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Bima C, Parasiliti-Caprino M, Rumbolo F, Ponzetto F, Gesmundo I, Nonnato A, Fornengo P, Vaula G, Ghigo E, Mengozzi G, Settanni F. Asymmetric and symmetric dimethylarginine as markers of endothelial dysfunction in cerebrovascular disease: A prospective study. Nutr Metab Cardiovasc Dis 2024:S0939-4753(24)00117-0. [PMID: 38570234 DOI: 10.1016/j.numecd.2024.03.015] [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: 08/21/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND AND AIM Asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) have been proposed as mediators of endothelial dysfunction. In this study, we aimed to investigate the diagnostic and prognostic role of ADMA and SDMA in acute cerebrovascular disease. METHODS AND RESULTS A prospective case-control study was performed, enrolling 48 patients affected by ischemic stroke with no cardioembolic origin, 20 patients affected by TIA, 40 subjects at high cardiovascular risk and 68 healthy subjects. ADMA levels were significantly lower in high-risk subjects (18.85 [11.78-22.83] μmol/L) than in patients with brain ischemic event, both transient (25.70 [13.15-40.20] μmol/L; p = 0.032) and permanent (24.50 [18.0-41.33] μmol/L; p = 0.001). SDMA levels were different not only between high-risk subjects and ischemic patients, but also between TIA and stroke patients, reaching higher levels in TIA group and lower levels in stroke group (1.15 [0.90-2.0] vs 0.68 [0.30-1.07] μmol/L; p < 0.001). SDMA was also correlated with short-term prognosis, with lower levels in case of adverse clinical course, evaluated by type of discharge (p = 0.009) and need of prolonged rehabilitation (p = 0.042). CONCLUSIONS The present study highlights the relationship between l-arginine, ADMA, SDMA and acute cerebrovascular events. Therefore, our results suggested a potential role of SDMA as a specific marker of transient ischemic damage and as a short-term positive prognostic marker.
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Affiliation(s)
- Chiara Bima
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mirko Parasiliti-Caprino
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Francesca Rumbolo
- Clinical Biochemistry Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Federico Ponzetto
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Iacopo Gesmundo
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Antonello Nonnato
- Clinical Biochemistry Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Fornengo
- Internal Medicine 3, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giovanna Vaula
- Stroke Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Ezio Ghigo
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giulio Mengozzi
- Clinical Biochemistry Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fabio Settanni
- Clinical Biochemistry Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
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2
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Porta M, Chiesa M, Fornengo P, Franceschini M, Tricarico L, Mazzeo A, Di Leva A, Bertello S, Clerico A, Oleandri S, Trento M. Detection of real-life activities by a tri-axial accelerometer worn at different body locations: Analysis and interpretation. Diabet Med 2021; 38:e14609. [PMID: 34043833 PMCID: PMC8518063 DOI: 10.1111/dme.14609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Massimo Porta
- Laboratory of Clinical PedagogyDepartment of Medical SciencesUniversity of TurinTurinItaly
| | | | - Paolo Fornengo
- Laboratory of Clinical PedagogyDepartment of Medical SciencesUniversity of TurinTurinItaly
| | - Marta Franceschini
- Laboratory of Clinical PedagogyDepartment of Medical SciencesUniversity of TurinTurinItaly
| | - Lucia Tricarico
- Laboratory of Clinical PedagogyDepartment of Medical SciencesUniversity of TurinTurinItaly
| | - Aurora Mazzeo
- Laboratory of Clinical PedagogyDepartment of Medical SciencesUniversity of TurinTurinItaly
| | - Anna Di Leva
- Laboratory of Clinical PedagogyDepartment of Medical SciencesUniversity of TurinTurinItaly
| | | | | | | | - Marina Trento
- Laboratory of Clinical PedagogyDepartment of Medical SciencesUniversity of TurinTurinItaly
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3
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Trento M, Franceschini M, Fornengo P, Tricarico L, Mazzeo A, Bertello S, Clerico A, Oleandri S, Chiesa M, Di Leva A, Charrier L, Cavallo F, Porta M. Ambient intelligence for long-term diabetes care (AmILCare). Qualitative analysis of patients' expectations and attitudes toward interactive technology. Endocrine 2021; 73:472-475. [PMID: 33768444 PMCID: PMC7993083 DOI: 10.1007/s12020-021-02694-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/11/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Marina Trento
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Marta Franceschini
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Fornengo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lucia Tricarico
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Aurora Mazzeo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | | | | | - Mario Chiesa
- Links Foundation, Polytechnic University of Turin, Turin, Italy
| | - Anna Di Leva
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorena Charrier
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Franco Cavallo
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Massimo Porta
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy
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4
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Trento M, Fornengo P, Amione C, Salassa M, Barutta F, Gruden G, Mazzeo A, Merlo S, Chiesa M, Cavallo F, Charrier L, Porta M. Self-management education may improve blood pressure in people with type 2 diabetes. A randomized controlled clinical trial. Nutr Metab Cardiovasc Dis 2020; 30:1973-1979. [PMID: 32811740 DOI: 10.1016/j.numecd.2020.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 01/29/2020] [Revised: 06/12/2020] [Accepted: 06/20/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Diabetes is a suitable model to evaluate intervention programmes aimed at chronic diseases, because of its well-defined and measurable process and outcome indicators. In this study, we aimed at investigating the effects of group based self-management education on clinical and psychological variables in type 2 diabetes. METHODS AND RESULTS Four-year randomized controlled clinical trial (ISRCTN14558376) comparing Group Care and traditional one-to-one care. Clinical and psychological variables were monitored at baseline, 2 and 4 years. Although differences between groups appear to be non-significant at univariate analysis, body weight, BMI and HbA1c, systolic and diastolic blood pressure improved in the patients followed by Group Care but not among Controls. Prescription of lipid-lowering and anti-hypertensive agents did not change among the patients on Group Care, whereas anti-hypertensives were stepped up among Controls without improving their blood pressure. Multivariable analysis suggests that blood pressure improvement among patients on Group Care was independent of BMI, duration of diabetes and antihypertensive medication, suggesting a direct effect of education, presumably by increasing adherence. The "Powerful Others" dimension of the Locus of Control worsened and fear of complications decreased among Controls. CONCLUSIONS The results confirm that a multidisciplinary structured group educational approach improves blood pressure, presumably through better adherence to healthy lifestyle and medication, in people with type 2 diabetes. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN14558376.
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Affiliation(s)
- Marina Trento
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy.
| | - Paolo Fornengo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy
| | - Cristina Amione
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy
| | - Martina Salassa
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy
| | - Federica Barutta
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy
| | - Gabriella Gruden
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy
| | - Aurora Mazzeo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy
| | - Stefano Merlo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy
| | - Mario Chiesa
- Links Foundation, Polytechnic University of Turin, Italy
| | - Franco Cavallo
- Department of Public Health and Paediatric Sciences, University of Turin, Italy
| | - Lorena Charrier
- Department of Public Health and Paediatric Sciences, University of Turin, Italy
| | - Massimo Porta
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy
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5
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Felicetti F, Cento AS, Fornengo P, Cassader M, Mastrocola R, D'Ascenzo F, Settanni F, Benso A, Arvat E, Collino M, Fagioli F, Aragno M, Brignardello E. Advanced glycation end products and chronic inflammation in adult survivors of childhood leukemia treated with hematopoietic stem cell transplantation. Pediatr Blood Cancer 2020; 67:e28106. [PMID: 31820553 DOI: 10.1002/pbc.28106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/06/2019] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Among survivors of pediatric acute lymphoblastic leukemia (ALL), those who received hematopoietic stem cell transplantation (HSCT) conditioned with total-body irradiation (TBI) show the highest risk of late complications, including cardiovascular (CV) disease. Advanced glycation end products (AGEs) have been associated with CV disease in diabetes mellitus and other clinical conditions. This study explores AGEs plasma levels, inflammatory status, and lipid profile in survivors of pediatric ALL who received HSCT conditioned with TBI. PROCEDURE Inclusion criteria were (a) previous diagnosis of ALL at age < 18 years, treated with HSCT conditioned with TBI; (b) age > 18 at the time of the study enrollment; (c) off-therapy for at least five years. Radiotherapy other than TBI, preexisting heart disease, glucose metabolism impairment, body mass index > 25, active graft versus host disease (GvHD), smoking, or treatment with cholesterol lowering medications were exclusion criteria. Eighteen survivors and 30 age-matched healthy controls were enrolled. RESULTS AGEs plasma levels were markedly higher in ALL survivors than in healthy subjects (2.15 ± 2.21 vs 0.29 ± 0.15 pg/mL, P < 0.01). Survivors also showed higher levels of high-sensitivity C-reactive protein (2.32 ± 1.70 vs 0.88 ± 1.09 mg/dL, P < 0.05), IL-1β (7.04 ± 1.52 vs 4.64 ± 2.02 pg/mL, P < 0.001), IL17 (37.44 ± 3.51 vs 25.19 ± 6.34 pg/mL, P < 0.001), an increased glutathione/reduced glutathione ratio (0.085 ± 0.07 vs 0.041 ± 0.036, P < 0.05) and slight alterations in their lipid profile. CONCLUSIONS Our data show AGEs accumulation and chronic inflammation in ALL survivors who received HSCT conditioned with TBI. These alterations may contribute to the increased risk of CV disease reported in these subjects.
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Affiliation(s)
- Francesco Felicetti
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Turin, Italy.,Department of Medical Science, University of Turin, Turin, Italy
| | - Alessia Sofia Cento
- General Pathology Unit, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Paolo Fornengo
- Department of Medicine, Città della Salute e della Scienza Hospital, Turin, Italy
| | | | - Raffaella Mastrocola
- General Pathology Unit, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Department of Medical Science, University of Turin, Turin, Italy.,Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Fabio Settanni
- Division of Endocrinology, Diabetology and Metabolism, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Andrea Benso
- Department of Medical Science, University of Turin, Turin, Italy.,Division of Endocrinology, Diabetology and Metabolism, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Emanuela Arvat
- Department of Medical Science, University of Turin, Turin, Italy.,Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Massimo Collino
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | - Franca Fagioli
- Division of Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy, Città della Salute e della Scienza Hospital, Turin, Italy.,Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Manuela Aragno
- General Pathology Unit, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Enrico Brignardello
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Turin, Italy
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6
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Trento M, Charrier L, Cavallo F, Bertello S, Oleandri S, Donati MC, Rizzo S, Virgili G, Picca G, Bandello F, Lattanzio R, Aragona E, Perilli R, Casati S, Beltramo E, Mazzeo A, Fornengo P, Durando O, Merlo S, Porta M. Vision-related quality of life and locus of control in type 1 diabetes: a multicenter observational study. Acta Diabetol 2019; 56:1209-1216. [PMID: 31313005 DOI: 10.1007/s00592-019-01384-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/22/2019] [Accepted: 06/22/2019] [Indexed: 10/26/2022]
Abstract
AIMS Diabetic retinopathy remains asymptomatic until its late stages but remains a leading cause of vision impairment and blindness. We studied quality of life and the ability to deal with the discomfort deriving from the presence of a chronic disease in patients with type 1 diabetes and different stages of retinopathy. METHODS Multicenter collaborative observational study involving nine centers screening for retinopathy in different areas of Italy. The National Eye Institute 25-item visual functioning questionnaire and the locus of control tool were administered to 449 people with type 1 diabetes between February 2016 and March 2018. Socio-demographic and clinical data were collected. RESULTS On multivariable analysis, severe retinopathy is associated with worse scores for general vision, ocular pain, near vision activities, distance vision activities, driving, color vision, peripheral vision and lower values of internal control, independently of visual acuity. Women had a perception of worse general health, distance vision activities and driving, and lower internal control and trust in others. Worse scores for visual-specific social functioning, visual-specific mental health, visual-specific role difficulties, visual-specific dependency and peripheral vision were associated with higher HbA1c levels. Fatalism increased with rising HbA1c levels. CONCLUSIONS These results confirm that a gap exists between patients' knowledge and expectations on retinopathy and providers' expertise and assumptions. To bridge this gap, patient-centered education and engaging approaches may be more effective than simple information given during consultations.
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Affiliation(s)
- Marina Trento
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy.
| | - Lorena Charrier
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Franco Cavallo
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Stefania Bertello
- Endocrinology and Diabetology Unit, Health Unit 1, Savigliano, Italy
| | | | - Maria Carla Donati
- Eye Clinic, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Salvatore Rizzo
- Eye Clinic, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Gianni Virgili
- Eye Clinic, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Giuseppe Picca
- Endocrinology and Metabolic Diseases Unit, Hospital of Foggia, Foggia, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Rosangela Lattanzio
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Elena Aragona
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Roberto Perilli
- Department of Ophthalmology, Territorial Ophthalmology, Pescara, Italy
| | - Stefano Casati
- Eye Clinic, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elena Beltramo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Aurora Mazzeo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Fornengo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy
| | - Olga Durando
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy
| | - Stefano Merlo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy
| | - Massimo Porta
- Department of Medical Sciences, University of Turin, Turin, Italy
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7
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Fadini GP, Frison V, Simioni N, Lapolla A, Gatti A, Bossi AC, Del Buono A, Fornengo P, Gottardo L, Laudato M, Perseghin G, Bonora E, Avogaro A. Changes in the Prescription of Glucose-Lowering Medications in Patients With Type 2 Diabetes Mellitus After a Cardiovascular Event: A Call to Action From the DATAFILE Study. J Am Heart Assoc 2019; 8:e012244. [PMID: 31269877 PMCID: PMC6662129 DOI: 10.1161/jaha.119.012244] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 12/25/2022]
Abstract
Background Evidence accumulated that some glucose‐lowering medications protect against cardiovascular events (CVEs) in patients with type 2 diabetes mellitus (T2DM) and established cardiovascular disease. The present study evaluated if and how glucose‐lowering medication prescription pattern changes in T2DM after a CVE. Methods and Results DATAFILE (Diabetes Therapy After a Cardiovascular Event) was a retrospective multicenter study conducted at 12 diabetes mellitus specialist outpatient clinics in Italy. We identified T2DM patients with an incident CVE for whom a follow‐up visit was available after the event. We selected control T2DM patients without an incident CVE, who were matched with cases for age, sex, known diabetes mellitus duration, baseline hemoglobin A1c, kidney function, and follow‐up time. We extracted clinical variables and compared prescribed therapies at baseline and follow‐up. We included 563 patients with and 497 matched patients without an incident CVE. As expected, patients with a subsequent CVE had a higher baseline prevalence of ischemic heart disease. After a median of 9.5 months, in patients with versus those without a CVE, there was a significant increase in the prescription of beta‐blockers, loop diuretics, dual antiplatelet therapy, and, among glucose‐lowering medications, a significant decrease in metformin. Hemoglobin A1c marginally declined only in the control group, whereas low‐density lipoprotein cholesterol decreased only in patients with CVE. Conclusions This study highlights that occurrence of a CVE in T2DM patients did not prime the prescription of glucose‐lowering medications provided with cardiovascular protective effects, even though glucose control remained poor. These data emphasize the need to optimize the therapeutic regimen of T2DM patients with established cardiovascular disease, according to updated guidelines.
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Affiliation(s)
| | - Vera Frison
- 2 Diabetology Service ULSS6 Cittadella Italy
| | | | | | - Adriano Gatti
- 4 Diabetology Service ASL Napoli 1 Centro Napoli Italy
| | | | | | - Paolo Fornengo
- 7 Department of Medicine Internal Medicine 3 University Hospital of Turin Italy
| | | | | | - Gianluca Perseghin
- 10 Department of Medicine and Rehabilitation Policlinico di Monza and University of Milan Bicocca Monza Italy
| | - Enzo Bonora
- 11 Division of Endocrinology, Diabetes and Metabolism University and Hospital Trust of Verona Verona Italy
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8
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Porta M, Amione C, Barutta F, Fornengo P, Merlo S, Gruden G, Albano L, Ciccarelli M, Ungaro P, Durazzo M, Beguinot F, Berchialla P, Cavallo F, Trento M. The co-activator-associated arginine methyltransferase 1 (CARM1) gene is overexpressed in type 2 diabetes. Endocrine 2019; 63:284-292. [PMID: 30173329 DOI: 10.1007/s12020-018-1740-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 08/23/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE We examined the expression of a panel of epigenetic enzymes catalyzing histone tails post-transcriptional modifications, together with effectors of metabolic and inflammatory alterations, in type 2 diabetes. METHODS Cross-sectional, case-control study of 21 people with type 2 diabetes and 21 matched controls. Total RNA was extracted from white cells and reverse transcribed. PCR primer assays for 84 key genes encoding enzymes known to modify genomic DNA and histones were performed. Western blot was performed on lysates using primary antibodies for abnormally expressed enzymes. Hormones and cytokines were measured by multiplex kits. A Bayesian network was built to investigate the relationships between epigenetic, cytokine, and endocrine variables. RESULTS Co-activator-associated aRginine Methyltransferase 1 (CARM1) expression showed a five-fold higher median value, matched by higher protein levels, among patients who also had increased GIP, IL-4, IL-7, IL-13, IL-17, FGF basic, G-CSF, IFN-γ, and TNFα and decreased IP-10. In a Bayesian network approach, CARM1 expression showed a conditional dependence on diabetes, but was independent of all other variables nor appeared to influence any. CONCLUSIONS Increased CARM1 expression in type 2 diabetes suggests that epigenetic mechanisms are altered in human diabetes. The impact of lifestyle and pharmacological treatment on regulation of this enzyme should be further investigated.
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Affiliation(s)
- Massimo Porta
- Department of Medical Sciences, Laboratory of Clinical Pedagogy, University of Turin, Turin, Italy.
| | - Cristina Amione
- Department of Medical Sciences, Laboratory of Clinical Pedagogy, University of Turin, Turin, Italy
| | - Federica Barutta
- Department of Medical Sciences, Laboratory of Clinical Pedagogy, University of Turin, Turin, Italy
| | - Paolo Fornengo
- Department of Medical Sciences, Laboratory of Clinical Pedagogy, University of Turin, Turin, Italy
| | - Stefano Merlo
- Department of Medical Sciences, Laboratory of Clinical Pedagogy, University of Turin, Turin, Italy
| | - Gabriella Gruden
- Department of Medical Sciences, Laboratory of Clinical Pedagogy, University of Turin, Turin, Italy
| | - Luigi Albano
- National Research Council, URT of the Institute of Experimental Endocrinology Oncology "G. Salvatore", Naples, Italy
| | - Marco Ciccarelli
- National Research Council, URT of the Institute of Experimental Endocrinology Oncology "G. Salvatore", Naples, Italy
| | - Paola Ungaro
- National Research Council, URT of the Institute of Experimental Endocrinology Oncology "G. Salvatore", Naples, Italy
| | - Marilena Durazzo
- Department of Medical Sciences, Laboratory of Clinical Pedagogy, University of Turin, Turin, Italy
| | - Francesco Beguinot
- National Research Council, URT of the Institute of Experimental Endocrinology Oncology "G. Salvatore", Naples, Italy
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Franco Cavallo
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Marina Trento
- Department of Medical Sciences, Laboratory of Clinical Pedagogy, University of Turin, Turin, Italy
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9
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Proietti M, Antoniazzi S, Monzani V, Santalucia P, Franchi C, Fenoglio LM, Melchio R, Fabris F, Sartori MT, Manfredini R, De Giorgi A, Fabbian F, Biolo G, Zanetti M, Altamura N, Sabbà C, Suppressa P, Bandiera F, Usai C, Murialdo G, Fezza F, Marra A, Castelli F, Cattaneo F, Beccati V, di Minno G, Tufano A, Contaldi P, Lupattelli G, Bianconi V, Cappellini D, Hu C, Minonzio F, Fargion S, Burdick L, Francione P, Peyvandi F, Rossio R, Colombo G, Monzani V, Ceriani G, Lucchi T, Brignolo B, Manfellotto D, Caridi I, Corazza GR, Miceli E, Padula D, Fraternale G, Guasti L, Squizzato A, Maresca A, Liberato NL, Tognin T, Rozzini R, Bellucci FB, Muscaritoli M, Molfino A, Petrillo E, Dore M, Mete F, Gino M, Franceschi F, Gabrielli M, Perticone F, Perticone M, Bertolotti M, Mussi C, Borghi C, Strocchi E, Durazzo M, Fornengo P, Dallegri F, Ottonello LC, Salam K, Caserza L, Barbagallo M, Di Bella G, Annoni G, Bruni AA, Odetti P, Nencioni A, Monacelli F, Napolitano A, Brucato A, Valenti A, Castellino P, Zanoli L, Mazzeo M. Use of oral anticoagulant drugs in older patients with atrial fibrillation in internal medicine wards. Eur J Intern Med 2018; 52:e12-e14. [PMID: 29657108 DOI: 10.1016/j.ejim.2018.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Marco Proietti
- Department of Neuroscience, Laboratory of Quality Assessment of Geriatric Therapies and Services, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Stefania Antoniazzi
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Biomedical and Clinical Sciences, Clinical Pharmacology Unit, ASST Fatebenefratelli - Sacco University Hospital, University of Milan, Milan, Italy
| | - Valter Monzani
- Department of Emergency Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Santalucia
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; IRCCS Centro Neurolesi Bonino Pulejo - Ospedale Piemonte, Messina, Italy
| | - Carlotta Franchi
- Unit of Pharmacoepidemiological Research in Older People, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | - Luigi M Fenoglio
- Azienda Ospedaliera Santa Croce e Carle di Cuneo - Medicina Interna, Italy
| | - Remo Melchio
- Azienda Ospedaliera Santa Croce e Carle di Cuneo - Medicina Interna, Italy
| | - Fabrizio Fabris
- Azienda Ospedaliera Universitaria di Padova - Clinica Medica I, Italy
| | | | - Roberto Manfredini
- Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale S. Anna - Clinica Medica, Italy
| | - Alfredo De Giorgi
- Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale S. Anna - Clinica Medica, Italy
| | - Fabio Fabbian
- Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale S. Anna - Clinica Medica, Italy
| | - Gianni Biolo
- Azienda Sanitaria Universitaria Integrata di Trieste, Ospedale di Cattinara - Clinica Medica, Italy
| | - Michela Zanetti
- Azienda Sanitaria Universitaria Integrata di Trieste, Ospedale di Cattinara - Clinica Medica, Italy
| | - Nicola Altamura
- Azienda Sanitaria Universitaria Integrata di Trieste, Ospedale di Cattinara - Clinica Medica, Italy
| | - Carlo Sabbà
- Azienda Ospedaliero-Universitaria Policlinico di Bari - Medicina Interna, Italy
| | - Patrizia Suppressa
- Azienda Ospedaliero-Universitaria Policlinico di Bari - Medicina Interna, Italy
| | | | - Carlo Usai
- Azienda Ospedaliero-Universitaria di Sassari - Medicina Interna, Italy
| | - Giovanni Murialdo
- Ospedale Policlinico San Martino, Genova - Clinica di Medicina Interna 2, Italy
| | - Francesca Fezza
- Ospedale Policlinico San Martino, Genova - Clinica di Medicina Interna 2, Italy
| | - Alessio Marra
- Ospedale Policlinico San Martino, Genova - Clinica di Medicina Interna 2, Italy
| | - Francesca Castelli
- Ospedale Policlinico San Martino, Genova - Clinica di Medicina Interna 2, Italy
| | - Federico Cattaneo
- Ospedale Policlinico San Martino, Genova - Clinica di Medicina Interna 2, Italy
| | - Valentina Beccati
- Ospedale Policlinico San Martino, Genova - Clinica di Medicina Interna 2, Italy
| | - Giovanni di Minno
- Azienda Ospedaliera Universitaria Federico II di Napoli - Medicina Interna, Italy
| | - Antonella Tufano
- Azienda Ospedaliera Universitaria Federico II di Napoli - Medicina Interna, Italy
| | - Paola Contaldi
- Azienda Ospedaliera Universitaria Federico II di Napoli - Medicina Interna, Italy
| | - Graziana Lupattelli
- Ospedale "Santa Maria della Misericordia", S. Andrea delle Fratte di Perugia - Medicina Interna, Italy
| | - Vanessa Bianconi
- Ospedale "Santa Maria della Misericordia", S. Andrea delle Fratte di Perugia - Medicina Interna, Italy
| | - Domenica Cappellini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna, Italy
| | - Cinzia Hu
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna, Italy
| | - Francesca Minonzio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna, Italy
| | - Silvia Fargion
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna ad Indirizzo Metabolico, Italy
| | - Larry Burdick
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna ad Indirizzo Metabolico, Italy
| | - Paolo Francione
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna ad Indirizzo Metabolico, Italy
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Ematologia non tumorale e Coagulopatie, Italy
| | - Raffaella Rossio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Ematologia non tumorale e Coagulopatie, Italy
| | - Giulia Colombo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Ematologia non tumorale e Coagulopatie, Italy
| | - Valter Monzani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna ad Alta Intensità Di Cura, Italy
| | - Giuliana Ceriani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna ad Alta Intensità Di Cura, Italy.
| | - Tiziano Lucchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Geriatria, Italy
| | - Barbara Brignolo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Geriatria, Italy
| | - Dario Manfellotto
- Ospedale San Giovanni Calibita Fatebenefratelli di Roma - Medicina Interna, Italy
| | - Irene Caridi
- Ospedale San Giovanni Calibita Fatebenefratelli di Roma - Medicina Interna, Italy
| | | | - Emanuela Miceli
- IRCCS Fondazione Policlinico San Matteo di Pavia - Clinica Medica I, Italy
| | - Donatella Padula
- IRCCS Fondazione Policlinico San Matteo di Pavia - Clinica Medica I, Italy
| | - Giacomo Fraternale
- IRCCS Fondazione Policlinico San Matteo di Pavia - Clinica Medica I, Italy
| | - Luigina Guasti
- Ospedale di Circolo e Fondazione Macchi, Azienda Socio-Sanitaria Territoriale Sette-Laghi, Varese, Università degli Studi dell'Insubria Varese - Medicina Interna 1, Italy
| | - Alessandro Squizzato
- Ospedale di Circolo e Fondazione Macchi, Azienda Socio-Sanitaria Territoriale Sette-Laghi, Varese, Università degli Studi dell'Insubria Varese - Medicina Interna 1, Italy
| | - Andrea Maresca
- Ospedale di Circolo e Fondazione Macchi, Azienda Socio-Sanitaria Territoriale Sette-Laghi, Varese, Università degli Studi dell'Insubria Varese - Medicina Interna 1, Italy
| | - Nicola Lucio Liberato
- Azienda Socio-Sanitaria Territoriale di Pavia Ospedale Civile "C. Mira" di Casorate Primo - Medicina Interna, Italy
| | - Tiziana Tognin
- Azienda Socio-Sanitaria Territoriale di Pavia Ospedale Civile "C. Mira" di Casorate Primo - Medicina Interna, Italy
| | - Renzo Rozzini
- Fondazione Poliambulanza Istituto Ospedaliero di Brescia - Geriatria, Italy
| | | | - Maurizio Muscaritoli
- Dipartimento di Medicina Clinica, Sapienza Università di Roma, Policlinico Umberto I di Roma - Medicina Interna e Nutrizione Clinica, Italy
| | - Alessio Molfino
- Dipartimento di Medicina Clinica, Sapienza Università di Roma, Policlinico Umberto I di Roma - Medicina Interna e Nutrizione Clinica, Italy
| | - Enrico Petrillo
- Dipartimento di Medicina Clinica, Sapienza Università di Roma, Policlinico Umberto I di Roma - Medicina Interna e Nutrizione Clinica, Italy
| | - Maurizio Dore
- Ospedale degli Infermi Di Rivoli - Medicina Generale, Italy
| | - Francesca Mete
- Ospedale degli Infermi Di Rivoli - Medicina Generale, Italy
| | - Miriam Gino
- Ospedale degli Infermi Di Rivoli - Medicina Generale, Italy
| | - Francesco Franceschi
- Fondazione Policlinico Universitario "Agostino Gemelli" di Roma - Medicina D'Urgenza e Pronto Soccorso, Italy
| | - Maurizio Gabrielli
- Fondazione Policlinico Universitario "Agostino Gemelli" di Roma - Medicina D'Urgenza e Pronto Soccorso, Italy
| | - Francesco Perticone
- Azienda Ospedaliero Universitaria "Mater Domini" di Catanzaro - Geriatria, Italy
| | - Maria Perticone
- Azienda Ospedaliero Universitaria "Mater Domini" di Catanzaro - Geriatria, Italy
| | - Marco Bertolotti
- Nuovo Ospedale Civile S. Agostino Estense di Modena - Geriatria e Post-Acuzie Geriatria, Italy
| | - Chiara Mussi
- Nuovo Ospedale Civile S. Agostino Estense di Modena - Geriatria e Post-Acuzie Geriatria, Italy
| | - Claudio Borghi
- Azienda Ospedaliero Universitaria - Policlinico S.Orsola-Malpighi di Bologna - Medicina Interna, Italy
| | - Enrico Strocchi
- Azienda Ospedaliero Universitaria - Policlinico S.Orsola-Malpighi di Bologna - Medicina Interna, Italy
| | - Marilena Durazzo
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino - Presidio Molinette, Medicina Interna 3, Italy
| | - Paolo Fornengo
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino - Presidio Molinette, Medicina Interna 3, Italy
| | - Franco Dallegri
- Ospedale Policlinico San Martino, Genova - Medicina Interna, Italy
| | | | - Kassem Salam
- Ospedale Policlinico San Martino, Genova - Medicina Interna, Italy
| | - Lara Caserza
- Ospedale Policlinico San Martino, Genova - Medicina Interna, Italy
| | - Mario Barbagallo
- Azienda Ospedaliera Universitaria Policlinico P. Giaccone di Palermo - Geriatria, Italy
| | - Giovanna Di Bella
- Azienda Ospedaliera Universitaria Policlinico P. Giaccone di Palermo - Geriatria, Italy
| | - Giorgio Annoni
- Ospedale S.Gerardo di Monza, Azienda Socio-Sanitaria Territoriale di Monza, Clinica Geriatrica Università degli Studi di Milano-Bicocca - Clinica Geriatrica, Italy
| | - Adriana Antonella Bruni
- Ospedale S.Gerardo di Monza, Azienda Socio-Sanitaria Territoriale di Monza, Clinica Geriatrica Università degli Studi di Milano-Bicocca - Clinica Geriatrica, Italy
| | - Patrizio Odetti
- Ospedale Policlinico San Martino, Genova - Clinica Geriatrica, Italy
| | - Alessio Nencioni
- Ospedale Policlinico San Martino, Genova - Clinica Geriatrica, Italy
| | | | | | - Antonio Brucato
- Ospedale Papa Giovanni XXIII di Bergamo - Medicina Interna, Italy
| | - Anna Valenti
- Ospedale Papa Giovanni XXIII di Bergamo - Medicina Interna, Italy
| | - Pietro Castellino
- Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele" di Catania - Medicina Interna, Italy
| | - Luca Zanoli
- Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele" di Catania - Medicina Interna, Italy
| | - Marco Mazzeo
- Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele" di Catania - Medicina Interna, Italy
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10
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Vaccaro O, Masulli M, Nicolucci A, Bonora E, Del Prato S, Maggioni AP, Rivellese AA, Squatrito S, Giorda CB, Sesti G, Mocarelli P, Lucisano G, Sacco M, Signorini S, Cappellini F, Perriello G, Babini AC, Lapolla A, Gregori G, Giordano C, Corsi L, Buzzetti R, Clemente G, Di Cianni G, Iannarelli R, Cordera R, La Macchia O, Zamboni C, Scaranna C, Boemi M, Iovine C, Lauro D, Leotta S, Dall'Aglio E, Cannarsa E, Tonutti L, Pugliese G, Bossi AC, Anichini R, Dotta F, Di Benedetto A, Citro G, Antenucci D, Ricci L, Giorgino F, Santini C, Gnasso A, De Cosmo S, Zavaroni D, Vedovato M, Consoli A, Calabrese M, di Bartolo P, Fornengo P, Riccardi G. Effects on the incidence of cardiovascular events of the addition of pioglitazone versus sulfonylureas in patients with type 2 diabetes inadequately controlled with metformin (TOSCA.IT): a randomised, multicentre trial. Lancet Diabetes Endocrinol 2017; 5:887-897. [PMID: 28917544 DOI: 10.1016/s2213-8587(17)30317-0] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [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: 08/03/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND The best treatment option for patients with type 2 diabetes in whom treatment with metformin alone fails to achieve adequate glycaemic control is debated. We aimed to compare the long-term effects of pioglitazone versus sulfonylureas, given in addition to metformin, on cardiovascular events in patients with type 2 diabetes. METHODS TOSCA.IT was a multicentre, randomised, pragmatic clinical trial, in which patients aged 50-75 years with type 2 diabetes inadequately controlled with metformin monotherapy (2-3 g per day) were recruited from 57 diabetes clinics in Italy. Patients were randomly assigned (1:1), by permuted blocks randomisation (block size 10), stratified by site and previous cardiovascular events, to add-on pioglitazone (15-45 mg) or a sulfonylurea (5-15 mg glibenclamide, 2-6 mg glimepiride, or 30-120 mg gliclazide, in accordance with local practice). The trial was unblinded, but event adjudicators were unaware of treatment assignment. The primary outcome, assessed with a Cox proportional-hazards model, was a composite of first occurrence of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or urgent coronary revascularisation, assessed in the modified intention-to-treat population (all randomly assigned participants with baseline data available and without any protocol violations in relation to inclusion or exclusion criteria). This study is registered with ClinicalTrials.gov, number NCT00700856. FINDINGS Between Sept 18, 2008, and Jan 15, 2014, 3028 patients were randomly assigned and included in the analyses. 1535 were assigned to pioglitazone and 1493 to sulfonylureas (glibenclamide 24 [2%], glimepiride 723 [48%], gliclazide 745 [50%]). At baseline, 335 (11%) participants had a previous cardiovascular event. The study was stopped early on the basis of a futility analysis after a median follow-up of 57·3 months. The primary outcome occurred in 105 patients (1·5 per 100 person-years) who were given pioglitazone and 108 (1·5 per 100 person-years) who were given sulfonylureas (hazard ratio 0·96, 95% CI 0·74-1·26, p=0·79). Fewer patients had hypoglycaemias in the pioglitazone group than in the sulfonylureas group (148 [10%] vs 508 [34%], p<0·0001). Moderate weight gain (less than 2 kg, on average) occurred in both groups. Rates of heart failure, bladder cancer, and fractures were not significantly different between treatment groups. INTERPRETATION In this long-term, pragmatic trial, incidence of cardiovascular events was similar with sulfonylureas (mostly glimepiride and gliclazide) and pioglitazone as add-on treatments to metformin. Both of these widely available and affordable treatments are suitable options with respect to efficacy and adverse events, although pioglitazone was associated with fewer hypoglycaemia events. FUNDING Italian Medicines Agency, Diabete Ricerca, and Italian Diabetes Society.
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Affiliation(s)
- Olga Vaccaro
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Del Prato
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Aldo P Maggioni
- National Association of Hospital Cardiologists (ANMCO) Research Center, Florence, Italy
| | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Carlo B Giorda
- Diabetes Unit, Azienda Sanitaria Locale (ASL) Torino 5, Torino, Italy
| | - Giorgio Sesti
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Paolo Mocarelli
- University Department Laboratory Medicine, Hospital of Desio, Monza, Italy
| | - Giuseppe Lucisano
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Michele Sacco
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Stefano Signorini
- University Department Laboratory Medicine, Hospital of Desio, Monza, Italy
| | | | | | | | | | - Giovanna Gregori
- Diabetes Unit, Massa Carrara, Azienda Unità Sanitarie Locali (USL) Toscana Nord Ovest, Carrara, Italy
| | - Carla Giordano
- Section of Endocrinology, Diabetology and Metabolic Diseases, University of Palermo, Palermo, Italy
| | - Laura Corsi
- Diabetes Unit, ASL 4 Chiavarese, Chiavari, Italy
| | | | - Gennaro Clemente
- Institute for Research on Population and Social Policies-National Research Council, Penta di Fisciano, Italy
| | | | - Rossella Iannarelli
- Diabetes Unit, Department of Medicine, San Salvatore Hospital, L'Aquila, Italy
| | - Renzo Cordera
- Diabetes Unit, School of Medicine, University of Genova, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Martino Hospital, Genova, Italy
| | - Olga La Macchia
- Endocrinology, Azienda Ospedaliero Universitaria Ospedali Riuniti, Foggia, Italy
| | | | - Cristiana Scaranna
- Endocrinology and Diabetology, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Massimo Boemi
- Diabetes and Metabolism Unit, IRCCS Istituto Nazionale Riposo e Cura Anziani, Ancona, Italy
| | - Ciro Iovine
- Diabetes Unit, University of Naples Federico II, Naples, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Sergio Leotta
- UOC Diabetologia Ospedale Sandro Pertini, Rome, Italy
| | | | | | - Laura Tonutti
- Endocrinology, Diabetes, Metabolism and Clinical Nutrition Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | | | | | - Francesco Dotta
- Diabetes Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Antonino Di Benedetto
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Citro
- Endocrinology and Diabetes Unit, Azienda Sanitaria Locale di Potenza, Potenza, Italy
| | | | | | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Endocrinology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Apulia, Italy
| | - Costanza Santini
- Department Endocrinology and Diabetology, Cesena Hospital, Cesena, Italy
| | - Agostino Gnasso
- Department of Clinical and Experimental Medicine, Magna Graecia University of Catanzaro, Italy
| | - Salvatore De Cosmo
- Unit of Internal Medicine, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Monica Vedovato
- Metabolism Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Agostino Consoli
- Department of Medicine and Aging Sciences, and Aging and Translational Medicine Research Center (CeSI-Met), D'Annunzio University, Chieti-Pescara, Italy
| | | | - Paolo di Bartolo
- Diabetes Unit, Ravenna Internal Medicine Department, Romagna Local Health Unit, Ravenna, Italy
| | - Paolo Fornengo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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11
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Amione C, Giunti S, Fornengo P, Soedamah-Muthu SS, Chaturvedi N, Fuller JH, Barutta F, Gruden G, Bruno G. Incidence of prolonged QTc and severe hypoglycemia in type 1 diabetes: the EURODIAB Prospective Complications Study. Acta Diabetol 2017. [PMID: 28634852 DOI: 10.1007/s00592-017-1018-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/24/2022]
Abstract
AIMS To assess the independent role of severe hypoglycemia on 7-year cumulative incidence of prolonged QTc in a large cohort of patients with type 1 diabetes. METHODS People with type 1 diabetes recruited by the EURODIAB Prospective Complications Study who had normal QTc were examined at baseline and after 7 years with standardized methods (n = 1415; mean age ± SD 32.1 ± 9.6 years; diabetes duration 14.2 ± 8.8 years). Hypoglycemic episodes were assessed by a questionnaire. QTc was calculated according to Bazett's formula. In logistic regression analysis, we examined the role of severe hypoglycemia (none, 1-2, or 3 and more episodes/year) on the cumulative incidence of prolonged QTc, independently of age, sex, HbA1c, blood pressure, BMI, physical activity, distal symmetrical and autonomic neuropathy. RESULTS In total, 264/1415 (17%) patients had incident prolonged QTc. Compared to those with persistently normal QTc, a greater proportion of incident cases had 3 and more hypoglycemic episodes at baseline (16.3 vs 11.2%, p = 0.03) and after 7 years (15.2 vs 9.6%, p = 0.01). In logistic regression analysis, 3 or more episodes of severe hypoglycemia at baseline did not increase cumulative incidence of prolonged QTc (OR 1.34, 95% CI 0.88-2.03). By contrast, severe hypoglycemia at the follow-up examination was associated with higher incidence of QTc prolongation (OR 1.68, 1.09-2.58), which reverted to not significant after adjustment for diabetic neuropathy. CONCLUSIONS Severe hypoglycemia was not associated with incidence QTc prolongation in type 1 diabetic patients from the EURODIAB PCS.
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Affiliation(s)
- Cristina Amione
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - Sara Giunti
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - Paolo Fornengo
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | | | - Nish Chaturvedi
- Department of Epidemiology and Public-Health, University College London, London, UK
| | - J H Fuller
- Department of Epidemiology and Public-Health, University College London, London, UK
| | - Federica Barutta
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - Gabriella Gruden
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - Graziella Bruno
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
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12
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Bosio A, Pallisco O, Monaco G, Fornengo P, De Feo C, Corgnier A, Ferretti G, Boccuzzi G, Vaudano GP, Pascale C. Giant aneurysm of circumflex coronary artery in asymptomatic patient. Ital J Med 2016. [DOI: 10.4081/itjm.2016.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report a case of a 74 years old woman presented to the hospital for fever and uncontrolled hypertension. We found, incidentally, a giant aneurysm of the circumflex coronary artery measuring 6.4 x 5.5 cm. We show suggestive CT scan images and multislice reconstructions and a review of the epidemiology, diagnosis and treatment of this condition.
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13
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Pinna G, Pascale C, Fornengo P, Arras S, Piras C, Panzarasa P, Carmosino G, Franza O, Semeraro V, Lenti S, Pietrelli S, Panzone S, Bracco C, Fiorini R, Rastelli G, Bergandi D, Zampaglione B, Musso R, Marengo C, Santoro G, Zamboni S, Traversa B, Barattini M, Bruno G. Hospital admissions for hypertensive crisis in the emergency departments: a large multicenter Italian study. PLoS One 2014; 9:e93542. [PMID: 24695800 PMCID: PMC3973569 DOI: 10.1371/journal.pone.0093542] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 03/04/2014] [Indexed: 12/20/2022] Open
Abstract
Epidemiological data on the impact of hypertensive crises (emergencies and urgencies) on referral to the Emergency Departments (EDs) are lacking, in spite of the evidence that they may be life-threatening conditions. We performed a multicenter study to identify all patients aged 18 years and over who were admitted to 10 Italian EDs during 2009 for hypertensive crises (systolic blood pressure ≥220 mmHg and/or diastolic blood pressure ≥120 mmHg). We classified patients as affected by either hypertensive emergencies or hypertensive urgencies depending on the presence or the absence of progressive target organ damage, respectively. Logistic regression analysis was then performed to assess variables independently associated with hypertensive emergencies with respect to hypertensive urgencies. Of 333,407 patients admitted to the EDs over the one-year period, 1,546 had hypertensive crises (4.6/1,000, 95% CI 4.4-4.9), and 23% of them had unknown hypertension. Hypertensive emergencies (n = 391, 25.3% of hypertensive crises) were acute pulmonary edema (30.9%), stroke (22.0%,), myocardial infarction (17.9%), acute aortic dissection (7.9%), acute renal failure (5.9%) and hypertensive encephalopathy (4.9%). Men had higher frequency than women of unknown hypertension (27.9% vs 18.5%, p<0.001). Even among known hypertensive patients, a larger proportion of men than women reported not taking anti-hypertensive drug (12.6% among men and 9.4% among women (p<0.001). Compared to women of similar age, men had higher likelihood of having hypertensive emergencies than urgencies (OR = 1.34, 95% CI 1.06-1.70), independently of presenting symptoms, creatinine, smoking habit and known hypertension. This study shows that hypertensive crises involved almost 5 out of 1,000 patients-year admitted to EDs. Sex differences in frequencies of unknown hypertension, compliance to treatment and risk of hypertensive emergencies might have implications for public health programs.
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Affiliation(s)
- Giuliano Pinna
- Department of Internal Medicine, Ospedale Cottolengo, Torino, Italy
| | - Claudio Pascale
- Department of Internal Medicine, Ospedale Cottolengo, Torino, Italy
| | - Paolo Fornengo
- Department of Medical Sciences, Univerity of Torino, Torino, Italy
| | | | - Carmela Piras
- Emergency Department, Ospedale Civile, Alghero, Sassari, Italy
| | | | | | - Orietta Franza
- Emergency Department, Ospedale Cardinal Massaia, Asti, Italy
| | | | | | | | - Sergio Panzone
- Emergency Department, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | - Christian Bracco
- Emergency Department, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | | | | | | | | | - Roberto Musso
- Emergency Department, Ospedale Santa Croce, Moncalieri, Italy, Torino, Italy
| | - Claudio Marengo
- Emergency Department, Ospedale Santa Croce, Moncalieri, Italy, Torino, Italy
| | | | | | - Barbara Traversa
- Emergency Department, Ospedale SS. Antonio e Margherita, Tortona, Italy
| | | | - Graziella Bruno
- Department of Medical Sciences, Univerity of Torino, Torino, Italy
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14
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Perotto M, Panero F, Gruden G, Fornengo P, Lorenzati B, Barutta F, Ghezzo G, Amione C, Cavallo-Perin P, Bruno G. Obesity is associated with lower mortality risk in elderly diabetic subjects: the Casale Monferrato study. Acta Diabetol 2013; 50:563-8. [PMID: 22068621 DOI: 10.1007/s00592-011-0338-1] [Citation(s) in RCA: 16] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 09/27/2011] [Indexed: 11/30/2022]
Abstract
The relationship between obesity and mortality in people with type 2 diabetes has not been definitely assessed. We have examined this issue in a well-characterized population-based cohort of Mediterranean diabetic people. Standardized anthropometric data from the population-based Casale Monferrato Study have been prospectively analyzed. The cohort included 1,475 people (62.6% aged ≥65 years) who had been recruited in 1991 and followed-up to December 31, 2006. Cox proportional hazards modeling was employed to estimate the independent associations between all-cause and cardiovascular mortality and BMI. Out of 1,475 people, 972 deaths occurred during a 15-year follow-up. Cox regression analyses showed that with respect to BMI <24.2 kg/m(2), values of 30.0 kg/m(2) and over were associated with lower all-cause and cardiovascular mortality risk (HR = 0.68, 95% CI 0.56-0.85, P for trend = 0.001; HR = 0.59, 0.44-0.80, P for trend = 0.002), independently of classical and new risk factors. As interaction between age and BMI was significant, we performed a stratified analysis by age, providing evidence that our finding was entirely due to a significant protective effect of BMI of 30.0 kg/m(2) and over in the elderly (all-cause mortality HR = 0.75, 95% CI 0.58-0.96; cardiovascular mortality HR = 0.67, 95% CI 0.45-0.95). In contrast, obesity was not significantly associated with mortality risk in diabetic subjects aged <65 years. Results were confirmed even excluding from the analysis individuals who died within 2 years of follow-up, smokers and those with CHD. In Mediterranean diabetic people aged ≥65 years, obesity is significantly associated with lower 15-year mortality risk. In contrast, it was not significantly associated with mortality risk in diabetic subjects aged <65 years. As more than two-thirds of people with type 2 diabetes are elderly, our findings, if confirmed, could have clinical implications.
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Affiliation(s)
- Massimo Perotto
- Department of Internal Medicine, University of Turin, Corso Dogliotti 14, I-10126, Turin, Italy
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15
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Gruden G, Barutta F, Catto I, Bosco G, Caprioli MG, Pinach S, Fornengo P, Cavallo-Perin P, Davini O, Cerrato P, Bruno G. Serum levels of heat shock protein 27 in patients with acute ischemic stroke. Cell Stress Chaperones 2013; 18:531-3. [PMID: 23334892 PMCID: PMC3682014 DOI: 10.1007/s12192-013-0403-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 01/03/2013] [Accepted: 01/04/2013] [Indexed: 11/26/2022] Open
Abstract
Expression of intracellular heat shock protein 27 (Hsp27) rises in the brain of animal models of cerebral ischemia and stroke. Hsp27 is also released into the circulation and the aim of the present study was to investigated if serum Hsp27 (sHsp27) levels are altered in patients with acute ischemic stroke. sHsp27 was measured in 15 patients with acute ischemic stroke and in 14 control subjects comparable for age, sex, and cardiovascular risk factors. In patients, measurements were performed at admission and 1, 2, and 30 days thereafter. At admission, mean sHsp27 values were threefold higher in patients than in controls. In patients, sHsp27 values dropped after 24 h, rose again at 48 h, and markedly declined at 30 days, indicating the presence of a temporal trend of sHsp27 values following acute ischemic stroke.
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Affiliation(s)
- Gabriella Gruden
- Department of Medical Science, University of Turin, Corso Dogliotti 14, Turin, Italy.
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16
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Giunti S, Gruden G, Fornengo P, Barutta F, Amione C, Ghezzo G, Cavallo-Perin P, Bruno G. Increased QT interval dispersion predicts 15-year cardiovascular mortality in type 2 diabetic subjects: the population-based Casale Monferrato Study. Diabetes Care 2012; 35:581-3. [PMID: 22301117 PMCID: PMC3322722 DOI: 10.2337/dc11-1397] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the predictive role of increased corrected QT (QTc) and QT interval dispersion (QTd) on all-cause and cardiovascular mortality in a large, unselected type 2 diabetic population. RESEARCH DESIGN AND METHODS The prospective study included 1,357 type 2 diabetic patients from the Casale Monferrato Study. At baseline, QTc intervals >0.44 s and QTd intervals >0.08 s were considered abnormally prolonged. Both all-cause and cardiovascular mortality were assessed 15 years after the baseline examination. RESULTS During the follow-up period, 862 subjects per 12,450 person-years died. Multivariate analysis showed that the hazard ratio (HR) of cardiovascular mortality was significantly increased in subjects with prolonged QTd (1.26 [95% CI 1.02-1.55]) and was only slightly reduced after multiple adjustments. Conversely, prolonged QTc did not increase the HRs for all-cause or cardiovascular mortality. CONCLUSIONS Increased QTd predicts cardiovascular mortality after a long-term follow-up period in a large, unselected population of type 2 diabetic subjects.
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Affiliation(s)
- Sara Giunti
- Department of Internal Medicine, University of Turin, Turin, Italy.
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17
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Panero F, Gruden G, Perotto M, Fornengo P, Barutta F, Greco E, Runzo C, Ghezzo G, Cavallo-Perin P, Bruno G. Uric acid is not an independent predictor of cardiovascular mortality in type 2 diabetes: a population-based study. Atherosclerosis 2011; 221:183-8. [PMID: 22239868 DOI: 10.1016/j.atherosclerosis.2011.11.042] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 11/25/2011] [Accepted: 11/30/2011] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Although some studies have suggested that uric acid is a risk factor for mortality, this relationship is still uncertain in people with type 2 diabetes. METHODS The study base was the population-based cohort of 1540 diabetic subjects (median age 68.9 years) of the Casale Monferrato Study. The role of serum uric acid on 15-years all-cause, cardiovascular and non-cardiovascular mortality was assessed by multivariate Cox proportional hazards modeling. RESULTS Baseline levels of serum uric acid were negatively correlated with HbA1c, were higher in men and in the elderly and were independently associated with components of the metabolic syndrome. Out of 14,179 person-years, 1000 deaths (514 due to cardiovascular diseases) were observed. Compared to the lower quartile of uric acid, HRs (95% CI) in the upper quartile were 1.47 (1.22-1.76) for all-cause mortality; 1.40 (1.09-1.80) for cardiovascular mortality and 1.50 (1.15-1.96) for non-cardiovascular mortality. In multiple adjusted models, however, HRs were 1.30 (1.06-1.60) for all-cause mortality, 1.13 (0.85-1.50) for cardiovascular mortality and 1.50 (1.11-2.02) for non-cardiovascular mortality (men 1.87, 1.19-2.95; women 1.20, 0.80-1.80); the latter appeared to be due to neoplastic diseases (HR in all combined quartiles vs. lower quartile: both sexes 1.59, 1.05-2.40; men 1.54, 0.83-2.84, women 1.68, 0.95-2.92). CONCLUSIONS In diabetic people, uric acid is associated with components of the metabolic syndrome but it may not be accounted as an independent risk factor for cardiovascular mortality. The increased all-cause mortality risk with higher levels of uric acid might be due to increased neoplastic mortality and deserves future studies.
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Affiliation(s)
- F Panero
- Department of Internal Medicine, University of Torino, Italy
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18
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Abstract
The pathophysiology of hyperglycemia in type 2 diabetes (T2DM) involves 3 main defects: insulin deficiency, excess hepatic glucose output, and insulin resistance. Oral anti-diabetic agents act in a variety of ways. These include agents that stimulate insulin secretion, reduce hepatic glucose production, delay digestion and absorption of intestinal carbohydrate or improve insulin action. Because of improved knowledge of pathophysiology, new drugs with mechanisms of action focussed on specific pathophysiological alterations have appeared, in order to utilize all the possibilities of treating this condition. Here, we focus on the new agents used in the latest years and the overcoming ones in future, in particular incretin-based therapies, drugs inhibiting kidney glucose reabsorption (SGLT2 inhibitors), and glucokinase activators. The strategy for new drug development advocated here is to establish a broad range of anti-diabetic medicines with different mechanisms of action and potential opportunities for effective combination therapies.
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Affiliation(s)
- Paolo Cavallo Perin
- Department of Internal Medicine, University of Torino, Corso AM Dogliotti 14, Turin, Italy.
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19
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Targher G, Bellis A, Fornengo P, Ciaravella F, Pichiri I, Cavallo Perin P, Trimarco B, Marchesini G. Prevention and treatment of nonalcoholic fatty liver disease. Dig Liver Dis 2010; 42:331-40. [PMID: 20207207 DOI: 10.1016/j.dld.2010.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [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: 01/25/2010] [Accepted: 02/01/2010] [Indexed: 12/11/2022]
Abstract
A better knowledge of the biochemical mechanisms implicated in the development and progression of nonalcoholic fatty liver disease, linking fatty liver to insulin resistance and the metabolic syndrome, has shifted the goal of treatment from a mere clearing of fat from the liver to a systematic treatment of metabolic risk factors for fatty liver. Any attempt to modify the "unhealthy" habits responsible for fatty liver requires an integrated approach, based on the cognitive theory of behaviour by a multidisciplinary team including physicians, psychologists, dieticians and physical exercise experts, and recent data demonstrate that this is feasible and effective. Whenever this goal is not attained, a treatment based on insulin-sensitizers remains the best option, to simultaneously tackle all metabolic alterations of the metabolic syndrome. However, in individual patients, both raised blood pressure and dyslipidemia need to be controlled, in order to reduce cardiovascular risk. In these areas, any attempt should be made to use of drugs less likely to induce a deterioration of glucose control. It remains to be determined whether these treatments are able to modify the natural history of nonalcoholic fatty liver disease in the long term.
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Affiliation(s)
- Giovanni Targher
- Sezione di Endocrinologia, Dipartimento di Scienze Biomediche e Chirurgiche, Università di Verona, Verona, Italy
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20
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Fornengo P, Novelli G, Bruno G, Perin PC. An unusual dysphagia. Eur J Cardiothorac Surg 2010; 37:961. [DOI: 10.1016/j.ejcts.2009.09.031] [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] [Received: 06/22/2009] [Revised: 09/07/2009] [Accepted: 09/10/2009] [Indexed: 10/20/2022] Open
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21
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Bruno G, Fornengo P, Novelli G, Panero F, Perotto M, Segre O, Zucco C, Deambrogio P, Bargero G, Perin PC. C-reactive protein and 5-year survival in type 2 diabetes: the Casale Monferrato Study. Diabetes 2009; 58:926-33. [PMID: 19074985 PMCID: PMC2661603 DOI: 10.2337/db08-0900] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [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] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine to what extent plasma C-reactive protein (CRP) values influence 5-year all-cause and cardiovascular mortality in type 2 diabetic individuals, independently of albumin excretion rate (AER) and other cardiovascular risk factors, and its incremental usefulness for predicting individual risk of mortality. RESEARCH DESIGN AND METHODS Measurements of CRP were performed in 2,381 of 3,249 (73.3%) subjects as part of the population-based Casale Monferrato Study. Its association with 5-year all-cause and cardiovascular mortality was assessed with multivariate Cox proportional hazards modeling. The C statistic and measures of calibration and global fit were also assessed. RESULTS Results are based on 496 deaths in 11.717 person-years of observations (median follow-up 5.4 years). With respect to subjects with CRP < or =3 mg/l, those with higher values had an adjusted hazard ratio (HR) of 1.51 (95% CI 1.18-1.92) for all-cause mortality and 1.44 (0.99-2.08) for cardiovascular mortality. In normoalbuminuric subjects, respective HRs of CRP were 1.56 (1.13-2.15) and 1.65 (1.00-2.74), AER being neither a modifier nor a confounder of CRP association. In analysis limited to diabetic subjects without cardiovascular disease (CVD), adjusted HRs were 1.67 (1.24-2.24) for all-cause mortality and 1.36 (0.83-2.24) for cardiovascular mortality. The improvement in individual risk assessment was marginal when measured with various statistical measures of model discrimination, calibration, and global fit. CONCLUSIONS CRP measurement is independently associated with short-term mortality risk in type 2 diabetic individuals, even in normoalbuminuric subjects and in those without a previous diagnosis of CVD. Its clinical usefulness in individual assessment of 5-year risk of mortality, however, is limited.
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Affiliation(s)
- Graziella Bruno
- Department of Internal Medicine, University of Torino, Torino, Italy.
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22
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Panero F, Novelli G, Zucco C, Fornengo P, Perotto M, Segre O, Grassi G, Cavallo-Perin P, Bruno G. Fasting plasma C-peptide and micro- and macrovascular complications in a large clinic-based cohort of type 1 diabetic patients. Diabetes Care 2009; 32:301-5. [PMID: 19017769 PMCID: PMC2628697 DOI: 10.2337/dc08-1241] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE A protective effect of residual beta-cell function on microvascular complications of type 1 diabetes has been suggested. Our aim was to retrospectively evaluate the association of fasting plasma C-peptide values with micro- and macrovascular complications. RESEARCH DESIGN AND METHODS We recruited a clinic-based cohort of 471 type 1 diabetic patients born after 1945 and cared for in the period 1994-2004. Centralized measurements and standardized procedures of ascertainment of micro- and macrovascular complications were employed. Individual cumulative averages of A1C up to 2007 were calculated. RESULTS Residual beta-cell secretion was detected even many years after diabetes diagnosis. In multivariate linear regression analysis, fasting plasma C-peptide values were positively associated with age at diagnosis (beta = 0.02; P < 0.0001) and triglycerides (beta = 0.20; P = 0.05) and inversely associated with diabetes duration (beta = -0.03; P < 0.0001) and HDL cholesterol (beta = -0.006; P = 0.03). The final model explained 21% of fasting C-peptide variability. With respect to fasting C-peptide values in the lowest tertile (<0.06 nmol/l), higher values were associated with lower prevalence of microvascular complications (odds ratio [OR] 0.59 [95% CI 0.37-0.94]) independently of age, sex, diabetes duration, individual cumulative A1C average during the study period, hypertension, and cardiovascular diseases. No association was evident with macrovascular complications (0.77 [0.38-1.58]). CONCLUSIONS Our study shows an independent protective effect of residual beta-cell function on the development of microvascular complications in type 1 diabetes, suggesting the potential beneficial effect of treatment that allows the preservation of even modest beta-cell function over time.
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Affiliation(s)
- Francesco Panero
- Department of Internal Medicine, University of Turin, Turin, Italy
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23
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Lentini A, Fornengo P, Bosco G, Caprioli M, Destefanis E, Cerrato P. Cryptogenic cerebral infarction in a young patient with very high lipoprotein(a) serum level as the only risk factor. Neurol Sci 2007; 28:42-4. [PMID: 17385095 DOI: 10.1007/s10072-007-0747-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Accepted: 12/27/2006] [Indexed: 11/24/2022]
Abstract
Lipoprotein(a) [Lp(a)] is a plasma lipoprotein that consists of a low-density lipoprotein (LDL)-like particle containing APO B-100 and apolipoprotein(a), linked by a disulphide bridge. There is evidence that higher serum level of Lp(a) is a predictor of various vascular diseases, such as myocardial infarction, coronary stenosis, re-occlusion of aortocoronary bypass vein grafts, peripheral atherosclerosis and cerebral infarction [1-4]. We describe a young man with a cryptogenic stroke with very high serum level of Lp(a) as the only vascular risk factor.
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Affiliation(s)
- A Lentini
- First Division of Neurology, Department of Neuroscience, University of Turin, Via Cherasco 15, I-10126 Turin, Italy.
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24
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Fornengo P, Bosio A, Epifani G, Pallisco O, Mancuso A, Pascale C. Prevalence of silent myocardial ischaemia in new-onset middle-aged Type 2 diabetic patients without other cardiovascular risk factors. Diabet Med 2006; 23:775-9. [PMID: 16842483 DOI: 10.1111/j.1464-5491.2006.01910.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [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] [Indexed: 11/26/2022]
Abstract
AIMS Coronary artery disease (CAD) is the leading cause of death in patients with Type 2 diabetes and is often asymptomatic. Silent myocardial ischaemia (SMI) is frequent in diabetic subjects and is responsible for a late diagnosis of CAD; its early detection is important. There are some data about the prevalence of SMI in Type 2 diabetic patients at high risk for cardiovascular disease, while no data are available in subjects at the onset of diabetes without other cardiovascular risk factors. METHODS We screened 274 consecutive patients (mean age 64.3 +/- 8.4 years, 66% male) at the time of diagnosis of Type 2 diabetes; we enrolled 111 subjects without other cardiovascular disease risk factors (dyslipidaemia, hypertension, peripheral vascular disease, retinopathy, microalbuminuria, history of heart disease) and with normal resting electrocardiogram (ECG). Participants performed a maximal ECG exercise protocol and, if positive, underwent coronary angiography. RESULTS The ECG exercise test was positive in 19 patients (17.1%); of those 14 (13%) had angiographic coronary disease (one with three-vessel disease, three with two vessels and 10 with one vessel involved). The positive predictive value of the exercise ECG for predicting angiographic coronary disease was 73%. CONCLUSIONS The prevalence of SMI was 17% and angiographic coronary disease was found in 13% of middle-aged subjects with new-onset Type 2 diabetes without other cardiovascular risk factors. This prevalence is similar to that observed in studies of subjects with long duration diabetes who have additional cardiovascular risk factors.
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Affiliation(s)
- P Fornengo
- Division of Internal Medicine and Service of Cardiology, Cottolengo Hospital, Turin, Italy.
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25
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Cerrato P, Baima C, Grasso M, Lentini A, Bosco G, Cassader M, Gambino R, Cavallo Perin P, Pagano G, Fornengo P, Imperiale D, Bergamasco B, Bruno G. Apolipoprotein E Polymorphism and Stroke Subtypes in an Italian Cohort. Cerebrovasc Dis 2005; 20:264-9. [PMID: 16123547 DOI: 10.1159/000087709] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2004] [Accepted: 06/07/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies have indicated that apolipoprotein E (ApoE)-epsilon4 is a risk factor for ischemic cerebrovascular diseases (ICVD), but the existence of this association is still controversial. The aims of this study were: (1) to compare ApoE genotype and allele frequencies in Italian cases with ICVD and in healthy control subjects and (2) to compare ApoE allele frequencies among ischemic stroke subtypes. METHODS A hospital-based cohort of 302 Italian subjects with ICVD and 228 healthy subjects have been recruited to investigate the role of ApoE polymorphisms as risk factors for ICVD. TOAST criteria were employed to stratify ICVD cases by subtypes. RESULTS No significant differences in ApoE genotype and allele frequencies were found between cases and control subjects. The frequency of ApoE-epsilon4 was lower in cases than in control subjects (6% vs. 10.1%), although not significantly. No differences in ApoE genotype and allele frequencies were evident among ICVD subtypes. However, out of 36 ApoE-epsilon4 alleles 23 (3.7%) were found in subjects with ICVD related to primary degenerative arterial disease related to large vessel disease and small vessel disease, and 13 (2.1%) in remaining subjects. Using logistic regression analysis we assessed whether ApoE-epsilon4 allele was independently associated with risk of ICVD related to a primary degenerative arterial disease compared to other ICVD subtypes. While classical risk factors were significantly associated with higher risk for ICVD due to large vessel disease and small vessel disease than other ICVD subtypes, the role of ApoE-epsilon4 allele was not significant (OR 1.25, 95% CI 0.57-2.74). CONCLUSION Our study shows similar ApoE-epsilon4 genotype and allele frequencies in patients with ICVD and in control subjects. No differences were found among different ICVD subtypes either.
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Affiliation(s)
- P Cerrato
- Department of Neuroscience, University of Turin, Turin, Italy.
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26
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De Micheli C, Fornengo P, Bosio A, Epifani G, Pascale C. Severe radiation-induced proctitis treated with botulinum anatoxin type A. J Clin Oncol 2003; 21:2627. [PMID: 12829690 DOI: 10.1200/jco.2003.99.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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28
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Cerrato P, Imperiale D, Fornengo P, Bruno G, Cassader M, Maffeis P, Cavallo Perin P, Pagano G, Bergamasco B. Higher lipoprotein (a) levels in atherothrombotic than lacunar ischemic cerebrovascular disease. Neurology 2002; 58:653-5. [PMID: 11865151 DOI: 10.1212/wnl.58.4.653] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To investigate the role of plasma lipid abnormalities in ischemic cerebrovascular disease related to primary vessel disease, the authors assess lipid profiles in a hospital-based cohort of 202 consecutive patients with atherothrombotic or lacunar stroke subtypes. Lipoprotein (a) was the unique lipid parameter that differs between these two subtypes being its value twofold higher in patients with atherothrombotic than in lacunar stroke. This suggests that lipoprotein (a) promotes large vessel atheromatosis rather than small vessel arteriolosclerosis and favors thrombosis on atheromatous plaques by suppressing local fibrinolysis.
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Affiliation(s)
- P Cerrato
- Department of Neuroscience, University of Turin, Torino, Italy.
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29
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Fornengo P, Bruno A, Gambino R, Cassader M, Pagano G. Severe hypertriglyceridemia in a patient with high plasma levels of apolipoprotein C II. ATHEROSCLEROSIS SUPP 2001. [DOI: 10.1016/s1567-5688(01)80426-8] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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30
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Fornengo P, Bruno G, De Salvia A, Arcari R, Pisu E, Pagano G. Low adherence of General Practitioners to National Cholesterol Education Program guidelines for the management of hyperlipidaemia. Diabetes Nutr Metab 2000; 13:263-8. [PMID: 11105968] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Aim of our study was to assess adherence to the National Cholesterol Education Program Adult-Treatment Panel II (NCEP-ATP II) in patients cared for by General Practitioners (GPs) in an Italian community. The design of the work was cross-sectional cohort study; the base was an unselected cohort of 1,168 patients cared for by GPs and screened at our lipid clinic in 1994-1995 in the Province of Turin (Italy). Blood samples were collected after 12-hr fast to measure plasma levels of total cholesterol, triglycerides, HDL-cholesterol, glucose and thyroid-stimulating hormone (TSH). LDL-cholesterol was calculated using Friedewald's formula. In patients with body mass index (BMI) >30 kg/m2, an oral glucose tolerance test was performed. Blood pressure was measured in all patients, and a baseline ECG or a stress test was performed in those with unknown cardiovascular disease (CVD), then they were classified following the NCEP-ATP II criteria. Primary hyperlipidaemia accounted for 86.9% of the cohort with most patients requiring pharmacological treatment; in 34.4% of the patients, LDL-cholesterol values were > or = 6.46 mmol/l (250 mg/dl) and in 23.7% with established CVD, LDL-cholesterol levels were > or = 5.68 mmol/l (220 mg/dl). In only 7.3% of patients the NCEP treatment goals were achieved, with 1.3% among those in secondary prevention. We observed great discrepancies between clinical practice and international recommendations for the management of hyperlipidaemia.
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Affiliation(s)
- P Fornengo
- Department of Internal Medicine, University of Turin, Torino, Italy
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31
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Fornengo P, Bruno A, Gambino R, Cassader M, Pagano G. Resistant hypertriglyceridemia in a patient with high plasma levels of apolipoprotein CII. Arterioscler Thromb Vasc Biol 2000; 20:2329-39. [PMID: 11031224 DOI: 10.1161/01.atv.20.10.2329] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pellacani A, Fornengo P, Bruno A, Ceruti C, Mioletti S, Curto M, Rinaudo MT, Pagano G, Cavallo-Perin P. Acute methylprednisolone administration induces a transient alteration of glucose tolerance and pyruvate dehydrogenase in humans. Eur J Clin Invest 1999; 29:861-7. [PMID: 10583428 DOI: 10.1046/j.1365-2362.1999.00553.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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] [Indexed: 11/20/2022]
Abstract
BACKGROUND Glucocorticoid administration induces alteration of glucose tolerance, and impairment of glucose oxidation may contribute to glucocorticoid-induced derangement of glucose metabolism. We investigated glucose tolerance following methylprednisolone administration in humans. In the same model, we evaluated pyruvate dehydrogenase (PDH), the rate limiting enzyme of glucose oxidation, in peripheral blood mononuclear cells. MATERIALS AND METHODS Methylprednisolone (2 x 40 mg, iv, one dose every 12 h) was administered to six healthy volunteers. Glucose tolerance was evaluated through an oral glucose tolerance test (oGTT, 75 g glucose) at least a week before and after drug administration (2 and 24 h post-drug). To assess modifications of lipid metabolism circulating free fatty acids (FFA) and glycerol were measured, during fasting and oGTT. The active form of PDH (PDHa) was evaluated in peripheral blood mononuclear cells, both as ex vivo activity and as in vitro response to insulin (30 pmol l-1). RESULTS Methylprednisolone induced an alteration of glucose tolerance 2 h after its administration. Such alteration was completely reversed at 24 h. Alteration of glucose tolerance was accompanied by decreased ex vivo PDHa activity. PDH responsiveness to insulin in vitro was also impaired. Circulating FFA were unmodified, but decreased glycerol levels suggested a slight inhibition of lipolysis. CONCLUSIONS Acute methylprednisolone administration in humans induced a transient decrease of glucose tolerance 2 h after drug administration, accompanied by hyperinsulinaemia, inhibition of ex vivo PDH activity and its response to insulin in vitro. These alterations were completely abolished at 24 h, suggesting that methylprednisolone can be safely administered acutely. Furthermore, methylprednisolone induced only minor modifications of circulating FFA and glycerol, indicating minimal impact on lipid metabolism.
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Affiliation(s)
- A Pellacani
- Department of Internal Medicine; University of Torino, Italy
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Fornengo P, Bruno A, Grassi G, Vineis P, Pagano G. Concordance between American Diabetes Association and World Health Organization criteria in a northwestern Italian population. Diabetes Care 1999; 22:652-3. [PMID: 10189553 DOI: 10.2337/diacare.22.4.652] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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