Silvia Burlina

The effects of psyllium on lipoproteins in type II diabetic patients

We examined the effects of 2 months of psyllium treatment in optimizing metabolic control and lipoprotein profile, and its postprandial effects on lipids in type II diabetes. We recruited 40 type II diabetic patients who were on sulfonylureas and a controlled diet, sequentially assigning them to psyllium treatment (G1) or to a control group (G2) treated with dietary measures alone. After 2 months of treatment, body mass index, waist circumference, HbA1c (hemoglobin A1c) and fasting plasma glucose levels had significantly decreased in both groups. There were no postprandial differences in the lipoprotein profile between the two groups. Triglycerides were significantly lower in G1, but not in G2. Our study contributes toward elucidating the effects of psyllium on serum lipids, and suggests that psyllium treatment may help in reducing triglycerides (a known risk factor for cardiovascular disease) in type II diabetic patients.

Ketoacidosis in diabetic pregnancy

Abstract Diabetic ketoacidosis (DKA) is a serious medical and obstetrical emergency previously considered typical of type 1 diabetes but now reported also in type 2 and GDM patients. Although it is a fairly rare condition, DKA in pregnancy can compromise both fetus and mother. Metabolic changes occurring during pregnancy predispose to DKA in fact it can develop even in setting of normoglycemia. This article will provide the reader with information regarding the pathophysiology underlying DKA, in particular euglycemic DKA, and will provide information regarding all possible effects of ketones on the fetus.

Gestational Diabetes Mellitus and Future Cardiovascular Risk: An Update

The prevalence of gestational diabetes mellitus is increasing in parallel with the rising prevalence of type 2 diabetes and obesity around the world. Current evidence strongly suggests that women who have had gestational diabetes mellitus are at greater risk of cardiovascular disease later in life. Given the growing prevalence of gestational diabetes mellitus, it is important to identify appropriate reliable markers of cardiovascular disease and specific treatment strategies capable of containing obesity, diabetes, and metabolic syndrome in order to reduce the burden of cardiovascular disease in the women affected.

A preliminary study on human placental tissue impaired by gestational diabetes: a comparison of gel-based versus gel-free proteomics approaches.

Gestational diabetes (GDM) is the most common complication of pregnancy and it is associated with maternal and fetal short- and long-term consequences. GDM modifies placental structure and function, but many of the underlying mechanisms are still unclear. The aim of this study is to develop and compare two different methods, based respectively on gel-based and gel-free proteomics, in order to investigate the placental proteome in the absence or in the presence of GDM and to identify, through a comparative approach, possible changes in protein expression due to the GDM condition. Placenta homogenates obtained by pooling six control samples and six samples from GDM pregnant women were analyzed by two-dimensional (2D) electrophoresis coupled with mass spectrometry [nano-liquid chromatography (nano-LC) tandem mass spectrometry (MS/MS) and matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS)] and by a label-free mass spectrometry method based on LC-MSE. The gel-based approach highlights 13 over-expressed proteins and 16 under-expressed proteins, while the label-free method shows the over-expression of 10 proteins and the under-expression of nine proteins. As regards 2D gel electrophoresis, a comparison between two different protein identification methods, based respectively on nLC-electrospray ionization-MS/MS and MALDI-MS/MS, was performed taking into consideration the sequence coverage, the MASCOT score and the exponentially modified protein abundance index. The analysis of the complex proteome through an integrated strategy revealed that the quantitative gel-free and label-free MS approach might be suitable to identify candidate markers of GDM.

An effective and rapid determination by MALDI/TOF/TOF of methionine sulphoxide content of ApoA-I in type 2 diabetic patients

Increased oxidation of low density lipoprotein (LDL) is characteristic of atherosclerosis. In this frame, high density lipoproteins (HDL) play an important role, being able to remove lipid peroxides (LPOs) and cholesterol from oxidized LDL, so exhibiting a protective role against atherosclerosis. A wide range of reactive compounds lead to the oxidation of methionine (Met) residues with the formation of methionine sulphoxide (MetO) in apolipoprotein A-I (ApoA-I). Consequently, the determination of MetO level can give both an evaluation of oxidative stress and the reduced capability of ApoA-I in LPOs and cholesterol transport. For these reasons, the development of analytical methods able to determine the MetO level is surely of interest, and we report here the results obtained by MALDI mass spectrometry.

Diabetic pregnancy outcomes in mothers treated with basal insulin lispro protamine suspension or NPH insulin: a multicenter retrospective Italian study

Abstract Objective: The aim of this study was to study the efficacy and safety of long-acting insulin analog insulin lispro protamine suspension (ILPS) in diabetic pregnant women. Methods: In a multicenter observational retrospective study, we evaluated pregnancy outcome in 119 women affected by type 1 diabetes and 814 with gestational diabetes (GDM) treated during pregnancy with ILPS, compared with a control group treated with neutral protamine hagedorn (NPH) insulin. Results: Among type 1 diabetic patients, fasting blood glucose at the end of pregnancy was significantly lower in ILPS-treated than in NPH-treated patients. HbA1c levels across pregnancy did not differ between groups. Caesarean section and preterm delivery rates were significantly lower in the ILPS-women. Fetal outcomes were similar in the ILPS and NPH groups. Among GDM women, fasting blood glucose at the end of pregnancy was significantly lower in ILPS-treated than in NPH-treated patients. Duration of gestation was significantly longer, caesarian section and preterm delivery rates were lower in the ILPS-treated group. In addition, there were significantly fewer babies with an excessive ponderal index or neonatal hypoglycemic episodes in the ILPS group than in the NPH group. Conclusions: Association of ILPS with rapid-acting analogs in pregnancy is safe in terms of maternal and fetal outcomes.

High-density lipoprotein oxidation in type 2 diabetic patients and young patients with premature myocardial infarction

BACKGROUND AND AIMS ApoA-I can undergo oxidative changes that reduce anti-atherogenic role of HDL. The aim of this study was to seek any significant differences in methionine sulfoxide (MetO) content in the ApoA-I of HDL isolated from young patients with coronary heart disease (CHD), type 2 diabetics and healthy subjects. METHODS AND RESULTS We evaluated the lipid profile of 21 type 2 diabetic patients, 23 young patients with premature MI and 21 healthy volunteers; we determined in all patients the MetO content of ApoA-I in by MALDI/TOF/TOF technique. The typical MALDI spectra of the tryptic digest obtained from HDL plasma fractions all patients showed a relative abundance of peptides containing Met(112)O in ApoA-I in type 2 diabetic and CHD patients. This relative abundance is given as percentages of oxidized ApoA-I (OxApoA-I). OxApoA-I showed no significant correlations with lipoproteins in all patients studied, while a strong correlation emerged between the duration of diabetic disease and OxApoA-I levels in type 2 diabetic patients. CONCLUSIONS The most remarkable finding of our study lies in the evidence it produced of an increased HDL oxidation in patients highly susceptible to CHD. Levels of MetO residues in plasma ApoA-I, measured using an accurate, specific method, should be investigated and considered in prospective future studies to assess their role in CHD.

Short- and long-term consequences for offspring exposed to maternal diabetes: a review

Abstract The prevalence of gestational diabetes mellitus is increasing, as is the worldwide prevalence of type 2 diabetes and obesity, even in children and adolescents. Exposure in utero to maternal diabetes carries several short-term consequences due mainly to maternal hyperglycemia, and consequent fetal hyperinsulinemia. Current evidence also supports the hypothesis that adult health and disease have developmental origins, and that disorders in early-life environments prompt metabolic imprinting that results in a greater risk of negative metabolic outcomes later in life. In particular, exposure in utero to maternal diabetes seems to influence long-term metabolic outcomes, carrying a higher risk of obesity and type 2 diabetes, and thus creating a vicious cycle for future generations. In this paper, the short- and long-term consequences of exposure in utero to hyperglycemia are reviewed, focusing particularly on the long-term metabolic consequences, and investigating the possible pathogenic mechanisms involved.

Team management of gestational diabetes: a training experience

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance developing or first recognized during pregnancy that is not clearly overt diabetes [1]. It affects from 5–6 up to 15–20% of pregnancies worldwide, depending on population demographics, screening methods, diagnostic criteria in use, and maternal lifestyle [2]. GDM is characterized by a defective insulin secretion and insulin resistance even in early pregnancy [3, 4]. Left untreated, GDM can complicate pregnancy, affecting neonatal growth and maternal health, and causing macrosomia, fetal congenital anomalies, intrauterine fetal death, neonatal hypoglycemia, neonatal hyperbilirubinemia, birth trauma, preeclampsia, premature delivery [1]. GDM is also associated with long-term consequences for the women. They have an increased risk of type 2 future diabetes, in particular in the presence of obesity, insulin treatment during pregnancy, and a family history of diabetes [5]. They also have a greater than threefold risk of metabolic syndrome compared to women with normal glucose tolerance in pregnancy [6]. A multidisciplinary team operating in a secondary or tertiary care setting is a commonly adopted model for the provision of pregnancy care to women with diabetes. In fact, in the literature, there are evidences that demonstrated that a systematic multidisciplinary management of pregnant women in the diagnosis and treatment of GDM is essential to contain these maternal and fetal complications [7]. The universal implementation of this best practice could transform the outcomes for women with GDM. But, on the basis of clinical experience, the organization of outpatient clinic and the composition of the multidisciplinary team vary according to local circumstances. These circumstances can lead to some problems in management of GDM patient decreasing the quality of patients’ management. The Italian DAWN Study Group on Pregnancy performed a survey to evaluate the wishes and the needs of Italian and immigrant women affected by GDM. The results showed that all women received structured care from a multidisciplinary team comprising diabetologists, experienced nurses, and dietitians. On the other hand, gynecologists and diabetes specialists cooperated in only 25–26% of cases, and 73% of pregnant women felt that a better cooperation between practitioners is the best way to improve the care available to pregnant women with GDM [8]. To overcome the weaknesses of multidisciplinary teams operating at different diabetic outpatient clinics in different Italian regions, enabling them to facilitate task sharing and standardize their GDM patient management, we conducted a training experience. Our clinic adopt a multidisciplinary team approach meeting the standards recommended in national and international guidelines, so our team experienced in GDM management, including a diabetologist, a nurse, a dietitian, and a gynecologist, was the trainer team of the experience. A total of 13 multidisciplinary teams comprising a diabetologist, a nurse, a dietitian, and a gynecologist operating at different diabetic outpatient clinics of 5 Italian regions (Veneto, Lombardia, Emilia Romagna, Trentino Alto Managed by Antonio Secchi.

Clinical and biochemical approach to predicting post-pregnancy metabolic decompensation

The prevalence of gestational diabetes in the developed world is increased and parallels that of obesity. Apart from the maternal and fetal complications occurring during pregnancy, GDM is characterized by a high subsequent risk of type 2 diabetes, metabolic syndrome, and cardiovascular disease. In this paper, we outline the different factors to consider in assessing the future risk of diabetes developing in women with a history of GDM. Looking at the modifiable risk factors, it is worth noting that promoting a healthy diet and lifestyle before (physical activity), during and after pregnancy (breast feeding) in women of fertile age are fundamental to the success of efforts to reduce the burden of diabetes in these young people.