New drugs for type 2 diabetes mellitus: The challenge of the health care sustainability combined with a better patient care access

The increased prescribing and dispensing of new drugs for type 2 diabetes mellitus due to less stringent prescription regulations has led both to bringing therapies closer to the patient, as required by post-Covid-19 European policies, and to an unpredictable increase in health care spending. In particular, in Italy, with the introduction of the National Plan for Reconstruction and Resilience, an attempt has been made to give more prescriptive freedom to the General Practitioner (GP). Through the introduction of prescriptive notes, patients can directly go to the primary care physician for the prescription of chronic therapies, without going to the specialist doctor anymore. Note 100, introduced at the beginning of 2022, defines the prescription of specific categories of medicines which are indicated for the treatment of type 2 diabetes mellitus and which are directly prescribed by the GP. This study aimed to analyze the prescribing trend of these medicines, by comparing the first half of the year 2021, without Note 100, with the first half of the year 2022, afterwards the introduction of the new regulations. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Sustainability and evolution of health care regarding treatments concerning type 2 diabetes mellitus

Background: In Italy, prescriptions of new drugs for type 2 diabetes mellitus increased gradually. New regulatory regulations have facilitated the prescription of these drugs, with the aim of bring patients closer to therapies with difficult access. This European policy has been adopted in the wake of the Covid-19 pandemic. However, a gradual undesirable increase in health care spending related to the consumption of these medicines has been noted. In Italy in 2022, the introduction of Note 100 allowed more prescribing to general practitioners (GPs) in the field of type 2 diabetes. Methods: At Asl Napoli 3 Sud, a computer system recording all dispensations of these drugs was queried, and a Defined Dose Die (DDD) analysis was conducted. Results: The study showed dispensing data for the first half of 2021, when Note 100 was not in effect, compared with the first six months of 2022, following the introduction of the new regulations. The results show an increase in prescriptions for drugs belonging to the GLP-1 class (+74.01%) and SGLT2 (+25.93%). The dispensations of DPP4 inhibitors (+0.22) and the gold standard therapeutic metformin (–0.16%) turn out to be constant. Conclusion: European policies highlighted the need to implement healthcare strategies closer to citizens, but nevertheless the prescription of higher-cost drugs should be contained, according to the good principles of therapeutic appropriateness. Facilitation of access to care is necessary, but always ensuring the sustainability of our health care system. © 2023 Elsevier Masson SAS

SARS-CoV-2 caused a surge in antibiotic consumption causing a silent pandemic inside the pandemic. A retrospective analysis of Italian data in the first half of 2022.

BACKGROUND: The phenomenon of antibiotic resistance shows no sign of stopping, despite global policies to combat it that have been in place for several years. The risk of forms of pathogenic microorganisms that are increasingly resistant to common antibiotics has led health authorities around the world to pay greater attention to the phenomenon. The worrying situation, has led to further recommendations from the World Health Organization (WHO) and national recommendations in Italy through the new National Plan against Antibiotic Resistance 2022-2025 (PNCAR 2022-2025). AIM: This manuscript aims to raise the awareness of all health professionals to follow what is suggested by regulatory agencies and scientific societies. METHOD: We conducted a retrospective study of antibiotic pharmacoutilization in Italy, in the Campania region at the Azienda Sanitaria Locale (ASL) Napoli 3 Sud, on consumption in the first half of 2022 in a population of more than 1 million people. RESULT: The results indicate that consumption, based on defined daily doses (DDDs), is above the national average. Probably the COVID-19 pandemic has influenced this growth in prescriptions. CONCLUSIONS: Our study suggests an informed and appropriate use of antibiotics, so as to embark on a virtuous path in the fight against antibiotic resistance.

Association between microbiota and immune response to Sars-CoV-2 infection.

In recent times, the key role of the human microbiota in the body's response to infectious diseases has been increasingly demonstrated. The human microbiota is the set of symbiotic microorganisms which coexist with the human organism without harming it. However, diseases related to the microbiota occur and are being studied, and numerous publications suggest that altered microbiota composition is implicated in psychiatric diseases, chronic inflammatory diseases, and some viral infections. On the other hand, the role of the human microbiota in the host immune response to viral infections is not entirely clear. Metabolites or components produced by the microbiota are the main mediators of microbiota-host interactions that influence host immunity. It has been shown that in patients with COVID-19 and post-acute COVID-19 syndrome (PACS), the microbiota is significantly altered. In this brief review, we examine the associations between the role of the microbiota in response to COVID-19 infection in terms of molecular biology and clinical relevance. We finally discuss the mechanisms by which metabolites produced by the microbiota modulate host immune responses to SARS-CoV-2 infection.