Pain may be absent in a substantial proportion of elderly patients with acute abdominal conditions. This study explored the association between type 2 diabetes mellitus (T2DM) and asymptomatic presentation. We conducted a cross-sectional analysis of 215 patients aged ≥ 65 years admitted with acute abdominal conditions. Demographic, clinical, and laboratory data were extracted from medical records. Descriptive statistics and multivariable logistic regression were used to identify associative predictors of asymptomatic acute abdomen (AAA). The median age was 82 years [77–86]; 54.4

Traditional anthropometric indices reflect total body adiposity, whereas novel shape-based indices capture fat distribution and unfavorable adiposity. How these measures relate to hepatic steatosis and fibrosis risk across the spectrum of metabolic dysfunction–associated steatotic liver disease (MASLD) remains unclear. In this cross-sectional study, 222 patients with MASLD were included. Body mass index (BMI), waist circumference (WC), a body shape index (ABSI) and body roundness index (BRI) were evaluated. Hepatic steatosis was assessed by ultrasonography using the Bright Liver Echo Pattern (BLEP), while fibrosis risk was estimated using the Fibrosis-4 (FIB-4) index. BMI, WC, and BRI were higher in individuals with moderate-to-severe hepatic steatosis (BLEP ≥ 2), whereas ABSI did not differ according to steatosis severity. In multivariable logistic regression, BMI was independently associated with BLEP ≥ 2 (OR 1.19; 95

A comprehensive approach to the management of obesity, considering its complications besides the disease itself, may be advantageous, and effective obesity medications are now available. Several aspects of the integrated management of overweight/obesity are still unclear or are rapidly evolving. We conducted a multicenter, multispecialty consensus based on the iterative modified Delphi methodology. The study ensured the fundamental principles of anonymity, iteration, controlled feedback, and statistical stability of the consensus. Management of two main patient subgroups was investigated, i.e., patients with overweight (body mass index, BMI 27-<30 kg/m2) with ≥ 1 weight-related comorbidity, and patients with obesity (BMI ≥ 30 kg/m2). Fifteen panelists had the required criteria and participated in the survey. Two Delphi rounds were required to complete the study, for a total of 93 items investigated. Almost all panelists (high consensus, 93

Recurrent weight gain after bariatric surgery (BS) or endoscopic bariatric therapy (EBT) remains a long-term clinical challenge, potentially undermining long-term treatment success. Tirzepatide, a dual agonist of the glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors, has shown promising results in obesity treatment, but data regarding its use in post BS or EBT recurrent weight gain are limited. This observational cohort study evaluated the effectiveness and safety of tirzepatide in patients with recurrent weight gain after BS or EBT. Anthropometric data, BMI categories, and adverse events were collected at baseline and after 24 weeks of treatment. A total of 34 patients (26 females, 8 males) who experienced recurrent weight gain after BS (n = 32) or EBT (n = 2) were treated with once-weekly subcutaneous tirzepatide (dosing range 2.5–10 mg/week). After 24 weeks, the mean percentage total body weight loss (

AIMS:Overweight and obesity are major global health challenges and key drivers of cardiovascular disease (CVD), yet patients with established CVD and excess body weight remain systematically under-recognized and undertreated. This consensus paper, developed by an Italian multidisciplinary panel of cardiology, endocrinology and obesity experts, aims to characterize the clinical phenotype of CVD patients most likely to benefit from semaglutide therapy, identify barriers to its implementation, and propose patient-centered strategies to optimize treatment pathways. DATA SYNTHESIS:The document reviews the pathophysiological relevance of adiposity in cardiovascular risk, and discusses the evolving diagnostic framework beyond body mass index (e.g., waist-to-height ratio). Evidence from SELECT trial is contextualized to support semaglutide as a disease-modifying therapy with benefits largely independent of weight loss. The expert panel highlights persistent barriers related to reimbursement, organizational limitations, cultural bias, and therapeutic inertia. To address these gaps, a flexible multidisciplinary care model is proposed, centered on systematic patient identification, shared follow-up responsibilities among cardiologists, general practitioners and obesity specialists, structured clinical pathways, and digital or automated tools to reduce missed opportunities for treatment. Emphasis is placed on consistent clinician education and patient empowerment as essential components for long-term adherence and cardiometabolic risk reduction. CONCLUSIONS:Integrating semaglutide into routine cardiovascular care requires a coordinated, patient-centered approach supported by specialty networking, aligned educational frameworks, and organizational tools to streamline identification, initiation, and monitoring. Implementing these strategies can strengthen secondary prevention, reduce therapeutic inertia, and ensure that patients with CVD and excess adiposity receive timely, evidence-based, and holistic management.

Unannounced meals pose a major challenge to type 1 diabetes patients. This study compared the performance of two automated insulin delivery (AID) algorithms, the Medtronic MiniMed 780G’s proportional-integral-derivative (PID) and the Tandem t: slim X2’s model predictive control (MPC), following unannounced breakfasts (ClinicalTrials.gov identifier: NCT07455643, retrospectively registered the 3rd of February 2026). In a randomized crossover study, we enrolled 20 children between 11 and 18 years using the MiniMed 780G or the Tandem t: slim X2 AID system. Endpoints included 2-hour and 4-hour blood glucose difference (ΔBG), glucose peak, time to peak, and time spent above (TAR), below (TBS), in range (TIR), and in tight range (TITR). Two meals were tested: a carbohydrate (CHO) meal and a mixed one, both containing 30 g of carbohydrates, and additional 15 g proteins for the mixed meal. Announced (AM) and unannounced (UM) meals were analyzed. AM, compared to UM, showed significant higher 2-hourΔBG; conversely 4-hourΔBG did not differ significantly. In CHO AM, algorithms were comparable. In mixed AM, PID gained lower peaks and TAR, with higher TIR and TITR. In UM, PID obtained lower 2-hourΔBG than MPC, with reduced peak, TAR, and improved TIR and TITR. Differences in 4-hourΔBG and time-at-peak were not significant. Both AID algorithms mitigated postprandial glycemia and returned glucose to baseline levels within 4 h without safety concerns. The PID demonstrated higher reactivity to unannounced meals, while performances were comparable when meal boluses were properly announced. NCT07455643.

Bariatric surgery is a well-established therapeutic strategy for the treatment of obesity and type 2 diabetes mellitus (T2DM). However, some patients do not achieve the expected benefits, such as the remission of T2DM or experience a relapse of the disease sometime after the intervention. This article aims to explore the topic of diabetes after bariatric surgery by analyzing the possible causes of the lack of remission, the clinical characteristics of these patients, and the most effective therapeutic strategies for managing this condition.

OBJECTIVE:This study aimed to correlate the parameters of advanced hybrid closed loop (AHCL) function to the glycometabolic outcomes in a cohort of patients with type 1 diabetes (T1D) using different AHCL systems. RESEARCH DESIGN AND METHODS:This was a retrospective cross-sectional study on 124 adult (n = 87) and pediatric (n = 37) patients correlating the total daily insulin dose (TDD), the total daily basal (TDBa) and bolus (TDBo) insulin doses, the percentage of auto-bolus out of total daily bolus (Automated Correction Index - ACI) to the glycated hemoglobin (HbA1c) and the sensor-derived metrics. RESULTS:The ACI was the only AHCL-derived parameter directly associated to HbA1c (p = 0.03) and time above range (TAR180-250 mg/dL, 10-13.9 mmol/L, p < 0.01), and inversely correlated to time in range (TIR70-180 mg/dL, 3.9-10 mmol/L, p < 0.01). Patients with ACI < 30 % showed reduced HbA1c levels (6.21 % ± 0.5 vs. 6.95 % ± 0.8, p = 0.02) and a higher probability of having TIR > 70 % (OR 3.18, CI 1.19-8.46, p = 0.02) and coefficient of variation (CV) < 36 % (OR 2.86, CI 1.07-8.27, p = 0.03) compared to those with ACI ≥ 30 %. CONCLUSION:The ACI could represent a useful and easy-to-assess metric for AHCL-treated individuals with T1D. In our cohort an ACI < 30 % was associated to better glucose control and variability.

Prostate cancer is the most prevalent cancer among men in Western countries and is commonly managed by androgen deprivation therapy for locally advanced or metastatic stages. Even if initially effective, most patients eventually develop resistance to this treatment. Approved in 2011 for castration-resistant prostate cancer, abiraterone acetate inhibits the CYP17A1 enzyme, which is crucial in androgen and cortisol synthesis. This inhibition disrupts feedback on adrenocorticotropic hormone (ACTH), causing mineralocorticoid excess syndrome (MES), which is characterized by fluid retention, hypokalemia, and hypertension. MES can persist even with glucocorticoid supplementation, as observed in some cases. This study describes the case of a 68-year-old male with prostate cancer who developed severe, treatment-resistant hypokalemia after 6 years of abiraterone and prednisone therapy. The patient presented with poorly controlled diabetes and notable hypokalemia despite oral and parenteral potassium supplementation. Imaging revealed an adrenal adenoma; however, low renin and aldosterone levels suggested that abiraterone-induced MES, rather than primary aldosteronism, was responsible for his hypokalemia. The main therapy adjustment consisted of switching prednisone to dexamethasone to enhance ACTH suppression, effectively resolving the patient’s hypokalemia. This case underscores the need for MES monitoring in patients on abiraterone, as MES can develop or worsen over time. Physicians should consider dexamethasone over prednisone in persistent MES cases, always monitoring also for the risk of developing Cushing syndrome. Given the rising prostate cancer incidence, clinicians must remain vigilant for MES-related complications with abiraterone, including delayed-onset severe hypokalemia.

Background/Objectives: Over the past decade, numerous studies have explored the bidirectional relationship between obesity and mental health, mainly eating disorders (EDs). This study aimed to assess the prevalence and characteristics of altered eating behaviors (AEBs) in a cohort of people with obesity (PwO) using the validated Eating Behaviors Assessment for Obesity (EBA-O). Methods: We conducted a cross-sectional study from May 2023 to April 2024, recruiting consecutive PwO seeking weight loss. Participants completed the 18-item EBA-O questionnaire, which focuses on five primary eating behaviors: night eating, food addiction, sweet eating, hyperphagia, and binge eating. Unlike other validated tools, the EBA-O is specifically designed to capture these behaviors in PwO and is easy for patients to self-administer. We also collected sociodemographic and clinical data. Results: A total of 127 participants were included (76 women, median age 52 years, median BMI 42.9 kg/m2). We found a significant prevalence of AEBs: 33.1% for sweet eating, 23.6% for hyperphagia, 15.7% for food addiction, 14.2% for binge eating, and 7.1% for night eating. The EBA-O scores correlated positively with BMI (r = 0.201, p = 0.024) and increased across BMI categories (p = 0.001). Males had higher scores for night eating and hyperphagia (p = 0.01), and active smokers had higher hyperphagia scores (p = 0.043) than ex-smokers and non-smokers. The night eating scores were inversely correlated with sleep hours (r = -0.197, p = 0.026), and food addiction was positively correlated with age (r = 0.261, p = 0.003); conversely, hyperphagia (r = -0.198, p = 0.025) and binge eating (r = -0.229, p = 0.010) were inversely correlated with age. PwO without diabetes had higher scores for food addiction (p = 0.01) and binge eating (p = 0.004) compared to those with diabetes. Conclusions: These results highlight the potential to characterize PwO based on their AEBs, offering new opportunities to tailor treatment strategies for PwO by targeting specific eating behaviors.

Metabolic syndrome (MS), a cluster of cardiometabolic disorders, and sexual dysfunction are two conditions that impact a large proportion of the general population. Although they can occur independently, they are frequently linked and significantly affect people’s quality of life. In recent years, research has increasingly focused on the importance of diet, particularly the Mediterranean diet (MD), in modulating sexual function due to its anti-inflammatory, antioxidant, and vasodilatory properties. In this narrative review, we examined the relationship between MS and sexual function in both men and women, with a special emphasis on the MD’s therapeutic efficacy in improving sexual dysfunction. In men, MD has been shown to ameliorate erectile dysfunction, as well as several sperm parameters, perhaps leading to improved fertility. On the other hand, adherence to MD has been demonstrated to partially recover several sexual dysfunctions in women, such as those related to their menstrual cycle, menopause, endometriosis, and polycystic ovary syndrome. These favorable effects of MD have been demonstrated in both sexes also among people affected by MS. However, more targeted studies are needed to validate these data for different dietary approaches as well.

Background Late dumping syndrome (LDS) refers to reactive hyperinsulinemic hypoglycemia episodes that occur one to 3 h following a high-carbohydrate meal in persons who have had gastric surgery. Dietary adjustments (such as regular composite meals containing lipids, protein, and carbohydrates with a low glycemic index) are effective in treating the majority of LDS patients; however, pharmaceutical interventions are required in some cases. Case presentation We describe the case of a 60-year-old woman with type 2 diabetes (T2DM) who developed late dumping syndrome symptoms following a gastric cancer gastrectomy. Both the 75-g oral glucose tolerance test (OGTT) and the mixed-meal tolerance test (MMTT) revealed reactive hyperinsulinemic hypoglycemia. We began therapy with canagliflozin, a sodium glucose-cotransporter (SGLT) inhibitor 300 mg before lunch after realizing that dietary changes were insufficient in reducing the occurrence of symptomatic hypoglycemic episodes. We repeated the OGTT after treatment, and the results showed still the presence of symptomatic hypoglycemia without significant differences in peak insulin values compared to the OGTT performed before treatment. Instead, the MMT showed a small, flattened insulin response without any hypoglycemic episodes. Furthermore, improvements were observed in glucose trends/targets as demonstrated by time in (TIR), above (TAR) and below (TBR) range and glucose variability (e.g. coefficient of variation) based on data collected from Flash Glucose Monitoring (FGM) before and during canagliflozin therapy. Conclusion The rapid transit of inadequately digested chyme from the stomach into the small intestine is one of the most important pathophysiological processes in LDS. Canagliflozin, unlike other molecules in the same family, inhibits intestine SGLT-1. By delaying glucose absorption at that level, it may reduce postprandial glucose and insulin rises. Our case report, however, demonstrates that the effect of canagliflozin on glucose homeostasis is determined by appropriate dietary habits, which seem to be critical for successfully reducing symptoms related to reactive hyperinsulinemic hypoglycemia following a gastric bypass surgery.

Purpose Poor response to bariatric surgery, characterized by insufficient weight loss (IWL) or weight regain (WR), poses a significant challenge in obesity treatment. This study aims to assess the effectiveness of liraglutide in addressing this issue. Materials and Methods A retrospective, multicenter cohort study investigated the impact of liraglutide 3 mg on weight loss in adults with suboptimal responses or weight regain after bariatric surgery (BS). Additionally, a systematic review and meta-analysis were conducted for a comprehensive evaluation. Results A total of 119 patients (mean age 41.03 ± 11.2 years, 71.4% female) who experienced IWL or WR after BS received pharmacologic therapy with liraglutide 3 mg. Mean percent weight loss in the entire cohort was 5.6 ± 2.6% at 12 weeks and 9.3 ± 3.6% at 24 weeks with a significant reduction in waist circumference ( p < 0.0001). No serious side effects were reported. A meta-analysis, utilizing the fixed effect model with the metafor package in R, included 6 and 5 papers for the change in body weight and BMI after liraglutide treatment, respectively. The analysis demonstrated a considerable reduction in body weight (7.9; CI − 10.4; − 5.4, p < 0.0001) and BMI (3.09; CI 3.89; − 2.28, p < 0.0001). Conclusion Liraglutide 3 mg emerges as a viable option for significant weight loss in patients experiencing IWL or WR after BS. Its inclusion in a multimodal, sequential obesity treatment approach proves promising. Graphical Abstract

Background:Bariatric surgery (BS) represents the most effective therapy for obesity class III, or class II with at least one weight-related comorbidity. However, some patients have insufficient weight loss or clinically relevant weight regain after a successful primary procedure. This study aimed to assess the efficacy of liraglutide treatment on weight loss, body composition and improvement of metabolic syndrome (MS) in patients defined as poor responders after BS.Methods:The study involved 59 non-diabetic adults with obesity (M/F: 17/42, age: 38.6 ± 11.8 years, BMI 38.3 ± 5.5 kg/m2) who had been treated with BS and experienced a poor response, categorized as either IWL (insufficient weight loss) or WR (weight regain). All patients were prescribed pharmacological therapy with liraglutide and attended nutritional counseling. Anthropometric and clinical measurements, body composition and the presence of MS defined according to the ATP-III classification were evaluated before starting liraglutide and after 24 weeks of treatment.Results:After 24 weeks of treatment with liraglutide, the mean weight loss was 8.4% ± 3.6% with no difference between gender, bariatric procedure, or type of poor response (IWL or WR). A significant decrease in fat mass, free-fat mass and total body water was documented. After 24 weeks, patients presented significantly lowered fasting glucose, total cholesterol, triglycerides, AST and ALT. The prevalence of MS was reduced from 35% at baseline to 1.6% after 24 weeks. No patients discontinued the treatment during the study.Conclusion:In patients who experience poor response after BS, liraglutide is well tolerated and promotes significant weight loss, ameliorates cardiometabolic comorbidities, and reduces the prevalence of MS.

Heart failure (HF), type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) are some of the most important health problems of this century, and these three conditions often coexist, one worsening the prognosis of the other two. No disease is more important than the others in the composition of risk, which is significantly increased by their overlap. Thus, it would be more appropriate to refer to this cluster as cardio-nephro-metabolic syndrome. The aim of this review is to promote the development of an integrated multidisciplinary approach to the treatment of HF, T2DM and CKD in a perspective of paradigm shift from an individual management among different specialists to a shared one. Nowadays, this is achievable thanks to telemedicine and optimized therapy consisting in the new drugs with pleiotropic effect available today. The need is to have technological solutions, which also include telemedicine, for the management of patients affected by all three diseases to consider their fragility, sometimes due to a wrong, partial, or incomplete treatment. Multicentric, multidisciplinary trials on cardio-nephro-metabolic syndrome and new telemedicine/telemonitoring technologies could help place the chronic and fragile patient at the center of such multidimensionally integrated care.

Purpose Poor response to bariatric surgery, namely insufficient weight loss (IWL) or weight regain (WR), is a critical issue in the treatment of obesity. The purpose of our study was to assess the efficacy, feasibility, and tolerability of very low-calorie ketogenic diet (VLCKD) for the management of this condition. Methods A real-life prospective study was conducted on twenty-two patients who experienced poor response after bariatric surgery and followed a structured VLCKD. Anthropometric parameters, body composition, muscular strength, biochemical analyses, and nutritional behavior questionnaires were evaluated. Results A significant weight loss (mean 14.1 ± 4.8%), mostly due to fat mass, was observed during VLCKD with the preservation of muscular strength. The weight loss obtained allowed patients with IWL to reach a body weight significantly lower than that obtained at the post-bariatric surgery nadir and to report the body weight of patients with WR at the nadir observed after surgery. The significantly beneficial changes in nutritional behaviors and metabolic profiles were observed without variations in kidney and liver function, vitamins, and iron status. The nutritional regimen was well tolerated, and no significant side effects were detected. Conclusion Our data demonstrate the efficacy, feasibility, and tolerability of VLCKD in patients with poor response after bariatric surgery.

Treaty interpretation in the EU involves not only the observance of principles governing the interpretation of international agreements, but also the observance of substantive rules of international law applicable in the relations between the parties. While compliance with the former rarely presents an issue for the EU Court of Justice, perhaps because of the open-ended character of rules on treaty interpretation, its judicial practice shows the importance of carefully interpreting treaties so as to ensure their full consistency with customary international rules of a peremptory nature, such as the principle of self-determination of peoples. The Western Sahara saga is illustrative in this regard. These issues are addressed by the article.

BACKGROUND AND AIMS:Type 2 Diabetes Mellitus (T2D) has heterogeneous clinical phenotypes related to different risk of developing diabetes complications. We investigated the correlation between generalized and abdominal adiposity and the prevalence of both micro- and macrovascular complications in Caucasian patients with T2D. METHODS AND RESULTS:We evaluated 769 individuals with T2D consecutively referred to our diabetes center. Body mass index (BMI), waist circumference (WC), waist to hip (W/H) ratio, glycated hemoglobin (HbA1c), systolic and diastolic blood pressure, lipid profile, smoking habit, diabetes therapy, and micro- and macrovascular complications were recorded. Patients were divided into three groups based on BMI and WC: non-obese with normal WC (nWC, n = 220), non-obese with excess of abdominal fat (AF, n = 260) and obese (Ob, n = 289). We found that nWC, compared with AF and Ob individuals, were predominantly males (p<0.01), had lower HbA1c (p<0.01), diastolic blood pressure (p<0.01), triglycerides (p<0.01), and showed a significantly lower prevalence of diabetic retinopathy (DR) (p = 0.01). The rate of proliferative DR was significantly higher in Ob (13.2 %) compared to the other groups (p = 0.03). Multivariate analyses showed a significantly decreased prevalence of DR in nWC compared to both AF (OR 0.58, 95 CI 0.34-0.96; p = 0.03) and Ob (OR 0.57, 95 CI 0.33-0.98; p = 0.04) individuals. Conversely, DR was associated, mainly in women, to higher WC and W/H ratio. The prevalence of the other diabetes-related complications was similar among the studied groups. CONCLUSIONS:In our population, nWC subjects showed a lower prevalence of DR. An increased generalized and abdominal adiposity was associated to a higher prevalence of DR, especially among females.

Introduction: Obesity is a complex chronic disease and requires a long-term multidisciplinary management. Even patients undergoing bariatric surgery, one the most effective treatments for obesity, can have insufficient weight loss (IWL) than expected (primary non responder) or weight regain (WR) after a successful primary procedure (secondary non responder). A poor response represents a challenge of bariatric surgery that can induce persistence or recurrence of obesity-related comorbidities, prejudicing benefits of surgery. Increasing evidence suggests that weight loss medications represent a useful strategy in obesity care also after bariatric surgery procedures. Evidence acquisition: This narrative review summarizes the evidence concerning anti-obesity therapy in the management of no-responders to primary bariatric surgery. Available data on liraglutide (one randomized double-blind placebo-controlled trial, three prospective and three retrospective studies), naltrexone/bupropion (three retrospective studies), orlistat (one case control prospective and one retrospective studies) and topiramate and phentermine (5 retrospective studies) have been considered. Evidence synthesis: Available data suggest that weight loss medications could offer a significant adjunctive benefit to lifestyle and behavioral modifications in the life-long management of obesity. Conclusions: Newer treatment modalities including the use of anti-obesity drugs provide patients and healthcare providers with more options in the management of poor response after bariatric surgery.

Dall’anamnesi personale bisogna ricavare informazioni dettagliate sulla storia del peso, il peso alla nascita, l’età di insorgenza dell’obesità, i tentativi dietetici pregressi, il pregresso utilizzo di farmaci allo scopo di perdere peso. La raccolta di tali dati può essere agevolata dall’utilizzo del grafico del peso da elaborare insieme al paziente. A questo segue l’anamnesi alimentare attraverso un recall delle 24 h o l’uso del diario alimentare. Un’attenta analisi del comportamento alimentare consentirà di escludere la presenza di disturbi dell’alimentazione associati all’obesità come il disturbo da alimentazione incontrollata (DAI), la cui diagnosi può essere facilitata dall’utilizzo di test per la valutazione delle abbuffate compulsive (es. Binge Eating Scale, BES). Le informazioni sullo stile di vita, il livello di attività fisica attuale e pregresso completano la valutazione anamnestica [1].