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Gentile S, Strollo F. Should insulin needles be used once or several times? An unresolved conundrum. Diabetes Res Clin Pract 2024; 209:111600. [PMID: 38428747 DOI: 10.1016/j.diabres.2024.111600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Sandro Gentile
- Vanvitelli University, Naples, Italy; Nefrocenter Research Network, Torre del Greco, Italy.
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Gentile S, Guarino G, Strollo F. Unexpected evolution of a monster case of insulin-induced skin lipohypertrophy. Diabetes Res Clin Pract 2023; 206:110994. [PMID: 37931883 DOI: 10.1016/j.diabres.2023.110994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023]
Abstract
In this journal, in 2020, we published the case of a 74-year-old female outpatient with type-2 diabetes mellitus who self-injected insulin four times a day according to the basal-bolus regimen, with an high glycemic variability and an high rate of severe hypoglycemic episodes. Three years before, we had found two extraordinarily large skin lipohypertrophies, with large underlying fluid collections with high insulin concentration. A long educational and intensive training completely repaired the skin lesions with the disappearance of the subcutaneous insulin reservoirs. Glycemic variability has been reduced dramatically, severe hypoglycemia has almost completely disappeared and the daily dose of insulin has been reduced by 38%. However, this extraordinary, albeit unexpected, result was achieved in five years.
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Affiliation(s)
- S Gentile
- Department of Internal Medicine, Campania University ''Luigi Vanvitelli'', Naples, Italy; Nefrocenter Research Netwofk, Torre del Greco, Italy.
| | - G Guarino
- Department of Internal Medicine, Campania University ''Luigi Vanvitelli'', Naples, Italy; Nefrocenter Research Netwofk, Torre del Greco, Italy.
| | - F Strollo
- Endocrinology and Diabetes, IRCCS San Raffaele Pisana, Rome, Italy.
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Guarino G, Strollo F, Della Corte T, Satta E, Gentile S. Effect of Policaptil Gel Retard on Liver Fat Content and Fibrosis in Adults with Metabolic Syndrome and Type 2 Diabetes: A Non-invasive Approach to MAFLD. Diabetes Ther 2023; 14:2089-2108. [PMID: 37789214 PMCID: PMC10597984 DOI: 10.1007/s13300-023-01478-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/12/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Non-alcoholic fatty liver disease (NAFLD) is part of a disease spectrum ranging from steatosis to steatohepatitis (NASH), fibrosis, and cirrhosis, and when associated with metabolic syndrome (MS), and overt diabetes is defined as metabolic NAFLD (MAFLD). Some easily available, inexpensive biomarkers have been validated based on common anthropometric and laboratory parameters, including the Fatty Liver Index (FLI), the Fibrosis (FIB)-4 Score (FIB-4), and the NAFLD Fibrosis Score (NFS). In people with overweight/obesity, MS, and diabetes, the pathogenesis of fatty liver involves parameters known to be positively affected by Policaptil Gel Retard (PGR), a phytocomplex already successfully used in adolescents and adults with MS and type 2 diabetes mellitus (T2DM). This study's primary outcome was to assess PGR's ability to improve indirect validated signs of liver steatosis and fibrosis, i.e., FLI, FIB-4, and NFS Scores; as the secondary outcome, we aimed to confirm PGR's positive effects on anthropometric parameters and lipid levels and to assess any eventually occurring cytolysis liver marker changes in patients with MS/T2DM and MAFLD/NASH. METHODS In this spontaneous, longitudinal, single-blind, randomized clinical study, 245 outpatients with MS/T2DM were enrolled and randomized to PGR or placebo for 24 weeks. All underwent a low-calorie diet (20-25% less than the calories required to maintain current weight) and were encouraged to intensify physical activity. Fat distribution, liver fat content/fibrosis, and biochemical parameters were evaluated at baseline and after 24 weeks. RESULTS Our data show for the first time in adults with MAFLD that, when added to lifestyle changes including a hypocaloric diet and intensified physical activity, PGR improves lipid and glucose metabolism-related parameters, including insulin-resistance, and significantly reduces not only visceral fat but also liver fat content and related liver fibrosis severity. The prevalence of subjects with severe steatosis (FLI > 60) significantly decreased from 95.08 to 47.53% (p < 0.001) only in the treatment group, which also displayed a significantly decreased prevalence of medium-severe cases (F3-F4) from 83.62% to 52.35% (p < 0.001) and a markedly increased prevalence of low degree cases (F0-F1) from 9.01 to 42.15% (p < 0.001). CONCLUSIONS The effect of PGR is related to a reduction in the post-meal blood glucose and insulin peaks. As glucose absorption (GA) directly regulates pancreatic insulin release, the attenuated insulin response is likely due to delayed GA with decreased body weight, visceral fat, and cardiovascular risk. Also, an effect on the intestinal microbiota, already documented in the animal model, cannot be excluded, especially considering the reported PGR-related shift from the Firmicutes, notoriously responsible for increased lipid gut absorption, to the Bacteroides phylum.
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Affiliation(s)
- Giuseppina Guarino
- Campania University "Luigi Vanvitelli", Naples, Italy
- Nefrocenter Research Network & Nyx Research Start-Up, Naples, Italy
| | | | | | - Ersilia Satta
- Nefrocenter Research Network & Nyx Research Start-Up, Naples, Italy
| | - Sandro Gentile
- Campania University "Luigi Vanvitelli", Naples, Italy.
- Nefrocenter Research Network & Nyx Research Start-Up, Naples, Italy.
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Monda VM, Voci C, Strollo F, Passaro A, Greco S, Monesi M, Bigoni R, Porcellati F, Piani D, Satta E, Gentile S. Protective Effects of Home T2DM Treatment with Glucagon-Like Peptide-1 Receptor Agonists and Sodium-Glucose Co-transporter-2 Inhibitors Against Intensive Care Unit Admission and Mortality in the Acute Phase of the COVID-19 Pandemic: A Retrospective Observational Study in Italy. Diabetes Ther 2023; 14:2127-2142. [PMID: 37801224 PMCID: PMC10597965 DOI: 10.1007/s13300-023-01472-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/31/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a relevant risk factor for severe forms of COVID-19 (SARS coronavrus 2 [SARS-CoV-2] disease 2019), and calls for caution because of the high prevalence of T2DM worldwide and the high mortality rates observed in patients with T2DM who are infected with SARS-CoV-2. People with T2DM often take dipeptidyl peptidase-4 inhibitors (DPP-4is), glucagon-like peptide-1 receptor agonists (GLP-1ras), or sodium-glucose co-transporter-2 inhibitors (SGLT-2is), all of which have clear anti-inflammatory effects. The study aimed to compare (i) the severity and duration of hospital stay between patients with T2DM categorized by pre-hospitalization drug class utilization and (ii) the COVID-19-related death rates of those three groups. METHODS We designed an observational, retrospective, multi-center, population-based study and extracted the hospital admission data from the health care records of 1916 T2DM patients over 18 years old who were previously on GLP-1ra, SGLT-2i, or DPP-4i monotherapy and were hospitalized for COVID-19 (diagnosis based on ICD.9/10 codes) between January 2020 and December 2021 in 14 hospitals throughout Italy. We analyzed general data, pre-admission treatment schedules, date of admission or transfer to the intensive care unit (ICU) (i.e., the index date; taken as a marker of increased COVID-19 disease severity), and death (if it had occurred). Statistics analyzed the impact of drug classes on in-hospital mortality using propensity score logistic regressions for (i) those admitted to intensive care and (ii) those not admitted to intensive care, with a random match procedure used to generate a 1:1 comparison without diabetes cohort replacement for each drug therapy group by applying the nearest neighbor method. After propensity score matching, we checked the balance achieved across selected variables if a balance was ever achieved. We then used propensity score matching between the three drug classes to assemble a sample in which each patient receiving an SGLT-2i was matched to one on a GLP-1ra, and each patient on a DPP-4i was matched to one on a GLP-1ra, adjusting for covariates. We finally used GLP-1ras as references in the logistic regression. RESULTS The overall mortality rate (MR) of the patients was 14.29%. The MR in patients with COVID was 53.62%, and it was as high as 42.42% in the case of associated T2DM, regardless of any glucose-lowering therapy. In those on DPP-4is, there was excess mortality; in those treated with GLP-1ras and SGLT-2is, the death rate was significantly lower, i.e., almost a quarter of the overall mortality observed in COVID-19 patients with T2DM. Indeed, the odds ratio (OR) in the logistic regression resulted in an extremely high risk of in-hospital death in individuals previously treated with DPP-4is [incidence rate (IR) 4.02, 95% confidence interval (CI) 2.2-5.7) and only a slight, nonsignificantly higher risk in those previously treated with SGLT-2is (IR 1.42, 95% CI 0.6-2.1) compared to those on GLP-1ras. Moreover, the longer the stay, the higher the death rate, which ranged from 22.3% for ≤ 3-day stays to 40.3% for 4- to 14-day stays (p < 0.01 vs. the former) and 77.4% for over-14-day stays (p < 0.001 vs. both the others). DISCUSSION Our data do not support a protective role of DPP-4is; indeed, this role has already been questioned due to previous observations. However, the data do show a strong protective effect of SGLT-2is and GLP-1ras. Beyond lowering circulating glucose levels, those two drug classes were found to exert marked anti-phlogistic effects: SGLT-2is increased adiponectin and reduced urate, leptin, and insulin concentrations, thus positively affecting overall low-grade inflammation, and GLP-1ras may also greatly help at the lung tissue level, meaning that their extra-glycemic effects extend well beyond those acknowledged in the cardiovascular and renal fields. CONCLUSIONS The aforedescribed observational clinical data relating to a population of Italian inpatients with T2DM suggest that GLP-1ras and SGLT-2is can be considered antidiabetic drugs of choice against COVID-19, and might even prove beneficial in the event of any upcoming pandemic that has life-threatening effects on the pulmonary and cardiovascular systems.
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Affiliation(s)
- Vincenzo M. Monda
- Primary Care Department, Diabetes Unit “Santissima Annunziata” Hospital, Cento, Ferrara Italy
| | - Claudio Voci
- University Hospital of the City of Health and Science, Turin, Italy
| | - Felice Strollo
- Department of Endocrinology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Angelina Passaro
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Salvatore Greco
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Internal Medicine, Delta Hospital, Ferrara, Lagosanto Italy
| | - Marcello Monesi
- Primary Care Department, Diabetes Unit, Ferrara “Sant’Anna” Hospital, Ferrara, Italy
| | - Renato Bigoni
- Department of Internal Medicine, Delta Hospital, Ferrara, Lagosanto Italy
| | - Francesca Porcellati
- Section of Internal Medicine, Endocrinology and Metabolism, Department of Medicine, Perugia University School of Medicine, Perugia, Italy
| | - Daniela Piani
- Unit of Internal Medicine and Diabetology, Department of Primary Care, AUSL Modena, Modena, Italy
| | - Ersilia Satta
- Nefrocenter Research Network, Cava dè Tirreni, Salerno, Italy
| | - Sandro Gentile
- Nefrocenter Research Network, Cava dè Tirreni, Salerno, Italy
- Department of Precision Medicine, Campania University “Luigi Vanvitelli”, Naples, Italy
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Cialdai F, Brown AM, Baumann CW, Angeloni D, Baatout S, Benchoua A, Bereiter-Hahn J, Bottai D, Buchheim JI, Calvaruso M, Carnero-Diaz E, Castiglioni S, Cavalieri D, Ceccarelli G, Choukér A, Ciofani G, Coppola G, Cusella G, Degl'Innocenti A, Desaphy JF, Frippiat JP, Gelinsky M, Genchi G, Grano M, Grimm D, Guignandon A, Hahn C, Hatton J, Herranz R, Hellweg CE, Iorio CS, Karapantsios T, van Loon J, Lulli M, Maier J, Malda J, Mamaca E, Morbidelli L, van Ombergen A, Osterman A, Ovsianikov A, Pampaloni F, Pavezlorie E, Pereda-Campos V, Przybyla C, Puhl C, Rettberg P, Risaliti C, Rizzo AM, Robson-Brown K, Rossi L, Russo G, Salvetti A, Santucci D, Sperl M, Strollo F, Tabury K, Tavella S, Thielemann C, Willaert R, Szewczyk NJ, Monici M. How do gravity alterations affect animal and human systems at a cellular/tissue level? NPJ Microgravity 2023; 9:84. [PMID: 37865644 PMCID: PMC10590411 DOI: 10.1038/s41526-023-00330-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 10/11/2023] [Indexed: 10/23/2023] Open
Abstract
The present white paper concerns the indications and recommendations of the SciSpacE Science Community to make progress in filling the gaps of knowledge that prevent us from answering the question: "How Do Gravity Alterations Affect Animal and Human Systems at a Cellular/Tissue Level?" This is one of the five major scientific issues of the ESA roadmap "Biology in Space and Analogue Environments". Despite the many studies conducted so far on spaceflight adaptation mechanisms and related pathophysiological alterations observed in astronauts, we are not yet able to elaborate a synthetic integrated model of the many changes occurring at different system and functional levels. Consequently, it is difficult to develop credible models for predicting long-term consequences of human adaptation to the space environment, as well as to implement medical support plans for long-term missions and a strategy for preventing the possible health risks due to prolonged exposure to spaceflight beyond the low Earth orbit (LEO). The research activities suggested by the scientific community have the aim to overcome these problems by striving to connect biological and physiological aspects in a more holistic view of space adaptation effects.
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Affiliation(s)
- Francesca Cialdai
- ASAcampus Joint Laboratory, ASA Res. Div., DSBSC-University of Florence, Florence, Italy
| | - Austin M Brown
- Honors Tutorial College, Ohio University, Athens, OH, USA
| | - Cory W Baumann
- Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Debora Angeloni
- Inst. of Biorobotics, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Sarah Baatout
- Radiobiology Unit, Belgian Nuclear Research Centre (SCK CEN) Boeretang 200, 2400, Mol, Belgium
| | | | - Juergen Bereiter-Hahn
- Inst. for Cell and Neurobiol, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Daniele Bottai
- Dept. Pharmaceutical Sciences, University of Milan, Milan, Italy
| | - Judith-Irina Buchheim
- Laboratory of "Translational Research, Stress & Immunity", Department of Anesthesiology, LMU University Hospital Munich, Munich, Germany
| | - Marco Calvaruso
- Inst. Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, Italy
| | - Eugénie Carnero-Diaz
- Inst. Systematic, Evolution, Biodiversity, Sorbonne University, NMNH, CNRS, EPHE, UA, Paris, France
| | - Sara Castiglioni
- Dept. of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | | | - Gabriele Ceccarelli
- Dept of Public Health, Experimental Medicine and Forensic, University of Pavia, Pavia, Italy
| | - Alexander Choukér
- Laboratory of "Translational Research, Stress & Immunity", Department of Anesthesiology, LMU University Hospital Munich, Munich, Germany
| | - Gianni Ciofani
- Smart Bio-Interfaces, Istituto Italiano di Tecnologia, 56025, Pontedera (PI), Italy
| | - Giuseppe Coppola
- Institute of Applied Science and Intelligent Sistems - CNR, Naples, Italy
| | - Gabriella Cusella
- Dept of Public Health, Experimental Medicine and Forensic, University of Pavia, Pavia, Italy
| | - Andrea Degl'Innocenti
- Dept Medical Biotechnologies, University of Siena, Siena, Italy
- Smart Bio-Interfaces, IIT, Pontedera (PI), Italy
| | - Jean-Francois Desaphy
- Dept. Precision and Regenerative Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Jean-Pol Frippiat
- Stress, Immunity, Pathogens Laboratory, SIMPA, Université de Lorraine, Nancy, France
| | - Michael Gelinsky
- Centre for Translational Bone, Joint & Soft Tissue Research, TU Dresden, Dresden, Germany
| | - Giada Genchi
- Smart Bio-Interfaces, Istituto Italiano di Tecnologia, 56025, Pontedera (PI), Italy
| | - Maria Grano
- Dept. Precision and Regenerative Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Daniela Grimm
- Dept. Microgravity and Translational Regenerative Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Dept of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Alain Guignandon
- SAINBIOSE, INSERM U1059, Université Jean Monnet, F-42000, Saint-Etienne, France
| | | | | | - Raúl Herranz
- Centro de Investigaciones Biológicas Margarita Salas (CSIC), Madrid, Spain
| | - Christine E Hellweg
- Radiation Biology Dept., Inst. of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | | | | | - Jack van Loon
- Amsterdam University Medical Center, ACTA/VU, Amsterdam, The Netherlands
| | - Matteo Lulli
- Dept. Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Jeanette Maier
- Dept. of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Jos Malda
- Dept. Orthopaedics, Univ. Med. Center Utrecht & Dept. Clinical Sciences, Utrecht Univ, Utrecht, The Netherlands
| | - Emina Mamaca
- European and International Affairs Dept, Ifremer centre Bretagne, Plouzané, France
| | | | | | - Andreas Osterman
- Max von Pettenkofer Institute, Virology, LMU Munich & DZIF, Partner Site Munich, Munich, Germany
| | - Aleksandr Ovsianikov
- 3D Printing and Biofabrication, Inst. Materials Science and Technology, TU Wien, Vienna, Austria
| | - Francesco Pampaloni
- Buchmann Inst. for Molecular Life Sciences, Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Elizabeth Pavezlorie
- Ludwig Boltzmann Inst. for Traumatology, Res. Center in Cooperation with AUVA, Vienna, Austria
| | - Veronica Pereda-Campos
- GSBMS/URU EVOLSAN - Medecine Evolutive, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Cyrille Przybyla
- MARBEC, Univ Montpellier, CNRS, Ifremer, IRD, Palavas les Flots, France
| | - Christopher Puhl
- Space Applications NV/SA for European Space Agency, Houston, USA
| | - Petra Rettberg
- DLR, Inst of Aerospace Medicine, Research Group Astrobiology, Köln, Germany
| | - Chiara Risaliti
- ASAcampus Joint Laboratory, ASA Res. Div., DSBSC-University of Florence, Florence, Italy
| | - Angela Maria Rizzo
- Dept. of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Kate Robson-Brown
- Dept of Engineering Mathematics, and Dept of Anthropology and Archaeology, University of Bristol, Bristol, UK
| | - Leonardo Rossi
- Dept. Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giorgio Russo
- Inst. Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, Italy
| | | | - Daniela Santucci
- Center for Behavioural Sciences and Mental Health, Ist. Superiore Sanità, Rome, Italy
| | | | - Felice Strollo
- Endocrinology and Metabolism Unit, IRCCS San Raffaele Pisana, Rome, Italy
| | - Kevin Tabury
- Radiobiology Unit, Belgian Nuclear Research Centre (SCK CEN) Boeretang 200, 2400, Mol, Belgium
| | - Sara Tavella
- IRCCS Ospedale Policlinico San Martino and University of Genoa, DIMES, Genoa, Italy
| | | | - Ronnie Willaert
- Research Group NAMI and NANO, Vrije Universiteit Brussels, Brussels, Belgium
| | | | - Monica Monici
- ASAcampus Joint Laboratory, ASA Res. Div., DSBSC-University of Florence, Florence, Italy.
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Abstract
Semaglutide is a glucagon-like peptide-1 receptor agonist used either orally every day or subcutaneously once a week for the treatment of type 2 diabetes mellitus and, more recently, at higher doses, for the treatment of obesity. Both diseases are reaching epidemic proportions and often coexist, posing patients with a high risk for cardiovascular disease and death. Therefore, an agent such as semaglutide, which offers clinically significant weight loss and cardiovascular benefits, is essential and will be increasingly used in high-risk patients. However, during the SUSTAIN clinical trial program (Semaglutide Unabated Sustainability in treat-ment of type 2 diabetes), a safety issue concerning the progression and worsening of diabetic retinopathy emerged. The existing explanation so far mainly supports the role of the magnitude and speed of HbA1c reduction, a phenomenon also associated with insulin treatment and bariatric surgery. Whether and to which extent the effect is direct is still a matter of debate and an intriguing topic to investigate for suitable preventative and rehabilitative purposes. In this minireview, we will summarize the available data and suggest guidelines for a comprehensive semaglutide clinical utilization until new evidence becomes available.
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Affiliation(s)
| | - Felice Strollo
- Department of Endocrinology and Metabolism, IRCCS San Raffaele Pisana, Rome 00163, Italy
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Gentile S, Guarino G, Della Corte T, Marino G, Satta E, Pasquarella M, Romano C, Alfarone C, Giordano L, Loiacono F, Capece M, Lamberti R, Strollo F. Why Do So Many People with Type 2 Diabetes Who Take Insulin Have Lipohypertrophy? Fate or Educational Deficiencies? Diabetes Ther 2023; 14:179-191. [PMID: 36472805 PMCID: PMC9735184 DOI: 10.1007/s13300-022-01341-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Cutaneous lipohypertrophy (LH) is a thickened, "rubbery" lesion in the subcutaneous tissue following multiple injections performed at the same site, i.e., an incorrect injection technique. It is widespread, averaging 47% of insulin patients worldwide, and has severe direct and indirect consequences. Direct consequences consist mainly of poor metabolic control and frequent hypoglycemic events (HYPOs), and indirect ones of markedly increased healthcare costs related to hospital access due to acute events and long-term disease complications. This observation also holds for Italy, despite the National Health System organization expecting every patient with diabetes to undergo a series of visits by different care team members, each performing a specific treatment/education task. Indeed, the recent literature points to poor awareness of LH relevance and metabolic consequences among doctors from general and diabetic hospital wards, with educational deficiencies on correct injection practice in nurses too. The aim was to establish if, to what extent, and by whom they had received training on correct insulin injection techniques, and how many initially received notions had persisted over time. METHODS We investigated the possible causes of such a failure from the point of view of 1160 insulin-requiring subjects with type 2 diabetes (T2DM), reporting for the first time to specialized diabetic structures through a validated questionnaire and, in the same patients, we searched for LH by inspection/palpation according to international guidelines, further confirmed by ultrasound scans. We then analyzed differences in education and injecting behavior between subjects classified as LH+ or LH- depending on the presence or absence of LH lesions. RESULTS We documented significant educational gaps, with 50% of patients failing to refer to healthcare professionals and relying on their peers with diabetes, thought to be more experienced in 15% of the cases. Seventy-five percent of LH- patients received education from healthcare providers, while 90% of LH+ learned from another patient or could not remember how they knew, and 68% of LH+ versus 52% of LH- (p < 0.01) patients had failed to receive training on injection techniques by healthcare providers. All of this enabled the most disabling features of diabetes from the very beginning of the disease history. CONCLUSIONS This study documents, from the patients' point of view, that educational gaps are significant and that, even in initially trained subjects, education on correct injection techniques has a fleeting effect if not regularly recalled. Therefore, to rehabilitate LH+ patients as soon as possible and prevent LH- patients from inadvertently slipping into the other group, there is an urgent need to educate doctors and nurses repeatedly on the importance of correctly injecting insulin to improve patients' knowledge and skills.
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Affiliation(s)
- Sandro Gentile
- Nefrocenter Research and Nyx Start-Up, Naples, Italy
- Department of Internal Medicine, University ''Luigi Vanvitelli'', Naples, Campania, Italy
| | - Giuseppina Guarino
- Nefrocenter Research and Nyx Start-Up, Naples, Italy
- Department of Internal Medicine, University ''Luigi Vanvitelli'', Naples, Campania, Italy
| | - Teresa Della Corte
- Nefrocenter Research and Nyx Start-Up, Naples, Italy
- Department of Internal Medicine, University ''Luigi Vanvitelli'', Naples, Campania, Italy
| | - Giampiero Marino
- Department of Internal Medicine, University ''Luigi Vanvitelli'', Naples, Campania, Italy
| | - Ersilia Satta
- Nefrocenter Research and Nyx Start-Up, Naples, Italy
- Polyspecialistic Nephrologic Center CNP Srl, Fratta Maggiore, Italy
| | | | | | | | - Laura Giordano
- Emodialysis Center Srl, Nefrocenter Network, Naples, Italy
| | | | - Maurizio Capece
- Vomero Center Crisci Bersabea and C SNC, Nefrocenter Network, Naples, Italy
| | | | - Felice Strollo
- Endocrinology and Diabetes, IRCCS San Raffaele Pisana, Rome, Italy.
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8
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Defeudis G, Rossini M, Khazrai YM, Pipicelli AMV, Brucoli G, Veneziano M, Strollo F, Bellia A, Bitterman O, Lauro D, Mora D, Santarelli E. The gut microbiome as possible mediator of the beneficial effects of very low calorie ketogenic diet on type 2 diabetes and obesity: a narrative review. Eat Weight Disord 2022; 27:2339-2346. [PMID: 35773554 DOI: 10.1007/s40519-022-01434-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/11/2022] [Indexed: 10/17/2022] Open
Abstract
Several studies have shown a strong correlation between the different types of diets and gut microbiota composition on glycemia and weight loss. In this direction, low-carbohydrate and ketogenic diets have gained popularity, despite studies published so far leading to controversial results on subjects with diabetes. In this narrative review, firstly, we aimed to analyze the role of very-low-calorie ketogenic diets (VLCKDs) in type 2 diabetes (T2DM) and obesity management. Secondly, in this context, we focused attention on gut microbiota as a function of VLCKD, particularly in T2DM and obesity treatment. Finally, we reported all this evidence to underline the importance of gut microbiota to exalt new nutritional strategies for "tailor-made" management, treatment, and rehabilitation in subjects with T2DM and obesity, even with diabetic complications. In conclusion, this narrative review outlined the beneficial impact of VLCKD on gut microbiota even in subjects with T2DM and obesity, and, despite inner VLCKD short-duration feature allowing no sound-enough provisions for long-term outcomes, witnessed in favor of the short-term safety of VLCKD in those patients.Level of evidence Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Affiliation(s)
- G Defeudis
- Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico di Roma, Rome, Italy.
| | - M Rossini
- Diet and Diabetes Unit, ASL RM1, Rome, Italy
| | - Y M Khazrai
- Unit of Food Science and Nutrition, Department of Science and Technology for Humans and the Environment, University Campus Bio-Medico di Roma, Rome, Italy
| | - A M V Pipicelli
- UOC di Nefrologia, Dialisi e Trapianto, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Brucoli
- Diet and Diabetes Unit, ASL RM1, Rome, Italy
| | - M Veneziano
- Diet and Diabetes Unit, ASL RM1, Rome, Italy
| | - F Strollo
- Endocrinology and Diabetes Unit, IRCCS San Raffaele Pisana, Rome, Italy
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9
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Strollo F, Gentile S, Pipicelli AMV, Mambro A, Monici M, Magni P. Space Flight-Promoted Insulin Resistance as a Possible Disruptor of Wound Healing. Front Bioeng Biotechnol 2022; 10:868999. [PMID: 35646861 PMCID: PMC9136162 DOI: 10.3389/fbioe.2022.868999] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/14/2022] [Indexed: 12/02/2022] Open
Abstract
During space flight, especially when prolonged, exposure to microgravity results in a number of pathophysiological changes such as bone loss, muscle atrophy, cardiovascular and metabolic changes and impaired wound healing, among others. Interestingly, chronic low-grade inflammation and insulin resistance appear to be pivotal events linking many of them. Interestingly, real and experimental microgravity is also associated to altered wound repair, a process that is becoming increasingly important in view of prolonged space flights. The association of insulin resistance and wound healing impairment may be hypothesized from some dysmetabolic conditions, like the metabolic syndrome, type 2 diabetes mellitus and abdominal/visceral obesity, where derangement of glucose and lipid metabolism, greater low-grade inflammation, altered adipokine secretion and adipocyte dysfunction converge to produce systemic effects that also negatively involve wound healing. Indeed, wound healing impairment after traumatic events and surgery in space remains a relevant concern for space agencies. Further studies are required to clarify the molecular connection between insulin resistance and wound healing during space flight, addressing the ability of physical, endocrine/metabolic, and pharmacological countermeasures, as well as nutritional strategies to prevent long-term detrimental effects on tissue repair linked to insulin resistance. Based on these considerations, this paper discusses the pathophysiological links between microgravity-associated insulin resistance and impaired wound healing.
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Affiliation(s)
- F. Strollo
- Endocrinology and Metabolism Unit, IRCCS San Raffaele Pisana, Rome, Italy
- *Correspondence: F. Strollo,
| | - S. Gentile
- Department of Internal Medicine, Campania University “Luigi Vanvitelli”, Naples, Italy and Nefrocenter Research Network, Naples, Italy
| | - A. M. V. Pipicelli
- Nephrology, Dialysis and Transplant Unit, Medical and Surgical Sciences Department, “A. Gemelli” Sacred Heart Catholic University, Rome, Italy
| | - A. Mambro
- Anesthesiology and Intensive Care Unit, Pertini General Hospital, Rome, Italy
| | - M. Monici
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, ASA Campus Joint Laboratory, ASA Res. Div, University of Florence, Florence, Italy
| | - P. Magni
- Department of Pharmacological and Biomolecular Sciences, Università Degli Studi di Milano, Milan, Italy
- IRCCS Multimedica Hospital, Sesto San Giovanni, Milan, Italy
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Gentile S, Guarino G, Satta E, Strollo F. Comment on the article Determination of insulin-related lipohypertrophy frequency and risk factors in patients with diabetes. ENDOCRINOL DIAB NUTR 2022; 69:387-388. [PMID: 35697472 DOI: 10.1016/j.endien.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/18/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Sandro Gentile
- Vanvitelli University, School of Medicine, Naples, Italy; Nefrocenter Research and Nyx Start-up, Naples, Italy.
| | | | - Ersilia Satta
- Nefrocenter Research and Nyx Start-up, Naples, Italy
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11
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Gentile S, Guarino G, Della Corte T, Marino G, Satta E, Pasquarella M, Romano C, Alfrone C, Giordano L, Loiacono F, Capece M, Lamberti R, Strollo F. The Economic Burden of Insulin Injection-Induced Lipohypertophy. Role of Education: The ISTERP-3 Study. Adv Ther 2022; 39:2192-2207. [PMID: 35306633 PMCID: PMC9056437 DOI: 10.1007/s12325-022-02105-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
Abstract
Introduction The history of insulin-induced skin lipohypertrophy (LH) runs parallel to that of insulin's 100 years, and an average of 47% of insulin-treated patients still suffer from it today. The metabolic and economic effects of LH are significant, with hypoglycemia being the most striking. The objective of the study was to perform a 52-week follow-up of 713 insulin-treated patients with type 2 diabetes (T2DM) and LH to detect any differences in the occurrence of hypoglycemic events (HYPOs) and related healthcare costs as well as in LH rates and injection habits between an intensive education intervention group (IG) and control group (CG) provided with a single educational session at the starting point. Methods All participants were trained in accurately self-monitoring blood glucose and recording all HYPOs for 6 months, which allowed baseline recordings before they were randomized into the IG, comprising 395 insulin-treated subjects undergoing repeated, structured multimodal education on correct injection techniques as a longstanding behavioral rehabilitation strategy, and the CG, comprising 318 subjects receiving the same structured, multimodal educational session, but only initially. Results Changes in LH rate and size and in performance were large in the IG and only slight and transient in the CG. A striking difference in the rate of decrease of HYPOs was also apparent between groups. Indeed, estimated costs of health interventions for severe and symptomatic HYPOs, which were on the order of €70,000 and €9300, respectively, in the two groups at baseline decreased by 5.9 times and 13.7 times, respectively, at the end of follow-up in the IG and by only approximately half in the CG. Full details of the changes occurring as a result of intensive education are provided in the text. Conclusions The effect of only initial education in the CG was not significant, thus providing evidence of the virtual worthlessness of a single training session on injection techniques, typical of worldwide daily clinical practice, and easily explaining the extremely high prevalence of LH in insulin-treated patients. Conversely, highly positive effects on LH prevalence and size as well as costs expected from decreased HYPO rate were obtained in the IG. To our knowledge, ours is the first 18-month randomized trial in the field. If our experimental model were to be used as an effective, longstanding behavioral rehabilitation strategy and therefore adapted to real-world settings universally, LH prevalence and costs related to their clinical consequences would be drastically reduced. However, only with a strong, relentless commitment of universities, scientific societies, and patient associations can we achieve this ambitious goal, which would provide great institutional savings and improved quality of life for people with diabetes. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02105-5.
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Affiliation(s)
- Sandro Gentile
- Nefrocenter Research and Nyx Start-Up, Naples, Italy
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
| | - Giuseppina Guarino
- Nefrocenter Research and Nyx Start-Up, Naples, Italy
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
| | - Teresa Della Corte
- Nefrocenter Research and Nyx Start-Up, Naples, Italy
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
| | - Giampiero Marino
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
| | - Ersilia Satta
- Nefrocenter Research and Nyx Start-Up, Naples, Italy
- Polyspecialistic Nephrologic Center CNP Srl, Fratta Maggiore, Italy
| | | | | | | | - Laura Giordano
- Emodialysis Center Srl, Nefrocenter Network, Naples, Italy
| | | | - Maurizio Capece
- Vomero Center Crisci Bersabea & C SNC, Nefrocenter Network, Naples, Italy
| | | | - Felice Strollo
- Endocrinology and Diabetes, IRCCS San Raffaele Pisana, Rome, Italy.
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Gentile S, Guarino G, Satta E, Strollo F. Comment on the article Determination of insulin-related lipohypertrophy frequency and risk factors in patients with diabetes. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Monda VM, Gentile S, Porcellati F, Satta E, Fucili A, Monesi M, Strollo F. Heart Failure with Preserved Ejection Fraction and Obstructive Sleep Apnea: A Novel Paradigm for Additional Cardiovascular Benefit of SGLT2 Inhibitors in Subjects With or Without Type 2 Diabetes. Adv Ther 2022; 39:4837-4846. [PMID: 36112311 PMCID: PMC9525351 DOI: 10.1007/s12325-022-02310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/24/2022] [Indexed: 01/30/2023]
Abstract
After examining the complex interplay between heart failure (HF) in its various clinical forms, metabolic disorders like nonalcoholic fatty liver disease (NAFLD), and obstructive sleep apnea (OSA) syndrome, in this mini-review we described possible favorable effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) on HF with preserved (i.e., ≥ 50%) ejection fraction (HFpEF) through enhanced cardiorenal function and visceral-subcutaneous body fat redistribution. In greater detail, on the basis of pathophysiological mechanisms underlying OSA onset and the direct positive SGLT2i effect on renal function benefiting chronic kidney disease, we emphasized the promising role of SGLT2is in prevention, rehabilitation, and treatment of patients with OSA regardless of coexisting type 2 diabetes (T2DM). Indeed, SGLT2is enhance lipolysis and fatty acid beta-oxidation. These phenomena might prevent OSA by reducing the size of visceral and subcutaneous adipose tissue and, as proven in humans and animals with T2DM, counteract NAFLD onset and progression. The aforementioned mechanisms may represent an additional SGLT2i cardioprotective effect in terms of HFpEF prevention in patients with OSA, whose NAFLD prevalence is estimated to be over 50%.
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Affiliation(s)
| | - Sandro Gentile
- Department of Precision Medicine, Campania University “Luigi Vanvitelli”, Naples, Italy ,Nefrocenter Research Network, Cava dé Tirreni, Italy
| | - Francesca Porcellati
- Section of Internal Medicine, Endocrinology and Metabolism, Department of Medicine, Perugia University School of Medicine, Perugia, Italy
| | - Ersilia Satta
- Polyspecialistic Nephrologic Center CNP Srl, Fratta Maggiore, Italy ,Nefrocentre Research Network, Cava dé Tirreni, Italy
| | | | | | - Felice Strollo
- Department of Endocrinology and Diabetes, IRCCS San Raffaele Pisana, Rome, Italy
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Gentile S, Guarino G, Della Corte T, Marino G, Satta E, Pasquarella M, Romano C, Alfrone C, Giordano L, Loiacono F, Capace M, Lamberti R, Strollo F. The Durability of an Intensive, Structured Education-Based Rehabilitation Protocol for Best Insulin Injection Practice: The ISTERP-2 Study. Diabetes Ther 2021; 12:2557-2569. [PMID: 34383261 PMCID: PMC8385007 DOI: 10.1007/s13300-021-01108-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/25/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Studies on the durability of an intensive, structured education protocol on best insulin injection practice are missing for people with type 2 diabetes mellitus (T2DM). The aim of this study was to assess the durability of an intensive, structured education-based rehabilitation protocol on best insulin injection practice in well-trained subjects from our previous intensive, multimedia intervention study registered as the ISTERP-1 study. A total of 158 subjects with T2DM from the well-trained group of the 6-month-long ISTERP-1 study, all of whom had successfully attained lower glucose levels compared to baseline levels with lower daily insulin doses and with less frequent and severe hypoglycemic episodes, participated in the present investigation involving an additional 6-month follow-up period, called the ISTERP-2 study. METHODS Participants were randomized into an intervention group and a control group, depending on whether they were provided or not provided with further education refresher courses for 6 months. At the end of the 6 months, the two groups were compared in terms of injection habits, daily insulin dose requirement, number of severe or symptomatic hypoglycemic events, and glycated hemoglobin (HbA1c) levels. RESULTS Despite being virtually superimposable at baseline, the two groups behaved quite differently during the follow-up. The within-group analysis of observed parameters showed that the subjects in the intervention group maintained and even improved the good behavioral results learned during the ISTERP-1 study by further reducing both the rate of injection technique errors (p < 0.001) and size of lipohypertrophic lesions at injection sites (p < 0.02). Conversely, those in the control group progressively abandoned best practice, except for the use of ice-cold insulin and, consequently, had significantly higher HbA1c levels and daily insulin dose requirements at the end of the follow-up than at baseline (p < 0.05). In addition, as expected from all the above, the rate of hypoglycemic episodes also decreased in the intervention group (p < 0.05), resulting in a significant difference between groups after 6 months (p < 0.02). CONCLUSION Our data provide evidence that intensive, structured education refresher courses have no outstanding durability, so that repeated refresher courses, at least at 6-month intervals, are needed to have positive effects on people with T2DM, contributing not only to prevention but also to long-term rehabilitation. TRIAL REGISTRATION Trial Registration no. 118 bis/15.04.2018.
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Affiliation(s)
- Sandro Gentile
- Nefrocenter Research and Nyx Start-Up, Naples, Italy
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
| | - Giuseppina Guarino
- Nefrocenter Research and Nyx Start-Up, Naples, Italy
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
| | - Teresa Della Corte
- Nefrocenter Research and Nyx Start-Up, Naples, Italy
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
| | - Giampiero Marino
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
| | - Ersilia Satta
- Nefrocenter Research and Nyx Start-Up, Naples, Italy
- Polispecialistic Nephrological Center CNP Srl, Fratta Maggiore, Italy
| | | | | | | | - Laura Giordano
- Emodialysis Center Srl, Nefrocenter Network, Naples, Italy
| | | | - Maurizio Capace
- Vomero Center Crisci Bersabea & C SNC, Nefrocenter Network, Naples, Italy
| | | | - Felice Strollo
- Endocrinology and Diabetes, IRCCS San Raffaele Pisana, Rome, Italy.
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Di Bartolo P, Eckel RH, Strollo F, Gentile S. Hundred-year experience with insulin and lipohypertrophy: An unresolved issue. Diabetes Res Clin Pract 2021; 178:108924. [PMID: 34153354 DOI: 10.1016/j.diabres.2021.108924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
In the article recently published in Diab Res Clin Pract (1), we described one of the most exciting paths in the history of medicine from the perspective of diabetologists and people with type 1 diabetes. Such a history lasted 100 years, from the discovery of insulin to the most technologically advanced technologies aimed at making treatment as close to physiology and user-friendly as possible. Indeed, we are luckier than others because, by living in Italy and the USA, respectively, we have access to miniaturized and computerized insulin delivery systems, but this is not the case worldwide. Due to that, while receiving many favorable comments from colleagues and friends, we were encouraged to further expand on the issue and go deeper into insulin injection technique.
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Affiliation(s)
- Paolo Di Bartolo
- Diabetes Clinic of Ravenna, Ravenna Dept. of Internal Medicine, Romagna Local Health Authority, Italy
| | - Robert H Eckel
- Division of Endocrinology, Metabolism and Diabetes, Division of Cardiology, University of Colorado Anschutz Medical Campus, United States
| | - Felice Strollo
- Endocrinology and Diabetes, IRCCS San Raffaele Pisana, Rome, Italy.
| | - Sandro Gentile
- Department of Experimental and Clinical Medicine, Campania University "Luigi Vanvitelli", and Nefrocenter Research, Naples, Italy
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Gentile S, Satta E, Strollo F, Guarino G, Romano C, Della Corte T, Alfarone C. Insulin-induced skin lipohypertrophies: A neglected cause of hypoglycemia in dialysed individuals with diabetes. Diabetes Metab Syndr 2021; 15:102145. [PMID: 34186346 DOI: 10.1016/j.dsx.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) is the leading cause of end-stage renal disease and 50% of dialysis patients are insulin-treated. AIM to search for unexplained hypoglycemia (HYPO). METHODS identify a possible cause of HYPO due to altered insulin absorption. RESULTS insulin injected into subcutaneous lipo-hypertrophy (LH) nodules leads to unpredictable HYPOS. CONCLUSION looking for LH systematically and training patients to the best injection technique are new challenges for nephrologists to reduce HYPO and emergency hospitalization rates, thus sparing healthcare resources and improving the quality of life of insulin-treated dialysis patients.
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Affiliation(s)
- Sandro Gentile
- Nefrocenter Research Network & Nyx Innovative Research Start-Up, Naples, Italy; Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
| | - Ersilia Satta
- Nefrocenter Research Network & Nyx Innovative Research Start-Up, Naples, Italy; Multi-specialty Nephrology Center (CNP) SrL, Frattamaggiore, Italy
| | - Felice Strollo
- Nefrocenter Research Network & Nyx Innovative Research Start-Up, Naples, Italy; Endocrinology and Diabetes, San Raffaele Termini Institute, Rome, Italy
| | - Giuseppina Guarino
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
| | - Carmine Romano
- Nefrocenter Research Network & Nyx Innovative Research Start-Up, Naples, Italy
| | - Teresa Della Corte
- Nefrocenter Research Network & Nyx Innovative Research Start-Up, Naples, Italy; Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy.
| | - Carmelo Alfarone
- Nefrocenter Research Network & Nyx Innovative Research Start-Up, Naples, Italy
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Guarino G, Della Corte T, Strollo F, Gentile S. Policaptil Gel Retard in adult subjects with the metabolic syndrome: Efficacy, safety, and tolerability compared to metformin. Diabetes Metab Syndr 2021; 15:901-907. [PMID: 33906073 DOI: 10.1016/j.dsx.2021.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Policaptil Gel Retard® (PGR), is a new macromolecule complex based on polysaccharides slowing the rate of carbohydrate and fat absorption. It proved to significantly reduce body weight, acanthosis nigricans expression, HbA1c levels, and glucose metabolism abnormalities in obese, hyper-insulinemic adolescents. No such data are available for adults. AIM to compare the effects of PGR vs. metformin in adult subjects with the Metabolic Syndrome (MS) and T2DM on a Low Glycemic Index diet. SUBJECTS AND METHODS This spontaneous clinical, longitudinal, single-blind, randomized study based on a per-protocol analysis enrolled 100 outpatients with MS and T2DM consecutively referring to our clinic for three months, and randomly assigned to either the active treatment (Group A:, 6 tablets/day) or the comparator (Group B: Metformin tablets, 1500-2000 mg/day in two divided doses during the two main meals, to minimize side effects) to be taken 30 min before each main meal in equally divided doses. Serum lipid profile, anthropometry, HOMA-IR index, and tolerability parameters were evaluated before and after a 6-month follow-up period. RESULTS all parameters improved at a similar rate in both groups but for the lipid profile, which got even better in Group A. Group A also experienced less prominent gastrointestinal side effects than its counterpart. CONCLUSION For the first time, we showed the non-inferiority of PGR compared to metformin in obese adult subjects with the MS and T2DM as for glycemic control and a clear-cut superiority of PGR in terms of both serum lipid-lowering capacity and tolerability.
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Affiliation(s)
- G Guarino
- Campania University "Luigi Vanvitelli", Naples, Italy
| | - T Della Corte
- Campania University "Luigi Vanvitelli", Naples, Italy; Nefrocenter Research Network & Nyx Research Start-Up, Naples, Italy.
| | - F Strollo
- IRCCS San Raffaele Pisana, Rome, Italy
| | - S Gentile
- Campania University "Luigi Vanvitelli", Naples, Italy; Nefrocenter Research Network & Nyx Research Start-Up, Naples, Italy
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Gentile S, Guarino G, Della Corte T, Marino G, Satta E, Pasquarella M, Romano C, Alfrone C, Strollo F. Role of Structured Education in Reducing Lypodistrophy and its Metabolic Complications in Insulin-Treated People with Type 2 Diabetes: A Randomized Multicenter Case-Control Study. Diabetes Ther 2021; 12:1379-1398. [PMID: 33738775 PMCID: PMC8099954 DOI: 10.1007/s13300-021-01006-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/15/2021] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION It is essential to use the correct injection technique (IT) to avoid skin complications such as lipohypertrophy (LH), local inflammation, bruising, and consequent repeated unexplained hypoglycemia episodes (hypos) as well as high HbA1c (glycated hemoglobin) levels, glycemic variability (GV), and insulin doses. Structured education plays a prominent role in injection technique improvement. The aim was to assess the ability of structured education to reduce (i) GV and hypos, (ii) HbA1c levels, (iii) insulin daily doses, and (iv) overall healthcare-related costs in outpatients with T2DM who were erroneously injecting insulin into LH. METHODS 318 patients aged 19-75 years who had been diagnosed with T2DM for at least 5 years, were being treated with insulin, were routinely followed by a private network of healthcare centers, and who had easily seen and palpable LH nodules were included in the study. At the beginning of the 6-month run-in period (T-6), all patients were trained to perform structured self-monitoring of blood glucose and to monitor symptomatic and severe hypos (SyHs and SeHs, respectively). After that (at T0), the patients were randomly and equally divided into an intervention group who received appropriate IT education (IG) and a control group (CG), and were followed up for six months (until T+6). Healthcare cost calculations (including resource utilization, loss of productivity, and more) were carried out based on the average NHS reimbursement price list. RESULTS Baseline characteristics were the same for both groups. During follow-up, the intra-LH injection rate for the CG progressively decreased to 59.9% (p < 0.001), a much smaller decrease than seen for the IG (1.9%, p < 0.001). Only the IG presented significant decreases in HbA1c (8.2 ± 1.2% vs. 6.2 ± 0.9%; p < 0.01), GV (247 ± 61 mg/dl vs. 142 ± 31 mg/dl; p < 0.01), insulin requirement (- 20.7%, p < 0.001), and SeH and SyH prevalence (which dropped dramatically from 16.4 to 0.6% and from 83.7 to 7.6%, respectively; p < 0.001). In the IG group only, costs-including those due to the reduced insulin requirement-decreased significantly, especially those relating to SeHs and SyHs, which dropped to €25.8 and €602.5, respectively (p < 0.001). CONCLUSION Within a 6-month observation period, intensive structured education yielded consistently improved metabolic results and led to sharp decreases in the hypo rate and the insulin requirement. These improvements resulted in a parallel drop in overall healthcare costs, representing a tremendous economic advantage for the NHS. These positive results should encourage institutions to resolve the apparently intractable problem of LH by financially incentivizing healthcare teams to provide patients with intensive structured education on proper injection technique. TRIAL REGISTRATION Trial registration no. 118/15.04.2018, approved by the Scientific and Ethics Committee of Campania University "Luigi Vanvitelli," Naples, Italy, and by the institutional review board (IRB Min. no. 9926 dated 05.05.2018).
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Affiliation(s)
- Sandro Gentile
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy.
- Nefrocenter Research Network and Nyx Start-Up, Naples, Italy.
| | - Giuseppina Guarino
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
- Nefrocenter Research Network and Nyx Start-Up, Naples, Italy
| | - Teresa Della Corte
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
- Nefrocenter Research Network and Nyx Start-Up, Naples, Italy
| | - Giampiero Marino
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
- Nefrocenter Research Network and Nyx Start-Up, Naples, Italy
| | - Ersilia Satta
- Nefrocenter Research Network and Nyx Start-Up, Naples, Italy
| | | | - Carmine Romano
- Nefrocenter Research Network and Nyx Start-Up, Naples, Italy
| | - Carmelo Alfrone
- Nefrocenter Research Network and Nyx Start-Up, Naples, Italy
| | - Felice Strollo
- Endocrinology and Diabetes, IRCCS San Raffaele Pisana, Rome, Italy
- Nefrocenter Research Network and Nyx Start-Up, Naples, Italy
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Gentile S, Guarino G, Della Corte T, Marino G, Satta E, Romano C, Alfrone C, Lmberti C, Strollo F. Bruising: A Neglected, Though Patient-Relevant Complication of Insulin Injections Coming to Light from a Real-Life Nationwide Survey. Diabetes Ther 2021; 12:1143-1157. [PMID: 33687646 PMCID: PMC7994491 DOI: 10.1007/s13300-021-01026-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/08/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Despite the availability of sophisticated devices and suitable recommendations on how to best perform insulin injections, lipohypertrophy (LH) and bruising (BR) frequently occur as a consequence of improper injection technique. AIM The purpose of this nationwide survey was to check literature-reported LH risk factors or consequences for any association with BR METHOD: This was a cross-sectional, observational, multicenter study based on the identification of skin lesions at all patient-reported insulin injection sites in 790 subjects with diabetes. General and injection habit-related elements were investigated as possible BR risk factors. RESULTS While confirming the close relationship existing between LH and a full series of factors including missed injection site rotation, needle reuse, long-standing insulin treatment, frequent hypoglycemic events (hypos), and great glycemic variability (GV), the observed data could find no such association with BR, which anyhow came with high HbA1c levels, missed injection site rotation, and long-standing insulin treatment. CONCLUSION BR most likely depends on the patient's habit of pressing the injection pen hard onto the skin. Despite being worrisome and affecting quality of life, BR seems to represent a preliminary stage of LH but does not affect the rate of hypos and GV. TRIAL REGISTRATION 207/19.09.2017.
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Affiliation(s)
- Sandro Gentile
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy.
- Nefrocenter Research Network & Nyx Start-Up, Naples, Italy.
| | - Giuseppina Guarino
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
- Nefrocenter Research Network & Nyx Start-Up, Naples, Italy
| | - Teresa Della Corte
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
- Nefrocenter Research Network & Nyx Start-Up, Naples, Italy
| | - Giampiero Marino
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
- Nefrocenter Research Network & Nyx Start-Up, Naples, Italy
| | - Ersilia Satta
- Nefrocenter Research Network & Nyx Start-Up, Naples, Italy
| | - Carmine Romano
- Nefrocenter Research Network & Nyx Start-Up, Naples, Italy
| | | | - Clelia Lmberti
- Nefrocenter Research Network & Nyx Start-Up, Naples, Italy
| | - Felice Strollo
- Endocrinology and Diabetes, IRCCS San Raffaele Pisana, Rome, Italy
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Strollo F, Vernikos J. Aging-like metabolic and adrenal changes in microgravity: State of the art in preparation for Mars. Neurosci Biobehav Rev 2021; 126:236-242. [PMID: 33757818 DOI: 10.1016/j.neubiorev.2021.01.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 01/01/2021] [Accepted: 01/07/2021] [Indexed: 01/11/2023]
Abstract
Endocrine and metabolic changes that typically accompany aging on Earth have been consistently observed in space. Support for the role of gravity in aging has mostly come from ground simulation studies in head down bed rest. However, uncertainties remain and have to be resolved in planning for the ambitious enterprise of sending humans to Mars and back. Stress-related corticosteroid changes and metabolic adaptation to microgravity and their relationship with aging are the object of the present review mostly, albeit of course non exclusively, coming from the personal experience of the authors. The picture coming out of it is that of some, not easily proven, stress-induced cortisol increase accompanied by insulin resistance, both of which represent typical aging-like phenomena mediated by chronic low-grade inflammation. This suggests the need for humans to consider the long journey to safely land, live and work on Mars by taking advantage of integrative medicine solutions including synthetic torpor and/or continuous self-monitoring of eating, sleeping, moving to enable remotely supervised self-treatment.
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Affiliation(s)
- Felice Strollo
- Elle-Di and San Raffaele Research Institute, Rome, Italy.
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Strollo F, Furia A, Verde P, Bellia A, Grussu M, Mambro A, Petrelli MD, Gentile S. Technological innovation of Continuous Glucose Monitoring (CGM) as a tool for commercial aviation pilots with insulin-treated diabetes and stakeholders/regulators: A new chance to improve the directives? Diabetes Res Clin Pract 2021; 172:108638. [PMID: 33358969 DOI: 10.1016/j.diabres.2020.108638] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022]
Abstract
Civil aviation pilots who develop insulin-treated diabetes and want to renew a Commercial Pilot License (CPL) represent a medical, social and regulatory problem. This depends on justified concerns about hypoglycemia, the most threatening event for people who carry out jobs requiring a high level of concentration and reliability. This negatively affects social and working aspects of pilots' lives, who have a high profile and a high-cost professional qualification. It could be possible now to revise this attitude thanks to the availability of Continuous Glucose Monitoring (CGM) devices. CGM clearly showed to prevent hypoglycemic events in insulin-treated diabetic patients by allowing strict monitoring and trend prediction of glucose levels. By systematizing available data on such devices and present regulations in CPL issuance worldwide, our review can be used as handy tool for a fruitful discussion among the scientific community, national and international civil aviation regulators, stakeholders and pilots, aimed at evaluating the evidence-based opportunity to revise CPL issuance criteria for insulin-treated diabetic pilots. For the above-mentioned reasons, there are, among the regulatory administrations of Civil Aviation around the globe, several different approaches and limitations set for the subjects with insulin-treated diabetes who want to obtain, or renew, a CPL.
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Affiliation(s)
- F Strollo
- AMD (Associazione Medici Diabetologi), ESAM (European Society of Aerospace Medicine) and IRCCS San Raffaele Pisana, Rome, Italy.
| | - A Furia
- ENAC (Italian National Civil Aviation Authority), Aeromedical Section, Rome, Italy
| | - P Verde
- AIMAS (Italian Association of AeroSpace Medicine) and IAF (Italian Air Force), Experimental Flight Center, Aerospace Medicine Department, Pratica di Mare, Rome, Italy
| | - A Bellia
- SID (Società Italiana di Diabetologia), Department of Systems Medicine, Rome University, "Tor Vergata", Italy
| | - M Grussu
- ANIAD (Italian National Association of Athletes with Diabetes), Oristano, Italy
| | - A Mambro
- AIMAS (Italian Association of AeroSpace Medicine), Anesthesiology and Resuscitation Unit, Alesini CTO Hospital, Rome, Italy
| | - M D Petrelli
- SID (Società Italiana di Diabetologia), Clinic of Endocrinology and Metabolic Diseases, Polytechnic University of Marche, Ancona, Italy
| | - S Gentile
- Associazione Medici Diabetologi), Campania University "Luigi Vanvitelli", Naples, Italy, and Nefrocenter Research & Nyx Start-UP, Naples, Italy
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Gentile S, Guarino G, Della Corte T, Marino G, Fusco A, Corigliano G, Colarusso S, Piscopo M, Improta MR, Corigliano M, Martedi E, Oliva D, Russo V, Simonetti R, Satta E, Romano C, Vaia S, Strollo F. Lipohypertrophy in Elderly Insulin-Treated Patients With Type 2 Diabetes. Diabetes Ther 2021; 12:107-119. [PMID: 33219928 PMCID: PMC7843727 DOI: 10.1007/s13300-020-00954-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The number of older adults with insulin-treated diabetes mellitus (DM) is steadily increasing worldwide. Errors in the insulin injection technique can lead to skin lipohypertrophy (LH), which is the accumulation of fat cells and fibrin in the subcutaneous tissue. While lipohypertrophic lesions/nodules (LHs) due to incorrect insulin injection techniques are very common, they are often flat and hardly visible and thus require thorough deep palpation examination and ultrasonography (US) for detection. Detection is crucial because such lesions may eventually result in poor diabetes control due to their association with unpredictable insulin release patterns. Skin undergoes fundamental structural changes with aging, possibly increasing the risk for LH. We have therefore investigated the effect of age on the prevalence of LHs and on factors potentially associated with such lesions. METHODS A total of 1227 insulin-treated outpatients with type 2 DM (T2DM) referred to our diabetes centers were consecutively enrolled in the study. These patients underwent a thorough clinical and US evaluation of the skin at injection sites, as previously described, with up to 95% concordance betweenthe clinical and US screening techniques. Of these 1227 patients, 718 (59%) had LH (LH+) and 509 (41%) were LH-free (LH-). These patients were then assigned to two age class groups (≤ 65 years and > 65 years), and several clinical features, diabetes complication rates, and injection habits were investigated. RESULTS Comparison of the two age subgroups revealed that 396 (48%) and 322 (79%) patients in the younger and older groups, respectively, had LHs (p < 0.001). Compared to the younger subgroup, the older subgroup displayed a higher LH rate in the abdomen (52.9 vs. 38.3%; p < 0.01) and a lower rate in the arms (25.4 vs. 35.8%; p < 0.05), thighs (26.7 vs. 33.4%; p < 0.05), and buttocks (4.9 vs. 26.2%; p < 0.01). In older subjects, the most relevant parameters were: habit of injecting insulin into LH nodules (56 vs. 47% [younger subjects]; p < 0.01), rate of post-injection leakage of insulin from injection site (drop-leaking rate; 47 vs. 39% [younger subjects]; p < 0.05), and rate of painful injections (5 vs. 16% [younger subjects]; p < 0.001). Multivariate analysis showed a stronger association between LH and poor habits, as well as between several clinical parameters, among which the most relevant were hypoglycemic events and glycemic variability. DISCUSSION The higher rate of post-injection drop-leaking and pain-free injections might find an explanation in skin changes typically observed in older adults, including lower thickness, vascularity and elasticity, and a more prominent fibrous texture, all of which negatively affect tissue distensibility. Consequently, in addition to the well-known association between aging skin impaired drug absorption rate, aging skin displays a progressively decreasing ability to accommodate large volumes of insulin-containing fluid. CONCLUSIONS The strong association between LH rate and hypoglycemic events plus glycemic variability suggests the need (1) to take specific actions to prevent and control the high risk of acute cardiovascular events expected to occur in older subjects in the case of hypoglycemic events, and (2) to identify suitable strategies to fulfill the difficult task of performing effective educational programs specifically targeted to the elderly. TRIAL REGISTRATION Trial registration number 172-11:12.2019, Scientific and Ethical Committee of Campania University "Luigi Vanvitelli", Naples, Italy).
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Affiliation(s)
- Sandro Gentile
- Department of Internal Medicine, Campania University “Luigi Vanvitelli”, Naples, Italy
- Diabetes Unit AID Stabia, Nefrocenter Research and Nyx Start-Up, Naples, Italy
| | - Giuseppina Guarino
- Department of Internal Medicine, Campania University “Luigi Vanvitelli”, Naples, Italy
| | - Teresa Della Corte
- Department of Internal Medicine, Campania University “Luigi Vanvitelli”, Naples, Italy
- Nutrition, Nefrocenter Research and Nyx Start-Up, Naples, Italy
| | - Giampiero Marino
- Department of Internal Medicine, Campania University “Luigi Vanvitelli”, Naples, Italy
| | - Alessandra Fusco
- Diabetes Unit, Italian Association for Diabetes (AID) Napoli, Naples, Italy
| | - Gerardo Corigliano
- Diabetes Unit, Italian Association for Diabetes (AID) Napoli, Naples, Italy
| | | | | | | | - Marco Corigliano
- Diabetes Unit, Italian Association for Diabetes (AID) Napoli, Naples, Italy
| | | | - Domenica Oliva
- Diabetes Unit, AID Cava dè Tirreni, Cava dè Tirreni, Italy
| | - Viviana Russo
- Diabetes Unit, Italian Association for Diabetes (AID) Napoli, Naples, Italy
| | | | - Ersilia Satta
- Dialysis Unit, Nefrocenter Research Network, Naples, Italy
| | - Carmine Romano
- Dialysis Unit, Nefrocenter Research Network, Naples, Italy
| | - Sebastiano Vaia
- Neuropsicology Unit, Nefrocenter Research Network, Naples, Italy
| | - Felice Strollo
- Diabetes, Endocrinology and Metabotic Disease, IRCCS San Raffaele Pisana, Rome, Italy
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Gentile S, Guarino G, Strollo F. How to treat improper insulin injection-related lipohypertrophy: A 3-year follow-up of a monster case and an update on treatment. Diabetes Res Clin Pract 2021; 171:108534. [PMID: 33181200 DOI: 10.1016/j.diabres.2020.108534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 11/23/2022]
Affiliation(s)
- S Gentile
- Department of Internal Medicine, Campania University ''Luigi Vanvitelli'', Naples, Italy; Nefrocenter Research Network and Nyx Start-up, Naples, Italy
| | - G Guarino
- Department of Internal Medicine, Campania University ''Luigi Vanvitelli'', Naples, Italy
| | - F Strollo
- Diabetes Research Consultant, IRCCS San Raffaele Pisana, Rome, Italy.
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Gentile S, Strollo F, Mambro A, Ceriello A. COVID-19, ketoacidosis and new-onset diabetes: Are there possible cause and effect relationships among them? Diabetes Obes Metab 2020; 22:2507-2508. [PMID: 32790021 PMCID: PMC7436911 DOI: 10.1111/dom.14170] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/09/2020] [Accepted: 08/09/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Sandro Gentile
- Campania University, “Luigi Vanvitelli”, and Nefrocenter Research & Nyx Start‐UPNaplesItaly
| | | | - Andrea Mambro
- Anesthesiology and Resuscitation UnitCTO, Andrea Alesini HospitalRomeItaly
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Affiliation(s)
- Vincenzo M Monda
- Diabetes Unit "Santissima Annunziata" Hospital Cento, Ferrara, Italy.
| | - Francesca Porcellati
- Section of Internal Medicine, Endocrinology and Metabolism, Department of Medicine, Perugia University School of Medicine, Perugia, Italy
| | - Felice Strollo
- Endocrinology and Diabetes, San Raffaele Termini Institute, Rome, Italy
| | - Sandro Gentile
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", and Nefrocenter Research and Nyx Start-Up, Naples, Italy
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Gentile S, Guarino G, Corte TD, Marino G, Fusco A, Corigliano G, Colarusso S, Piscopo M, Improta MR, Corigliano M, MartedÌ E, Oliva D, Russo V, Simonetti R, Satta E, Romano C, Alfarone C, Vetrano A, Martino C, Lamberti C, Vecchiato A, Cozzolino G, Brancario C, Strollo F. Insulin-Induced Skin Lipohypertrophy in Type 2 Diabetes: a Multicenter Regional Survey in Southern Italy. Diabetes Ther 2020; 11:2001-2017. [PMID: 32683659 PMCID: PMC7435140 DOI: 10.1007/s13300-020-00876-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Lipohypertrophies (LHs) due to incorrect insulin injection techniques have been described in the literature for decades. Their rate averages 38%, but this is still controversial because of the vast range reported by different publications, most of which fail to describe the selected detection protocol and therefore are not entirely reliable. We still need to identify the real LH rate, and only consistently using a standardized method in a large cohort of insulin-treated (IT) patients make this possible. METHODS Our group performed thorough clinical skin examinations on patients suffering from type 2 diabetes mellitus (T2DM): 1247 IT T2DM outpatients were examined according to a standardized protocol, previously published elsewhere, as well as an ultrasound scan of the same skin areas to assess the degree of concordance between the two methods and to evaluate the demographic, clinical, and behavioral risk factors (RF) as well as metabolic consequences of identified LHs. RESULTS The concordance between the two methods was 99%. Identified risk factors for LHs were needle reuse, failure to rotate injection sites, and ice-cold insulin injections. High HbA1c values, wide glycemic variability, and longstanding proneness to hypoglycemia with a high rate of ongoing hypoglycemic events proved to be significantly associated with LHs, too; the same applied to cardiovascular and renal complications as well as to living alone and being retired. CONCLUSIONS Based on a strict well-structured methodology, our data confirmed what has already been reported in the literature on factors leading to, or associated with, LHs and, for the first time in adults, indicated cryotrauma from ice-cold insulin injections and specific social conditions as factors facilitating LH occurrence. HCPs should therefore plan a yearly clinical examination of all injection sites to improve patient quality of life through better glucose control and a reduced rate of hypoglycemic events. TRIAL REGISTRATION Trial registration no. 127-11.01.2019, approved by the Scientific and Ethics Committee of Campania University "Luigi Vanvitelli," Naples, Italy.
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Affiliation(s)
- Sandro Gentile
- Department of Internal Medicine, Campania University "Luigi Vanvitelli" and Nefrocenter Research, Naples, Italy.
- Diabetes Unit AID Castellammare di Stabia, Castellammare di Stabia, Italy.
- Nefrocenter Research and Nyx Start-Up, Naples, Italy.
| | - Giuseppina Guarino
- Department of Internal Medicine, Campania University "Luigi Vanvitelli" and Nefrocenter Research, Naples, Italy
| | - Teresa Della Corte
- Department of Internal Medicine, Campania University "Luigi Vanvitelli" and Nefrocenter Research, Naples, Italy
- Diabetes Unit AID Castellammare di Stabia, Castellammare di Stabia, Italy
- Diabetes Unit AID Portici, Portici, Italy
- Diabetes Unit AID Cava de' Tirreni, Cava de' Tirreni, Italy
- Endocrinology and Diabetes, San Raffaele Termini Pisana Research Institute, Rome, Italy
- Nefrocenter Research and Nyx Start-Up, Naples, Italy
| | - Giampiero Marino
- Department of Internal Medicine, Campania University "Luigi Vanvitelli" and Nefrocenter Research, Naples, Italy
| | | | | | | | | | - Maria Rosaria Improta
- Diabetes Unit AID Castellammare di Stabia, Castellammare di Stabia, Italy
- Diabetes Unit AID Portici, Portici, Italy
- Diabetes Unit AID Cava de' Tirreni, Cava de' Tirreni, Italy
- Endocrinology and Diabetes, San Raffaele Termini Pisana Research Institute, Rome, Italy
- Nefrocenter Research and Nyx Start-Up, Naples, Italy
| | - Marco Corigliano
- Diabetes Unit AID Napoli, Napoli, Italy
- Diabetes Unit AID Benevento, Benevento, Italy
- Diabetes Unit AID Nola, Nola, Italy
- Diabetes Unit AID Castellammare di Stabia, Castellammare di Stabia, Italy
- Diabetes Unit AID Portici, Portici, Italy
- Diabetes Unit AID Cava de' Tirreni, Cava de' Tirreni, Italy
- Endocrinology and Diabetes, San Raffaele Termini Pisana Research Institute, Rome, Italy
- Nefrocenter Research and Nyx Start-Up, Naples, Italy
| | | | - Domenica Oliva
- Diabetes Unit AID Cava de' Tirreni, Cava de' Tirreni, Italy
- Endocrinology and Diabetes, San Raffaele Termini Pisana Research Institute, Rome, Italy
- Nefrocenter Research and Nyx Start-Up, Naples, Italy
| | | | | | - Ersilia Satta
- Nefrocenter Research and Nyx Start-Up, Naples, Italy
| | | | | | | | - Carmine Martino
- Diabetes Unit AID Castellammare di Stabia, Castellammare di Stabia, Italy
| | - Clelia Lamberti
- Diabetes Unit, AID Nocera Inferiore, Nocera Inferiore, Italy
| | | | | | | | - Felice Strollo
- Endocrinology and Diabetes, San Raffaele Termini Pisana Research Institute, Rome, Italy
- Nefrocenter Research and Nyx Start-Up, Naples, Italy
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Della Corte T, Gentile S, Guarino G, Satta E, Romano C, Alfarone C, Strollo F. HOW to make a mix of low glycemic index flours for a good Neapolitan pizza for patients with diabetes. Diabetes Metab Syndr 2020; 14:459-462. [PMID: 32380405 DOI: 10.1016/j.dsx.2020.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Our recent data document that a low glycemic index (LGI) Neapolitan pizza prepared with a mix of Kamut and whole wheat flours plus Glucomannan, (i) has a lower impact on postprandial hyperglycemic spikes than pizza made of whole wheat flour, (ii) is pleasant and appreciated as traditional one and (iii) does not cause any gastro-intestinal troubles. The aim of our study was to describe the validation process underlying the identification of the right mix of those elements for a LGI pizza preventing gastro-intestinal disturbances. METHODS we described all procedures followed to make good products with different combinations of the three components and a series of tests made by four well-experienced professional pasta-making masters, one nutritionist, five diabetologists, one nurse and twenty volunteers with T1DM. RESULTS we could identify the best workable and most suitable flour mix to achieve both pleasant taste and low glycemic impact proving to be efficient in real-life twin paper providing results from diabetic patients. CONCLUSIONS this kind of food will certainly help people with diabetes eat pizza without risking any serious deterioration of their own glucose control while fully enjoying socially active life.
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Affiliation(s)
- T Della Corte
- Campania University "Luigi Vanvitelli", Naples, Italy; Nefrocenter Research and Nyx Start-UP Study Group, Italy.
| | - S Gentile
- Campania University "Luigi Vanvitelli", Naples, Italy; Diabetes Unit, AID Stabia, Castellammare di Stabia, Italy; Nefrocenter Research and Nyx Start-UP Study Group, Italy
| | - G Guarino
- Campania University "Luigi Vanvitelli", Naples, Italy
| | - E Satta
- Dialysis Unit, Nefrocenter, Nola, Italy; Nefrocenter Research and Nyx Start-UP Study Group, Italy
| | - C Romano
- Nefrocenter Research and Nyx Start-UP Study Group, Italy
| | | | - F Strollo
- Elle-Di and San Raffaele Research Institute, Rome, Italy
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Gentile S, Mambro A, Strollo F. Parallel epidemics, or nearly so: Certainties and uncertainties about SARS-CoV-2 in Italy. Diabetes Res Clin Pract 2020; 164:108195. [PMID: 32407747 PMCID: PMC7214347 DOI: 10.1016/j.diabres.2020.108195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/02/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Sandro Gentile
- Campania University "Luigi Vanvitelli, and Nefrocenter Research & Nyx Start-UP, Naples, Italy
| | - Andrea Mambro
- Anesthesiology and Resuscitation Unit, CTO, Andrea Alesini Hospital, Rome, Italy
| | - Felice Strollo
- Elle-Di and San Raffaele Research Institute, Rome, Italy.
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Affiliation(s)
- Sandro Gentile
- Campania University “Luigi Vanvitelli” and Nefrocenter Research Network & Nyx, research start-up, Naples, Italy
| | - Felice Strollo
- Elle-Di and San Raffaele Research Institute, Rome, Italy
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Della-Corte T, Gentile S, Di Blasi V, Guarino G, Corigliano M, Cozzolino G, Fasolino A, Martino C, Improta MR, Oliva D, Lamberti C, Vecchiato A, Vaia S, Satta E, Romano C, Alfarone C, Strollo F. Is pizza sutable to type 1 diabetes? A real life identification of best compromise between taste and low glycemic index in patients on insulin pump. Diabetes Metab Syndr 2020; 14:225-227. [PMID: 32240944 DOI: 10.1016/j.dsx.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 02/06/2023]
Abstract
Opposed to whole wheat (WWP), traditional pizza (TP) is loved by patients with type 1 diabetes mellitus (T1DM) despite causing hyperglycemia. 50 well-trained T1DM patients had higher glucose levels after TP than after WWP or mixed flour pizza, which however was tasty, digestible and metabolically appropriate to break diet monotony.
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Affiliation(s)
- T Della-Corte
- Campania University "Luigi Vanvitelli", Naples, Italy.
| | - S Gentile
- Campania University "Luigi Vanvitelli", Naples, Italy; Diabetes Unit, AID Stabia, Castellammare di Stabia, Italy; Nefrocenter Research and Nyx Start-UP Study Group, Italy
| | | | - G Guarino
- Campania University "Luigi Vanvitelli", Naples, Italy
| | - M Corigliano
- Diabetes Unit, AID Oplonti, Torre Annunziata, Italy
| | | | - A Fasolino
- Diabetes Unit, AID Stabia, Castellammare di Stabia, Italy
| | - C Martino
- Diabetes Unit, AID Stabia, Castellammare di Stabia, Italy
| | - M R Improta
- Diabetes Unit, AID Stabia, Castellammare di Stabia, Italy
| | - D Oliva
- Diabetes Unit, AID Cava Dè Tirreni, Italy
| | - C Lamberti
- Diabetes Unit, AID Nocera Inferiore, Italy
| | | | - S Vaia
- Neuro-diagnostic Institute, Naples, Italy
| | - E Satta
- Dialysis Unit, Nefrocenter, Nola, Italy
| | - C Romano
- Nefrocenter Research and Nyx Start-UP Study Group, Italy
| | | | - F Strollo
- Elle-Di and San Raffaele Research Institute, Rome, Italy
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Affiliation(s)
| | - Felice Strollo
- Elle-Di and San Raffaele Research Institute, Rome, Italy.
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Affiliation(s)
- S Gentile
- Campania University "Luigi Vanvitelli", Naples, Italy.
| | - A Furia
- Aeromedical Section, Italian National Civil Aviation Authority - ENAC, Italy
| | - F Strollo
- Elle-Di and San Raffaele Research Institute, Rome, Italy
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Gentile S, Strollo F, Satta E, Della-Corte T, Romano C, Guarino G. Insulin-induced lypodistrophy in hemodialyzed patients: A new challenge for nephrologists? Diabetes Metab Syndr 2019; 13:3081-3084. [PMID: 31765982 DOI: 10.1016/j.dsx.2019.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
Diabetes Mellitus (DM) is the most common cause of renal failure and ESRD all over the world, and often requires an individualized insulin treatment regimen. Malnutrition, depression-related eating behavior changes, high on-off-dialysis day-to-day glycemic variability and frequent hypoglycemic events occurring during or immediately after dialysis make it hard to identify best insulin dosage in hemodialyzed patients. This suggests a prudent attitude including non-stringent control, despite which repeated hypoglycemia quite often occurs in such patients. When looking for possible sources of hypoglycemia, health professionals too often overlook the identification of skin lipodystrophy (LD) due to an incorrect insulin injection technique. This mini-review focuses on the high frequency (57%) of LD in a cohort of 1004 insulin-treated people with DM on dialysis consecutively referring to our joint medical centers, and on its relationship with hypoglycemia and glycemic control/variability. When taking on such patients, care team members accept to face a complex disease burdened with several risk factors requiring high professional skills, and have to keep in mind also the possible presence of any LD areas eventually interfering with expected results. A timely educational intervention on the correct injection technique can help reduce the high risk of hypoglycemia and large glycemic variability in dialysed people with DM.
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Affiliation(s)
- S Gentile
- Campania University ''Luigi Vanvitelli", Naples, Italy; Nefrocenter Research Network, Naples, Italy.
| | - F Strollo
- Nefrocenter Research Network, Naples, Italy; Elle-Di and San Raffaele Research Institute, Rome, Italy
| | - E Satta
- Nefrocenter Research Network, Naples, Italy
| | - T Della-Corte
- Campania University ''Luigi Vanvitelli", Naples, Italy; Nefrocenter Research Network, Naples, Italy
| | - C Romano
- Nefrocenter Research Network, Naples, Italy
| | - G Guarino
- Campania University ''Luigi Vanvitelli", Naples, Italy
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Strollo F, Gentile S, Assaloni R, De Fazio C, Corigliano G. Corrigendum to "Exercise related care pathways for people with diabetes: Literature review and expert consensus" [Diabetes, Metab Syndr: Clin Res Rev 13 (4) (2019) 2755-2762]. Diabetes Metab Syndr 2019; 13:2973-2974. [PMID: 31520806 DOI: 10.1016/j.dsx.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gentile S, Strollo F, Satta E, Della Corte T, Romano C, Guarino G. Insulin-Related Lipohypertrophy in Hemodialyzed Diabetic People: a Multicenter Observational Study and a Methodological Approach. Diabetes Ther 2019; 10:1423-1433. [PMID: 31222593 PMCID: PMC6612327 DOI: 10.1007/s13300-019-0650-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION End-stage renal disease (ESRD) is associated with increased cardiovascular mortality (CVM) and diabetes mellitus (DM), which in many cases is treated with insulin. Skin lipohypertrophy (LH) very often occurs in insulin-treated (IT) patients as a consequence of inadequate injection technique and is one of the most prominent contributors to hypoglycemia (HYPO), glycemic variability (GV), and poor metabolic control (PMC). METHOD The aim of our multicenter observational study was to assess LH prevalence at self-injection sites and any possible factors predicting high LH/HYPO rates and GV in 296 dialyzed ITDM patients characterized by 64 ± 7 years of age, 7 ± 2 years disease duration, 2.6 ± 2.2 years dialysis duration, preferred pen utilization (80%), and basal-bolus regimen (87.4%) with self-injections (62.6%) largely surpassing caregiver-assisted ones (16.9%), and a mix of the two injection methods (20.5%). RESULTS LH was detected in 57% of patients. Univariate analysis followed by backwards stepwise multivariate logistic regression function showed increased odds for developing LH in patients characterized by needle reuse, smaller injection areas, missed injection site rotation, higher HbA1c levels, and more prominent rates of HYPO and GV. CONCLUSION This was the first time such observation was made. It is now time for further studies aimed at providing evidence also in ESRD ITDM patients for the cause-effect relationship among wrong injection behavior, LH, and poor metabolic control and for the long-term preventative role of suitable educational countermeasures.
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Affiliation(s)
- Sandro Gentile
- Campania University "Luigi Vanvitelli", Naples, Italy.
- Nefrocenter Research Network, Naples, Italy.
| | - Felice Strollo
- Elle-Di and San Raffaele Research Institute, Rome, Italy
| | | | - Teresa Della Corte
- Campania University "Luigi Vanvitelli", Naples, Italy
- Nefrocenter Research Network, Naples, Italy
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Strollo F, Simons R, Mambro A, Strollo G, Gentile S. Continuous Glucose Monitoring for In-Flight Measurement of Glucose Levels of Insulin-Treated Pilots. Aerosp Med Hum Perform 2019; 90:735-737. [PMID: 31331425 DOI: 10.3357/amhp.5315.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION: Due to the risk of hypoglycemia-related incapacitation, diabetic pilots requiring insulin are assessed as unfit according to the International Civil Aviation Organization and most national authorities. Some authorities, such as those from Canada, the United Kingdom, and the United States, permit selected insulin-treated pilots (ITDM-pilots) to fly subject to a protocol requiring pre- and in-flight capillary glucose measurements to show safe levels (>100-<300 mg · dl-1). Critics of such permission question the practicability of these in-flight measurements and whether clinically desired glycemic targets can be achieved while keeping glucose levels in the safe range. Subcutaneous continuous glucose monitoring (CGM) has recently been approved by the FDA as a stand-alone method to provide accurate glucose levels and treatment decision guidance in patients. This commentary considers that use of CGM by ITDM pilots facilitates practicability and recording of in-flight glucose measurements and facilitates achievement of clinically desired glycemic targets without increasing hypoglycemia risks.Strollo F, Simons R, Mambro A, Strollo G, Gentile S. Continuous glucose monitoring for in-flight measurement of glucose levels of insulin-treated pilots. Aerosp Med Hum Perform. 2019; 90(8):735-737.
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Strollo F, Gentile S, Assaloni R, De Fazio C, Corigliano G. Exercise related care pathways for people with diabetes: Literature review and expert consensus. Diabetes Metab Syndr 2019; 13:2755-2762. [PMID: 31405704 DOI: 10.1016/j.dsx.2019.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/10/2019] [Indexed: 11/25/2022]
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Bonfiglio T, Biggi F, Bassi AM, Ferrando S, Gallus L, Loiacono F, Ravera S, Rottigni M, Scarfì S, Strollo F, Vernazza S, Sabbatini M, Masini MA. Simulated microgravity induces nuclear translocation of Bax and BCL-2 in glial cultured C6 cells. Heliyon 2019; 5:e01798. [PMID: 31338440 PMCID: PMC6580195 DOI: 10.1016/j.heliyon.2019.e01798] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/21/2019] [Accepted: 05/20/2019] [Indexed: 12/21/2022] Open
Abstract
Alterations in the control of apoptotic processes were observed in cells during space flight or under simulated microgravity, the latter obtained with the 3D-Random Positioning Machine (3D-RPM). Usually the proteins Bax and Bcl-2, act as pro- or anti-apoptotic regulators. Here we investigated the effects of simulated microgravity obtained by the 3D-RPM on cell viability, localization and expression of Bax and Bcl-2 in cultures of glial cancerous cells. We observed for the first time a transient cytoplasmic/nuclear translocation of Bax and Bcl-2 triggered by changing gravity vector. Bax translocates into the nucleus after 1 h, is present simultaneously in the cytoplasm after 6 h and comes back to the cytoplasm after 24 h. Bcl-2 translocate into the nucleus only after 6 h and comes back to the cytoplasm after 24 h. Physiological meaning, on the regulation of apoptotic event and possible applicative outcomes of such finding are discussed.
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Affiliation(s)
- Tommaso Bonfiglio
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV 6, 16132 Genoa, Italy
| | | | - Anna Maria Bassi
- DIMES, University of Genoa, Viale Benedetto XV 6, 16132 Genoa, Italy
| | - Sara Ferrando
- DISTAV, University of Genova, Corso Europa 26, 16132 Genoa, Italy
| | - Lorenzo Gallus
- DISTAV, University of Genova, Corso Europa 26, 16132 Genoa, Italy
| | | | - Silvia Ravera
- DIMES, Biochemistry Lab., University of Genoa, Viale Benedetto XV 3, 16132 Genoa, Italy
| | - Marino Rottigni
- DISTAV, University of Genova, Corso Europa 26, 16132 Genoa, Italy
| | - Sonia Scarfì
- DISTAV, University of Genova, Corso Europa 26, 16132 Genoa, Italy
| | - Felice Strollo
- Endocrinology and Diabetes Unit, St. Peter's FBF Hospital, Via Cassia 600, 00189 Rome, Italy
| | | | - Maurizio Sabbatini
- DISIT, University of Piemonte Orientale, Via Teresa Michel 11, Alessandria, Italy
| | - Maria A Masini
- DISIT, University of Piemonte Orientale, Via Teresa Michel 11, Alessandria, Italy
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Abstract
We are hereby reporting on a woman with type 1 diabetes getting insulin, 4 shots a day, and referring to us for an episode of severe hypoglycemia occurred after vigorously rubbing a lipo-hypertrophy (LH). She had always injected insulin into an abdominal LH area but had never suffered from any hypoglycemic event (Hypo) during the last period. Nevertheless her history included frequent Hypos, mostly mild-to-moderate but sometimes severe and eventually ending into unconsciousness and her glycemic control was poor (HbA1c 8.3%, mean FPG 161 ± 22 mg/dl, mean PPG 218 ± 51 mg/dl, glycemic variability (106 ± 44 mg/dl). In fact, all of a sudden she rubbed vigorously the LH area trying to get rid of the abdominal skin thickening and soon after a severe Hypo occurred causing her to need for emergency medical assistance. When back at home, she corrected her technique and carefully refrained from inject insulin into the LH so that after six months the lesion disappeared, glycemic control improved and no Hypo occurred any more. Based on the recent publication reporting on a woman with a large LH consisting of thickened skin surrounding some fluid containing insulin at concentrations 13 fold those in blood, we hypothesize that such severe depended on massive insulin release from rubbed skin stores into the blood stream.
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Affiliation(s)
- M R Improta
- Nefrocenter Research Network, AID Stabia, Casrellammare di Stabia, Naples, Italy
| | - F Strollo
- Endocrinology and Diabetes, San Raffaele Termini Institute, Rome, Italy
| | - S Gentile
- Campania University ''Luigi Vanvitell" and Nefrocenter Research Network, Naples, Italy.
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40
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Gentile S, Strollo F, Guarino G. Why are so huge differences reported in the occurrence rate of skin lipohypertrophy? Does it depend on method defects or on lack of interest? Diabetes Metab Syndr 2019; 13:682-686. [PMID: 30641790 DOI: 10.1016/j.dsx.2018.11.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
Lipohypertophy (LH) is the most common skin complication of incorrect injection technique which does not only represent an aesthetic defect but also severely disrupts insulin pharmacokinetics/pharmacodynamics. As a consequence of that, hormone release is delayed and unexplained/unpredictable hypoglycemia occurs, both deteriorating metabolic control while negatively affecting adherence to treatment and quality of life. The economic burden due to unwanted intra-LH injections is accounted for by inappropriately high insulin requirements, increased emergency-related hospitalizations, and loss of work days. Greater attention has to be paid by diabetes care teams to education programs with periodic refreshers to achieve better metabolic control and reduce the economic burden of diabetes.
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Affiliation(s)
- S Gentile
- Campania University ''Luigi Vanvitelli", Naples, Italy; Nefrocenter Research Network, Naples, Italy.
| | - F Strollo
- Elle-Di and San Raffaele Research Institute, Rome, Italy
| | - G Guarino
- Campania University ''Luigi Vanvitelli", Naples, Italy
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Abstract
Astronauts coming back from long-term space missions present with different health problems potentially affecting mission performance, involving all functional systems and organs and closely resembling those found in the elderly. This review points out the most recent advances in the literature in areas of expertise in which specific research groups were particularly creative, and as they relate to aging and to possible benefits on Earth for disabled people. The update of new findings and approaches in space research refers especially to neuro-immuno-endocrine-metabolic interactions, optic nerve edema, motion sickness and muscle-tendon-bone interplay and aims at providing the curious - and even possibly naïve young researchers – with a source of inspiration and of creative ideas for translational research.
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Affiliation(s)
| | - Sandro Gentile
- Campania University "Luigi Vanvitelli" and Nefrocenter Research Network, Naples, Italy
| | | | - Andrea Mambro
- Anesthesiology and Resuscitation Unit, "Misercordia" Hospital, Grosseto, Italy
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42
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Bianchini F, Verde P, Colangeli S, Boccia M, Strollo F, Guariglia C, Bizzarro G, Piccardi L. Effects of oral contraceptives and natural menstrual cycling on environmental learning. BMC Womens Health 2018; 18:179. [PMID: 30404622 PMCID: PMC6223061 DOI: 10.1186/s12905-018-0671-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 10/21/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Endogenous ovarian hormones as well as exogenous oestradiol and progesterone play an important role in cognitive processing. Specifically, these hormones play a role in different aspects of memory, both in terms of storage capacity and temporal duration of the mnemonic track. These hormones also have various effects on different types of memory (i.e., verbal, visuo-spatial, prospective). This study investigated the effects of hormones on topographic memory, a type of memory specifically needed to recall a pathway and to acquire spatial information about locations, distances, and directions. METHODS We compared 25 naturally cycling women (NCW) in two different cycling phases, the early follicular phase (4th - 5th days) and the mid-luteal phase (20th-21st days), with 26 women taking oral contraceptives (OC) tested in the active pill phase (20th to 21st day of OC cycle) and the inactive pill phase (2nd to 4th day of OC cycle). Both groups performed the Walking Corsi Test to assess topographic memory in their respective cycling phases. Women were instructed to learn an eight-step sequence path and recall the path five minutes later. RESULTS We found that the two groups differed in terms of learning the 8-step sequence path; OC users were always better (4-5 days vs. 20-21 days) than NCW. No differences emerged in the delayed recall of the same path. CONCLUSIONS As already observed in other memory domains (i.e., verbal memory, emotional memory), OC users showed an advantage in terms of topographic learning. Our results might be explained by hormonal mechanisms and may suggest the future application of OC in women with topographic disorders or visuo-spatial difficulties.
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Affiliation(s)
| | - Paola Verde
- Aerospace Medicine Department, Italian Air Force, Experimental Flight Centre, Pratica di Mare, Pomezia (RM), Italy.
| | - Stefano Colangeli
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - Maddalena Boccia
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Neuropsychology Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Felice Strollo
- Department of Pharmacology and Biomolecular Sciences, Milan University, Milan, Italy
| | - Cecilia Guariglia
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Neuropsychology Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Giuseppe Bizzarro
- Aerospace Medicine Department, Italian Air Force, Experimental Flight Centre, Pratica di Mare, Pomezia (RM), Italy
| | - Laura Piccardi
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy.,Department of Life, Health and Environmental Sciences, L'Aquila University, L'Aquila, Italy
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43
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Strollo F, Macchi C, Eberini I, Masini MA, Botta M, Vassilieva G, Nichiporuk I, Monici M, Santucci D, Celotti F, Magni P, Ruscica M. Body composition and metabolic changes during a 520-day mission simulation to Mars. J Endocrinol Invest 2018. [PMID: 29532423 DOI: 10.1007/s40618-018-0861-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE The "Mars-500 project" allowed to evaluate the changes in psychological/physiological adaptation over a prolonged confinement, in order to gather information for future missions. Here, we evaluated the impact of confinement and isolation on body composition, glucose metabolism/insulin resistance and adipokine levels. METHODS The "Mars-500 project" consisted of 520 consecutive days of confinement from June 3, 2010 to Nov 4, 2011. The crew was composed of six male subjects (three Russians, two Europeans, and one Chinese) with a median age of 31 years (range 27-38 years). RESULTS During the 520-day confinement, total body mass and BMI progressively decreased, reaching a significant difference at the end (417 days) of the observation period (- 9.2 and - 5.5%, respectively). Fat mass remained unchanged. A progressive and significant increase of fasting plasma glucose was observed between 249 and 417 days (+ 10/+ 17% vs baseline), with a further increase at the end of confinement (up to + 30%). Median plasma insulin showed a non-significant early increment (60 days; + 86%). Total adiponectin halved (- 47%) 60 days after hatch closure, remaining at this nadir (- 51%) level for a further 60 days. High molecular weight adiponectin remained significantly lower from 60 to 168 days. CONCLUSIONS Based on these data, countermeasures may be envisioned to balance the potentially harmful effects of prolonged confinement, including a better exercise program, with accurate monitoring of (1) the individual activity and (2) the relationship between body composition and metabolic derangement.
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Affiliation(s)
- F Strollo
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - C Macchi
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - I Eberini
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - M A Masini
- Dipartimento di Scienze ed Innovazione Tecnologica, Università del Piemonte Orientale, Alessandria, Italy
| | - M Botta
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - G Vassilieva
- Institute of Biomedical Problems, Moscow, Russia
| | - I Nichiporuk
- Institute of Biomedical Problems, Moscow, Russia
| | - M Monici
- ASA Research Division, Department of Experimental and Clinical Biomedical Sciences, Università degli Studi di Firenze, Florence, Italy
| | - D Santucci
- Center for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - F Celotti
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - P Magni
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy.
| | - M Ruscica
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
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Gentile S, Strollo F. Cost saving effects of a short-term educational intervention entailing lower hypoglycaemic event rates in people with type 1 diabetes and lipo-hypertrophy. Diabetes Res Clin Pract 2018; 143:320-321. [PMID: 30076872 DOI: 10.1016/j.diabres.2018.07.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Sandro Gentile
- Campania University "Luigi Vanvitelli" and Nefrocenter Research Network, Naples, Italy
| | - Felice Strollo
- Elle-Di and San Raffaele Research Institute, Rome, Italy.
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45
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Gentile S, Strollo F, Della Corte T, Marino G, Guarino G. Insulin related lipodystrophic lesions and hypoglycemia: Double standards? Diabetes Metab Syndr 2018; 12:813-818. [PMID: 29703450 DOI: 10.1016/j.dsx.2018.04.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/09/2018] [Indexed: 10/17/2022]
Abstract
Lipohypertophy (LH) is the most common skin complication of incorrect injection technique which does not only represent an aesthetic defect but also severely disrupts insulin pharmacokinetics/pharmacodynamics. As a consequence of that, hormone release is delayed and unexplained/unpredictable hypoglycemia occurs, both deteriorating metabolic control while negatively affecting adherence to treatment and quality of life. The economic burden due to unwanted intra-LH injections is accounted for by inappropriately high insulin requirements, increased emergency-related hospitalizations, and loss of work days. Greater attention has to be paid by diabetes care teams to education programs with periodic refreshers to achieve better metabolic control and reduce the economic burden of diabetes.
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Affiliation(s)
- Sandro Gentile
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples Italy; Coordinator of the Study Group on Injection Technique of AMD (Medical Association of Diabetology), Italy.
| | - Felice Strollo
- Endocrinology and Diabetes, San Raffaele Termini Institute, Rome, Italy
| | - Teresa Della Corte
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples Italy
| | - Giampiero Marino
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples Italy
| | - Giuseppina Guarino
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples Italy
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46
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Gentile S, Guarino G, Martedì E, Della Corte T, Strollo F. Considerations on lipoatrophic skin lesions far from insulin injection sites. Diabetes Res Clin Pract 2018; 140:347-350. [PMID: 29679629 DOI: 10.1016/j.diabres.2018.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 04/09/2018] [Indexed: 11/16/2022]
Affiliation(s)
- S Gentile
- Campania University "Luigi Vanvitelli", Department of Clinical and Experimental Medicine, Naples, Italy.
| | - G Guarino
- Campania University "Luigi Vanvitelli", Department of Clinical and Experimental Medicine, Naples, Italy.
| | | | - T Della Corte
- Campania University "Luigi Vanvitelli", Department of Clinical and Experimental Medicine, Naples, Italy.
| | - F Strollo
- San Raffaele Research Institute, Rome, Italy.
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47
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Gentile S, Strollo F, Corte TD, Marino G, Guarino G. Skin complications of insulin injections: A case presentation and a possible explanation of hypoglycaemia. Diabetes Res Clin Pract 2018; 138:284-287. [PMID: 29427696 DOI: 10.1016/j.diabres.2018.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 11/23/2022]
Abstract
We are willing to report the case of a woman with type 2 diabetes treated with insulin, 4 shots a day, referring to us for 2 very large pigmented abdominal lipo-hypertrophy (LH) areas due to incorrect injection technique. The ultrasound examination showed the presence offluidwithin both LH lesions. Fluid examination showed insulin concentrations 13 times higher thancirculating ones. A12-month longstructured training on correct injection techniques normalized metabolic control and took rid of all sudden severe hypoglycemic episodes and the wide glycemic variability. In fact, both LH areas disappeared became softer and slightly smaller and got fluid-free. This is the first case documenting the presence of sort of an insulin reservoir within LH lesions and fluid reabsorption can explain the disappearance of hypoglycemic episodes and the improvement of glycemic control.
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Affiliation(s)
- S Gentile
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy; Study Group on Injection Technique of AMD (Medical Association of Diabetology), Italy.
| | - F Strollo
- Endocrinology and Diabetes, San Raffaele Termini Institute, Rome, Italy
| | - T Della Corte
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
| | - G Marino
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
| | - G Guarino
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy
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48
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Gentile S, Fusco A, Colarusso S, Piscopo M, Improta MR, Corigliano M, Martedi E, Oliva D, Santorelli A, Simonetti R, Giammarco A, Colella C, Miretto L, D'Alessandro A, Russo V, Guarino G, Marino G, Corigliano G, Strollo F. A randomized, open-label, comparative, crossover trial on preference, efficacy, and safety profiles of lispro insulin u-100 versus concentrated lispro insulin u-200 in patients with type 2 diabetes mellitus: a possible contribution to greater treatment adherence. Expert Opin Drug Saf 2018; 17:445-450. [PMID: 29564932 DOI: 10.1080/14740338.2018.1453495] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Several outstanding pharmacological advances making innovative drugs sophisticateddevices available during the last few years. Nevertheless too many patients still disappointingly fail to meetthe metabolic targets suggested by current guidelines. Incorrect insulin administration techniques may greatly affect metabolic control in T2DM people. The aim of our study was to compare glycemic control associated with a concentrated insulin analog preparation (U-200 lispro) in people with T2DM to the one observed with standard U-100 lispro. The secondary endpoint of our study was patients' preference and performance ratings of U-200 lispro. METHODS 126 patients with T2DM were enrolled. They were also assessed for limited joint mobility syndrome (LJMS),defined as limitation in at least two anatomical areas of the dominant upper extremity. After a 4-weekstructured insulin injection education period. Half of them were randomized to U-100 lispro, half to U-200 and after 12 weeks they were switched to the other preparation for 12 weeks. At the end a questionnaire was also administered to investigate patient preference. RESULTS No significant variation in fasting blood glucose, HbA1c, severe or mild hypoglycemic rate and daily fast-acting insulin analog dose was observed with U-100 lispro while U-200 lispro treatment was associated with a significant improvement of all the above mentioned parameters and with around 20% decrease in insulin requirement. Moreover patients' answers to the questionnaire pointed out a higher preference for U-200 lispro for continuing treatment due to fewer difficulties completing injection. DISCUSSION The explanation of better metabolic results with the U-200 device might be the lower inner piston inertia and volume and shorter duration of a complete injection. CONCLUSIONS Checking for LJIMS before insulin prescription could be adopted as a standard practiceaimed at choosing the most suitable device for patient's specific characteristics and abilities. The use of U-200 lispro might improve treatment adherence and metabolic control. This would also result intocost reduction by saving about half the amount of pens per year and of time spent to both fill prescriptionand dump the pharmacy.
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Affiliation(s)
- Sandro Gentile
- a Department of Clinical and Experimental Medicine , Università della Campania "Luigi Vanvitelli" , Napoli , Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Viviana Russo
- a Department of Clinical and Experimental Medicine , Università della Campania "Luigi Vanvitelli" , Napoli , Italy
| | - Giuseppina Guarino
- a Department of Clinical and Experimental Medicine , Università della Campania "Luigi Vanvitelli" , Napoli , Italy
| | - Giampiero Marino
- a Department of Clinical and Experimental Medicine , Università della Campania "Luigi Vanvitelli" , Napoli , Italy
| | | | - Felice Strollo
- j Istituto San Raffaele Termini, Endocrinology Unit , Roma , Italy
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Gentile S, Strollo F, Viazzi F, Russo G, Piscitelli P, Ceriello A, Giorda C, Guida P, Fioretto P, Pontremoli R, De Cosmo S. Five-Year Predictors of Insulin Initiation in People with Type 2 Diabetes under Real-Life Conditions. J Diabetes Res 2018; 2018:7153087. [PMID: 30327785 PMCID: PMC6169213 DOI: 10.1155/2018/7153087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 08/09/2018] [Indexed: 01/05/2023] Open
Abstract
We performed a real-life analysis of clinical and laboratory parameters, in orally treated T2DM patients aiming at identifying predictors of insulin treatment initiation. Overall, 366955 patients (55.8% males, age 65 ± 11 years, diabetes duration 7 ± 8 years) were followed up between 2004 and 2011. Each patient was analyzed step-by-step until either eventually starting insulin treatment or getting to the end of the follow-up period. Patients switching to insulin showed a worse global risk profile, longer disease duration (10 ± 9 years vs. 6 ± 7 years, respectively; p < 0.001), higher HbA1c (8.0 ± 1.6% vs. 7.2 ± 1.5%, respectively; p < 0.001), higher triglycerides, a greater prevalence of arterial hypertension, antihypertensive, lipid-lowering and aspirin treatment, a higher rate of nonproliferative/proliferative retinopathy, and a nearly 4 times lower prevalence of the "diet alone." They also showed a higher prevalence of subjects with eGFR < 60 ml/min/1.73 m2 (24.0% vs. 16.2%, respectively; p < 0.001). Multivariate analysis identified diabetes duration, HbA1c, triglyceride and low HDL-C values, presence of retinopathy or renal dysfunction, and sulphonylurea utilization (the risk being approximately 3 times greater in the latter case) as independent predictors of insulin treatment initiation. LDL-C, lipid-lowering treatment, and overweight/obese seem to be protective. Results of tree analysis showed that patients on sulphonylurea, with high HbA1c, eGFR below 50 ml/min/1.73 m2, and at least 5-year disease duration, are at very high risk to start insulin treatment. We have to stick to this real-life picture, of course, until enough data are collected on patients treated with innovative medications which are expected to improve beta cell survival and further delay treatment-related insulin requirement.
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Affiliation(s)
- Sandro Gentile
- Department of Clinical and Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genova, Italy
| | - Giuseppina Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Pamela Piscitelli
- IRCSS Casa Sollievo della Sofferenza-Unit of Internal Medicine, Scientific Institute, San Giovanni Rotondo, Italy
| | - Antonio Ceriello
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomedica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Department of Cardiovascular and Metabolic Diseases, IRCCS Multimedica, Milan, Italy
| | - Carlo Giorda
- Diabetes and Metabolism Unit ASL Turin 5, Chieri, Italy
| | - Piero Guida
- Statistical Consultant, Associazione Medici Diabetologi (AMD), Rome, Italy
| | - Paola Fioretto
- Department of Medicine, University of Padua, Padua, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genova, Italy
| | - Salvatore De Cosmo
- IRCSS Casa Sollievo della Sofferenza-Unit of Internal Medicine, Scientific Institute, San Giovanni Rotondo, Italy
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Gentile S, Guarino G, Marino G, Strollo F. Comment to: Assessment of insulin injection techniques among diabetes patients in a tertiary care centre. Diabetes Metab Syndr 2017; 11 Suppl 2:S1045-S1046. [PMID: 28778428 DOI: 10.1016/j.dsx.2017.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 07/24/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Sandro Gentile
- Department of Internal Medicine, Campania University, Naples, Italy; Endocrinology and Metabolism, Elle-di, Rome, Italy
| | - Giuseppina Guarino
- Department of Internal Medicine, Campania University, Naples, Italy; Endocrinology and Metabolism, Elle-di, Rome, Italy
| | - Giampiero Marino
- Department of Internal Medicine, Campania University, Naples, Italy; Endocrinology and Metabolism, Elle-di, Rome, Italy
| | - Felice Strollo
- Department of Internal Medicine, Campania University, Naples, Italy; Endocrinology and Metabolism, Elle-di, Rome, Italy.
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