dc24-2376","article-title":"Repeated OGTT Versus Continuous Glucose Monitoring for Predicting Development of Stage 3 Type 1 Diabetes: A Longitudinal Analysis","volume":"48","author":"Desouter","year":"2025","journal-title":"Diabetes Care"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Kong, S.Y., and Cho, M.K. (2024). Effects of Continuous Glucose Monitoring on Glycemic Control in Type 2 Diabetes: A Systematic Review and Meta-Analysis. Healthcare, 12.","DOI":"10.3390\/healthcare12050571"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Cho, S.H., Kim, S., Lee, Y.B., Jin, S.M., Hur, K.Y., Kim, G., and Kim, J.H. (2023). Impact of continuous glucose monitoring on glycemic control and its derived metrics in type 1 diabetes: A longitudinal study. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1165471"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e2221","DOI":"10.1210\/clinem\/dgac034","article-title":"Complications of Diabetes and Metrics of Glycemic Management Derived From Continuous Glucose Monitoring","volume":"107","author":"Yapanis","year":"2022","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1186\/s12966-024-01692-6","article-title":"The efficacy of using continuous glucose monitoring as a behaviour change tool in populations with and without diabetes: A systematic review and meta-analysis of randomised controlled trials","volume":"21","author":"Richardson","year":"2024","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/s12966-024-01622-6","article-title":"Leveraging continuous glucose monitoring as a catalyst for behaviour change: A scoping review","volume":"21","author":"Jospe","year":"2024","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_67","unstructured":"Daley, S.F., Masood, W., Annamaraju, P., and Khan Suheb, M.Z. (2025). The Ketogenic Diet: Clinical Applications, Evidence-based Indications, and Implementation. StatPearls, StatPearls."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1111\/dom.14837","article-title":"Very low carbohydrate (ketogenic) diets in type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials","volume":"24","author":"Weatherall","year":"2022","journal-title":"Diabetes Obes. Metab."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e70129","DOI":"10.1111\/jhn.70129","article-title":"Classical and Modified Ketogenic Diets for Children and Young People With Drug-Resistant Epilepsy: A Reflection of International Dietetic Practice and Best Practice Recommendations for Dietitians","volume":"38","author":"Schoeler","year":"2025","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1080\/1028415X.2024.2397624","article-title":"The effect of the modified Atkins diet and anti-seizure medications on lipid marker levels in adults with epilepsy","volume":"28","author":"Muller","year":"2025","journal-title":"Nutr. Neurosci."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"9222632","DOI":"10.1155\/2023\/9222632","article-title":"The Effectiveness of Modified Atkins Ketogenic Diet on Children with Intractable Epilepsy: A Pilot Study from Indonesia","volume":"2023","author":"Rafli","year":"2023","journal-title":"J. Nutr. Metab."},{"key":"ref_72","first-page":"914","article-title":"[Modified Atkins diet in the treatment of a glycogen storage disease type III patient]","volume":"63","author":"Zhang","year":"2025","journal-title":"Zhonghua Er Ke Za Zhi"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e15178","DOI":"10.1111\/dme.15178","article-title":"Type 1 diabetes and low carbohydrate diets-Defining the degree of nutritional ketosis","volume":"40","author":"Ozoran","year":"2023","journal-title":"Diabet. Med."},{"key":"ref_74","first-page":"e34214","article-title":"The Paleolithic Diet","volume":"15","author":"Singh","year":"2023","journal-title":"Cureus"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1186\/s12967-023-04352-8","article-title":"Adherence to the Paleolithic diet and Paleolithic-like lifestyle reduce the risk of colorectal cancer in the United States: A prospective cohort study","volume":"21","author":"Xiao","year":"2023","journal-title":"J. Transl. Med."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Fontes-Villalba, M., Granfeldt, Y., Sundquist, K., Memon, A.A., Hedelius, A., Carrera-Bastos, P., and Jonsson, T. (2024). Effects of a Paleolithic diet compared to a diabetes diet on leptin binding inhibition in secondary analysis of a randomised cross-over study. BMC Endocr. Disord., 24.","DOI":"10.1186\/s12902-024-01715-0"},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Goedeke, S., Murphy, T., Rush, A., and Zinn, C. (2024). Assessing the Nutrient Composition of a Carnivore Diet: A Case Study Model. Nutrients, 17.","DOI":"10.3390\/nu17010140"},{"key":"ref_78","first-page":"e36720","article-title":"Metabolic Effects of Ketogenic Diets and Their Utilization in Obesity Management: A Systematic Review","volume":"15","author":"Malhotra","year":"2023","journal-title":"Cureus"},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Zhou, C., Wang, M., Liang, J., He, G., and Chen, N. (2022). Ketogenic Diet Benefits to Weight Loss, Glycemic Control, and Lipid Profiles in Overweight Patients with Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trails. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191610429"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1528-1167.2008.01821.x","article-title":"History of the ketogenic diet","volume":"49","author":"Wheless","year":"2008","journal-title":"Epilepsia"},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Bostock, E.C.S., Kirkby, K.C., and Taylor, B.V.M. (2017). The Current Status of the Ketogenic Diet in Psychiatry. Front. Psychiatry, 8.","DOI":"10.3389\/fpsyt.2017.00043"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"115866","DOI":"10.1016\/j.psychres.2024.115866","article-title":"Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial","volume":"335","author":"Sethi","year":"2024","journal-title":"Psychiatry Res."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1001\/jamapsychiatry.2025.4431","article-title":"A Ketogenic Diet for Treatment-Resistant Depression: A Randomized Clinical Trial","volume":"83","author":"Gao","year":"2026","journal-title":"JAMA Psychiatry"},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Jacka, F.N., O\u2019Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., Castle, D., Dash, S., Mihalopoulos, C., and Chatterton, M.L. (2017). A randomised controlled trial of dietary improvement for adults with major depression (the \u2018SMILES\u2019 trial). BMC Med., 15.","DOI":"10.1186\/s12916-017-0791-y"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1001\/jamapsychiatry.2025.3261","article-title":"Ketogenic Diets and Depression and Anxiety: A Systematic Review and Meta-Analysis","volume":"83","author":"Vije","year":"2026","journal-title":"JAMA Psychiatry"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"2327","DOI":"10.1016\/S0140-6736(25)01012-8","article-title":"Understanding the drivers and consequences of early-onset type 2 diabetes","volume":"405","author":"Lim","year":"2025","journal-title":"Lancet"},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Jing, T., Zhang, S., Bai, M., Chen, Z., Gao, S., Li, S., and Zhang, J. (2023). Effect of Dietary Approaches on Glycemic Control in Patients with Type 2 Diabetes: A Systematic Review with Network Meta-Analysis of Randomized Trials. Nutrients, 15.","DOI":"10.3390\/nu15143156"},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Xiaoyu, W., Yuxin, X., and Li, L. (2024). The effects of different intermittent fasting regimens in people with type 2 diabetes: A network meta-analysis. Front. Nutr., 11.","DOI":"10.3389\/fnut.2024.1325894"},{"key":"ref_89","first-page":"e49141","article-title":"Latent Autoimmune Diabetes in Adults and a Continuous Glucose Monitoring Device: An Unfortunate Outcome","volume":"15","author":"Gupta","year":"2023","journal-title":"Cureus"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1556\/1886.2023.00020","article-title":"The impact of ketogenic diet on the onset and progression of multiple sclerosis","volume":"13","author":"Brockhoff","year":"2023","journal-title":"Eur. J. Microbiol. Immunol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"13871","DOI":"10.1038\/srep13871","article-title":"Subsequent Type 2 Diabetes in Patients with Autoimmune Disease","volume":"5","author":"Hemminki","year":"2015","journal-title":"Sci. Rep."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1186\/s12974-024-03308-z","article-title":"Ketogenic diet modulates immune cell transcriptional landscape and ameliorates experimental autoimmune uveitis in mice","volume":"21","author":"Duan","year":"2024","journal-title":"J. Neuroinflamm."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1038\/nature21363","article-title":"Inflammation, metaflammation and immunometabolic disorders","volume":"542","author":"Hotamisligil","year":"2017","journal-title":"Nature"},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Blanco, L.P., and Kaplan, M.J. (2023). Metabolic alterations of the immune system in the pathogenesis of autoimmune diseases. PLoS Biol., 21.","DOI":"10.1371\/journal.pbio.3002084"},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Romero-Castillo, R., Pabon-Carrasco, M., Kaknani-Uttumchandani, S., and Ponce-Blandon, J.A. (2025). Effects of Continuous Glucose Monitoring on Glycemic Control, Mental Health and Self-Management in Adults with Type 1 Diabetes: A Randomized Controlled Trial. Healthcare, 13.","DOI":"10.3390\/healthcare13243197"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"365","DOI":"10.2337\/dc21-0602","article-title":"CGM Metrics Predict Imminent Progression to Type 1 Diabetes: Autoimmunity Screening for Kids (ASK) Study","volume":"45","author":"Steck","year":"2021","journal-title":"Diabetes Care"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.diabres.2019.04.026","article-title":"Study of the difficult glycemic control in relation to the presence of diabetes-autoantibodies in a sample of Egyptians with type 1 diabetes","volume":"152","author":"Hamed","year":"2019","journal-title":"Diabetes Res. Clin. Pract."}],"container-title":["Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-7737\/15\/13\/1094\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T14:48:08Z","timestamp":1783522088000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-7737\/15\/13\/1094"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,7]]},"references-count":97,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["biology15131094"],"URL":"https:\/\/doi.org\/10.3390\/biology15131094","relation":{},"ISSN":["2079-7737"],"issn-type":[{"value":"2079-7737","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,7]]}}}