This 2023 AMD Annals Monograph aims to describe the care profiles of patients with type 2 diabetes mellitus (T2DM), with a specific focus on the elderly population.

DESIGN AND METHODS
A total of 571,910 “active” patients with T2DM in the year 2023, followed by 296 Italian diabetes clinics, were evaluated. Socio-demographic, clinical, process, intermediate and final outcome indicators, pharmacological treatment patterns, and overall quality-of-care (Q score) were analysed.

RESULTS
Of the 571,910 patients, 31.4% were <65 years, 33.7% were 6574 years, and 34.9%were ≥75 years. Men were predominant, although the proportion of women increased with age. Mean disease duration reached 16.6 years among the oldest patients. Across all age groups, 1 of 2 individuals received at least one assessment of HbA1c, lipid profile, blood pressure, and albuminuria. Glycaemic control (HbA1c) was similar across age categories, yet only a minority achieved the composite outcome (HbA1c ≤7%, LDL-C <100 mg/dL, BP <140/90 mmHg). Mean BMI was higher in younger patients and obesity prevalence declined with age. Individuals aged ≥75 years more frequently received insulin or DPP4i and less frequently SGLT2i and GLP1-RAs. Renal and lower-limb complications were comparable across age groups, whereas cardiovascular complications and diabetic retinopathy increased with age. More than 60% of patients achieved a Q score >25.

BACKGROUND
The introduction of SGLT2 inhibitors (SGLT2i) and GLP1 receptor agonists (GLP-1RA) has revolutionized the management of type 2 diabetes (T2D), significantly improving cardiovascular and renal outcomes. However, prescribing patterns remain inconsistent with clinical guidelines.

METHODS
This cross-sectional study analyzed data from 142.218 individuals in the AMD Annals 2023 database, stratified into four clinical risk groups based on ADA guidelines. The Logic Learning Machine algorithm was used to identify phenotypic predictors of SGLT2i and GLP-1RA prescriptions.

FINDINGS
SGLT2i prescriptions were more frequently associated with patients having an estimated glomerular filtration rate (eGFR) <60 mL/min and HbA1c levels between 6.3%-7.6%, whereas GLP-1RA were preferentially prescribed to younger patients with a BMI >30 kg/m² and HbA1c >9%. Predictive models for SGLT2i prescriptions demonstrated greater reliability compared to those for GLP-1RA.

INTERPRETATION
Adherence to guideline recommendations for SGLT2i appears to be higher than for GLP-1RA, which remain underutilized in high-risk patients.

KEY WORDS
Type 2 diabetes mellitus (T2D); sodium-glucose co-transporter-2 inhibitors (SGLT2i); glucagon-like peptide-1 receptor agonists (GLP1RA); machine learning analysis; cardiorenal risk stratification; prescription patterns.

Diabetic sensory-motor neuropathy affects the peripheral nerves, causing a combination of sensory and motor symptoms. Symptoms may include paraesthesia, pain, numbness, altered sensitivity to heat and cold, and hypoaesthesia. They vary in severity and location and, in more advanced cases, are responsible for significant functional limitations that negatively affect the quality of life of those affected. There are various diagnostic procedures that can identify it, and their application is sometimes very heterogeneous. From a therapeutic point of view, there are several possible approaches, including both drug therapies and supplementation with nutraceuticals.
A national survey comprising 23 questions was conducted online among AMD members with the aim of investigating the attitudes and awareness of clinicians involved in the management of this condition.

A total of 134 respondents took part in the survey. In 79.1% of cases, screening is carried out at the respondent’s workplace, but it is offered to less than 50% of the population receiving care. When a specific treatment is required, it is initiated in 69.4% of cases, while in 26.1% of cases, the patient is referred to a neurologist. Gabapentinoids are the most commonly used drugs. Nutraceuticals, either as a single therapy or in combination with drugs, are preferred by about half of the sample interviewed. 57.5% of survey respondents consider them moderately effective, while 35.1% consider them to be ineffective. The survey clearly shows that almost all respondents (97.1%) consider training on the management of complications to be useful, including wanting to be better informed about the use of nutraceuticals (71.6% of cases).

KEY WORDS
neuropathy; screening; pharmacological therapy; nutraceuticals

The prevalence of type 1 diabetes mellitus is constantly increasing globally, with important implications in terms of morbidity and mortality. With the advent of advanced technologies, diabetes management has undergone a major transformation, and we are currently experiencing a real revolution. Advanced Hybrid Closed-Loop Systems (AHCL) are improving clinical outcomes and quality of life for many people with diabetes and are recommended by Italian Ministerial guidelines.
However, barriers to access to these technologies remain, with equity issues related to both systemic and individual factors. This survey aims to explore the perspective of Italian diabetologists regarding the main challenges and opportunities in the prescribing process of AHCL systems, with particular attention to personalization of care, therapeutic education and some specific prescribing habits.

KEY WORDS AID
systems; barriers to access; personalization of care; Survey; type 1 diabetes.

INTRODUCTION
International and national guidelines emphasize the importance of correct insulin injection technique to ensure predictable absorption and prevent local complications, particularly lipohypertrophy (LH). Despite this, errors in injection technique are still frequent in clinical practice.
AIM The aim of the study is to evaluate the knowledge, attitudes, and clinical practices of Italian healthcare professionals regarding the management of injection techniques and LH.

METHOD
A national survey was conducted using a structured 22-item questionnaire, developed using the Delphi method by the AMD-OSDI Injection Therapy Study Group. The questionnaire, was administered online to AMD and OSDI members between February and July 2025. The data were analyzed descriptively and compared with the FITTER Forward and AMD-OSDI recommendations.

RESULTS
227 responses were collected from physicians (50.7%) and nurses (49.3%), mostly working in hospital settings. Only 50.2% systematically checked injection sites at each visit. Eighty-nine percent recognized the metabolic consequences of injecting into lipohypertrophic areas, but only 56.8% used a comprehensive clinical assessment method (inspection, palpation, and pinching). Nearly half of respondents underestimated the true prevalence of LH. 83.2% requested further training.

CONCLUSION
The survey highlights a gap between theoretical knowledge and its application in daily clinical practice. Targeted, practice-oriented educational interventions are needed to improve the recognition and prevention of lipohypertrophy and optimize glycemic control in people on insulin therapy.

KEY WORDS
insulin; injection technique; lipodystrophy; lipohypertrophy; education.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health issue often associated with Type 2 diabetes (T2D). A good glycaemic control is crucial in managing MASLD, but achieving targets can be challenging. This case report describes a 61-year-old man with obesity, liver cirrhosis due to MASLD/MASH (stage CHILD B), with an episode of hyperammonemia that resolved after starting chronic therapy with rifaximin and lactulose, and T2D treated by multiple-daily injection with a consistent HbA1c >12%. A multidisciplinary approach was adopted, including dietary intervention and the use of an automated insulin delivery (AID) system, the MiniMed™ 780G. HbA1c dropped to 6.5% after one year, while Time in Range (TIR 70-180 mg/dL) improved substantially from 10% to >75% within three months and remained stable at 12 months. MASLD improved, with no further episodes of hyperammonemia controlled with therapy, and an 8 kg weight loss achieved by following a low-glycemic diet. This case highlights the potential of combining an AID system with a dietary program to improve outcomes in patients with severe T2D and cirrhotic MASLD.

KEY WORDS
type 2 diabetes; MASLD; time in range; MiniMed™ 780G system.

Continuous glucose monitoring (CGM) is a technology strongly recommended by international guidelines and increasingly used in routine diabetes care. Extensive scientific evidence shows that CGM improves metabolic control and reduces adverse outcomes, including cardiovascular events and diabetes-related hospitalizations, in both type 1 and type 2 diabetes. CGM enables continuous tracking of glucose levels, helping patients optimize insulin and other therapies while preventing hypo- and hyperglycemia. It also enhances patients’ understanding of how food, physical activity, and daily habits affect glucose trends, improving quality of life. For clinicians, CGM provides a “real-time movie” of glycemic patterns, supporting better therapeutic decisions and assessment of treatment adherence. The dynamic glucose monitoring procedure (Glycemic Holter) has recently been added to the Italian Essential Levels of Care as a reimbursable procedure. Its integration into clinical practice requires clear guidance to ensure consistent and appropriate use nationwide. To address this need, the Conference on regional Presidents of AMD conducted a survey to explore opportunities and challenges associated with the new service. Their reflections were then shared with experts from the Italian Society of Diabetology and the joint Technologies and Diabetes group. The resulting insights offer practical recommendations and strategic directions. These aim to support the diabetes community in adopting the new service effectively.
Ultimately, the goal is to promote uniform, high-quality CGM use across Italy’s diabetes care system.
KEY WORDS continuous glucose monitoring; glycemic holter; essential levels of care; national guideline system.