Discordance between in vitro susceptibility and clinical response in early-onset neonatal sepsis caused by Morganella morganii: a case report in an extremely preterm infant.

Diabetes is a major and rapidly growing global health issue, which is accompanied by a range of micro and macrovascular comorbidities that significantly impact mortality and healthcare costs. Several studies have shown that containing risk factors within target ranges greatly improves outcomes in terms of these complications. In 1998, the United Kingdom Prospective Diabetes Study (UKPDS) was the first to show that intensive glucose control in patients newly diagnosed with type 2 diabetes (T2D) reduced the risk of microvascular complications [] with these results continuing to be borne out in the subsequent follow-ups []. Since then, several observational and cross-sectional studies have shown associations between lower glycated hemoglobin (HbA1c) levels and reduced risk of complications, [–] even though the ADVANCE trial, [] which was specifically designed to examine the effects of HbA1c reduction on macrovascular and microvascular outcomes or mortality, demonstrated only microvascular benefits with no robust evidence for macrovascular benefits, and, additionally, an increase in mortality. In specific trials, several drugs have been shown to significantly reduce major adverse cardiovascular events (MACE), leading the 2018 EASD-ADA Consensus Guidelines to recommend them as priority treatments for high risk patients and those requiring secondary prevention []. However, the cardioprotective effects should not overshadow the importance of achieving target HbA1c levels, which remains a fundamental goal for all patients with type 2 diabetes. In other words, while these drugs confer significant cardiovascular benefits, optimal glycemic control remains essential to achieve prevention of both microvascular and macrovascular complications. Randomized controlled trials (RCTs) of newer glucose-lowering drugs, such as GLP-1 receptor agonists (e.g., LEADER) [], and SGLT-2 inhibitors (e.g., EMPA-REG OUTCOME) [], have shown a reduction in HbA1c levels and in major cardiovascular events in type 2 diabetes. Although these studies were designed to assess cardiovascular outcomes, intervention groups consistently achieved lower HbA1c. This improved glycemic control may partly explain the observed benefits, but long-term efficacy has yet to be proven. While HbA1c is the gold standard for evaluating the risk of complications in diabetes, to date recommended HbA1c targets vary. The American Diabetes Association (ADA) 2026 Standards of Care [] recommend that most T2DM patients maintain levels of glycated hemoglobin < 7% (53 mmol/mol) and sets a more ambitious target of HbA1c ≤ 6.5% (48 mmol/mol) for newly diagnosed adults, without comorbidities and low hypoglycemia risk. The Italian guidelines, elaborated on the basis of a very strict methodology, provide similar recommendations to the AACE, and suggest values of ≤ 6.5% (48 mmol/mol) in patients on low hypoglycemia risk treatments, i.e., without insulin or sulfonylureas. []