Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Exp Med. Jun 20, 2026; 16(2): 121192
Published online Jun 20, 2026. doi: 10.5493/wjem.v16.i2.121192
Published online Jun 20, 2026. doi: 10.5493/wjem.v16.i2.121192
Letter to the Editor: Endocrine determinants of diabetic ketoacidosis outcomes in type 2 diabetes and insights into Gymnema sylvestre actions
Charalampos Milionis, Department of Endocrinology, Diabetes and Metabolism, Elena Venize
Emmanouil Zoumakis, First Department of Pediatrics, University of Athens Medical School, Agia Sofia Hospital, Athens GR-11527, Greece
Ioannis Ilias, Department of Endocrinology, Hippocration General Hospital, Athens 11527, Greece
Author contributions: Milionis C, Zoumakis E and Ilias I searched the literature; Milionis C, Zoumakis E and Ilias I wrote the first draft; Milionis C, Zoumakis E and Ilias I wrote the final draft; and all authors report no conflict of interest; and all authors agreed for the submission of this work.
AI contribution statement: ChatGPT was used for language/syntax editing of this manuscript's drafts and final version. The manuscript content was all created without the use of AI software.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Corresponding author: Ioannis Ilias, MD, PhD, Director, Department of Endocrinology, Hippocration General Hospital, No. 63 Evrou Street, Athens 11527, Greece.
Received: March 18, 2026
Revised: March 31, 2026
Accepted: April 14, 2026
Published online: June 20, 2026
Processing time: 86 Days and 19.4 Hours
Revised: March 31, 2026
Accepted: April 14, 2026
Published online: June 20, 2026
Processing time: 86 Days and 19.4 Hours
Core Tip
Core Tip: Endocrine parameters - including beta-cell reserve, incretin signaling, and glucagon dynamics - are critical but underexplored determinants of diabetic ketoacidosis (DKA) outcomes in type 2 diabetes mellitus. The concurrent occurrence of acute pancreatitis in DKA, which may affect at least 15% of cases and substantially worsens prognosis, adds diagnostic complexity by masking hallmark features of both conditions and amplifying metabolic and hormonal dysregulation. The metabolic effects of Gymnema sylvestre also require deeper hormonal characterization to clarify its mechanism of action.