Diabetology, Volume 6, Issue 3 (March 2025) – 8 articles

Over 100 years after its commercialization, the insulin administration method still needs elementary education. Such observation contrasts with technological progress constantly elaborating new (e.g., weekly) insulin preparations, capable of mimicking the pharmacokinetics of insulin produced by the human pancreas and exploring alternatives to injection. However, insulin administration remains anchored to the subcutaneous route, thus creating the conditions for lipohypertrophies (LHs), a still too frequent and ubiquitously widespread skin complication that, despite being avoidable with an adequate educational path, affects up to 60% of patients and even more. Considering that there are approximately 580 million adult diabetic people in the world today, at least half of whom (290 million) self-inject insulin, should 50% of the latter have LH, approximately 145 million people and even more? Considering that there are approximately 580 million adult diabetic people in the world today, at least half of whom (290 million) self-inject insulin, should 50% of the latter have LH, approximately 145 million people would suffer from such a complication, thus causing a severe problem for the global health system. Indeed, besides being unsightly, LHs cause poor glycemic control, large glucose variability, and frequent unexplained hypoglycemia, and display a strong correlation with micro- and macrovascular complications, inevitably worsening the quality of life of diabetic people. In this narrative review, after a brief description of the alternative routes of administration to subcutaneous injections, we will recall the causes, consequences, and possible corrective actions of LHs, stigmatizing the fundamental role of therapeutic education and hoping that all this can interest all the actors who revolve around the management of insulin therapy, which is too often underestimated and hastily addressed by health professionals, who probably prefer to dedicate time to titration of therapy. Ultimately, our aim is to provide the reader with a practical review of injection errors resulting from incorrect insulin injection techniques, analyzing the leading causes of error and the consequences of these errors, while also providing advice and suggestions to overcome all this. Full article

Introduction/Aim: Type 1 diabetes (T1D) challenges glycemic control, with sleep disturbances affecting insulin sensitivity and glucose variability. This study aimed to observe sleep quality in T1D patients and glycemic outcomes, particularly at bedtime hours. Methods: This retrospective observational study, conducted at an Italian clinical center, included T1D patients using Medtronic devices. Sleep quality was assessed using the Italian version of the Pittsburgh Sleep Quality Index (PSQI), and glycemic outcomes were analyzed with CGM data. Descriptive statistics and non-parametric tests were applied for statistical comparisons. Results: Of 45 patients, four were excluded, leaving 41 for analysis. The mean PSQI score was 6.0 ± 4.1, with 36.6% showing poor sleep quality. No significant differences in age, sex, BMI, or diabetes duration were found. Poor sleepers had a higher time above range level 2 (TAR2) (6.3 ± 6.2%) compared to good sleepers (4.1 ± 5.0%). During bedtime hours, poor sleepers showed a significantly higher TAR2 (6.7 ± 7.2% vs. 3.3 ± 6.2%, p = 0.013). Conclusions: Poor sleep quality is associated with increased nocturnal hyperglycemia in T1D patients. Enhancing sleep quality may contribute to improved glycemic control, particularly during nighttime. Future research should explore targeted sleep interventions in diabetes care, and specific lifestyle-based healthcare programs are recommended to optimize glycemic outcomes. Full article

Background/Objectives: We evaluated the effects of glucagon-like peptide-1 receptor agonists (GLP1-RAs) on body weight and metabolic parameters in people with HIV and diabetes (PWHD) receiving maintenance therapy with integrase inhibitor, using a real-world study design. Methods: PWHD on integrase inhibitors-based antiretroviral therapies for at least 6 months, and treated with GLP1-RAs for at least 3 months, were included in this retrospective study. The primary study outcome was the absolute and relative change in body weight, as assessed during routine outpatient visits. Secondary analyses included evaluating the impact of GLP1-RAs on additional metabolic parameters, such as serum glucose, glycated hemoglobin, and LDL-cholesterol. Results: A total of 25 PWHD (74% males, mean age 65 ± 7 years, with 16% having a body mass index > 30 Kg/m²) receiving GLP1-RAs-based antihyperglycemic therapy were identified from our hospital database. No significant effects of GLP1-RAs on body weight were observed (absolute reduction −1.9 ± 3.0 Kg; relative reduction −2.2 ± 3.7%). Treatment with GLP1-RAs was associated with a progressive and significant reduction in serum glucose and glycated hemoglobin, with no observed impact on LDL cholesterol. Conclusions: Long-term GLP1-RA treatment significantly reduced serum glucose and glycated hemoglobin in overweight PWHD with no effects on body weight. Full article

Background: Diabetes-related distress (DD) significantly impacts self-management and quality of life (QoL) in individuals with type 1 diabetes (T1D). While previous research has established a strong link between DD and glycemic control in type 2 diabetes, the relationship remains less consistent in T1D. Additionally, continuous glucose monitoring (CGM) has been shown to improve glycemic outcomes, yet its effects on self-management and QoL are still debated. This study aimed to examine the relationship between DD, self-management efficacy (SME), and QoL in T1D, incorporating both physiological and behavioral indicators. Furthermore, differences between CGM-users and non-users were investigated. Methods: A cross-sectional study including 108 T1D patients was conducted. Participants completed several validated self-report measures, including the Diabetes Distress Scale (DDS), Diabetes Self-Management Questionnaire (DSMQ), and Audit of Diabetes-Dependent Quality of Life (ADDQoL-19). HbA1c levels and CGM usage were retrieved from medical records. Structural equation modeling (SEM) was used to examine the relationships between DD, self-management, and QoL. Results: Distress level (DDS) had a significant negative effect on SME (β = −0.47, p < 0.001), suggesting that higher distress levels are associated with lower self-management. In contrast, SME showed no significant impact on quality of life (β = 0.03, p = 0.779). However, the relationship between quality of life and distress was significant and negative (β = −0.37, p < 0.001), meaning that higher distress levels are linked to a lower quality of life. No significant differences in DD, SME, HbA1c, or QoL were found among CGM users and non-users. Conclusions: DD significantly impacts self-management and QoL in individuals with T1D. Therefore, incorporating PROs on DD and on behavioral aspects of self-management alongside HbA1c levels in clinical care is essential for optimizing treatment plans and improving physical health outcomes. While CGM technology facilitates glucose regulation, it does not inherently improve QoL, which is more closely linked to distress. Full article

Diabetes mellitus (DM) is a chronic metabolic disorder associated with late diagnosis due to the absence of early symptoms in patients. Cutaneous manifestations of DM often serve as indicators of insulin resistance and vary with disease progression, highlighting severity and systemic involvements. With an increasing global burden and rapidly rising prevalence, skin findings associated with DM have become more crucial for the rapid identification and treatment of underlying metabolic processes. However, current challenges in identification include inaccurate or missed detection in darker-skinned populations, which may be attributed to the lack of inclusion of diverse skin types in textbooks and research studies. This review provides clinicians with comprehensive updates on the diagnosis and treatment of cutaneous signs, complications, comorbidities, medication-associated side effects associated with DM, and the treatment of these manifestations. Full article

Continuous glucose monitoring (CGM) and flash glucose monitoring (FGM) systems have revolutionized diabetes management by delivering real-time, dynamic insights into blood glucose levels. This article provides a concise overview of the evolution of CGM technology, highlights emerging innovations in the field and explores current and potential future applications (including insulin management, early diagnostics, predictive modeling, diabetes education and integration into automated insulin delivery (AID) systems) of CGM in healthcare. Full article

Background/Objectives: The chronic metabolic condition of hyperglycemia in type-2 diabetics is known to cause various neurological disorders and compromise recovery from brain insults. Previously, we reported a delayed and reduced glial cell response and a greater neuronal cell death in different brain regions of diabetic, db/db, mice following cerebral hypoxic- ischemic injury. In this study, we explored the changes in baseline activation of astrocytes and microglia and its impact on vascular permeability in different brain regions. Methods: The numbers of activated astrocytes (GFAP-positive) and microglia/macrophage (Iba-1-positive) in the motor cortex, caudate and hippocampal regions of 12-week old, type-2 diabetic db/db and non-diabetic db/+ mice were quantitated. The leakage of serum IgG and loss of occludin, a tight junctional protein observed in the cortex and caudate of db/db mice, indicated a compromised blood brain barrier. Results: Results indicated significant differences in activation of glial cells in the cortex and caudate along with increased vessel permeability in diabetic mice. Conclusions: The study suggests that a constant activation of glial cells in the diabetic brain may be the cause of impaired inflammatory response and/or degenerating cerebral blood vessels which contribute to neuronal cell death upon CNS injury. Full article

Objectives: To describe the association of race with type 2 diabetes complications and determine if differences in rates of complications exist between racial/ethnic groups of adult type 2 diabetes patients in the United States. Additionally, we model the odds of in-hospital patient mortality across racial/ethnic groups. Methods: A retrospective cohort study was conducted using data from the 2018 National Inpatient Sample of Healthcare Cost and Utilization Project, including 97,314 unweighted and 486,500 weighted adults with type 2 diabetes. Chi-square analysis was used to determine the association of race with diabetes complications, along with z-tests to determine the differences in complication rates of 11 different complications between racial/ethnic groups and binary logistic regression to model in-hospital mortality. Results: Our analysis revealed significant racial/ethnic disparities in both complication rates and odds of in-hospital mortality. Whites had the lowest rate of complications overall, except for arthropathy/oral complications (18.8%) and foot/skin ulcers (18.2%), while Black/African Americans had the highest rates of hyperosmolarity (7.3%), ketoacidosis (21.2%), neurological complications (8.9%), and hyperglycemia (13.4%). Asian/Pacific Islanders had the highest rates of hypoglycemia (17.6%) as well as kidney (7.2%) and ophthalmic (0.3%) complications, and Hispanics the highest rates of circulatory complications (19.0%). Hispanic ethnicity was associated with 10.6% reduced odds of in-hospital mortality, and Asian/Pacific Islanders and Other races had increased odds of mortality by 25.2% and 27.0%, respectively. Notably, neurological (OR = 0.278, 95% CI: 0.111, 0.702) complications and hyperglycemia (OR = 0.304, 95% CI: 0.124, 0.749) were associated with a reduction in mortality odds by 62.2% and 69.6%, possibly reflecting the study’s focus on in-hospital rather than all-cause or 30-day mortality. Conclusions: We demonstrated disparities in both rates of type 2 diabetes complications and odds of mortality between different racial/ethnic groups. These results lay groundwork for future research into the root causes of these disparities and highlight the importance of targeting interventions and equitable case for those most at risk. Full article