Obesity is an alarming public health problem. Tailored nutritional therapy is advisable since emerging evidence on complex cross-talks among multifactorial agents. In this picture, the gut microbiota is highly individualized and intricately dependent on dietary patterns, with implications for obesity management. Most of the papers on the topic are observational and often conflicting. This review aimed to systematically organize the body of evidence on microbiota deriving from dietary trials in adult obesity giving the most certain phylogenetic, and metabolomic signatures in relation to both the host metabolism and phenotype changes published until now. We retrieved 18 randomized control trials on 1385 subjects with obesity who underwent several dietary interventions, including standard diet and healthy dietary regimens. Some phyla and species were more related to diets rich in fibers and others to healthy diets. Weight loss, metabolism improvements, inflammatory markers decrease were specifically related to different microorganisms or functions. The Prevotella/Bacteroides ratio was one of the most reported predictors. People with the burden of obesity comorbidities had the most significant taxonomic changes in parallel with a general improvement. These data emphasize the possibility of using symbiotic approaches involving tailored diets, microbiota characteristics, and maybe drugs to treat obesity and metabolic disorders. We encourage Authors to search for specific phylogenetic associations beyond a too generally reported Firmicutes/Bacteroides ratio.

To overview the recent literature regarding the relationship between COVID-19 vaccines and glycemic control. Data were extracted from text and tables of all available articles published up to September 2023 in PubMed Database describing glucose homeostasis data in subjects exposed to COVID-19 vaccines, focusing on patients with diabetes mellitus (DM). It is debated if the immune system impairment observed in diabetic patients makes them susceptible to lower efficacy of vaccines, but evidence suggests a possible improvement in immune response in those with good glycemic control. Despite their proven protective role lowering infection rates and disease severity, COVID-19 vaccines can result in diabetic ketoacidosis, new-onset diabetes, or episodes of hyper- or hypoglycemia. Evidence with COVID-19 vaccines highlights the strong relationship existing between DM and immune system function. Clinicians should strive to achieve optimal glucose control before vaccination and promptly manage possible glucose homeostasis derangement following vaccine exposure.

Diabetic ketoacidosis (DKA) is the most serious and life-threatening complication of Diabetes Mellitus (DM), characterized by the triad of hyperglycemia, ketonemia, and anion gap metabolic acidosis. DKA is more common in young people with type 1 diabetes (T1D) but can also occur in patients with type 2 diabetes (T2D) and in pregnant women with pregestational T1D or T2D or gestational DM. Moreover, DKA may be a rare complication of immune check-point inhibitor therapy. Euglycemic DKA (eDKA) is a variant of DKA with normal or minimally elevated serum glucose associated with using sodium-glucose cotransporter-2 (SGLT2) inhibitors, a class of anti-hyperglycemic medications. Prompt identification of DKA in the emergency setting is mandatory, and the management of its critical aspects and its possible underlying precipitating factors are often life-changing choices for patients. Despite diagnostic and therapeutic improvements, DKA still stands as one of the main causes of morbidity and mortality in DM individuals. Recently, an inter-society consensus report has been published to provide up-to-date knowledge on DKA. Nevertheless, controversies concerning the clinical management of this acute complication of DM remain to be unfolded and high-quality evidence is lacking in concern to solve such critical aspects. This narrative review aims to explore and discuss DKA, its epidemiology, pathogenesis, diagnosis, clinical onset, and treatment, highlighting some of the main remaining open controversies.

Sommario Denosumab (Dmab) è un potente farmaco anti-riassorbitivo impiegato per il trattamento dell’osteoporosi al dosaggio di 60 mg sottocute ogni sei 6 mesi. A differenza dei bisfosfonati (BPs), Dmab non si accumula nella matrice ossea e, in caso di ritardo o interruzione delle somministrazioni, è noto un effetto rebound sul turnover osseo, che si traduce in una rapida perdita di Bone Mineral Density (BMD) e in un aumento del rischio di fratture vertebrali, spesso cliniche e multiple. Data la rilevanza clinica di tale fenomeno, si rende quindi necessario per gli specialisti dedicati al trattamento delle patologie osteometaboliche conoscere nel dettaglio quali sono le evidenze attualmente disponibili, nonché le principali raccomandazioni relative alla gestione della terapia anti-osteoporotica con Dmab, con particolare attenzione alla sua interruzione (programmata o accidentale), su cui si focalizzerà la presente Rassegna.