Nutraceuticals (“nutrition” and “pharmaceutical” crases) is a term coined by Dr. Stephen De Felice in 1989 and refers to the study of foods with beneficial effects on human health. A nutraceutical is therefore a food that combines nutritional components selected for their characteristics, such as high digestibility and hypoallergenicity, to the healing properties of natural active ingredients. The European Commission Concerted Action on Functional Food Science (FUFOSE) defines a “functional food” as one whose positive effect on one or more functions of the organism is such that it is relevant for improving health and/or reducing risk of disease, regardless of its nutritional effect; it must also be able to exert its effects on the amounts normally consumed with the diet. Otherwise, the “nutraceutical” is a real pharmaceutical preparation with active ingredients naturally present in food but extracted, purified, concentrated and taken in a pharmacological dose. In this discussion we will focus only on the evidence available in the literature on the use of nutraceuticals, supplements and probiotics in the prevention and treatment of type 2 diabetes mellitus.

KEYWORDS nutracetuticals; supplements; probiotics; diabetes.

Diabetes mellitus is associated with an increased incidence of some infections and a greater severity and/or frequency of complications related to these diseases. Influenza is characterized by an increased severity of clinical course and risk of complications, especially in diabetic patients who are more susceptible to influenza infection. For these reasons, the Italian Vaccine Prevention Plan 2017-19 provides an active and free offer of influenza vaccine for the diabetic subjects. In addition, among the vaccinations recommended by the Italian Prevention Plan in adults, including the diabetes ones, there is the diphtheria-tetanus-pertussis vaccine and the decennial booster. To investigate what is the perception of Italian diabetologists on the role and importance of the influenza and the diphtheria-tetanus-pertussis vaccines, AMD has promoted an online survey. Participants claimed to be aware of the importance of carrying out and recommending influenza vaccination, while awareness of the usefulness of performing and suggesting the decennial booster for diphtheria-tetanus-pertussis was lower. Diabetologists attribute to patients’ resistance and lack of interest in such vaccinations the main motivation for which they are not used to recommend them, even if they acknowledge that they have little knowledge about the decennial booster of diphtheria-tetanus-pertussis vaccine.

The survey shows that the percentage of patients with diabetes who seek advice on these vaccinations is inadequate and the diabetologists’ knowledge of the National Vaccination Prevention recommendations and the need to actively promote vaccinations is inappropriate. This survey has allowed to highlight the opinion, of a significant percentage of Italian diabetologists, on some key aspects of the vaccination therapy indicated in diabetic patient, allowing to gather important information to open a debate, to know strengths and weaknesses on this topic and implement training activities.

KEYWORDS diabetes mellitus; influenza vaccine; diphtheria-tetanus-pertussis vaccine; survey.

Diabetic Foot Syndrome (DFS) is a complex disease to be managed by a Multi Disciplinary Team (MDT). Nevertheless, a Team Leader (TL) should be designated to collaborate with members of the MDT in a patient-orientated approach.

A TL should know and manage diabetes, related complications and comorbidities. The TL should have deep knowledge of peripheral neuropathy and arterial disease and be able to diagnose and manage foot infections, including prompt surgical treatment when needed. In Italy, after the pioneering phase in which diabetologists began managing medical and surgical aspects of DFS to fill unmet needs, nowadays there is a network of Diabetic Foot (DF) clinics managed by diabetologists.

Italy is one of the countries belonging to Organization for Economic Cooperation and Development (OECD) with the lowest amputation rate in diabetic patients. In addition to the special attention to the care of diabetes, the unique expertise of diabetologists involved in DF management may have been a contributing factor. They all share a “patient centered model” of care mainly related to their internal medicine background and have skills in podiatric surgery to manage the specific needs of DF patients with acute or chronic conditions in a timely manner. In Italy, specific training courses and university master programs have been developed in recent years, to prepare internists (diabetologists/endocrinologists) to become TL’s. This has allowed DF care to move from the initial pioneering phase to a more structured phase, with the creation of specific pathways and roles.

KEYWORDS diabetes; diabetic foot; multidisciplinary Team; Team Leader.

It has been known for several years that hyperglycemia that develops during pregnancy and identifies the condition defined as gestational diabetes is able to increase the risk of adverse maternal and especially neonatal outcomes. Gestational diabetes is also associated with a high metabolic and cardiovascular risk for both affected mothers and their children even after pregnancy. However, the most controversial aspect still remains its mode of screening and diagnosis. Here the most significant historical milestones that over time have defined the criteria of screening and diagnosis of gestational diabetes are reviewed. A modern and probably more stimulating vision of these problems, considering the possible future scenarios, is discussed. Starting from the first attempt to define the criteria by O’ Sullivan, then perfected by Carpenter and Coustan, going through the recommendations of the World Health Organization and the positions expressed by the Conferences on Gestational Diabetes Workshops, in the early 2000s the HAPO study (Hyperglycemia and Adverse Pregancy Outcome) was published and internationally recognized criteria have been defined. In Italy, a ministerial Guideline recommends performing screening based on risk factors and only women at risk of developing gestational diabetes undergoing to a diagnostic test. Here are described some Italian studies that have explored at a national level or on a single regional level the problems of the transposition and application of this national Guideline. Finally, the most modern strands of research in this field are discussed, exploring the topic of predictive models for the risk of gestational diabetes, and exploring that area of study that suggests shifting the focus from the identification of the best diagnostic strategy of gestational diabetes directly to the identification of risk factors for the onset of adverse pregnancy outcomes.

KEYWORDS gestational diabetes; screening; diagnosis.

Gestational Diabetes Mellitus (GDM) is a very common complication of pregnancy. Although glucose tolerance returns to normal levels after delivery in the majority of women with GDM, this condition represents an early stage in the natural history of type 2 Diabetes Mellitus. Moreover, women with previous GDM exhibit an increased cardiovascular risk profile and a raised incidence of cardiovascular diseases. Lifestyle changes and pharmacological interventions might be able to reduce the incidence of type 2 diabetes in women with previous Gestational Diabetes, results are still not conclusive although encouraging. Pharmacological interventions are not yet recommended for prevention. Long term continuous program specifically addressed to women with previous GDM should be implemented, especially addressed to encourage them to regularly check glucose tolerance, lipid profile and other parameters related to cardiovascular diseases, aimed at improving women’s health. In this paper, we will review the relationship between type 2 diabetes, cardiovascular diseases and a history of GDM.

KEYWORDS gestational diabetes; type 2 diabetes; cardiovascular disease.

In the last years the number of pregestational pregnancies (especially type 2) has been increasing. Several studies have demonstrated that pregestational pregnancies are associated with an increased incidence of adverse maternal outcomes, an increased risk of neonatal mortality and congenital malformations; these risks are related to the glycemic control and to the therapies at the time of conception and during embryogenesis. These pregnancies, therefore, should never be random, as it often happens in our clinics, but they must be planned with pre-conceptional counselling paths dedicated to childbearing women, from puberty, continuing into adolescence and reaching adulthood. When the pregnancy desire becomes concrete, the woman with diabetes must be included in a multidisciplinary and structured program. The pregestational counselling must bring the woman, before conception, to the stabilization of complications, to the therapy improvement, to the achievement of the skills for the management of therapy and to the glycemic control. To reach these results it is necessary that the Diabetologic team works taking into account all the clinical and psycho-social aspects of childbearing women.

KEYWORDS pregestational diabetes; pregnancy; preconceptional counselling; maternal and fetal outcomes.

Diabetes in pregnancy is associated with an increased risk of maternal and neonatal complications. Several trials have showed that adequate pregnancy planning and optimal glucose control are essential to reduce the risk of fetal malformations and to improve maternal-fetal outcomes. In clinical practice it’s hard to reach an optimal glucose control in pregnancy. Thus, the new technologies designed to assist patient with diabetes (Continuous subcutaneous insulin infusion and/or Continuous Glucose Monitoring) are widely used during pregnancy planning and management. This article discusses the use of new technologies in the management of diabetes during pregnancy and their effects on glicemic control and maternal-fetal outcomes

KEYWORDS diabetes in pregnancy; continuous subcutaneous insulin infusion; continuous glucose monitoring; efficacy; safety