Identification of the Inappropriate Clinical Actions (DON'T) to Improve the Management of Patients with Type 2 Diabetes Failing Basal Insulin Supported Oral Treatment: Results of Survey for a Panel of Diabetes Specialists in Italy

Introduction Despite the development of several recommendations, glycemic control in a large proportion of patients with type 2 diabetes, including those treated with insulin, remains suboptimal. This study is aimed to identify a set of actions to promote the reduction of inappropriate clinical practices in type 2 diabetes failing basal insulin supported oral therapy (BOT). Methods A panel of diabetes specialists was assembled to identify a list of ten corrective actions, "things not to do," for the management of type 2 diabetes: five concerning treatments, procedures and diagnostic tests and five about relationship, communication and information. The Choosing Wisely methodology and approach were the inspiration. Results A total of 73/73 (100%) panelists responded to the survey. Twenty-four actions were proposed. The final list of inappropriate actions deemed most important to improve the management of patients with type 2 diabetes failing BOT were: (1) do not use secretagogues-do not neglect the use of innovative glucose-lowering agents; (2) do not underestimate the risk of lack of hypoglycemia awareness; (3) do not underestimate the benefit of personalization of therapy; (4) do not delay insulin intensification; (5) do not delay modification of the therapeutic regimen. In the area of patient communication, the following actions were identified: (1) do not fail to train in the management of hypoglycemia; (2) do not underestimate whether the patient has understood the modification of therapy; (3) do not prescribe injection therapy without adequately instructing the patient to titrate it; (4) do not ignore the patient's adherence; (5) do not stop listening to the patient and verify learning. Conclusion A set of corrective experience-based actions to enact in a timely manner, which can assist physicians in improving clinical outcomes and patients' needs in terms of communications and interaction, is proposed. The list is intended to promote discussions among diabetes specialists to provide high-value diabetes care

Clinical Features, Cardiovascular Risk Profile, and Therapeutic Trajectories of Patients with Type 2 Diabetes Candidate for Oral Semaglutide Therapy in the Italian Specialist Care

Introduction: This study aimed to address therapeutic inertia in the management of type 2 diabetes (T2D) by investigating the potential of early treatment with oral semaglutide. Methods: A cross-sectional survey was conducted between October 2021 and April 2022 among specialists treating individuals with T2D. A scientific committee designed a data collection form covering demographics, cardiovascular risk, glucose control metrics, ongoing therapies, and physician judgments on treatment appropriateness. Participants completed anonymous patient questionnaires reflecting routine clinical encounters. The preferred therapeutic regimen for each patient was also identified. Results: The analysis was conducted on 4449 patients initiating oral semaglutide. The population had a relatively short disease duration (42%  60% of patients, and more often than sitagliptin or empagliflozin. Conclusion: The study supports the potential of early implementation of oral semaglutide as a strategy to overcome therapeutic inertia and enhance T2D management

Breakdown in classical biological control of Argentine stem weevil: a matter of time

Earlier study at a national scale has shown that insect pests in agriculture can develop resistance to natural enemies following ongoing expansion and simplification of agricultural systems. Here, we used 25 years of field-sampling data segmented into three distinct ecoregions in New Zealand to show that parasitism rate of a key pasture pest (Listronotus bonariensis, Argentine stem weevil) by the introduced parasitoid (Microctonus hyperodae) has significantly declined. However, this decline has not happened simultaneously but with a one year time-lag. The variation in parasitism rate trends might be attributed to subsets of the weevil populations that became resistant to their biocontrol agent once having been exposed to seven years selection pressure (c. 14 generations) since the parasitoid releases. This result supports the hypothesis that adaptation leading to resistance might have similarly occurred in different parts of the country indicating that the genetic variation needed for the acquisition of resistance was equally present everywhere

In-field and in-vitro study of the moss Leptodictyum riparium as bioindicator of toxic metal pollution in the aquatic environment: ultrastructural damage, oxidative stress and HSP70 induction.

This study evaluate the effects of freshwater toxic metal pollution in the highly contaminated Sarno River (South Italy), by using the aquatic moss L. riparium in bags at 3 representative sites of the river. Biological damage was assessed by studying metal bioaccumulation, ultrastructural changes, oxidative stress, as Reactive Oxygen Species (ROS) production and Glutathione S-transferase (GST ) activity, and Heat Shock Proteins 70 (HSP70) induction. The results showed that L. riparium is a valuable bioindicator for toxic metal pollution of water ecosystem, accumulating different quantities of toxic metals from the aquatic environment. Toxic metal pollution caused severe ultrastructural damages, such as the increase of ROS production and the induction of GST and HSP70s in the samples from the polluted sites. To assess the role and the effects of toxic metals on plants, L. riparium samples cultured in vitro were exposed to Cd, Cr, Cu, Fe, Ni, Pb, Zn at the same concentrations as measured at the 3 sites. Ultrastructural damages, ROS, GST, HSP70s were also severely affected by toxic metals. From our finding we can conclude that L. riparium can be proposed as a model organism in biomonitoring projects, and GST and HSP70s as promising biomarkers of metal toxicity

Concentrations of metals as mg l^-1 in waters of Sarno River, measured at the three different exposure sites.

(TIFF)</p

Pearson correlation coefficients (r) obtained for the linear correlations between GST and ROS and metals concentrations measured in-field experiment.

Pearson correlation coefficients (r) obtained for the linear correlations between GST and ROS and metals concentrations measured in-field experiment.</p

In-field and in-vitro study of the moss <i>Leptodictyum riparium</i> as bioindicator of toxic metal pollution in the aquatic environment: Ultrastructural damage, oxidative stress and HSP70 induction - Fig 1

<p><b>TEM micrographs from leaflets of <i>L</i>. <i>riparium</i> specimens exposed in the river Sarno at the site A (1–5), site B (6–10) and site C (11–15).</b> Site A. (1) Thick wall delimited cells showing lenticular chloroplasts, with grana and starch grains, and large clear vacuoles occupying the centre of the protoplast. (2) A thick walled cell with regular chloroplasts and vacuole. The chloroplasts show well-developed grana. (3) The chloroplasts contain a well-developed thylakoid system, starch grains and rare plastoglobules. (4) The thick wall delimited cell shows regular chloroplasts, with grana and starch grains, and a central nucleus, with eu- and heterochromatin. (5) A section of a mitochondrion with cristae. Site B. (6) A thick wall delimited cell containing chloroplasts, with grana and plastoglobules, and cytoplasm lipid droplets. (7) The cell contains a miss-shaped chloroplast with grana and plastoglobules, cytoplasm lipid droplets and vesicles. (8) A miss-shaped chloroplast with a well-developed thylakoid system and plastoglobules. Lipid droplets and a mitochondrion with no cristae are between the chloroplasts. (9) A chloroplast with a well-developed thylakoid system and plastoglobules. (10) Vesicles at high magnification. Site C. (11) A severely altered cell featured by a highly fissured thick wall. The chloroplasts, still showing a developed thylakoid system with grana, are swollen and filled with large plastoglobules. Large lipid droplets are in the cytoplasm. (12) The altered cell shows cytoplasm lipid droplets and a swollen chloroplast with plastoglobules and thylakoids. (13–14) Chloroplasts showing large plastoglobules and thylakoid systems with still recognizable grana and intergrana membranes. Large lipid droplets around the chloroplast. (15) Magnified plastoglobules and thylakoids. Scala bars: 5 μ (1), 2 μ (4), 1 μ (2, 6, 7, 11, 15), 500 nm (3, 9, 12, 13, 14), 300 nm (5, 10)<b>. Lettering and marks: cw</b> cell wall; <b>m</b> mitochondrion; <b>n</b> nucleus; <b>*</b> starch grain; <b>black arrow</b> cytoplasm lipid droplet; <b>white arrow</b> plastoglobules.</p

In-field and in-vitro study of the moss <i>Leptodictyum riparium</i> as bioindicator of toxic metal pollution in the aquatic environment: Ultrastructural damage, oxidative stress and HSP70 induction - Fig 2

<p>The table shows TEM micrographs from leaflets of <i>L</i>. <i>riparium</i> specimens cultured in the toxic metal mixture at the same concentrations as in the site A (1–5), site B (6–10) and site C (11–15). Site A. (1) Thick wall delimited cells containing lenticular chloroplasts, with grana and starch grains, and large clear vacuoles. (2, 3) Regular chloroplasts featured by a well-developed thylakoid system and mitochondria. (4) A central nucleus (N) with eu- and heterochromatin, surrounded by chloroplasts and vacuoles. (5) A section of a mitochondrion with cristae. Site B. (6) Thick wall delimited cells showing plasmolysed protoplasts with severely swollen chloroplasts. (7, 8) Severely plasmolysed cells containing swollen chloroplasts with swollen thylakoids. (9, 10) Swollen chloroplasts with swollen thylakoids and small starch grains. Membranes have a thicker and not sharp appearance. Site C. (11) Inside the thick wall delimited cells are changed chloroplasts, vacuoles and a nucleus. (12) A cell with chloroplasts and plenty of cytoplasm vesicles. (13) A detail of a cell showing a misshaped chloroplast with grana and large plastoglobules in the stroma. A nucleus with eu- and etherochromatin is on the left. (14) Details of a misshaped chloroplast with grana, mitochondria and a multilamellar body. (15) A section of a mitochondrion with cristae. Scale bars: 5 μm (1), 3 μm (11), 2 μm (6, 12), 1 μm (4, 7, 8), 500 nm (2, 3, 9, 10, 13, 14), 300 nm (5, 15). Lettering and marks: cw cell wall; m mitochondrion; n nucleus; v vacuole; * starch grain; white arrow plastoglobules; + multilamellar body.</p

GST activity in <i>L</i>. <i>riparium</i> exposed in bags and <i>in vitro</i> cultured.

<p>GST activity in <i>L</i>. <i>riparium</i> exposed in bags at sites A, B and C of Sarno River (in-field experiment, left panel, a) and <i>in vitro</i> cultured with mixtures of toxic metal or with the single toxic metal at the concentrations measured in site C (CdCl₂ 0.14 mg l^-1, Cr(Cl) 3 9.05 mg l^-1, CuSO₄ 2.45 mg l^-1, FeCl₂ 308.0 mg l^-1, NiCl₂ 3.4 mg l^-1, Pb(CH₃COO)₂ 0.85 mg l^-1, ZnCl₂ 46.76 mg l^-1) (right panel, b). Data are shown as the mean ± standard deviation (n = 5). The GST activity was expressed as micromoles/ml min^-1. Bars not accompanied by the same letter are significantly different at p < 0.05, using post hoc Student-Neuman-Keuls test.</p