Numerous scientific evidence indicates that regular breakfast consumption is associated with improved health outcomes across all age groups. However, epidemiological data show that breakfast is often the most neglected and monotonous meal, sometimes limited to the intake of a single beve rage and frequently eaten away from home due to time constraints or habitual factors. The aim of this work is to critically examine the available evidence on the role of breakfast in metabolic, cognitive, and psychological health, while also exploring related habits and behavioral patterns. Although much of the available evidence is derived from observational studies, an association has been observed between an adequate breakfast and improvements in cognitive function, lipid profile, insulin sensitivity, and glucose tolerance, with favourable effects also observed on subsequent meals. Furthermore, regular breakfast consumption is associated with a lower BMI and a reduced risk of obesity, whereas breakfast skipping is linked to an increased risk of type 2 diabetes. Finally, omitting breakfast has been associated with
a higher risk of depressive symptoms, increased stress, and mood disturbances. In light of this evidence, and taking individual nutritional requirements into account, promoting and supporting regular breakfast consumption appears advisable. The growing attention to the hedonic and utilitarian components of food choice highlights the need to offer breakfasts that are palatable, varied, and nutritionally adequate. From this perspective, diversifying breakfast options, including the adoption of alternative models beyond traditional Italian dietary habits, may represent an effective strategy to improve both acceptability and regularity of consumption.

AIM OF THE STUDY
To review the fundamentals of exercise pathophysiology in type 1 diabetes (T1D), providing useful suggestions for adapting insulin therapy and carbohydrate intake for short-duration
aerobic activity. In support of this premise, we describe the metabolic adaptation strategies for a competitive 10-km race adopted by five athletes with T1D mostly using hybrid closed-loop insulin pumps in manual mode, and correlate glucose profiles with individualized therapeutic choices.

DESIGN AND METHODS
Critical review and observational analysis of five trained athletes regularly followed by sports-experienced diabetologists. All participants were treated with hybrid automated insulin
pumps. To ensure data homogeneity, an additional continuous glucose monitoring sensor (FreeStyle Libre 2 Plus) was worn simultaneously. Glucose trends during the race were analyzed together with basal rate adjustments, pre-race bolus modifications, and carbohydrate (CHO) supplementation strategies.

RESULTS
Despite heterogeneous management approaches–temporary basal reduction/ suspension, breakfast bolus adjustments, and targeted CHO intake–all athletes maintained satisfactory glycemic control during aerobic exercise. Glucose fluctuations were consistent with exercise intensity and duration, with occasional pre-race hyperglycemia related to adrenergic stress and mild post-exercise declines effectively prevented through tailored CHO supplementation. Marked interindividual variability was observed, influenced by training status, insulin sensitivity, and psychological factors.

Breakfast represents an important component of metabolic balance and chronic disease prevention; however, it is often characterized by repetitive habits and omission. The AMD Nutrition and Health Study Group conducted a survey to investigate personal breakfast habits among Italian diabetologists.
In September 2025, an online questionnaire was administered to AMD members, collecting 200 responses. Overall, 90% of participants reported regularly consuming breakfast, mainly at home (81.5%). However, 38% reported never varying their breakfast, while only 9% reported daily variation. Sweet breakfast was the predominant choice (over 80%).
The consumption of ultra-processed foods was not negligible, with 31.5% reporting daily or several-times-per-week intake.
These findings show a high adherence to breakfast consumption among diabetologists, but also limited variability and a significant presence of ultra-processed foods. These results highlight the need to promote greater awareness of breakfast nutritional quality also among healthcare professionals, with potential positive implications for clinical practice and patient education.

The management of type 1 diabetes in patients undergoing hemodialysis represents a complex clinical challenge due to glycemic variability and high risk of hypoglycemia associated with this condition. We report the case of a 62-year-old woman affected by multi-complicated type 1 diabetes and poor metabolic control, successfully treated by Minimed 780 Advanced Hybrid Closed Loop (AHCL) system. In addition to a marked improvement in TIR and GMI without increasing TBR, this system allowed a potential reduction of hypoglycemic crises, typically occurring during dialysis sessions, through the systematic use of the temporary target. Finally in our patient Simplera Sync provided glycemic measurements almost superimposable to those obtained with the types of glucometers considered most reliable in dialysis, indirect proof of the high accuracy of this sensor.

Acute diabetic foot can initially present with subtle clinical features, despite a high risk of progression to deep infection, sepsis, and major amputation. This case report describes a patient with long-standing diabetes mellitus, neuropathy, previously unrecognized distal arterial disease, and a minimal interdigital lesion. Although duplex ultrasound showed apparently preserved multiphasic waveforms, transcutaneous oximetry and angiography demonstrated critical impairment of foot perfusion, requiring targeted endovascular revascularization of infrapopliteal and pedal arteries. The combination of revascularization with surgical debridement, fourth-ray amputation, and pathogen-directed antibiotic therapy resulted in resolution of the infection and complete wound healing, thereby avoiding major amputation. This case underscores the importance of early recognition of insidious presentations, the limitations of ultrasound-based assessment alone, the need to extend angiographic evaluation and revascularization to distal vessels, and the “Time is tissue” concept within the multidisciplinary management of acute diabetic foot.

Type 1 diabetes mellitus (DM1)* is an autoimmune disease characterized by the destruction of pancreatic beta cells, leading to reduced life expectancy and quality of life, and a high risk of chronic complications, particularly cardiovascular disease. Despite advances in insulin therapy and delivery technologies, a substantial proportion of patients fail to achieve recommended glycemic targets and frequently present with extra-glycemic risk factors such as overweight, obesity, and insulin resistance, a condition often referred to as “double diabetes.” In this context, incretin-based therapies, widely used in type 2 diabetes and obesity, represent a potential adjunctive strategy in DM1. Current evidence, although still limited – especially for tirzepatide – suggests significant benefits on metabolic control and body weight. Randomized clinical trials and observational studies have shown reductions in glycated hemoglobin of approximately 0.5%, along with decreased insulin requirements, particularly prandial insulin, and improvements in time in range. Additionally, these agents demonstrate a notable effect on weight loss, particularly in overweight or obese individuals. Meta-analyses confirm a favorable safety profile, with no significant increase in the risk of severe hypoglycemia or diabetic ketoacidosis. Observational data also suggest a potential reduction in all-cause mortality and healthcare resource utilization. In conclusion, incretin-based therapies represent a promising adjunctive treatment option in DM1, particularly in selected patient subgroups. However, larger randomized controlled trials are needed to confirm their long-term efficacy and safety.

Optimal management of Type 1 Diabetes requires advanced technologies such as CGM, CSII, and AID systems to improve glycemic control and reduce complications. AID systems have evolved over time, thanks to increasing levels of automation: from insulin suspension function to fully automated, multi-hormonal closed loops. They employ PID, MPC, fuzzy logic, and machine learning algorithms. In parallel, DIY opensource systems such as AAPS, Loop, and OpenAPS have emerged. Several CTs and real-world studies show that HCL systems significantly improve TIR and HbA1c, while reducing hypoglycemia, ketoacidosis, and mortality compared to MDI, enhancing quality of life, empowerment and safety for patients and caregivers. The main commercial HCL systems differ in algorithms, automation level, and compatible devices. Minimed™ 780G, Tandem t:slim X2, CamAPS FX, DBLG1, Omnipod 5® , Medtrum® , and i-Let use PID, MPC, or adaptive models, offering customizable targets, safety features, and exercise modes. AID advancements include announced meals, full closed loop, new adaptive algorithms, and bi-hormonal systems. Emerging technologies such as new insulin pumps, advanced sensors, and implantable devices aim to reduce user intervention, improve glycemic control, and prevent hypoglycemia and complications.