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The huge development that advanced therapy medicinal products (AMTPs) have experienced in recent years, both commercial and research, represent a challenge for hospital pharmacy at all levels. The aim of this article is to describe the implementation of an advanced therapies unit (AUT) and the process of preparation of the AMTPs according to the “good manufacturing practices” (GMP), as well as the results obtained in a tertiary hospital, as an example of the challenges posed by MTA's academic production.

El enorme desarrollo que están experimentado en los últimos años los medicamentos de terapias avanzadas (MTA), tanto industriales como en investigación, suponen un reto para la farmacia hospitalaria a todos los niveles. El objetivo del trabajo es describir la puesta en marcha de una unidad de terapias avanzadas (UTA) y el proceso de elaboración de los MTA según las «normas de correcta fabricación» (NCF), así como los resultados obtenidos en un hospital terciario, como ejemplo de los retos que supone la producción académica de los MTA.

Aim: Oral semaglutide, an innovative orally administered GLP-1 receptor agonist for type 2 diabetes (T2D) management was herein evaluated for its effectiveness in a multi-center retrospective real-world study. Methods: We included new-users of oral semaglutide from 18 specialist care centres and collected retrospective data on baseline clinical characteristics. Updated values of HbA1c and body weight were analyzed using the mixed model for repeated measures. Results: The study included 166 individuals with T2D, predominantly men (64.5%), with a mean age of 64.4 years and a mean diabetes duration of 10.1 years. In the majority of patients (68.3%) oral semaglutide was used as a second-line drug, mostly with metformin. At baseline, mean BMI was 28.9 kg/m2and HbA1c was 7.5%. During the 18-month observation period, oral semaglutide demonstrated significant reductions in HbA1c, with a maximum change of − 0.9%, and 42.1% of patients achieved HbA1c values below 7.0%. Additionally, there was a substantial reduction in body weight, with an estimated change of − 3.4 kg at 18 months, and 30.3% of patients experienced a 5% or greater reduction in baseline body weight. Only 24.2% of patients reached the 14 mg dose. Subgroup analysis revealed that baseline HbA1c > 7%, persistence on drug, not being on a prior therapy with DPP-4 inhibitors, and loosing 5% or more the initial body weight were associated with greater HbA1c reductions. Conclusion: This study supports oral semaglutide as an effective option for T2D treatment, offering improved glucose control and weight management in a real-world setting.

Purpose: In the present short report, we encompass the radiobiological and dosimetric advantages of particle beam radiotherapy and we illustrate the oncological pathway for patients eligible for hadrontherapy being used at the National Center for Oncological Hadrontherapy (CNAO). Methods: With a narrative approach, we examined the clinical and practical aspects of hadrontherapy compared to traditional photon beam radiotherapy. We described the need to select patients considering the intrinsic characteristics both of the tumour and the patient. Moreover, we described the decisional oncological tree and the patient pathway by our facility. Results: Considering the dosimetric and radiobiological characteristics of particle beam radiotherapy, the selection of patients can not be done regardless of the intrinsic tumour and patient hallmarks. In particular, the tumour radioresistance, the patient radiosensitivity and the need to avoid post-actinic toxicities in long-term survivors should guide the clinical indication. The finite range of particles should be considered to avoid treatment uncertainties. Multidisciplinary national and international collaboration is crucial to better manage patients to treat with hadrontherapy and to create robust clinical evidence. Conclusion: Hadrontherapy, with its distinctive physical and biological advantages, heralds a promising era in the field of precision radiotherapy. Patients’ radiosensitivity, tumour radioresistance, and treatment uncertainties should be considered to enhance the efficacy and to ameliorate the selection of patients.

The increasing interest in Additive Manufacturing (AM) technologies is mainly driven by their high design flexibility and on-demand production. As these processes expand, there is a critical need to explore the material properties of resulting products under diverse loading conditions. This work investigates the impact response of the as-built aluminum alloy AlSi10Mg, additively manufactured employing a laser powder bed fusion (L-PBF) process. Taylor-cylinder impact tests have been performed with a light gas gun at different impact velocities to probe material deformation and damage behavior under high-rate loadings and complex stress paths. Three building orientations were systematically investigated– horizontal, vertical, and at 45°. At lower striking velocities (between 180 and 200 m/s), observable mushrooming deformation occurred with no apparent damage. The shape of the impact faces and deformed profiles were recorded to assess deformation differences across the tested printing directions. In the intermediate range of velocities (240–260 m/s), shear cracking emerged as the principal damage mechanism, resulting in the formation of 45°/135° oriented cracks on the samples’ lateral surface. Increasing the impact velocity promoted these cracks’ growth, ultimately leading to the samples’ fragmentation. The vertically printed sample exhibited a slightly lower onset fragmentation velocity than the other two building directions.

Purpose: To review experience and indications for head and neck (HN) tumors at our center in relation to the published literature. Methods: HN cancer patients treated at our center either with protons (PT) or carbon ions (CIRT) were extracted from our institutional retrospective and longitudinal Registry (NCT05203250 REGAL), including all the patients treated since the beginning of our clinical activity. A literature search was conducted with selection of most representative published studies for adenoid cystic carcinoma (ACC), mucosal melanoma (MM), sinonasal cancers (SNCs) and reirradiations. Results: Since the beginning of the clinical activity in 2011, 1311 HN tumors have been treated a tour center. Majority of treated patients were ACC (52%), non-ACC salivary gland tumors (18%), paranasal sinuses tumors (9%), MM (7%), and reirradiation of recurrent tumors after previous RT (14%). Oncological outcome in terms of safety and efficacy has been published on the series of 184 ACC and 40 MM, both treated with CIRT in the years 2013–2020. Reviewed reirradiation published series included a cohort of 52 recurrent salivary gland tumors retreated with CIRT from 2013 to 2016, and the experience of 2013–2020 of retreatment of 15 SNCs (13 with CIRT and 2 with PT). Conclusion: HN tumors are major indications for particle treatment around the world and at our center. Particle treatment might be personalized for each patient, with CIRT indicated for radioresistant tumors such as ACC and MM. Data on oncologic outcomes of CIRT at our center are consistent with published series.

As estate litigators, we see far too often what happens when reason gets thrown out the window and disputes--big and small--tear families apart. Here are some practical tips that can [...]

A visual inspection, which entails field surveying, such as photodocumentation and footage, is the first step of a multi-level approach to bridge health assessment. Furthermore, the use of surface models, CAD drawings, and orthophotos, guarantees complete and accurate documentation, thus allowing for a better understanding of the environment, the anthropic structures, and their relationships. All the georeferenced surveys’ outputs are especially advisable within a prespective of periodical monitoring, as forseen by national legislation. The work is aimed to study two adjacent bridges over the Arno River in Lastra a Signa, Italy. One of the bridges, Ponte nuovo sull’Arno, is an overpass for motor vehicles. The other one, which is called Passarella sull’Arno, is a pedestrian viaduct. A topographic reference network has been settled using the GNSS survey technique. 3D point clouds of the bridges have been acquired by performing a Laser Scanning survey. A bathymetric survey has been carried out to acquire a 3D point cloud of submerged bridges’ parts and the riverbed. Through a Photogrammetric survey from RPAS, an orthophoto of the area has been built. Finally, evidence of historical submerged bridge structures has been identified thanks to the multi beam survey. The work’s objective is to integrate surveying geomatics techniques to create a reliable survey of the bridges, the surrounding area, and the riverbed, as support to the most common structural health assessment methods.

Many food components have antiviral activity, but in most cases, studies in the literature do not report detailed investigations of molecular mechanisms. We performed a comprehensive molecular docking study to investigate the potential interaction of several food molecules, selected for their known antiviral activity, with twelve SARS-CoV-2 target proteins (NSP3, NSP5, NSP7, NSP8, NSP9, NSP10, NSP12, NSP15, NSP16, ORF7A, protein N, and Spike protein). The results suggest that some molecules, particularly β-carotene, all-trans-retinoic acid (ATRA), epigallocatechin 3-gallate and kaempferol, can interact with SARS-CoV-2 protein targets. The study opens new insights into the molecular mechanisms underlying the antiviral properties of food components.

Eating disorder psychopathology was found to be related to a history of trauma. Nonetheless, our understanding of the mediators of the relationship between childhood trauma and eating disorders remains to be improved. The current study revealed that certain early maladaptive schemas (i.e., defectiveness, failure, and negativity) mediated the relationship between childhood trauma and eating disorder symptoms and that outpatients who experienced severe childhood trauma reported more severe eating disorder symptoms and greater severity of certain early maladaptive schemas, such as emotional deprivation, defectiveness, failure, vulnerability, insufficient self-control, and negativity. Our findings support the need to consider early maladaptive schemas in the treatment of traumatized patients with eating disorders.

Purpose: In mice, adipose tissue-derived stem cells (ASCs) reach the systemic circulation and establish ectopic adipose depots fostering insulin resistance, but whether this occurs in humans is unknown. We examined circulating ASCs in individuals with various combination of metabolic syndrome traits. Methods: We enrolled patients attending a routine metabolic evaluation or scheduled for bariatric surgery. We quantified ASCs as CD34+CD45−CD31−(CD36+) cells in the stromal vascular fraction of subcutaneous and visceral adipose tissue samples and examined the presence and frequency of putative ASCs in peripheral blood. Results: We included 111 patients (mean age 59 years, 55% males), 40 of whom were scheduled for bariatric surgery. The population of CD34+CD45−CD31−ASCs was significantly more frequent in visceral than subcutaneous adipose depots (10.4 vs 4.1% of the stromal vascular fraction; p < 0.001), but not correlated with BMI or metabolic syndrome traits. The same phenotype of ASCs was detectable in peripheral blood of 58.6% of patients. Those with detectable circulating ASCs had significantly higher BMI (37.8 vs 33.3 kg/m2; p = 0.003) and waist (111.2 vs 105.4 cm; p = 0.001), but no difference in other metabolic syndrome traits (p = 0.84). After bariatric surgery, patients with detectable circulating ASCs had greater BMI reductions at 6 months (− 10.4 vs − 7.8 kg/m2; p = 0.014). Conclusion: Presence of putative circulating ASCs, antigenically similar to those observed in the adipose tissue, is associated with greater adiposity and larger BMI reduction after surgery, but not with clinical signs of metabolic impairment. The role of circulating ASCs in adipose tissue biology and systemic metabolism deserves further investigation.

Aim: To compare effectiveness of dapagliflozin versus DPP-4 inhibitors on individualized HbA1c targets and extra-glycaemic endpoints among elderly patients with type 2 diabetes (T2D). Methods: This was a multicentre retrospective study on patients aged 70–80 years with HbA1c above individualized target and starting dapagliflozin or DPP-4 inhibitors in 2015–2017. The primary outcome was the proportion reaching individualized HbA1c targets. Confounding by indication was addressed by inverse probability of treatment weighting (IPTW), multivariable adjustment (MVA), or propensity score matching (PSM). Results: Patients initiating dapagliflozin (n= 445) differed from those initiating DPP-4i (n= 977) and balance between groups was achieved with IPTW or PSM. The median follow-up was 7.5 months and baseline HbA1c was 8.3%. A smaller proportion of patients initiating dapagliflozin attained individualized HbA1c target as compared to those initiating DPP-4 inhibitors (RR 0.73, p< 0.0001). IPTW, MVA, and PSM yielded similar results. Between-group difference in the primary outcome was observed among patients with lower eGFR or longer disease duration. Dapagliflozin allowed greater reductions in body weight and blood pressure than DPP-4 inhibitors. Conclusions: Elderly patients with T2D initiating dapagliflozin had a lower probability of achieving individualized HbA1c targets than those initiating DPP-4 inhibitors but displayed better improvements in extra-glycaemic endpoints.

BackgroundThe regional emergency medical service (EMS) in Lombardy (Italy) developed clinical algorithms based on operator-based interviews to detect patients with COVID-19 and refer them to the most appropriate hospitals. Machine learning (ML)-based models using additional clinical and geospatial epidemiological data may improve the identification of infected patients and guide EMS in detecting COVID-19 cases before confirmation with SARS-CoV-2 reverse transcriptase PCR (rtPCR).MethodsThis was an observational, retrospective cohort study using data from October 2020 to July 2021 (training set) and October 2021 to December 2021 (validation set) from patients who underwent a SARS-CoV-2 rtPCR test within 7 days of an EMS call. The performance of an operator-based interview using close contact history and signs/symptoms of COVID-19 was assessed in the training set for its ability to determine which patients had an rtPCR in the 7 days before or after the call. The interview accuracy was compared with four supervised ML models to predict positivity for SARS-CoV-2 within 7 days using readily available prehospital data retrieved from both training and validation sets.ResultsThe training set includes 264 976 patients, median age 74 (IQR 55–84). Test characteristics for the detection of COVID-19-positive patients of the operator-based interview were: sensitivity 85.5%, specificity 58.7%, positive predictive value (PPV) 37.5% and negative predictive value (NPV) 93.3%. Contact history, fever and cough showed the highest association with SARS-CoV-2 infection. In the validation set (103 336 patients, median age 73 (IQR 50–84)), the best-performing ML model had an AUC of 0.85 (95% CI 0.84 to 0.86), sensitivity 91.4% (95 CI% 0.91 to 0.92), specificity 44.2% (95% CI 0.44 to 0.45) and accuracy 85% (95% CI 0.84 to 0.85). PPV and NPV were 13.3% (95% CI 0.13 to 0.14) and 98.2% (95% CI 0.98 to 0.98), respectively. Contact history, fever, call geographical distribution and cough were the most important variables in determining the outcome.ConclusionML-based models might help EMS identify patients with SARS-CoV-2 infection, and in guiding EMS allocation of hospital resources based on prespecified criteria.

Using concentration-time data from the NEAT001/ARNS143 study (single sample at week 4 and 24), we determined raltegravir pharmacokinetic parameters using nonlinear mixed effects modelling (NONMEM v.7.3; 602 samples from 349 patients) and investigated the influence of demographics and SNPs (SLC22A6and UGT1A1) on raltegravir pharmacokinetics and pharmacodynamics. Demographics and SNPs did not influence raltegravir pharmacokinetics and no significant pharmacokinetic/pharmacodynamic relationships were observed. At week 96, UGT1A1*28/*28was associated with lower virological failure (p= 0.012), even after adjusting for baseline CD4 count (p= 0.048), but not when adjusted for baseline HIV-1 viral load (p= 0.082) or both (p= 0.089). This is the first study to our knowledge to assess the influence of SNPs on raltegravir pharmacodynamics. The lack of a pharmacokinetic/pharmacodynamic relationship is potentially an artefact of raltegravir’s characteristic high inter and intra-patient variability and also suggesting single time point sampling schedules are inadequate to thoroughly assess the influence of SNPs on raltegravir pharmacokinetics.

In Dynamic Tensile Extrusion (DTE) test, the material is subjected to extreme conditions, such as severe plastic deformations, high pressures, and large variations of temperature and strain rate. Although the numerical simulation of this test is ideal for constitutive model validation, there are several computational features to assess before performing further analyses. This work aims to evaluate the influence of constitutive modeling and computational parameters on the predicted material jet in the simulation of DTE tests on Oxygen-Free High Conductivity Copper at different extrusion velocities. Dynamic transient analyses have been performed with implicit finite element code using a single-step Houbolt procedure. To begin with, three constitutive models (the Mechanical Threshold Stress, modified Johnson–Cook, and Zerilli-Armstrong) were selected and model parameters have been identified on available uniaxial tensile test data at different temperature and strain rates. Successively, the effect of friction, damping, remeshing, and extrusion die modeling has been investigated by performing parametric numerical simulations at 400 m/s extrusion velocity and an optimum set of computational parameters was determined. Finally, constitutive models' performance has been verified by comparing the predicted size, shape, and number of extruded fragments at different velocities with experimental data. The ability to correctly predict the size and shape of the last temporally forming fragment appears to be directly related to the ability of the constitutive model to accurately describe the material response in the viscous drag regime.

OBJECTIVE--To examine the association of hemoglobin (Hb) [A.sub.1c] variability with microvascular complications in the large cohort of subjects with type 2 diabetes from the Renal Insufficiency And Cardiovascular Events (RIACE) [...]

OBJECTIVE--To compare the performance of two glomerular filtration rate (GFR)-estimating equations in predicting the risk of all-cause and cardiovascular mortality in type 2 diabetic patients. RESEARCH DESIGN AND METHODS--We followed [...]

OBJECTIVE--To examine the association of aortic valve sclerosis (AVS) and mitral annulus calcification (MAC) with all-cause and cardiovascular mortality in type 2 diabetic individuals. RESEARCH DESIGN AND METHODS--We retrospectively analyzed [...]

OBJECTIVE--TO assess differences between the effects of aerobic and resistance training on [HbA.sub.1c] (primary outcome) and several metabolic risk factors in subjects with type 2 diabetes, and to identify predictors [...]

OBJECTIVE--Although a reduced estimated glomerular filtration rate (eGFR) was shown to be a powerful independent predictor of cardiovascular disease (CVD), other studies suggested that it confers a much lower risk [...]

OBJECTIVE--Recent studies have suggested an association between hyperuricemia and adverse renal outcomes in nondiabetic populations. Data on the relationship between hyperuricemia and the risk of incident chronic kidney disease (CKD) [...]

An International Expert Committee was convened in 2008 by the American Diabetes Association (ADA), the European Association for the Study of Diabetes, and the International Diabetes Federation to consider the [...]

OBJECTIVE--In genome-wide association studies, performed mostly in nondiabetic individuals, genetic variability of glucokinase regulatory protein (GCKR) affects type 2 diabetes-related phenotypes, kidney function, and risk of chronic kidney disease (CKD). [...]

The modern jury system is facing new challenges as people's habits of communicating and accessing information evolve in a rapidly expanding electronic world. Media reports and posttrial interviews reveal that [...]

OBJECTIVE--There is limited information on whether increased serum uric acid levels are independently associated with cardiovascular mortality in type 2 diabetes. We assessed the predictive role of serum uric acid [...]

In Italia vivono circa 4 milioni di persone con il diabete e ogni anno ci sono circa 350 mila nuove diagnosi. Le persone con diabete ricevono prescrizioni di farmaci, esami di laboratorio e strumentali e richiedono ricoveri ospedalieri più spesso delle persone senza il diabete. Il diabete è gravato da aumentata mortalità e accorcia la vita, soprattutto nelle persone di media età. La qualità della cura nelle persone con diabete è subottimale, soprattutto fra chi non è assistito nei centri diabetologici (che, peraltro, rappresentano dei luoghi “salvavita”). Il diabete contribuisce fortemente alla spesa sanitaria e comporta ingenti spese, non tutte specificamente sanitarie. Nonostante tutto questo e nonostante leggi nazionali e regionali, documenti di indirizzo nazionali e regionali, PDTA regionali e locali, promesse e proponimenti di varia provenienza, la pandemia diabete non riceve le attenzioni che merita.

OBJECTIVE--The purpose of this study was to evaluate whether insulin resistance is associated to cardiovascular disease (CVD) and to understand whether this association can be explained by traditional and novel [...]

Incidence rates and risk factors for type 2 diabetes in low-risk populations are not well documented. We investigated these in white individuals who were aged 40-79 years and from the population of Bruneck, Italy. Of an age- and sex-stratified random sample of 1,000 individuals who were identified in 1990, 919 underwent an oral glucose tolerance test (OGTT) and an assessment of physiological risk factors for diabetes, including insulin resistance (homeostasis model assessment, HOMA-IR), and postchallenge insulin response (Sluiter's Index). Diabetes at baseline by fasting or 2-h OGTT plasma glucose (World Health Organization criteria, n = 82) was excluded, leaving 837 individuals who were followed for 10 years. Incident cases of diabetes were ascertained by confirmed diabetes treatment or a fasting glucose [greater than or equal to] 7.0 mmol/l. At follow-up, 64 individuals had developed diabetes, corresponding to a population-standardized incidence rate of 7.6 per 1,000 person-years. Sex- and age-adjusted incidence rates were elevated 11-fold in individuals with impaired fasting glucose at baseline, 4-fold in those with impaired glucose tolerance, 3-fold in overweight individuals, 10-fold in obese individuals, and ~2-fold in individuals with dyslipidemia or hypertension. Incidence rates increased with increasing HOMA-IR and decreasing Sluiter's Index. As compared with normal insulin sensitivity and normal insulin response, individuals with low insulin sensitivity and low insulin response had a sevenfold higher risk of diabetes. Baseline impaired fasting glucose, BMI, HOMA-IR, and Sluiter's Index were the only independent predictors of incident diabetes in multivariate analyses. We conclude that ~1% of European white individuals aged 40-79 years develop type 2 diabetes annually and that 'subdiabetic' hyperglycemia, obesity, insulin resistance, and impaired insulin response to glucose are independent predictors of diabetes., Type 2 diabetes, by far the most common form of diabetes, is increasing at an alarming rate all over the world. Current projections estimate that the absolute number of cases [...]

The aim of this study was to validate the automated clean-in-place (CIP) system installed on a capsule filling machine to determine its ability to adequately eliminate contaminants. The results obtained [...]

OBJECTIVE -- The aim of the present work was to compare mortality from site-specific malignancies in type 2 diabetic patients with those in the general population. RESEARCH DESIGN AND METHODS [...]

OBJECTIVE--The present study aimed at prospectively evaluating carotid atherosclerosis and coronary heart disease (CHD) in subjects with the metabolic syndrome. RESEARCH DESIGN AND METHODS--Within a prospective population-based survey examining 888 [...]

We adapted a minimal model to assess β-cell function during a hyperglycemic glucose clamp and to uncover peculiar aspects of the relationship among β-cell function, plasma glucose, and insulin sensitivity (IS) in offspring of Caucasian patients with type 2 diabetes (OfT2D). We pooled two data sets of OfT2D (n = 69) and control subjects (n = 45) with normal glucose regulation. Plasma C-peptide was measured during a hyperglycemic clamp (~10 mmol/l) to quantify model-based first-phase secretion and glucose sensitivity of second-phase secretion (β). IS was quantified during the hyperglycemic clamp. In the pooled data, first-phase secretion was linearly and negatively related to fasting plasma glucose, but not IS; OfT2D lay on a distinct line shifted to the left of the control subjects. In contrast, β was negatively related to IS, and OfT2D lay on a distinct line shifted more and more to the left of the control subjects, as IS was worse. Thus, in OfT2D lower β-cell adaptive responses exist between ambient glycemia and first-phase insulin secretion and between IS and second-phase secretion. Under conditions leading to decreased insulin sensitivity, these disturbed relationships may lead to progression to diabetes in OfT2D., Type 2 diabetes is characterized by defects in both insulin secretion and insulin action (1). Both factors are important in the pathogenesis of the disease and both are influenced by [...]

OBJECTIVE -- To evaluate whether homeostasis model assessment--estimated insulin resistance (HOMA-IR) is an independent predictor of cardiovascular disease (CVD) in type 2 diabetes. RESEARCH DESIGN AND METHODS -- Conventional CVD [...]

OBJECTIVE -- To evaluate the extent of plasma glucose excursions with meals, the relations between plasma glucose levels at different times of the day, and the relations between the latter [...]

OBJECTIVE -- The purpose of this study was to explore the relation between insulin resistance and plasma levels of soluble adhesion molecules and to examine the effects of acute hyperinsulinemia [...]

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Mitochondrial permeability transition (mPT) is a phenomenon that abruptly causes the flux of low molecular weight solutes (molecular weight up to 1,500) across the generally impermeable inner mitochondrial membrane. The mPT is mediated by the so-called mitochondrial permeability transition pore (mPTP), a supramolecular entity assembled at the interface of the inner and outer mitochondrial membranes. In contrast to mitochondrial outer membrane permeabilization, which mostly activates apoptosis, mPT can trigger different cellular responses, from the physiological regulation of mitophagy to the activation of apoptosis or necrosis. Although there are several molecular candidates for the mPTP, its molecular nature remains contentious. This lack of molecular data was a significant setback that prevented mechanistic insight into the mPTP, pharmacological targeting and the generation of informative animal models. In recent years, experimental evidence has highlighted mitochondrial F1FoATP synthase as a participant in mPTP formation, although a molecular model for its transition to the mPTP is still lacking. Recently, the resolution of the F1FoATP synthase structure by cryogenic electron microscopy led to a model for mPTP gating. The elusive molecular nature of the mPTP is now being clarified, marking a turning point for understanding mitochondrial biology and its pathophysiological ramifications. This Review provides an up-to-date reference for the understanding of the mammalian mPTP and its cellular functions. We review current insights into the molecular mechanisms of mPT and validated observations — from studies in vivo or in artificial membranes — on mPTP activity and functions. We end with a discussion of the contribution of the mPTP to human disease. Throughout the Review, we highlight the multiple unanswered questions and, when applicable, we also provide alternative interpretations of the recent discoveries.

Purpose: Diabetes is a growing health problem. The aim of this study was to capture time trends in mortality associated with diabetes. Methods: The mortality database of the Veneto region (Italy) includes both the underlying causes of death, and all the diseases mentioned in the death certificate. The annual percent change (APC) in age-standardized rates from 2008 to 2017 was computed by the Joinpoint Regression Program. Results: Overall 453,972 deaths (56,074 with mention of diabetes) were observed among subjects aged ≥ 40 years. Mortality rates declined for diabetes as the underlying cause of death and from diabetes-related circulatory diseases. The latter declined especially in females − 4.4 (CI 95% − 5.3/− 3.4), while in males the APC was − 2.8 (CI 95% − 4.0/− 1.6). Conclusion: We observed a significant reduction in mortality during the period 2008–2017 in diabetes either as underlying cause of death or when all mentions of diabetes in the death certificate were considered.

The prevalence of insulin resistance in the most common metabolic disorders is still an undefined issue. We assessed the prevalence rates of insulin resistance in subjects with impaired glucose tolerance [...]