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Dysbiosis during this transition underlies elevated ketosis risk: the decline of VFA-producing taxaincluding Ruminococcus , Prevotella , Selenomonas , and Succinivibrionaceaeimpairs propionate fermentation pathways and reduces gluconeogenic precursor supply, while the concurrent expansion of opportunistic taxa such as Mycoplasma and Saccharimonas further destabilizes ruminal homeostasis (Table 2), collectively contributing to hypoglycemia, excessive mobilization of body fat, and ketone accumulation, which compromise lactation, reproductive performance, and offspring health 47,55,56,57

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The SURPASS-CVOT (Cardiovascular Outcomes Trial) is an ongoing dedicated study designed to assess cardiovascular outcomes in patients with type 2 diabetes at increased cardiovascular risk