{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T01:41:52Z","timestamp":1785548512086,"version":"3.56.0"},"reference-count":34,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,2,14]],"date-time":"2024-02-14T00:00:00Z","timestamp":1707868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Sanofi SpA"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["MAKE"],"abstract":"<jats:p>Background: International guidelines for diabetes care emphasize the urgency of promptly achieving and sustaining adequate glycemic control to reduce the occurrence of micro\/macrovascular complications in patients with type 2 diabetes mellitus (T2DM). However, data from the Italian Association of Medical Diabetologists (AMD) Annals reveal that only 47% of T2DM patients reach appropriate glycemic targets, with approximately 30% relying on insulin therapy, either solely or in combination. This artificial intelligence analysis seeks to assess the potential impact of timely insulin initiation in all eligible patients via a \u201cwhat-if\u201d scenario simulation, leveraging real-world data. Methods: This retrospective cohort study utilized the AMD Annals database, comprising 1,186,247 T2DM patients from 2005 to 2019. Employing the Logic Learning Machine (LLM), we simulated timely insulin use for all eligible patients, estimating its effect on glycemic control after 12 months within a cohort of 85,239 patients. Of these, 20,015 were employed for the machine learning phase and 65,224 for simulation. Results: Within the simulated scenario, the introduction of appropriate insulin therapy led to a noteworthy projected 17% increase in patients meeting the metabolic target after 12 months from therapy initiation within the cohort of 65,224 individuals. The LLM\u2019s projection envisages 32,851 potential patients achieving the target (hemoglobin glycated &lt; 7.5%) after 12 months, compared to 21,453 patients observed in real-world cases. The receiver operating characteristic (ROC) curve analysis for this model demonstrated modest performance, with an area under the curve (AUC) value of 70.4%. Conclusions: This study reaffirms the significance of combatting therapeutic inertia in managing T2DM patients. Early insulinization, when clinically appropriate, markedly enhances patients\u2019 metabolic goals at the 12-month follow-up.<\/jats:p>","DOI":"10.3390\/make6010021","type":"journal-article","created":{"date-parts":[[2024,2,14]],"date-time":"2024-02-14T09:30:18Z","timestamp":1707903018000},"page":"420-434","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Overcoming Therapeutic Inertia in Type 2 Diabetes: Exploring Machine Learning-Based Scenario Simulation for Improving Short-Term Glycemic Control"],"prefix":"10.3390","volume":"6","author":[{"given":"Musacchio","family":"Nicoletta","sequence":"first","affiliation":[{"name":"AMD-AI National Group Coordinator Coordinator, UOS Integrating Primary and Specialist Care, ASST Nord Milano, Via Filippo Carcano 17, 20149 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4590-9395","authenticated-orcid":false,"given":"Rita","family":"Zilich","sequence":"additional","affiliation":[{"name":"Mix-x Partner, Via Circonvallazione 5, 10015 Ivrea, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0820-633X","authenticated-orcid":false,"given":"Davide","family":"Masi","sequence":"additional","affiliation":[{"name":"Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0008-1336","authenticated-orcid":false,"given":"Fabio","family":"Baccetti","sequence":"additional","affiliation":[{"name":"Diabetes and Endocrinology Unit, ASL Nord-West Tuscany, 54100 Massa Carrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Besmir","family":"Nreu","sequence":"additional","affiliation":[{"name":"Diabetology Unit, Careggi Hospital, Largo G.A. Brambilla, 3, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4709-8696","authenticated-orcid":false,"given":"Carlo Bruno","family":"Giorda","sequence":"additional","affiliation":[{"name":"Diabetes and Endocrinology Unit, ASL TO5, 10023 Chieri, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6709-5898","authenticated-orcid":false,"given":"Giacomo","family":"Guaita","sequence":"additional","affiliation":[{"name":"Diabetes and Endocrinology Unit, ASL SULCIS, 09016 Sulcis, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lelio","family":"Morviducci","sequence":"additional","affiliation":[{"name":"Diabates and Nutrition UOC, S. Spirito Hospital\u2014ASL Roma 1, 00913 Rome 00913, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9999-2331","authenticated-orcid":false,"given":"Marco","family":"Muselli","sequence":"additional","affiliation":[{"name":"Rulex Innovation Labs, Rulex Inc., Via Felice Romani 9\/2, 16122 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0876-5134","authenticated-orcid":false,"given":"Alessandro","family":"Ozzello","sequence":"additional","affiliation":[{"name":"AMD Regional Past President, AI AMD National Group, 10090 Bruino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Pisani","sequence":"additional","affiliation":[{"name":"Mix-x Partner, Via Circonvallazione 5, 10015 Ivrea, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Ponzani","sequence":"additional","affiliation":[{"name":"Diabetes and Metabolic Disease Unit ASL 4 Liguria, 16043 Chiavari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8660-2146","authenticated-orcid":false,"given":"Antonio","family":"Rossi","sequence":"additional","affiliation":[{"name":"IRCCS Ospedale Galeazzi-Sant\u2019Ambrogio, 20149 Milan, Italy"},{"name":"Department of Biomedical and Clinical Sciencies, University of Milan, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Santin","sequence":"additional","affiliation":[{"name":"Data Scientist Deimos, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9912-3454","authenticated-orcid":false,"given":"Damiano","family":"Verda","sequence":"additional","affiliation":[{"name":"Rulex Innovation Labs, Rulex Inc., Via Felice Romani 9\/2, 16122 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graziano Di","family":"Cianni","sequence":"additional","affiliation":[{"name":"AMD Past President, Diabetes and Metabolic Diseases Unit, Nord-West Tuscany, Livorno Hospital, Viale Alfieri 36, 57124 Livorno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Candido","sequence":"additional","affiliation":[{"name":"AMD New President, Azienda Sanitaria Universitaria Giuliano Isontina, 34128 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1016\/S0140-6736(14)60460-8","article-title":"Global, Regional, and National Prevalence of Overweight and Obesity in Children and Adults during 1980\u20132013: A Systematic Analysis for the Global Burden of Disease Study 2013","volume":"384","author":"Ng","year":"2014","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"107","DOI":"10.2991\/jegh.k.191028.001","article-title":"Epidemiology of Type 2 Diabetes\u2013Global Burden of Disease and Forecasted Trends","volume":"10","author":"Khan","year":"2019","journal-title":"JEGH"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"110672","DOI":"10.1016\/j.diabres.2023.110672","article-title":"The AMD ANNALS: A Continuous Initiative for the Improvement of Type 2 Diabetes Care","volume":"199","author":"Russo","year":"2023","journal-title":"Diabetes Res. 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