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Aim: The study was designed to generate real‐world evidence on IDegLira in the Italian clinical practice in two groups of patients with type 2 diabetes (T2D), switching to IDegLira either from a basal only (basal group) or basal‐bolus insulin regimen (BB group). Materials and Methods: This was a non‐interventional, multicentre, single‐cohort, prospective study assessing the long‐term glycaemic control in patients with T2D, who switched to IDegLira from a basal insulin ± glucose‐lowering medication regimen with or without a bolus insulin component for approximately 18 months, conducted in 28 Italian diabetes centres. The primary endpoint was the change in glycated haemoglobin (HbA1c) levels from baseline to 6 months after IDegLira initiation. Results: The study included 358 patients with a mean age 67.2 years and diabetes duration of 15.7 years. HbA1c significantly decreased from IDegLira start to all study time points in the overall population (basal group −1.19%; BB group −0.60% at the end of observation). Patients achieving HbA1c <7% levels increased from 12.9% (n = 43) to 40.3% (n = 110) at 18 months. Fasting blood glucose and body weight also significantly decreased in both groups, although more in the BB group. Overall, 14.3% of completed patients had an intensification of treatment (mainly in the basal group) and 48.6% had a simplification of treatment (mainly in the BB group). Conclusions: Switching to IDegLira in a real‐world clinical setting is a valid therapeutic option for patients with T2D with inadequate glycaemic control on basal or BB insulin regimen and/or need to simplify their insulin therapy, with specific reasons and therapeutic goals according to different T2D management trajectories. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is one of the most common complications of diabetes mellitus and an independent risk factor for cardiovascular disease. Despite guideline-directed therapy of CKD in patients with type 2 diabetes, the risk of renal failure and cardiovascular events still remains high, and diabetes remains the leading cause of end-stage kidney disease in affected patients. To date, current medications for CKD and type 2 diabetes mellitus have not reset residual risk in patients due to a high grade of inflammation and fibrosis contributing to kidney and heart disease. This question-and-answer-based review will discuss the pharmacological and clinical differences between finerenone and other mineralocorticoid receptor antagonists and then move on to the main evidence in the cardiovascular and renal fields, closing, finally, on the potential role of therapeutic combination with sodium-glucose cotransporter 2 inhibitors (SGLT2is). [ABSTRACT FROM AUTHOR]

Purpose: Infection, which is one of the possible complications of diabetic foot ulcers (DFUs), makes the treatment of ulcers challenging because of its negative impact on healing processes and the high prevalence of multiresistant germs. This study is aimed at verifying the effect of a surgical CO2 laser (which reduces the bacterial load and allows a more accurate debridement), as compared with the traditional lancets, on the healing rate of DFU. Methods: The present case-control retrospective analysis was performed on patients with chronic (>6 months) DFU with Texas grade >1, treated with 80 W surgical CO2 laser (DEKA SmartXide2 C80, El.En. Group) and compared with a matched sample of patients with similar characteristics, who were treated with a traditional surgical approach. The debridement was performed trying to achieve the complete removal of nonviable tissues. The principal endpoint was the proportion of patients healed at 6 months. All analyses were carried out with SPSS 25.0. The study protocol was approved by the local ethical committee. Results: This study included 118 patients (59 cases and 59 controls). At 6 months, the proportion of healing patients was 35% and 18% in cases and controls, respectively (P =.034). The corresponding figure at 1 year was 62% and 38% (P =.009), whereas no difference was observed at 1, 2, and 3 months. No serious adverse event was observed. Conclusions: In this article, we show for the first time that CO2 laser treatment, in comparison with traditional surgical approaches, can be associated with an increased healing rate in patients with DFU. [ABSTRACT FROM AUTHOR]

The safety and efficacy of a novel superoxidized solution (Dermacyn™ Wound Care [DWC], Oculus Innovative Sciences, Petaluma, Calif) was evaluated for the treatment of wide postsurgical infected ulcers of the [...]

Aim: Not revascularised critical limb ischaemia (no-CLI) is affected by a high amputation rate (30% at one year) and high mortality rate (50% at one year). Treatment with autologous peripheral blood mononuclear cells (A-PBMNC) showed promising outcomes in limb salvage and survival rate. A-PBMNC implants are performed in the leg and the perilesional area with a 21 G needle, extremely painful also for neuropathic patients, repeated a maximum of three times. If necessary, foot surgery was performed at the same time as the last implant. In the study we evaluated long-term outcomes and retrospectively compared patient clinical parameters and surgeon comfort in a group treated with deep sedation (DS) in spontaneous breathing and a group treated with popliteal and saphenous block (PSB) under ultrasound guidance. Method: We evaluated 102 diabetic no-CLI patients with similar baseline features and indications who underwent 288 A-PBMNC implants from January 2017 to September 2022: 42 patients with DS (122 implants) and 60 with PSB (166 implants). During the implants all patients underwent no invasive hemodynamic monitoring (blood pressure, heart rate, oxygen saturation) and the post-operative NRS scale. Surgeon comfort as akinesia and side effects are reported. The minimum follow-up period was 12 months. Results / Discussion: During the procedures, SD determined a higher variation in blood pressure (±20 mmHg), heart rate (±20 bpm) and oxygen saturation (±5 mmHg) than in PSB, respectively 35 vs 26; 97 vs 33; 10 vs 7. In 160 PSB procedures, sufficient anaesthesia and akinesia were achieved, but in 6 cases we need to adjunct SD. Only in 32 SD procedures akinesia was achieved. The mean surgical time was 35.7 minutes. After the procedure, each PSB patient was asked to indicate his value on the VAS pain scale (2.4±0,8 during the process; 2.2±0,3 after). No side effects were registered. Sixty-nine patients completed at least a one-year follow-up alive and without recurrences; five patients achieved a five years follow-up, 17 patients a four years follow-up; six patients a three years follow-up; five patients a two-year and 26 patients a 1-year follow-up. The healing rate at the 12-month follow-up was 68% (69/102), and the recurrences rate was 7,2% (5/69). In patients in remission, the mean ulcer-free survival days was 946,4±521,26, and the median ulcer-free survival days was 594,55. The overall mortality rate was 32,3% (33/102). The overall amputation rate was 10.7% (11/102). Conclusion: In A-PBMNC implants, the choice of the best anaesthesia regimen remains an open question and PSB showed to be more effective and as safe as SD. In the long-term follow-up, A-PBMNC therapy effectively improves limb salvage, survival rate, long-term management and remission parameters in diabetic no-CLI patients. [ABSTRACT FROM AUTHOR]

Aim: Postoperative wounds may arise from several etiologies including open partial pedal amputation, postoperative infection, and dehiscence of surgical sites from wound failure or patient compliance issues. If negative pressure wound therapy is the gold standard, its application in the toes area could be challenging as a consequence standard care is most likely used. Reactive oxygen species are a key part of the normal wound-healing process and we evaluate the use of a new oxygen-enriched oil-based product (gROS) in this kind of ulcers. Method: A total of 22 diabetic patients with tunnelling post-surgical dehiscence of the foot (TUC IIA or IIIA) comprised the study population. Patients were randomised in two groups as follows: group 1 patients were treated with (gROS) and group 2 patients were treated with standard therapy. Primary outcome is healing rate. Secondary outcomes are new infections and side effects. Results / Discussion: After 16 weeks wound closure occurred in 9 patients (75%) in group 1 and 4 (33%) in group 2 (p=0,04). New infections affected 2 patients (17%) in group 1 and 7 patients (58%) in group 2 (p=0,05) and, of these, six patients (50%) needed a new surgical debridement. No severe side effects were reported in group 1 and only in 1 patient (8%) perilesional maceration was observed. In standard therapy frequency of dressing was twice a week and in gROS once a week, reducing costs related to nursing time and hospital visits, responsible of 80-85% of the total cost. Conclusion: Oleic matrix -- based gel releasing Reactive Oxygen Species promising to be effective, safe and efficient in tunnelling post-surgical dehiscence in diabetic foot. [ABSTRACT FROM AUTHOR]