Corinna Brangani

Glycated haemoglobin is inversely related to serum vitamin D levels in type 2 diabetic patients.

Objective A correlation between glucose control and 25(OH)D metabolism has been suggested by previous studies. However, this correlation has not yet been evaluated considering the impact of chronic complications of type 2 diabetes, especially the presence of nephropathy. Thus, the aim of this study was to determine the correlation between A1C and 25(OH)D in a well characterized cohort of type 2 diabetic patients. Research Design and Methods We cross-sectionally examined the association between A1C and serum 25(OH) D in 715 type 2 diabetic patients attending our clinic during the years 2011–2012. The average age was 68±12 years (range 26–94 years). The relation between A1C and serum 25(OH)D levels was modelled by multiple linear regression analyses. Results Serum 25(OH)D levels were inversely associated with A1C levels (r = −0.116, p = .003). This relation maintains its independence in the multivariate analysis after adjusting for age, sex, A1C, BMI, treatment and duration of diabetes and nephropathy. Conclusions In type 2 diabetic patients, high A1C levels are associated with low concentrations of serum 25(OH)D independently of duration of diabetes, diabetic treatment and nephropathy. Future studies are needed to clarify the biological relation between glucose control and vitamin D metabolism in type 2 diabetes.

Prevalence of neuropathy in type 2 diabetic patients and its association with other diabetes complications: The Verona Diabetic Foot Screening Program

AIMS Somatic neuropathy is a chronic complication of diabetes. The purpose of our study was to determine prevalence and clinical variables associated with somatic neuropathy applying a simple screening method. METHODS All outpatients with type 2 diabetes attending our diabetic clinic were offered to participate into a diabetic foot screening program, in the period January 2004-December 2012. A total of 3,591 diabetic patients (55.5% men, age 68±10years) underwent detection of somatic neuropathy using the Michigan Neuropathy Screening Instrument in its parts of symptoms (administering a questionnaire) and clinical assessment slightly modified (evaluating foot inspection, vibration sensation by biothesiometer, ankle reflexes). RESULTS The prevalence of somatic neuropathy was 2.2% in men and 5.5% in women (p<0.001) when assessed by symptom questionnaire, whereas it was 30.5% in men and 30.8% (p=NS) in women when identified by clinical assessment. In subjects with somatic neuropathy macro- and microvascular complications of diabetes were significantly more common. In multivariate logistic regression analyses BMI, HbA1c and ankle/brachial index independently predicted the presence of neuropathy. CONCLUSION The prevalence of somatic neuropathy in type 2 diabetes is nearly 30% when searched with clinical examination. Poor metabolic control, excess body weight and peripheral arteriopathy are independent markers of somatic neuropathy.

Lower levels of 25-hydroxyvitamin D3 are associated with a higher prevalence of microvascular complications in patients with type 2 diabetes

Objective Low levels of serum 25-hydroxyvitamin D [25(OH)D] are commonly found in type 2 diabetes. We examined whether there is an association between circulating 25(OH)D concentrations and the presence of microvascular complications in people with type 2 diabetes. Research design and methods We studied 715 outpatients with type 2 diabetes who regularly attended our clinic. Participants were evaluated for the presence of microvascular complications (namely retinopathy and/or nephropathy) by clinical evaluation, fundus examination, urine examination and biochemical tests. Serum 25(OH)D levels were also measured for each participant. Results Hypovitaminosis D (ie, a serum 25(OH)D level <30 ng/mL) was found in 75.4%, while deficiency (ie, a 25(OH)D level <20 ng/mL) was found in 36.6% of these patients. Serum 25(OH)D levels decreased significantly in relation to the severity of either retinopathy or nephropathy or both. In multivariate logistic regression analysis, lower 25(OH)D levels were independently associated with the presence of microvascular complications (considered as a composite end point; OR 0.758; 95% CI 0.607 to 0.947, p=0.015). Notably, this association remained significant even after excluding those with an estimated glomerular filtration rate <60 mL/min/1.73 m2. Conclusions We found an inverse and independent relationship between circulating 25(OH)D levels and the prevalence of microvascular complications in patients with type 2 diabetes. However, vitamin D may be simply a marker and causality cannot be implied from our cross-sectional study. Whether vitamin D supplementation in patients with type 2 diabetes may have beneficial effects on the risk of microvascular complications remains to be investigated.

Prevalence of Cardiovascular Autonomic Neuropathy in a Cohort of Patients With Newly Diagnosed Type 2 Diabetes: The Verona Newly Diagnosed Type 2 Diabetes Study (VNDS).

OBJECTIVE Cardiovascular autonomic diabetic neuropathy (CAN) is a serious complication of diabetes. No reliable data on the prevalence of CAN among patients with newly diagnosed type 2 diabetes are available. Therefore, the aim of this study was to estimate the prevalence of CAN among patients with newly diagnosed type 2 diabetes. RESEARCH DESIGN AND METHODS A cohort of 557 patients with newly diagnosed type 2 diabetes with cardiovascular autonomic test results available was selected. Early and confirmed neuropathy were assessed using a standardized methodology and their prevalences determined. A multivariate logistic regression analysis was modeled to study the factors associated with CAN. RESULTS In the entire cohort, the prevalence of confirmed CAN was 1.8%, whereas that of early CAN was 15.3%. Prevalence did not differ between men and women. In the multivariate analyses BMI results were independently and significantly associated with CAN after adjusting for age, sex, hemoglobin A1c, pulse pressure, triglyceride-to-HDL cholesterol ratio, kidney function parameters, and antihypertensive treatment. CONCLUSIONS CAN could be detected very early in type 2 diabetes. This study may suggest the importance of performing standardized cardiovascular autonomic tests after diagnosis of type 2 diabetes.

A Novel Insulin/Glucose Model after a Mixed-Meal Test in Patients with Type 1 Diabetes on Insulin Pump Therapy

Current closed-loop insulin delivery methods stem from sophisticated models of the glucose-insulin (G/I) system, mostly based on complex studies employing glucose tracer technology. We tested the performance of a new minimal model (GLUKINSLOOP 2.0) of the G/I system to characterize the glucose and insulin dynamics during multiple mixed meal tests (MMT) of different sizes in patients with type 1 diabetes (T1D) on insulin pump therapy (continuous subcutaneous insulin infusion, CSII). The GLUKINSLOOP 2.0 identified the G/I system, provided a close fit of the G/I time-courses and showed acceptable reproducibility of the G/I system parameters in repeated studies of identical and double-sized MMTs. This model can provide a fairly good and reproducible description of the G/I system in T1D patients on CSII, and it may be applied to create a bank of “virtual” patients. Our results might be relevant at improving the architecture of upcoming closed-loop CSII systems.

Metabolic Effects of Exercise

Exercise has a powerful action on metabolism, and adaptation of the body to changes induced by exercise is fundamental to be able to provide the energy required for muscle contraction and physiological functions of vital tissues. Depending on the intensity and duration of exercise, different mechanisms are called on to make energy available, and under homeostatic control, this is guaranteed by rapid and coordinated changes in the secretion of several hormones. Molecular mechanisms controlling muscle function and fiber phenotype are related to the specific mode of muscle activation. We can distinguish between two fundamental types of physical activity, endurance exercise and strength exercise, although there is a continuum between these exercise modalities. Besides the acute changes induced by a single exercise session, regular exercise may induce chronic adaptations, improving exercise capacity and affecting energy metabolism. Notably, although acute metabolic effects of exercise are mostly due to insulin-independent effects, exercise training may improve muscle insulin sensitivity and is considered a key tool in the prevention and treatment of metabolic disorders. This chapter focuses on the biochemistry of energy supply to the exercising muscle, on molecular mechanisms involved and on the physiology of energy metabolism during exercise in healthy subjects and patients with insulin resistance and/or diabetes.

American Diabetes Association 75th Scientific Meeting - Epidemiology/Genetics Section; Poster 1563-P: Pancreatic Beta-Cell Function, Insulin Sensitivity, and Metabolic Phenotypes in Type 2 Diabetes at the Time of Diagnosis—The Verona Newly Diagnosed Type 2 Diabetes Study (VNDS)

& 1472-P Disability-Free Life-Years Lost due to Diabetes Mellitus among Older U.S. Adults BARBARA BARDENHEIER, JI LIN, XIAOHUI ZHUO, MOHAMMED K. ALI, TED THOMPSON, EDWARD W. GREGG, Atlanta, GA, North Wales, PA Increases in diabetes incidence and life expectancy among the diabetes population have led to an increase in the number of years spent with diabetes. However, the effect of diabetes on the quality of those extra years is unknown. We analyzed longitudinal data from the Health and Retirement Study and modeled disability-free life-years lost due to diabetes over a lifetime in the United States. We estimated incidence of disability, remission from disability, and mortality by self-reported diabetes status among 11,141 adults aged > 50 years with baseline years of 1998 and 2004, followed to 2010. Three measures of disability were examined: severe functional decline (mobility), some diffi culty with >1 instrumental activities of daily living (IADL), and some diffi culty with >1 activities of daily living (ADL). Using these estimates, we developed a discrete-time fi ve state Markov model to estimate the numbers of years with and without disability by baseline age and diabetes status. From ages 50 and 60 for all 3 disability defi nitions, diabetes was signifi cantly associated (p<0.05) with earlier average age of disability onset, reduced total years of life and reduced disability-free life years. Compared to those without diabetics, from age 50 men have 1.5 to 2.2 more disabled years for all 3 disability measures and women have 3.5 more mobility loss disabled years and 2.6 more ADL disabled years. From age 50, men with diabetes have 6-7 years earlier onset of disability (mobility, IADL, ADL) than non-diabetic men, 2-4 fewer total years of remaining life, and have 6-7 fewer disability-free total years of life. From age 50, women with diabetes have a 7-8 year earlier onset of disability (mobility, IADL, ADL) than non-diabetic women, 2-4.5 fewer total years of remaining life, and have 6-7 fewer disability-free total years of life. This study suggests diabetes reduces the quality of life of adults by exposing them to disability at earlier ages and reducing disability-free years remaining compared to adults without diabetes.

Gli iperandrogenismi nella donna in post-menopausa

Il climaterio si caratterizza per una condizione di iperandrogenismo relativo, che può favorire la ridistribuzione androide del tessuto adiposo e modificazioni di profilo lipidico e tolleranza glucidica e che, talora, può provocare lieve irsutismo e/o alopecia. Un iperandrogenismo in età avanzata può anche rappresentare l’evoluzione di un quadro esordito precocemente nella vita, legato a una PCOS o a un difetto enzimatico surrenalico, benché l’iperandrogenismo legato alla PCOS tenda ad attenuarsi nella parte conclusiva della vita riproduttiva. Molto più raramente un reale iperandrogenismo può manifestarsi per la prima volta in post-menopausa, per cause eterogenee e da non sottovalutare [1], molto spesso tumorali (Tabella 1). Le neoplasie androgeno-secernenti, di origine ovarica o surrenalica, sono spesso associate a elevati livelli di androgeni circolanti, con rapida comparsa dei segni dell’iperandrogenismo, fino alla virilizzazione (irsutismo severo, clitoridomegalia, calvizie, abbassamento del tono della voce). Le neoplasie ovariche responsabili di iperandrogenismo sono rare e generalmente a basso potenziale maligno. Queste neoplasie producono tipicamente testosterone e, talora, estrogeni. I carcinomi virilizzanti surrenalici sono assai rari e hanno una prognosi sfavorevole. Si caratterizzano per un’elevata produzione di testosterone e DHEA-S, spesso con cosecrezione di cortisolo. In questi casi, la presentazione clinica può essere una sindrome di Cushing, con associata virilizzazione a rapida evoluzione. Anche adenomi surrenalici possono raramente provocare iperandrogenismo. L’ipertecosi ovarica è una condizione non tumorale, anch’essa rara, caratterizzata da iperplasia stromale con nidi