Diabetology | Issue Cover Collection Published in 2024

Twelve T2DM patients followed a diet whereby they randomly consumed 180 grams of bread as follows: bread prepared with functional alkaline (biocrystal) water (X), bread with “mother” yeast, sourdough-leavened bread (Y), bread with a commercial rapid leavening dough, and baker’s yeast bread (W). FGM was utilized for all patients. Peak glucose, insulin concentration, and glucose load were observed to be markedly (p < 0.05) higher for W compared to X and Y, with there being no significant differences between X and Y. In conclusion, the following points can be affirmed: (1) bread prepared with bio-crystal water has the same lower GL observed for sourdough bread in contrast with baker yeast bread, with easier management of the leavening/maturation period; (2) FGM is reliable for determining rapid glucose changes that people with type 2 diabetes experience after consuming a carbohydrate meal.

In our article, we debate the utility of reassessing the risk of foot complications in people with diabetes in a primary care setting. We found that at the two-year follow-up, less than 4% progress to a higher risk status according to the International Working Group on the Diabetic Foot classification. However, at the same time, there is a 2.6% regression, which may indicate concerns about the reliability of this classification. Our study supports the idea that foot risk reassessments can be every two years instead of yearly in this setting.

A correct injection technique is essential in ensuring the effectiveness of insulin and for achieving good metabolic control. Today, technological evolution has transformed insulin needles into innovative tools that are able to guarantee effective and safe administration of insulin, reduce local complications (such as lipodystrophies) that might obstruct the effectiveness of the treatment itself, and minimize the pain of the injection, a crucial factor in the acceptance of therapy and compliance. This document provides operational recommendations that integrate the standards of care for diabetes resulting from the latest scientific acquisitions, with the patient’s interests acting as a central focal point.

Metabolic syndrome (MetS) is a cluster of conditions—including obesity, hypertension, dyslipidemia, and insulin resistance—that increase the risk of cardiovascular disease and diabetes mellitus type II. Drug therapy for MetS is often complex due to the need for multi-drug regimens. This narrative review explores how variations in pharmacogenetics and pharmacokinetics impact drug responses and drug interactions in MetS treatment. By understanding these factors, we can enhance personalized treatment strategies, minimize adverse effects, and improve therapeutic outcomes, highlighting the potential of pharmacogenetic-guided therapy in advancing individualized treatment approaches.

Diabetic foot ulcers (DFUs) affect an estimated 34% of people with diabetes, leading to high mortality, morbidity, and over USD 9 billion in annual costs. Podiatric care has been shown to reduce adverse DFU outcomes and related hospitalizations. However, Medicaid coverage for podiatry varies by state; some states eliminate access entirely to cut costs. Our study examined the link between state Medicaid coverage for podiatric services and outcomes for beneficiaries with new-onset DFUs. We found that Medicaid beneficiaries in states with podiatry coverage had lower rates of major amputations and fewer hospitalizations for foot infections; these emphasize the critical role of podiatric care and access in DFU management under Medicaid.

Nearly 35% of people with diabetes develop related retinopathy (DR), a sight-threatening condition that is preventable with early diagnosis and treatment. Systematic screening, involving annual eye fundus exams, is recommended but has suboptimal adherence rates of 61%–89%. Research indicates that handheld fundus cameras used during routine appointments could increase access to screening for 11%–39% of individuals with diabetes. Primary care is the most suitable setting for opportunistic screenings, potentially raising diabetes-related retinopathy screening coverage. Handheld fundus cameras, successfully used in low-resource countries, can be integrated into telemedicine platforms, allowing for remote image reading by ophthalmologists and supporting the assessment of other eye conditions.

Insulin resistance (IR) risk factors include smoking, sex, and gender. This study examined the combined impact of sex, gender, and smoking on surrogate IR indexes in healthy young men and women. The female cohort was further divided into combined oral contraceptive (COC) users and non-users to assess the combined effects of COC use and smoking on IR. Results revealed that smoking influences the phenotype of both men and women, while COC use further alters the female phenotype. Smoking and COC use should be treated as independent variables in clinical studies due to their significant effects on phenotype, aiding in personalized prevention and care strategies.