Anna Rita Maurizi

Prevention of type 2 diabetes mellitus: is it feasible?

The increasing global prevalence of type 2 diabetes mellitus (T2DM) requires the implementation of preventive strategies to halt this trend, tailored to the specific needs of individual regions. Risk factors for T2DM are among the main targets for improving health outcomes and curbing the development of diabetes; excessive weight and obesity are two of the most important risk factors that need to be addressed. A growing body of evidence suggests that subjects with pre‐diabetes who lose body weight and increase physical activity can delay or prevent the onset of T2DM, and in some cases, blood glucose levels may return to normal. Several studies have shown that moderate to intensive levels of exercise are effective in reducing both intra‐abdominal and total adiposity among obese subjects, both improving cardiovascular risk profile and reducing the risk of T2DM development. These consistent observations have given rise to large‐scale randomized controlled trials that use lifestyle intervention (including behavioural strategies for the reinforcement of prescribed changes in nutritional intake, physical activity or both), with or without pharmacological treatment, in populations at high risk of developing T2DM. In this review, large‐scale national trials that have focused on the prevention of T2DM are critically evaluated. Copyright

A Novel Insulin Unit Calculator for the Management of Type 1 Diabetes

BACKGROUND Intensive insulin therapy is the gold standard therapy for type 1 diabetes (T1D) patients. To achieve optimal glycemic control, adjustments of insulin dose at mealtimes must be made taking into account several parameters: blood glucose levels, insulin/carbohydrate ratio, carbohydrate intake, and physical activity. Calsulin (Thorpe Products Ltd., Cambridge, UK) is a new tool for the administration of insulin dose before each meal. The aim of this study was to evaluate the efficacy of Calsulin on metabolic control in T1D patients undergoing intensive insulin therapy. SUBJECTS AND METHODS Forty consecutive patients affected by T1D, 18-65 years old, with disease duration of >1 year, were randomized to Calsulin or to the control group. Hemoglobin A1c (HbA1c) was evaluated at entry into the study and at 3- and 6-month follow-ups. Paired t test (two tailed) and analysis of variance were used to evaluate differences in HbA1c at 3 and 6 months in the two groups. RESULTS HbA1c at entry was 7.9 ± 1.0% (SD) in the Calsulin-treated group and 7.8 ± 1.6% (SD) in control patients (P not significant). Data showed a slight improvement in HbA1c levels at 3 months in the Calsulin-treated group (-0.61% vs. -0.14% difference, respectively; P not significant). At the 6-month follow-up, a significant reduction in HbA1c levels was observed in the Calsulin-treated group versus the control group (-0.85% vs. -0.07% difference, respectively; P < 0.05). CONCLUSIONS Calsulin is an acceptable and practical tool that makes the process of calculating insulin doses easy to use, and, most importantly, it improves metabolic control as shown by a significant reduction of HbA1c levels.

In vivo corneal confocal microscopy as a novel non-invasive tool to investigate cardiac autonomic neuropathy in Type 1 diabetes†

To investigate whether small nerve fibre degeneration detected using corneal confocal microscopy is associated with cardiac autonomic neuropathy in people with Type 1 diabetes.

Vitamin K and osteoporosis: Myth or reality?

Vitamin K is a liposoluble vitamin. The predominant dietary form, phylloquinone or vitamin K1, is found in plants and green vegetables; whereas menaquinone, or vitamin K2, is endogenously synthesized by intestinal bacteria and includes several subtypes that differ in side chain length. Aside from its established role in blood clotting, several studies now support a critical function of vitamin K in improving bone health. Vitamin K is in fact required for osteocalcin carboxylation that in turn regulates bone mineral accretion; it seems to promote the transition of osteoblasts to osteocytes and also limits the process of osteoclastogenesis. Several observational and interventional studies have examined the relationship between vitamin K and bone metabolism, but findings are conflicting and unclear. This systematic review aims to investigate the impact of vitamin K (plasma levels, dietary intake, and oral supplementation) on bone health with a particular interest in bone remodeling, mineral density and fragility fractures.

Computer use, free time activities and metabolic control in patients with type 1 diabetes.

We investigated the influence of computers use on metabolic control in 115 patients with type 1 diabetes (DM1). Multiple linear regression showed that HbA1c% was not related to age, DM1 duration, TV watching or computer use but was independently and negatively related to the weekly hours spent on physical exercise.

Position Statement on the management of continuous subcutaneous insulin infusion (CSII): The Italian Lazio experience

This document has been developed by a group of Italian diabetologists with extensive experience in continuous subcutaneous insulin infusion (CSII) therapy to provide indications for the clinical management of CSII in diabetic patients (both type 1 and type 2) based on delivery mode operating in Italy. Although the potential benefits of pump therapy in achieving glycemic goals is now accepted, such results cannot be obtained without specific knowledge and skills being conveyed to patients during ad hoc educational training. To ensure that these new technologies reach their full effectiveness, as demonstrated theoretically and clinically, a careful assessment of the overall therapeutic and educational process is required, in both qualitative and quantitative terms. Therefore, to ensure the cost‐effectiveness of insulin pump therapy and to justify reimbursement of therapy costs by the National Health System in Italy, in this article we present a model for diabetes and healthcare centers to follow that provides for different levels of expertise in the field of CSII therapy. This model will guarantee the provision of excellent care during insulin pump therapies, thus representing the basis for a successful outcome and expansion of this form of insulin treatment in patients with diabetes while also keeping costs under control.

Ipoglicemia cronica e deficit di memoria

L’ipoglicemia ricorrente per lo più secondaria al trattamento farmacologico, insulinico o con ipoglicemizzanti orali, rappresenta un serio e frequente evento avverso nel paziente diabetico. Sebbene sia noto che ricorrenti episodi ipoglicemici determinino una riduzione della risposta contro-regolatoria all’ipoglicemia, causando frequentemente la cosiddetta hypoglicaemia unawareness, l’impatto che ne deriva sulle funzioni cognitive e neuronali, data la molteplicità dei meccanismi fisiopatologici coinvolti, resta ancora controverso. In particolare, in corso di ipoglicemia, venendo meno l’assorbimento insulino-mediato del glucosio nell’ippocampo, è favorito il progressivo deterioramento delle capacità mnesiche. Inoltre, episodi di ipoglicemia severa si associano ad una minor densità di materia grigia nelle aree cerebrali responsabili della memoria e dell’elaborazione del linguaggio (Tab. 1). I dati dalla letteratura sul deterioramento cognitivo conseguente al deficit di substrato energetico proprio degli episodi ipoglicemici in pazienti con diabete tipo 2 (DT2) e diabete tipo 1 (DT1), risultano ancor oggi contrastanti. Infatti, già più di ottanta anni fa, prima ancora della scoperta della stessa insulina, è stato osservato che soggetti con DT2 mostravano prestazioni cognitive ai test di memoria e attenzione del 15–20% inferiori rispetto a soggetti di controllo non diabetici. Tale dato è stato confermato anche, più recentemente, in soggetti non diabetici in cui l’ipoglicemia moderata indotta da clamp iperinsulinemico determina una ridu-

Effect of GLP-1 and GIP on C-peptide secretion after glucagon or mixed meal tests: Significance in assessing B-cell function in diabetes

The aim of the study was to investigate the different B‐cell responses after a glucagon stimulation test (GST) versus mixed meal tolerance test (MMTT).

Quale terapia precoce per il diabete autoimmune dell’adulto?

RiassuntoL’acronimo LADA (latent autoimmune diabetes in adults) è stato introdotto nei primi anni’ 90 con l’intento di riconoscere come un’entità patologica a sé stante una forma di diabete autoimmune a insorgenza in età adulta e a lenta progressione che non necessita di trattamento insulinico alla diagnosi. Da allora il LADA è oggetto di innumerevoli controversie che riguardano i diversi aspetti della malattia: dalla sua definizione all’eziopatogenesi, dai criteri diagnostici ai diversi approcci terapeutici. Sebbene ad oggi non sia ancora chiaro quale sia l’atteggiamento terapeutico più appropriato per questa forma di diabete, è certo che un intervento terapeutico ideale dovrebbe non solo favorire un precoce e duraturo mantenimento del compenso glicemico ma agire con azione protettiva sul patrimonio β-cellulare residuo, al fine di evitare o ridurre la progressione delle complicanze croniche del diabete. Considerando che frequentemente la diagnosi di LADA resta misconosciuta e che di fatto pazienti affetti da LADA vengono per lungo tempo considerati come soggetti con diabete di tipo 2, sono necessari studi di intervento che abbiano come obiettivo quello di valutare quale sia il trattamento farmacologico più efficace.