Astronauts coming back from long-term space missions present with different health problems potentially affecting mission performance, involving all functional systems and organs and closely resembling those found in the elderly. This review points out the most recent advances in the literature in areas of expertise in which specific research groups were particularly creative, and as they relate to aging and to possible benefits on Earth for disabled people. The update of new findings and approaches in space research refers especially to neuro-immuno-endocrine-metabolic interactions, optic nerve edema, motion sickness and muscle-tendon-bone interplay and aims at providing the curious - and even possibly naïve young researchers – with a source of inspiration and of creative ideas for translational research.

Lipohypertrophy (LH) is a major complication of subcutaneous insulin treatment brought about by multiple overlapping injections and/or needle reuse. It is responsible for unacceptable glucose oscillations due to a high rate of hypoglycaemic episodes and rebound glucose spikes. Skin ultrasound scans (USS), the gold standard for its detection, is too expensive for screening purposes. To define a structured method allowing health professionals (HPs) to identify LH lesions as inexpensively and correctly as possible. Out of 129 insulin-treated people with diabetes identified by USS as having LH lesions, only 40 agreed to participate in the study (24 females, age 54 ± 15 years, daily insulin dosage 57 ± 12 IU). Each was blindly examined by four well trained and four non-trained HPs according to a standard method involving repeated well codified maneuvers. A specific training allowed inexperienced HPs to acquire high diagnostic accuracy in identifying LH lesions independent of site, size, shape, and even BMI. This kind of training also allowed to reach a 97 % consistency rate among HPs as compared to USS, while the lack of training was associated with a wide variability and inconsistency of identification results. Diabetes teams should follow systematically the simple procedure reported in this paper for the diagnosis of LH and try to get it further implemented and progressively refined in large scale studies. This would have a major impact on patient education in terms of (1) correct injection technique and (2) ability to identify lesions early enough to prevent poor metabolic outcome.

Physicians and patients have long been aware of skin lesions at the sites of insulin injections, referred to as lipodystrophy that can present as lipoatrophy (LA) or lipohypertrophy (LH). However, the reported prevalence of these different skin lesions varies widely, emphasizing the need for a correct identification method. In this short review we discuss LA and LH and also take into account other skin lesions, such as bruising, as well as different needle injuries, including those associated with the subcutaneous injection of pegvisomant (a drug aimed at counteracting the high levels of growth hormone associated with acromegaly), long-acting exenatide (a glucagon-like peptide-1 receptor agonist), and anti-tumor necrosis factor-alpha biologic agents (used against Crohn’s disease). In these latter cases specific studies are warranted to understand the pathophysiological background and possible prevention. However, the most common lesion is still insulin injection site-related LD, so a strong effort has to be made to avoid the confusion generated by previously misleading classifications which were barely able to reliably distinguish between LA and LH.

In obese diabetic subjects, a correct life style, including diet and physical activity, is part of a correct intervention protocol. Thus, the aim of this study was to evaluate the effects of aerobic training intervention, based on heart rate at aerobic gas exchange threshold (AerTge), on clinical and physiological parameters in obese elderly subjects with type 2 diabetes (OT2DM). Thirty OT2DM subjects were randomly assigned to an intervention (IG) or control group (CG). The IG performed a supervised aerobic exercise training based on heart rate atAerTgewhereas CG maintained their usual lifestyle. Anthropometric measures, blood analysis, peak oxygen consumption (V˙O2peak), metabolic equivalent (METpeak), work rate (WRpeak), andWRAerTgewere assessed at baseline and after intervention. After training, patients enrolled in the IG had significantly higher (P<0.001)V˙O2peak,METpeak,WRpeak, andWRAerTgeand significantly lower (P<0.005) weight, BMI, %FM, and waist circumference than before intervention. Both IG and CG subjects had lower glycated haemoglobin levels after intervention period. No significant differences were found for all the other parameters between pre- and posttraining and between groups. Aerobic exercise prescription based upon HR atAerTgecould be a valuable physical intervention tool to improve the fitness level and metabolic equilibrium in OT2DM patients.

Injectable insulin therapy is a valuable therapeutic option for millions of people with diabetes worldwide. However, many people with diabetes undergoing insulin therapy experience suboptimal outcomes and/or have complications because of inadequate injection technique and training. Practical, current, evidence-based recommendations are mandatory for primary care practitioners and diabetes specialists alike to address unmet needs in insulin injection technique, education, and consequent outcomes. The most recent global insulin injection technique best practices were published in 2016 by the Forum for Injection Technique and Therapy Expert Recommendations (FITTER). While injection technique efforts in different regions have reflected some developments since 2016, a global effort was warranted to comprehensively capture new evidence and modern expert perspectives. In this article, we share the output of the "FITTER Forward" initiative, authored by 16 diabetes specialists from 13 countries who met virtually in 2023-2024. FITTER Forward provides an updated rationale for the importance of proper injection technique training and its impact on diabetes management. The FITTER Forward recommendations are organized for use in clinical practice and include 4 sections describing (1) the foundational science informing injection device design, experiences, and outcomes, (2) proper injection technique procedures for insulin pens and syringes from insulin storage to needle disposal, (3) lipodystrophy risk reduction, with a focus on lipohypertrophy, and (4) structured injection technique training programs for people with diabetes. Overall, FITTER Forward aims to better equip health care professionals to advance diabetes care by empowering people with diabetes and their caregivers to correctly and safely deliver insulin.