The world of chronicity is progressively growing epidemiologically with a considerable commitment of resources aimed at meeting the need for continuity of care and long-term patient care, with integration between health professionals and care settings.

Within the PNRR, Ministerial Decree 77 (DM77) of 23/5/2022 identifies Community Houses as the privileged location for the provision of integrated, multidisciplinary and multi-professional interventions with the involvement of specialist and nursing clinics that operate in collaboration with general medicine and district structures, taking advantage of the necessary technological equipment, including telemedicine.
In this context, diabetology is faced with a complicated challenge: on the one hand, to take care of the patient with diabetes in its complexity and on the other hand, to face the objective difficulty of extending one’s knowledge beyond the specific field of diabetes, giving the right priority to the different clinical problems and different therapeutic actions, so as to avoid the fragmentation and redundancy of the diagnostic-therapeutic-care pathways.

The Territorial Specialist Department, recently created in the Azienda Sanitaria Universitaria Giuliano Isontina, aims to promote the so-called “Value Based Medicine”, that is, an effective but sustainable medicine, both in economic terms and in terms of individual and social values, reconciling the guidelines with the actual needs of the patient. The final objective is an initiative medicine program with systematic stratification of patients at greater risk/complexity for the clinical governance of the system and the planning of the activity in an efficient, appropriate and sustainable way.

KEY WORDS diabetes; comorbidities; assistance; multidisciplinarity; multi-professionalism.

In 2019, the Local Health Service – ASL Toscana Centro (TC) promoted the “Diabetes Project” towards General Practitioners (GP) aimed at deprescribing of sulphonylureas (SU) and glinides to the advantage of new hypoglycaemics drugs. This intervention proved to be particularly useful and was further strengthened in 2022 following the entry of AIFA Nota 100, which allowed the prescription of newer molecules as to GP as cardiologists, nephrologist and internal medicine doctors.

Aim of this study was to evaluate the impact of this territorial project, analyzing the trend of prescription of SU and of the other organ protective hypoglycemic drugs. Prescription of hypoglycemic drugs was retrieved through ATC classification system (ATC A10). In the ASL TC, subjects with pharmacologically treated diabetes has constantly grown in the years 2020-2023, from 5.5% to 6.2%, with a prevalence in males. Data showed that SU utilization is reduced by 75% from 2020 to 2023.

A significant increase was appreciated for the new classes of drugs, greater for SGLT2i (+54%), in line with national scenario. The increase was also notable for GLP1RA (+51%), while DPP4i were essentially stable, thus representing 14% of hypoglycemic drugs prescribed by 2023. However, the rise in associations (SGLT2i+DDP4i) prescription was minimal.

KEY WORDS guidelines; AIFA nota 100; hypoglycemic drugs; prescriptive trend.

The presence of disparities in patients with type 2 diabetes mellitus (T2D) according to geographic regions has been widely assumed; however, to date, comprehensive information about the quality of care of migrant populations with diabetes is still lacking. For this purpose, we analyzed indicators from AMD Annals 2022 data to assess any disparities in outcome or quality of care in foreign compared with European patients. Among all active patients with type 2 diabetes mellitus, those in whom information regarding the country of origin was recorded were selected. The ISTAT classification was used to define the geographic area of origin, and key process, intermediate, final outcome, and Q score indicators were assessed by individual country of origin.

Country of origin information was available for 179,536 patients with T2D. Of these, 19.3% had a foreign origin, and the main countries of origin by sample size were North Africa, Central and Eastern Europe, Central and South Asia, and Central and South America. Foreign patientsare younger with a delta of more than 20 years when compared with, for example, Central and South Asia and resulting in shorter disease duration. Evaluation of process indicators shows good adherence to diabetes indications with less attention to microalbuminuria assay and retinopathy screening. Overall, intensity/appropriateness indicators were lower in populations from North and West Africa and Central and South Asia. In contrast, the use of innovative therapies was comparable to that in the European population. The lowest mean Q Score was found in patients from West Africa (26.4±9.1 vs. 29.1±8.0), and the percentage of patients with the lowest Q Score>25 was found in patients from Central and South Asia (51.6%) and West Africa (50.1%), but also from Eastern Europe (53.1%), almost 10 percentage points lower. Overall, differences in age, disease
duration, and treatment intensity emerged among patients from different geographic areas. The type of treatment offered shows a focus on equitable use of drug therapies, but the results, while not so far apart, suggest the need for even more targeted therapeutic interventions to overcome the several barriers that exist

KEY WORDS quality of care; migrant population; type 2 diabetes.

The term One Health embodies the concept that human health, animal health and the health of our planet are closely interconnected with each other. The factors involved in the preservation and promotion of this concept are many. Among these, one of the major determinants is nutrition. Indeed, scientific research has shown how diet is one of the main elements to counteract several diseases, especially those defined as chronic non-communicable, such as diabetes, hypertension, cardiovascular diseases, which represent, all together, one of the main causes of death worldwide. At the same time, the food supply chain is one of the most responsible for producing climate-altering gases, land consumption and water use. Within this scenario, it is well understood that it is necessary to adopt lifestyles and dietary patterns that allow to simultaneously promote human health, animal well-being and the health of our planet. Two examples in this sense are the Planetary Diet and the Mediterranean Diet, which will be briefly presented and analyzed under the different profiles mentioned above.

KEY WORDS nutrition; planet; sustainability; health.

The consumption of certain food additives (emulsifiers) has long been associated with an increased risk of developing chronic diseases (obesity, cardiovascular diseases and cancer). The analysis of the recent NutriNet-Santé Cohort Study, carried out in France between 2009 and 2023, also suggests that there may also be a link with the onset of diabetes. The food diaries of 104,139 volunteer participants (79% women) were collected with a prospective survey, which contained information on the quantity of consumption and brand of products of a wide range of ultra-processed foods (chocolate, ice cream, biscuits, pastries, fruit and vegetables and processed cereals, dairy products, mayonnaise, edible oils and syrups).

The overall statistical analysis of the data collected, on 61 substances evaluated, suggested that a higher intake of 7 groups of emulsifiers (E407, E340, E472e, E331, E412, E414, E415) may be associated with an increased risk of developing type 2 diabetes (1,056 cases diagnosed, equal to 1,01% of the sample: not a very high percentage, considering the prevalence of type 2 diabetes and the duration of the study). The major sources of consumption of these emulsifiers are included in ultra-processed fruits and vegetables (in 18.5% of cases – canned/canned foods); cakes and biscuits (in 14%); dairy products (in 10%), products often considered part of a healthy diet.

These data, if confirmed by further studies, could have important implications for public health. However, it is useful to limit the consumption of ultra-processed foods, learning to draw important nutritional information from reading food labels.

KEY WORDS ultra-processed foods; food additives; emulsifiers; Nutri-Net Santé Cohort; type 2 diabetes.

Insulin autoimmune syndrome (IAS) is a rare disorder characterized by hyperinsulinemic hypoglycemia due to insulin-binding autoantibodies, often secondary to the use of alpha-lipoic acid(1). This syndrome is chal-lenging during pregnancy as the autoantibodies can cross the placenta. To the best of our knowledge, this is one of the first case of IAS during pregnancy: a 28-year-old african female developed recurrent hypo-glicemic episodes starting from 24th week of pregnancy. Drug history included supplementation of alfa lipoic acid. Diagnosis was made on the basis of high levels of insulin autoantibodies. Oral prednisone was prescribed to reduce autoantibodies production and hypoglicemic ep-isodes, metformin, and diet theraphy were added to reduce maternal steroid-related hyperglicemic status. Vaginal birth has been induced at 36 +4 weeks, maternal insulin antibody levels were lower but still pos-itive so the newborn developed hypoglicemic episodes due to a sec-ondary IAS.

KEY WORD insulin autoimmune syndrome; pregnancy, lipoic acid; hy-poglicaemia.

Cardiovascular disease (CV) is the leading cause of morbidity and mortality in the World, especially for people with diabetes. Diabetes and the hyperglycemia are themselves a powerful risk factor for cardiovascular disease. Therefore, it is essential in people with diabetes to simultaneously pursue the optimization of glycemic control and LDL cholesterol for reducing the risk of  developing major cardiovascular events. In clinical practice, however, our patients often have LDL cholesterol levels far from the targets set by the guidelines. This phenomenon is partly due to under-treatment of cardiovascular risk factors by clinicians and partly attributable to poor therapeutic adherence in our patients. In recent years, scientific research has made available to new lipid lowering agents which are very effective in reducing LDL cholesterol levels and potentially able to promote patient adherence by virtue of their ease of use, the few side effects and the possibility of being taken by the patient monthly oreven semi-annually to the benefit of adherence to therapy. Today, however, not all Italian diabetologists are able to use of this new drugs for the care of their patients, both for bureaucratic problems and organizational limitations. The aim of this survey is to evaluate among a representative group of Italian diabetologists what is the state of the art in the management of dyslipidemia in the various realities where they operate.

KEY WORDS dyslipidemia, cardiovascular risk, survey, AMD Annals.