Diabetes continues to be one of Italy’s most pressing public health emergencies. According to a report submitted to Parliament by the Ministry of Health, approximately one in sixteen citizens presently has diabetes, with regional and social disparities further amplifying the prevalence of the disease. At the same time, therapeutic innovation is propelling drug spending to unprecedented heights, fueled by new classes of next-generation antidiabetic medications. In 2023, public spending on antidiabetic medications reached €1.5 billion, accounting for 5.6% of total national pharmaceutical spending, a 7.6% rise from 2022. The ministerial report updated to 2024 affirms the magnitude of the health challenge: in Italy, approximately 4 million individuals are diagnosed with diabetes, representing 6.2% of the population (6.9% among men and 5.7% among women), with an additional 1.5 million cases remaining undiagnosed. The incidence rises to 20% among people over 75. Type 2 diabetes accounts for over 90% of cases and is strongly associated with obesity, sedentary lifestyles, and low socioeconomic status: 70% of diabetics are overweight, and 48% are entirely inactive. Overall, 86% of diabetics are on medication, mainly oral hypoglycemics (79%) and insulin (25%).