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Balducci S, Haxhi J, Sacchetti M, Orlando G, Cardelli P, Vitale M, Mattia L, Iacobini C, Bollanti L, Conti F, Zanuso S, Nicolucci A, Pugliese G, Pugliese G, Balducci S, Sacchetti M, Zanuso S, Cardelli P, Nicolucci A, Pugliese G, Ribaudo MC, Alessi E, Vitale M, Cirrito T, Bollanti L, Conti FG, Di Biase N, La Saracina F, Balducci S, Ranuzzi M, Haxhi J, D'Errico V, Sacchetti M, Orlando G, Milo L, Milo R, Balducci G, Spinelli E, Cardelli P, Cavallo S, Balducci S, Alessi E, Balducci G, Orlando G, Zanuso S, Cardelli P, Lucisano G. Relationships of Changes in Physical Activity and Sedentary Behavior With Changes in Physical Fitness and Cardiometabolic Risk Profile in Individuals With Type 2 Diabetes: The Italian Diabetes and Exercise Study 2 (IDES_2). Diabetes Care 2022; 45:213-221. [PMID: 34728529 DOI: 10.2337/dc21-1505] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 07/19/2021] [Accepted: 10/01/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In the Italian Diabetes and Exercise Study_2 (IDES_2), behavioral counseling promoted a sustained increase in physical activity (PA) volume (+3.3 MET h ⋅ week-1), moderate- to vigorous-intensity PA (MVPA) (+6.4 min ⋅ day-1), and light-intensity PA (LPA) (+0.8 h ⋅ day-1) and decrease in sedentary time (SED-time) (-0.8 h ⋅ day-1). Here, we investigated the relationships of changes in PA/SED-time with changes in physical fitness and cardiometabolic risk profile in individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS In this 3-year randomized clinical trial, 300 physically inactive and sedentary patients were randomized 1:1 to receive 1-month theoretical and practical counseling once a year or standard care. Changes in physical fitness and cardiovascular risk factors/scores according to quartiles of accelerometer-measured changes in PA/SED-time were assessed, together with univariate and multivariable associations between these parameters, in the whole cohort and by study arm. RESULTS Physical fitness increased and HbA1c and coronary heart disease 10-year risk scores decreased with quartiles of MVPA and SED-time change. In quartile IV of MVPA increase and SED-time decrease, cardiorespiratory fitness increased by 5.23 and 4.49 mL ⋅ min-1 ⋅ kg-1 and HbA1c decreased by 0.73 and 0.85%, respectively. Univariate correlations confirmed these relationships, and mean changes in both MPVA and SED-time predicted changes in physical fitness and cardiovascular risk factors/scores independently of one another and of other confounders. Similar findings were observed with LPA and PA volume and in each group separately. CONCLUSIONS Even modest increments in MVPA may have a clinically meaningful impact, and reallocating SED-time to LPA may also contribute to improved outcomes, possibly by increasing total energy expenditure.
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Affiliation(s)
- Stefano Balducci
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy.,3Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Jonida Haxhi
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy.,3Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Massimo Sacchetti
- 4Department of Human Movement and Sport Sciences, University of Rome "Foro Italico," Rome, Italy
| | - Giorgio Orlando
- 4Department of Human Movement and Sport Sciences, University of Rome "Foro Italico," Rome, Italy.,5Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, U.K
| | - Patrizia Cardelli
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,6Laboratory of Clinical Chemistry, Sant'Andrea University Hospital, Rome, Italy
| | - Martina Vitale
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Lorenza Mattia
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Carla Iacobini
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Lucilla Bollanti
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Francesco Conti
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Silvano Zanuso
- 7Center for Applied Biological and Exercise Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, U.K.,8Centre for Human Performance and Sport, University of Greenwich, Chatham Maritime, U.K
| | - Antonio Nicolucci
- 9Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy.,10Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, Italy
| | - Giuseppe Pugliese
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
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Zoppi S, Dondo A, Di Blasio A, Vitale N, Carfora V, Goria M, Chiavacci L, Giorgi I, D'Errico V, Irico L, Franco A, Battisti A. Livestock-Associated Methicillin-Resistant Staphylococcus aureus and Related Risk Factors in Holdings of Veal Calves in Northwest Italy. Microb Drug Resist 2021; 27:1136-1143. [PMID: 33570474 DOI: 10.1089/mdr.2020.0226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/18/2022] Open
Abstract
Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) have emerged worldwide as zoonotic pathogens. Data on LA-MRSA in veal calf production in Italy are lacking; the aim of this survey was to fill current knowledge gaps in its prevalence and characteristics. Between February 2012 and January 2013 nasal swabs were taken from 1650 three- to six-month-old veal calves on 55 farms in Piedmont (northwest Italy), including gathering-related epidemiological data. S. aureus were screened for methicillin resistance by phenotypic and molecular (mecA gene detection) methods. MRSA were further genotyped by multilocus sequence typing. About 30% of the herds tested positive for MRSA: three different clonal complexes (CC398, CC97, and CC1) and staphylococcal cassette chromosome mec types (IVa, IVb, and V) were detected. Multilevel logistic regression model indicated poor cleaning, importation from Austria, and animal age as risk factors and coagulase-negative staphylococci colonization as a predictive factor for the occurrence of MRSA. The detection of CCs circulating in pigs and dairy cattle in Italy underscores the ability of the LA-MRSA clones to spread among animal production systems. In addition to maintaining preventive control measures for human health, better cleaning procedures need to be implemented, especially after new calves have been introduced into the herd.
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Affiliation(s)
- Simona Zoppi
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Torino, Italy
| | - Alessandro Dondo
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Torino, Italy
| | - Alessia Di Blasio
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Torino, Italy
| | - Nicoletta Vitale
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Torino, Italy
| | - Virginia Carfora
- National Reference Laboratory for Antimicrobial Resistance, Department of General Diagnostics, Centro di Referenza Nazionale per l'Antibioticoresistenza, Istituto Zooprofilattico Sperimentale di Lazio e Toscana "M. Aleandri," Rome, Italy
| | - Maria Goria
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Torino, Italy
| | - Laura Chiavacci
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Torino, Italy
| | - Ilaria Giorgi
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Torino, Italy
| | - Valeria D'Errico
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Torino, Italy
| | - Lara Irico
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Torino, Italy
| | - Alessia Franco
- National Reference Laboratory for Antimicrobial Resistance, Department of General Diagnostics, Centro di Referenza Nazionale per l'Antibioticoresistenza, Istituto Zooprofilattico Sperimentale di Lazio e Toscana "M. Aleandri," Rome, Italy
| | - Antonio Battisti
- National Reference Laboratory for Antimicrobial Resistance, Department of General Diagnostics, Centro di Referenza Nazionale per l'Antibioticoresistenza, Istituto Zooprofilattico Sperimentale di Lazio e Toscana "M. Aleandri," Rome, Italy
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Ingravalle F, Ceballos LA, D'Errico V, Mirabelli D, Capella S, Belluso E, Pezzolato M, Bozzetta E, Dondo A, Di Blasio A, Meistro S, Vizio C, Fraccaro E, Ardizzone M, Seghesio A, Ru G. Wild rats as urban detectives for latent sources of asbestos contamination. Sci Total Environ 2020; 729:138925. [PMID: 32371204 DOI: 10.1016/j.scitotenv.2020.138925] [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] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/09/2020] [Accepted: 04/21/2020] [Indexed: 06/11/2023]
Abstract
Based on a large body of evidence asbestos minerals have been classified as carcinogens. Despite the Italian ban on asbestos in 1992 and the subsequent remediation activities, latent sources of contamination may still represent a hazard where asbestos were particularly used. Using wild rats as sentinel animals, this study aimed at uncovering sites with the greatest potential for non-occupational exposure to asbestos in the city of Casale Monferrato (Piedmont Region, Italy), where the largest Italian manufacturing plant of asbestos-cement had been active. During the study period (2013-2015) a total of 40 wild rats were captured from 16 sampling capture points. The lungs of wild rats have been investigated by using scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS). The SEM-EDS detected the presence of asbestos fibers (tremolite/actinolite, amosite, and chrysotile) in rats' lungs from 11 sampling points. The hypothetical rats' home-range and the observed site-specific concentration of asbestos fibers per gram of dry lung tissue were used to identify areas to be targeted by additional search of latent sources of asbestos. In conclusion, our results showed that the use of wild rats as sentinel animals may effectively integrate the strategies currently in use to reduce the exposure to asbestos.
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Affiliation(s)
- F Ingravalle
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Turin, Italy
| | - L A Ceballos
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Turin, Italy.
| | - V D'Errico
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Turin, Italy; SC Sanità animale, ASL TO5, Turin, Italy
| | - D Mirabelli
- Azienda Ospedaliero-Universitaria San Giovanni Battista di Torino, SCDU Epidemiologia Tumori, Turin, Italy
| | - S Capella
- Università degli Studi di Torino, Dipartimento di Scienze della Terra and Centro Interdipartimentale per lo Studio degli Amianti e di altri Particolati Nocivi "G. Scansetti", Turin, Italy
| | - E Belluso
- Università degli Studi di Torino, Dipartimento di Scienze della Terra and Centro Interdipartimentale per lo Studio degli Amianti e di altri Particolati Nocivi "G. Scansetti", Turin, Italy
| | - M Pezzolato
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Turin, Italy
| | - E Bozzetta
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Turin, Italy
| | - A Dondo
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Turin, Italy
| | - A Di Blasio
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Turin, Italy
| | - S Meistro
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Turin, Italy
| | - C Vizio
- Azienda Ospedaliero-Universitaria San Giovanni Battista di Torino, SCDU Epidemiologia Tumori, Turin, Italy; Cella Monte, Alessandria, Italy
| | - E Fraccaro
- Azienda Ospedaliero-Universitaria San Giovanni Battista di Torino, SCDU Epidemiologia Tumori, Turin, Italy
| | - M Ardizzone
- Azienda Ospedaliero-Universitaria San Giovanni Battista di Torino, SCDU Epidemiologia Tumori, Turin, Italy; European Food Safety Authority (EFSA), Parma, Italy
| | - A Seghesio
- Presidio Multizonale di Profilassi e Polizia Veterinaria di Alessandria ed Asti, Alessandria, Italy
| | - G Ru
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Turin, Italy
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4
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Orlando G, Sacchetti M, D'Errico V, Haxhi J, Rapisarda G, Pugliese G, Balducci S. Muscle fatigability in patients with type 2 diabetes: relation with long-term complications. Diabetes Metab Res Rev 2020; 36:e3231. [PMID: 31670895 DOI: 10.1002/dmrr.3231] [Citation(s) in RCA: 6] [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: 04/02/2019] [Revised: 06/27/2019] [Accepted: 10/13/2019] [Indexed: 12/20/2022]
Abstract
AIMS It is unclear whether long-term complications play a role in muscle fatigue characteristic of patients with type 2 diabetes mellitus (T2DM). The purpose of this study was to investigate the association between muscle fatigability and microvascular and macrovascular complications in patients with T2DM. METHODS One-hundred forty-six patients with T2DM (80 males, 66 females, aged 66.9 ± 7.9 years) were recruited. Maximal voluntary contraction (MCV) and endurance time (ET, 50% of the MVC) were assessed at the knee extensor muscles with an isometric dynamometer. Univariate and multivariate correlations of ET values with diabetic complications, a wide range of surrogate measures of these sequelae, and cardiovascular risk factors were examined. RESULTS A higher muscle fatigability was detected in patients with diabetic peripheral neuropathy (DPN, ET: -32.4%), cardiovascular disease (CVD, ET: -32.1%), retinopathy (ET: -35.8%), and nephropathy (ET: -30.4%). At univariate analysis, muscle fatigability was associated with age, physical activity level, diabetes duration, HbA1c , systolic blood pressure, albuminuria, eGFR, and several parameters of nervous and vascular function. Multivariate analysis showed that, after adjusting for covariates, ET was independently associated with sensory nerve conduction velocity, vibration perception threshold at malleolus, and ankle-brachial index. In addition, ET values were independently associated with the presence of DPN, CVD, and retinopathy. CONCLUSIONS In T2DM, muscle fatigability is associated with presence of DPN, CVD, and retinopathy. Such defect appears to be mediated predominantly by sensory nerve and peripheral vascular dysfunction.
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Affiliation(s)
- Giorgio Orlando
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Massimo Sacchetti
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | | | - Jonida Haxhi
- Department of Clinical and Molecular Medicine, La Sapienza University, and Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Gianvito Rapisarda
- Department of Clinical and Molecular Medicine, La Sapienza University, and Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, La Sapienza University, and Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Stefano Balducci
- Department of Clinical and Molecular Medicine, La Sapienza University, and Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
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5
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Bianchi DM, Giorgi I, Zuccon F, Somma DD, D'Errico V, Martelli W, Muzzani A, Soncin V, Collarino S, Adriano D, Decastelli L. Evaluation of the efficacy of a training course in food safety addressed to food charity volunteers. Ital J Food Saf 2019; 8:8316. [PMID: 31897399 PMCID: PMC6912145 DOI: 10.4081/ijfs.2019.8316] [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: 06/11/2019] [Accepted: 10/16/2019] [Indexed: 11/23/2022] Open
Abstract
In Italy, the Banco Alimentare Onlus manages a network of 8,000 charitable organizations that distribute 67,000 tons of foodstuffs to 1.6 million needy persons. To provide their volunteers with the required food safety knowledge, the Banco Alimentare del Piemonte Onlus commissioned the Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d’Aosta to hold training courses in food safety. Before and after each session, the participants completed a questionnaire to evaluate their knowledge on the topic of food safety. The responses were entered in a dedicated database and analyzed using STATA ver. 15.1. Comparison of the scores for each participant before and after training revealed a considerable discordance [ICC 0.06, 95% confidence interval (CI) 0.00-0.18]. Analysis of the post-training questionnaires showed that the number of questions left unanswered decreased and the number of correct answers increased. The difference between the percentage of correct and incorrect responses before and after the training course was statistically significant (P<0.001). Comparison of responses to the pre- and post-training questionnaires provided the data for statistical evaluation of the efficacy of the training course.
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Affiliation(s)
| | - Ilaria Giorgi
- Biostatistics Epidemiology and Risk Analysis Unit, The Veterinary Medical Research Institute for Piedmont, Liguria and the Aosta Valley, Turin
| | | | - Donatella De Somma
- Biostatistics Epidemiology and Risk Analysis Unit, The Veterinary Medical Research Institute for Piedmont, Liguria and the Aosta Valley, Turin
| | - Valeria D'Errico
- Biostatistics Epidemiology and Risk Analysis Unit, The Veterinary Medical Research Institute for Piedmont, Liguria and the Aosta Valley, Turin
| | - Walter Martelli
- Biostatistics Epidemiology and Risk Analysis Unit, The Veterinary Medical Research Institute for Piedmont, Liguria and the Aosta Valley, Turin
| | | | - Vilma Soncin
- Banco Alimentare Piemonte Onlus, Moncalieri, Italy
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Balducci S, Conti F, Sacchetti M, Russo CR, Argento G, Haxhi J, Orlando G, Rapisarda G, D'Errico V, Cardelli P, Pugliese L, Laghi A, Vitale M, Bollanti L, Zanuso S, Nicolucci A, Pugliese G. Study to Weigh the Effect of Exercise Training on BONE quality and strength (SWEET BONE) in type 2 diabetes: study protocol for a randomised clinical trial. BMJ Open 2019; 9:e027429. [PMID: 31690602 PMCID: PMC6858163 DOI: 10.1136/bmjopen-2018-027429] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 09/13/2019] [Accepted: 10/11/2019] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) is associated with an increased fracture risk despite normal-to-increased bone mineral density, suggesting reduced bone quality. Exercise may be effective in reducing fracture risk by ameliorating muscle dysfunction and reducing risk of fall, though it is unclear whether it can improve bone quality. METHODS AND ANALYSIS The 'Study to Weigh the Effect of Exercise Training on BONE quality and strength (SWEET BONE) in T2D' is an open-label, assessor-blinded, randomised clinical trial comparing an exercise training programme of 2-year duration, specifically designed for improving bone quality and strength, with standard care in T2D individuals. Two hundred T2D patients aged 65-75 years will be randomised 1:1 to supervised exercise training or standard care, stratified by gender, age ≤ or >70 years and non-insulin or insulin treatment. The intervention consists of two weekly supervised sessions, each starting with 5 min of warm-up, followed by 20 min of aerobic training, 30 min of resistance training and 20 min of core stability, balance and flexibility training. Participants will wear weighted vests during aerobic and resistance training. The primary endpoint is baseline to end-of-study change in trabecular bone score, a parameter of bone quality consistently shown to be reduced in T2D. Secondary endpoints include changes in other potential measures of bone quality, as assessed by quantitative ultrasound and peripheral quantitative CT; bone mass; markers of bone turnover; muscle strength, mass and power; balance and gait. Falls and asymptomatic and symptomatic fractures will be evaluated over 7 years, including a 5-year post-trial follow-up. The superiority of the intervention will be assessed by comparing between-groups baseline to end-of-study changes. ETHICS AND DISSEMINATION This study was approved by the institutional ethics committee. Written informed consent will be obtained from all participants. The study results will be submitted for peer-reviewed publication. TRIAL REGISTRATION NUMBER NCT02421393; Pre-results.
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Affiliation(s)
- Stefano Balducci
- Department of Clinical and Molecular Medicine, La Sapienza University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Francesco Conti
- Department of Clinical and Molecular Medicine, La Sapienza University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Massimo Sacchetti
- Department of Human Movement and Sport Sciences, Foro Italico University, Rome, Italy
| | | | | | - Jonida Haxhi
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
- Department of Human Movement and Sport Sciences, Foro Italico University, Rome, Italy
| | - Giorgio Orlando
- Department of Human Movement and Sport Sciences, Foro Italico University, Rome, Italy
- School of Healthcare Science, Faculty of Science & Engineering, Manchester Metropolitan University, Manchester, UK
| | - Gianvito Rapisarda
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Valeria D'Errico
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Patrizia Cardelli
- Department of Clinical and Molecular Medicine, La Sapienza University, Rome, Italy
- Laboratory of Clinical Chemistry, Sant'Andrea University Hospital, Rome, Italy
| | - Luca Pugliese
- Radiology Unit, Sant'Andrea University Hospital, Rome, Italy
- Department of Diagnostic Imaging, "Tor Vergata" University, Rome, Italy
| | - Andrea Laghi
- Radiology Unit, Sant'Andrea University Hospital, Rome, Italy
- Department of Radiological Sciences, Oncology and Pathology, ''La Sapienza'' University, Rome, Italy
| | - Martina Vitale
- Department of Clinical and Molecular Medicine, La Sapienza University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Lucilla Bollanti
- Department of Clinical and Molecular Medicine, La Sapienza University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Silvano Zanuso
- Centre for Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | - Antonio Nicolucci
- Centre for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, La Sapienza University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
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7
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Maurella C, Gallina S, Ru G, Adriano D, Bellio A, Bianchi DM, Chiavacci L, Crescio MI, Croce M, D'Errico V, Dupont MF, Marra A, Natangelo U, Pomilio F, Romano A, Stanzione S, Zaccaria T, Zuccon F, Caramelli M, Decastelli L. Outbreak of febrile gastroenteritis caused by Listeria monocytogenes 1/2a in sliced cold beef ham, Italy, May 2016. ACTA ACUST UNITED AC 2019. [PMID: 29536831 PMCID: PMC5850591 DOI: 10.2807/1560-7917.es.2018.23.10.17-00155] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In May 2016, two separate clusters of febrile gastroenteritis caused by Listeria monocytogenes were detected by the local health authority in Piedmont, in northern Italy. We carried out epidemiological, microbiological and traceback investigations to identify the source. The people affected were students and staff members from two different schools in two different villages located in the Province of Turin; five of them were hospitalised. The epidemiological investigation identified a cooked beef ham served at the school canteens as the source of the food-borne outbreak. L. monocytogenes was isolated from the food, the stools of the hospitalised pupils and the environment of the factory producing the cooked beef ham. All isolates except one were serotype 1/2a, shared an indistinguishable PFGE pattern and were 100% identical by whole genome sequencing (WGS). By combining a classical epidemiological approach with both molecular subtyping and WGS techniques, we were able to identify and confirm a Listeria gastroenteritis outbreak associated with consumption of sliced cold beef ham.
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Affiliation(s)
- Cristiana Maurella
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, Turin, Italy
| | - Silvia Gallina
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, Turin, Italy
| | - Giuseppe Ru
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, Turin, Italy
| | - Daniela Adriano
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, Turin, Italy
| | - Alberto Bellio
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, Turin, Italy
| | - Daniela Manila Bianchi
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, Turin, Italy
| | - Laura Chiavacci
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, Turin, Italy
| | - Maria Ines Crescio
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, Turin, Italy
| | - Margherita Croce
- Igiene degli Alimenti e della Nutrizione (Food hygien and Nutrition Service) Local Health Unit TO4, Ciriè, Italy
| | - Valeria D'Errico
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, Turin, Italy
| | - Maria Franca Dupont
- Igiene degli Alimenti e della Nutrizione (Food hygien and Nutrition Service) Local Health Unit TO4, Ciriè, Italy
| | - Alessandro Marra
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, Turin, Italy
| | - Ubaldo Natangelo
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, Turin, Italy
| | - Francesco Pomilio
- Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise, National Reference Centre for Listeria monocytogenes, Teramo, Italy
| | - Angelo Romano
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, Turin, Italy
| | - Stefano Stanzione
- Igiene degli Alimenti e della Nutrizione (Food hygien and Nutrition Service) Local Health Unit TO4, Ciriè, Italy
| | - Teresa Zaccaria
- Laboratorio Microbiologia e Virologia U Città della Salute di Torino, Turin, Italy
| | - Fabio Zuccon
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, Turin, Italy
| | - Maria Caramelli
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, Turin, Italy
| | - Lucia Decastelli
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, Turin, Italy
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Balducci S, D'Errico V, Haxhi J, Sacchetti M, Orlando G, Cardelli P, Vitale M, Bollanti L, Conti F, Zanuso S, Lucisano G, Nicolucci A, Pugliese G. Effect of a Behavioral Intervention Strategy on Sustained Change in Physical Activity and Sedentary Behavior in Patients With Type 2 Diabetes: The IDES_2 Randomized Clinical Trial. JAMA 2019; 321:880-890. [PMID: 30835309 DOI: 10.1001/jama.2019.0922] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [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: 01/01/2023]
Abstract
IMPORTANCE There is no definitive evidence that changes in physical activity/sedentary behavior can be maintained long term in individuals with type 2 diabetes. OBJECTIVE To investigate whether a behavioral intervention strategy can produce a sustained increase in physical activity and reduction in sedentary time among individuals with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS The Italian Diabetes and Exercise Study 2 was an open-label, assessor-blinded, randomized clinical superiority trial, with recruitment from October 2012 to February 2014 and follow-up until February 2017. In 3 outpatient diabetes clinics in Rome, 300 physically inactive and sedentary patients with type 2 diabetes were randomized 1:1 (stratified by center, age, and diabetes treatment) to receive a behavioral intervention or standard care for 3 years. INTERVENTIONS All participants received usual care targeted to meet American Diabetes Association guideline recommendations. Participants in the behavioral intervention group (n = 150) received 1 individual theoretical counseling session and 8 individual biweekly theoretical and practical counseling sessions each year. Participants in the standard care group (n = 150) received only general physician recommendations. MAIN OUTCOMES AND MEASURES Co-primary end points were sustained change in physical activity volume, time spent in light-intensity and moderate- to vigorous-intensity physical activity, and sedentary time, measured by an accelerometer. RESULTS Of the 300 randomized participants (mean [SD] age, 61.6 [8.5] years; 116 women [38.7%]), 267 completed the study (133 in the behavioral intervention group and 134 in the standard care group). Median follow-up was 3.0 years. Participants in the behavioral intervention and standard care groups accumulated, respectively, 13.8 vs 10.5 metabolic equivalent-h/wk of physical activity volume (difference, 3.3 [95% CI, 2.2-4.4]; P < .001), 18.9 vs 12.5 min/dof moderate- to vigorous-intensity physical activity (difference, 6.4 [95% CI, 5.0-7.8]; P < .001), 4.6 vs 3.8 h/d of light-intensity physical activity (difference, 0.8 [95% CI, 0.5-1.1]; P < .001), and 10.9 vs 11.7 h/d of sedentary time (difference, -0.8 [95% CI, -1.0 to -0.5]; P < .001). Significant between-group differences were maintained throughout the study, but the between-group difference in moderate- to vigorous-intensity physical activity decreased during the third year from 6.5 to 3.6 min/d. There were 41 adverse events in the behavioral intervention group and 59 in the standard care group outside of the sessions; participants in the behavioral intervention group experienced 30 adverse events during the sessions (most commonly musculoskeletal injury/discomfort and mild hypoglycemia). CONCLUSIONS AND RELEVANCE Among patients with type 2 diabetes at 3 diabetes clinics in Rome who were followed up for 3 years, a behavioral intervention strategy compared with standard care resulted in a sustained increase in physical activity and decrease in sedentary time. Further research is needed to assess the generalizability of these findings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01600937.
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Affiliation(s)
- Stefano Balducci
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Valeria D'Errico
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Jonida Haxhi
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Massimo Sacchetti
- Department of Human Movement and Sport Sciences, ''Foro Italico'' University, Rome, Italy
| | - Giorgio Orlando
- Department of Human Movement and Sport Sciences, ''Foro Italico'' University, Rome, Italy
| | - Patrizia Cardelli
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Laboratory of Clinical Chemistry, Sant'Andrea University Hospital, Rome, Italy
| | - Martina Vitale
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Lucilla Bollanti
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Francesco Conti
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Silvano Zanuso
- Centre for Human Performance and Sport, University of Greenwich, Chatham Maritime, United Kingdom
- Currently with Center for Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, United Kingdom
| | - Giuseppe Lucisano
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, Italy
- Currently with Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Antonio Nicolucci
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, Italy
- Currently with Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
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Balducci S, D'Errico V, Haxhi J, Sacchetti M, Orlando G, Cardelli P, Vitale M, Bollanti L, Conti F, Zanuso S, Nicolucci A, Pugliese G. Effect of a Behavioral Intervention Strategy for Adoption and Maintenance of a Physically Active Lifestyle: The Italian Diabetes and Exercise Study 2 (IDES_2): A Randomized Controlled Trial. Diabetes Care 2017; 40:1444-1452. [PMID: 28821576 DOI: 10.2337/dc17-0594] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 03/24/2017] [Accepted: 07/23/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Adherence to physical activity (PA) recommendations is hampered by the lack of effective strategies to promote behavior change. The Italian Diabetes and Exercise Study 2 (IDES_2) is a randomized controlled trial evaluating a novel behavioral intervention strategy for increasing PA and decreasing sedentary time (SED-time) in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS The study randomized 300 physically inactive and sedentary patients with type 2 diabetes 1:1 to receive theoretical and practical counseling once yearly for 3 years (intervention group [INT]) or standard care (control group [CON]). Here, we report the 4-month effects on objectively (accelerometer) measured daily light-intensity PA (LPA), moderate-to-vigorous-intensity PA (MVPA), and SED-time, and cardiovascular risk factors. RESULTS LPA and MVPA both increased, and SED-time decreased in both groups, although changes were significantly more marked in INT participants (approximately twofold for LPA and SED-time and approximately sixfold for MVPA). A significant reduction in HbA1c was observed only in INT subjects. An increase in LPA >0.92 h · day-1 and in MVPA >7.33 min · day-1 and a decrease in SED-time >1.05 h · day-1 were associated with an average decrease in HbA1c of ∼1% and also with significant improvements in fasting glucose, body weight, waist circumference, and hs-CRP. Changes in PA and SED-time were independent predictors of improvements in HbA1c. CONCLUSIONS This behavioral intervention is effective in the short term for increasing LPA and MVPA and reducing SED-time. Significant improvements in cardiometabolic risk profiles were observed in subjects experiencing the most pronounced changes in PA and SED-time, even if below the recommended level.
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Affiliation(s)
- Stefano Balducci
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy.,Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.,Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Valeria D'Errico
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy.,Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.,Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Jonida Haxhi
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy.,Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.,Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Massimo Sacchetti
- Department of Human Movement and Sport Sciences, ''Foro Italico'' University, Rome, Italy
| | - Giorgio Orlando
- Department of Human Movement and Sport Sciences, ''Foro Italico'' University, Rome, Italy
| | - Patrizia Cardelli
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy.,Laboratory of Clinical Chemistry, Sant'Andrea Hospital, Rome, Italy
| | - Martina Vitale
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy.,Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
| | - Lucilla Bollanti
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy.,Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
| | - Francesco Conti
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy.,Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
| | - Silvano Zanuso
- Center for Applied Biological and Exercise Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, U.K
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy .,Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
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Santoboni F, Balducci S, D'Errico V, Haxhi J, Vetrano M, Piccinini G, Ferretti A, Pugliese G, Vulpiani MC. Extracorporeal Shockwave Therapy Improves Functional Outcomes of Adhesive Capsulitis of the Shoulder in Patients With Diabetes. Diabetes Care 2017; 40:e12-e13. [PMID: 27899492 DOI: 10.2337/dc16-2063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 09/26/2016] [Accepted: 10/28/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Flavia Santoboni
- Department of Medical and Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Rome, Italy.,Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, Rome, Italy
| | - Stefano Balducci
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.,Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.,Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Valeria D'Errico
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.,Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.,Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Jonida Haxhi
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.,Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.,Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Mario Vetrano
- Department of Medical and Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Rome, Italy.,Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, Rome, Italy
| | - Giulia Piccinini
- Department of Medical and Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Rome, Italy.,Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, Rome, Italy
| | - Andrea Ferretti
- Department of Medical and Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Rome, Italy.,Orthopaedic Unit and Kirk Kilgour Sports Injury Center, Sant'Andrea Hospital, Rome, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.,Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
| | - Maria Chiara Vulpiani
- Department of Medical and Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Rome, Italy .,Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, Rome, Italy
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Conti F, Balducci S, Pugliese L, D'Errico V, Vitale M, Alessi E, Salerno G, Iacobini C, Menini S, Bollanti L, Nicolucci A, Pugliese G. Correlates of Calcaneal Quantitative Ultrasound Parameters in Patients with Diabetes: The Study on the Assessment of Determinants of Muscle and Bone Strength Abnormalities in Diabetes. J Diabetes Res 2017; 2017:4749619. [PMID: 29057273 PMCID: PMC5625809 DOI: 10.1155/2017/4749619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/12/2017] [Accepted: 07/19/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Quantitative ultrasound (QUS) provides an estimate of bone mineral density (BMD) and also evaluates bone quality, which has been related to increased fracture risk in people with diabetes. This study aimed at assessing the correlates of calcaneal QUS parameters in diabetic subjects encompassing various degrees of micro and macrovascular complications and a wide-range of peripheral nerve function. METHODS Four hundred consecutive diabetic patients were examined by QUS to obtain values of broadband ultrasound attenuation (BUA), the speed of sound (SOS), quantitative ultrasound index (QUI), and BMD. RESULTS Among surrogate measures of complications, sensory and motor nerve amplitude and heart rate response to cough test and standing correlated with QUS parameters at univariate analysis, together with age, body mass index (BMI), waist circumference, lipid profile, and renal function. Multivariate analysis revealed that BUA, SOS, QUI, and BMD were independently associated with age, male gender, hemoglobin A1c, BMI (or fat, but not fat-free mass), and somatic and autonomic nerve function parameters. CONCLUSIONS These data indicate that peripheral nerve dysfunction is associated with worse QUS parameters, possibly contributing to increased fracture risk in diabetes. The positive relation of QUS measures with adiposity needs further investigation. This trial is registered with ClinicalTrials.gov (NCT01600924).
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MESH Headings
- Adiposity
- Age Factors
- Aged
- Autonomic Nervous System/physiopathology
- Biomarkers/blood
- Body Mass Index
- Bone Density
- Calcaneus/diagnostic imaging
- Calcaneus/physiopathology
- Chi-Square Distribution
- Cross-Sectional Studies
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/diagnostic imaging
- Diabetes Mellitus, Type 1/physiopathology
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/diagnostic imaging
- Diabetes Mellitus, Type 2/physiopathology
- Diabetic Neuropathies/diagnosis
- Diabetic Neuropathies/etiology
- Diabetic Neuropathies/physiopathology
- Female
- Fractures, Bone/diagnosis
- Fractures, Bone/etiology
- Fractures, Bone/physiopathology
- Glycated Hemoglobin/analysis
- Humans
- Linear Models
- Male
- Middle Aged
- Multivariate Analysis
- Predictive Value of Tests
- Prospective Studies
- Risk Factors
- Sex Factors
- Ultrasonography
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Affiliation(s)
- Francesco Conti
- Department of Clinical and Molecular Medicine, “La Sapienza” University, Via di Grottarossa 1035, 00189 Rome, Italy
- Diabetes Unit, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Stefano Balducci
- Department of Clinical and Molecular Medicine, “La Sapienza” University, Via di Grottarossa 1035, 00189 Rome, Italy
- Diabetes Unit, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
- Metabolic Fitness Association, Via Nomentana 27, Monterotondo, 00015 Rome, Italy
| | - Luca Pugliese
- Radiology Unit, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Valeria D'Errico
- Department of Clinical and Molecular Medicine, “La Sapienza” University, Via di Grottarossa 1035, 00189 Rome, Italy
- Diabetes Unit, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
- Metabolic Fitness Association, Via Nomentana 27, Monterotondo, 00015 Rome, Italy
| | - Martina Vitale
- Department of Clinical and Molecular Medicine, “La Sapienza” University, Via di Grottarossa 1035, 00189 Rome, Italy
- Diabetes Unit, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Elena Alessi
- Department of Clinical and Molecular Medicine, “La Sapienza” University, Via di Grottarossa 1035, 00189 Rome, Italy
- Diabetes Unit, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Gerardo Salerno
- Department of Clinical and Molecular Medicine, “La Sapienza” University, Via di Grottarossa 1035, 00189 Rome, Italy
- Laboratory of Clinical Chemistry, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Carla Iacobini
- Department of Clinical and Molecular Medicine, “La Sapienza” University, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Stefano Menini
- Department of Clinical and Molecular Medicine, “La Sapienza” University, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Lucilla Bollanti
- Department of Clinical and Molecular Medicine, “La Sapienza” University, Via di Grottarossa 1035, 00189 Rome, Italy
- Diabetes Unit, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Via Tiziano Vecellio 2, 65124 Pescara, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, “La Sapienza” University, Via di Grottarossa 1035, 00189 Rome, Italy
- Diabetes Unit, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
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12
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Zanuso S, Bergamin M, Jimenez A, Pugliese G, D'Errico V, Nicolucci A, Ermolao A, Balducci S. Determination of metabolic equivalents during low- and high-intensity resistance exercise in healthy young subjects and patients with type 2 diabetes. Biol Sport 2016; 33:77-82. [PMID: 26929474 PMCID: PMC4763546 DOI: 10.5604/20831862.1194124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 10/01/2014] [Revised: 01/06/2015] [Accepted: 08/27/2015] [Indexed: 11/15/2022] Open
Abstract
The purpose of this study was to quantify the metabolic equivalents (METs) of resistance exercise in obese patients with type 2 diabetes (T2DM) and healthy young subjects and to evaluate whether there were differences between sessions executed at low- versus high-intensity resistance exercise. Twenty obese patients with T2DM (62.9±6.1 years) and 22 young subjects (22.6±1.9 years) performed two training sessions: one at vigorous intensity (80% of 1-repetition maximum (1RM)) and one at moderate intensity (60% of 1RM). Both groups carried out three strength exercises with a 2-day recovery between sessions. Oxygen consumption was continuously measured 15 min before, during and after each training session. Obese T2DM patients showed lower METs values compared with young healthy participants at the baseline phase (F= 2043.86; P<0.01), during training (F=1140.59; P<0.01) and in the post-exercise phase (F=1012.71; P<0.01). No effects were detected in the group x intensity analysis of covariance. In this study, at both light-moderate and vigorous resistance exercise intensities, the METs value that best represented both sessions was 3 METs for the obese elderly T2DM patients and 5 METs for young subjects.
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Affiliation(s)
- S Zanuso
- Centre for Sport Sciences and Human Performance, Department of Sports Science, University of Greenwich, London, United Kingdom
| | - M Bergamin
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - A Jimenez
- School of Sports Science, European University of Madrid, Madrid, Italy
| | - G Pugliese
- Diabetes Unit, Sant'Andrea Hospital, Department of Clinical and Molecular Medicine, La Sapienza University, Rome, Italy
| | - V D'Errico
- Diabetes Unit, Sant'Andrea Hospital, Department of Clinical and Molecular Medicine, La Sapienza University, Rome, Italy
| | - A Nicolucci
- Center for Outcomes Research and Clinical Epidemiology (CORE), Pescara, Italy
| | - A Ermolao
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - S Balducci
- Diabetes Unit, Sant'Andrea Hospital, Department of Clinical and Molecular Medicine, La Sapienza University, Rome, Italy; Metabolic Fitness Association, Monterotondo, Rome, Italy
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D'Errico V, Sarnelli A, Bianchini D, Menghi E, Mezzenga E, Marcocci F, Strigari L, Benassi M. Exploiting the machine log files for VMAT and IMRT treatment verification. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.062] [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] Open
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Balducci S, Sacchetti M, Haxhi J, Orlando G, Zanuso S, Cardelli P, Cavallo S, D'Errico V, Ribaudo MC, Di Biase N, Salvi L, Vitale M, Bollanti L, Conti FG, Nicolucci A, Pugliese G. The Italian Diabetes and Exercise Study 2 (IDES-2): a long-term behavioral intervention for adoption and maintenance of a physically active lifestyle. Trials 2015; 16:569. [PMID: 26651484 PMCID: PMC4676117 DOI: 10.1186/s13063-015-1088-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 03/26/2015] [Accepted: 11/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity (PA)/exercise have become an integral part of the management of type 2 diabetes mellitus (T2DM). However, current guidelines are difficult to put into action in this population due to a number of barriers, especially the lack of acceptable, feasible, and validated behavioral intervention strategies. The present manuscript reports the rationale, study design and methods, and design considerations of the Italian Diabetes and Exercise Study (IDES)-2, a randomized controlled trial testing the efficacy of a behavior change strategy in increasing total daily PA and reducing sedentary time (SED-time) in patients with T2DM. METHODS/DESIGN Starting 7 January 2014, the IDES_2 began enrolling 300 patients with known T2DM of at least 1-year duration in three tertiary referral outpatient Diabetes Clinics in Rome. Additional requirements are age 40 to 80 years, body mass index 27 to 40 kg/m(2), sedentary lifestyle, and physically inactive for at least 6 months, ability to walk 1.6 km without assistance, and eligibility after cardiovascular evaluation. Patients are randomized by center and within each center, by age and type of diabetes treatment to either the intervention or the control group. Patients in the intervention (INT) group (n = 150) receive theoretical and practical exercise counseling consisting of aggregated behavior change techniques (one individual theoretical counseling session plus eight twice-a-week individual theoretical and practical exercise counseling sessions) once a year for 3 years. Patients in the control (CON) group (n = 150), receive standard care, including general physician recommendations for daily PA. The primary outcomes are total daily PA and SED-time, as measured objectively by the use of an accelerometer. Secondary outcomes include physical fitness, modifiable cardiovascular risk factors, musculoskeletal disturbances, well-being/depression, and health-related quality of life. DISCUSSION The behavioral intervention strategy tested in the IDES_2 is based on solid theoretical grounds and uses several behavioral change techniques, two factors which were found to improve effectiveness of behavioral intervention. In addition, physicians and exercise specialists have been specifically trained for counselling/prescribing and supervising PA/exercise, respectively, in subjects suffering from metabolic disorders. Finally, the large sample size, the long study duration, and the objective measurement of PA allow statistically significant and scientifically robust conclusions to be drawn on the feasibility and efficacy of this intervention in T2DM patients. TRIAL REGISTRATION ClinicalTrials.gov; NCT01600937 ; 10 October 2012.
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Affiliation(s)
- Stefano Balducci
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Via di Grottarossa, 1035-1039 - 00189, Rome, Italy.
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
- Metabolic Fitness Association, Monterotondo, Rome, Italy.
| | - Massimo Sacchetti
- Department of Human Movement and Sport Sciences, "Foro Italico" University, Rome, Italy.
| | - Jonida Haxhi
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
- Metabolic Fitness Association, Monterotondo, Rome, Italy.
- Department of Human Movement and Sport Sciences, "Foro Italico" University, Rome, Italy.
| | - Giorgio Orlando
- Department of Human Movement and Sport Sciences, "Foro Italico" University, Rome, Italy.
| | | | - Patrizia Cardelli
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Via di Grottarossa, 1035-1039 - 00189, Rome, Italy.
- Laboratory of Clinical Chemistry, Sant'Andrea Hospital, Rome, Italy.
| | - Stefano Cavallo
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Via di Grottarossa, 1035-1039 - 00189, Rome, Italy.
- Laboratory of Clinical Chemistry, Sant'Andrea Hospital, Rome, Italy.
| | - Valeria D'Errico
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
- Metabolic Fitness Association, Monterotondo, Rome, Italy.
| | | | | | - Laura Salvi
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
| | | | | | - Francesco G Conti
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Via di Grottarossa, 1035-1039 - 00189, Rome, Italy.
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology (CORE), Pescara, Italy.
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Via di Grottarossa, 1035-1039 - 00189, Rome, Italy.
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
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Balducci S, Cardelli P, Pugliese L, D'Errico V, Haxhi J, Alessi E, Iacobini C, Menini S, Bollanti L, Conti FG, Nicolucci A, Pugliese G. Volume-dependent effect of supervised exercise training on fatty liver and visceral adiposity index in subjects with type 2 diabetes The Italian Diabetes Exercise Study (IDES). Diabetes Res Clin Pract 2015; 109:355-63. [PMID: 26047682 DOI: 10.1016/j.diabres.2015.05.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 12/03/2014] [Revised: 02/26/2015] [Accepted: 05/02/2015] [Indexed: 02/06/2023]
Abstract
AIMS This study evaluated the effect of supervised exercise training on liver enzymes and two surrogate measures of non-alcoholic fatty liver disease (NAFLD) in subjects with type 2 diabetes. METHODS Sedentary patients from 22 outpatient diabetes clinics were randomized by center, age and treatment to twice-a-week supervised aerobic and resistance training plus structured exercise counseling (exercise group, EXE; n=303) versus counseling alone (control group, CON; n=303) for 12 months. EXE participants were further randomized to low-to-moderate (n=142) or moderate-to-high (n=161) intensity training of equal energy cost. Baseline and end-of-study levels of liver enzymes, fatty liver index (FLI) and visceral adiposity index (VAI) were obtained. RESULTS Enzyme levels did not change, whereas FLI and VAI decreased significantly in EXE, but not CON participants. Physical activity (PA) volume was an independent predictor of both FLI and VAI reductions, the extent of which increased from the 1st to the 4th quintile of PA volume and baseline to end-of-study changes in fitness parameters. Differences in the effect of LI versus HI training were negligible. CONCLUSIONS Data from this large cohort of subjects with type 2 diabetes indicate that FLI and VAI decrease with supervised training in a volume-dependent manner.
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Affiliation(s)
- Stefano Balducci
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Diabetes Unit, Sant'Andrea Hospital, Rome, Italy; Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Patrizia Cardelli
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Laboratory of Clinical Chemistry, Sant'Andrea Hospital, Rome, Italy
| | - Luca Pugliese
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Radiology Unit, Sant'Andrea Hospital, Rome, Italy
| | - Valeria D'Errico
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Diabetes Unit, Sant'Andrea Hospital, Rome, Italy; Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Jonida Haxhi
- Metabolic Fitness Association, Monterotondo, Rome, Italy; Department of Human Movement and Sport Sciences, "Foro Italico" University, Rome, Italy
| | - Elena Alessi
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Carla Iacobini
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy
| | - Stefano Menini
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy
| | - Lucilla Bollanti
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
| | - Francesco G Conti
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
| | - Antonio Nicolucci
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, Chieti, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy.
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Balducci S, Vulpiani MC, Pugliese L, D'Errico V, Menini S, Salerno G, Gargiulo L, Ferretti A, Pugliese G. Effect of supervised exercise training on musculoskeletal symptoms and function in patients with type 2 diabetes: the Italian Diabetes Exercise Study (IDES). Acta Diabetol 2014; 51:647-54. [PMID: 24566991 DOI: 10.1007/s00592-014-0571-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 11/05/2013] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
Abstract
Musculoskeletal disorders are common in subjects with type 2 diabetes mellitus (T2DM) and may represent a barrier to physical activity (PA). In the Italian Diabetes and Exercise Study, we assessed whether a strategy aimed at minimizing the risk of injury and worsening of musculoskeletal symptoms favors participation in exercise training and results in improvements in joint-specific functional scores, along with amelioration of metabolic profile. Sedentary patients with T2DM (n = 606) from 22 outpatient diabetes clinics were randomized to twice-a-week supervised aerobic and resistance training plus exercise counseling (EXE) versus counseling alone (CON) for 12 months. Musculoskeletal symptoms were evaluated at baseline in the entire cohort by the use of a self-reported questionnaire in order to design tailored exercise programs with exclusion of painful segments, and validated joint-specific scores were calculated at the end of study in a subgroup of CON (n = 65) and EXE subjects (n = 62). Musculoskeletal symptoms were present in more than ¾ of EXE and CON subjects. Yet, volumes of non-supervised PA were high, whereas dropout rates and adverse events were low in both groups. Moreover, in the EXE group, no difference was observed between patients with and without symptoms in session attendance and PA/exercise volume. Scores for symptoms and functional status of limbs and spine were significantly better in EXE than in CON subjects and correlated with PA/exercise volume and improvements in fitness parameters. Preliminary evaluation of musculoskeletal symptoms is useful in favoring compliance with supervised training programs and obtaining significant benefits to the functional status of the involved joints.
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Affiliation(s)
- Stefano Balducci
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy,
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Balducci S, Sacchetti M, Haxhi J, Orlando G, D'Errico V, Fallucca S, Menini S, Pugliese G. Physical exercise as therapy for type 2 diabetes mellitus. Diabetes Metab Res Rev 2014; 30 Suppl 1:13-23. [PMID: 24353273 DOI: 10.1002/dmrr.2514] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [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: 10/23/2013] [Accepted: 12/19/2013] [Indexed: 12/14/2022]
Abstract
Many studies have highlighted the importance of physical activity (PA) for health, and recent evidence now points to the positive improvements associated with exercise in type 2 diabetes mellitus (T2DM). However, few physicians are willing to prescribe exercise as a therapy for diabetic patients. In addition, there is a lack of information on how to implement exercise therapy especially in long-term exercise regimens. The purpose of this manuscript is to summarize standards of exercise therapy for patients with T2DM, both in terms of prescribing and monitoring, according to the American College of Sports Medicine and the American Diabetes Association guidelines. We present details of the exercise therapies used in long-term studies, describing how the parameters for exercise prescription were applied in clinical practice. These parameters are described in terms of frequency, intensity, duration, mode and rate of progression in long-term therapeutic prescriptions. Individual responses to exercise dose are discussed, and critical issues to be considered in patients with underlying disease and in T2DM patients are highlighted.
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Affiliation(s)
- Stefano Balducci
- Metabolic Fitness Association, Rome, Italy; Department of Clinical and Molecular Medicine, 'La Sapienza' University, Rome, Italy; Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
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Balducci S, Sacchetti M, Orlando G, Salvi L, Pugliese L, Salerno G, D'Errico V, Iacobini C, Conti FG, Zanuso S, Nicolucci A, Pugliese G. Correlates of muscle strength in diabetes: The study on the assessment of determinants of muscle and bone strength abnormalities in diabetes (SAMBA). Nutr Metab Cardiovasc Dis 2014; 24:18-26. [PMID: 24095149 DOI: 10.1016/j.numecd.2013.04.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [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: 10/18/2012] [Revised: 04/09/2013] [Accepted: 04/25/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Apart from late motor nerve dysfunction, factors affecting muscle strength in diabetes are largely unknown. This study was aimed at assessing muscle strength correlates in diabetic subjects encompassing a wide range of peripheral nerve function and various degrees of micro and macrovascular complications. METHODS AND RESULTS Four-hundred consecutive patients with type 1 and 2 diabetes (aged 46.4 ± 13.9 and 65.8 ± 10.3 years, respectively) from the Study on the Assessment of Determinants of Muscle and Bone Strength Abnormalities in Diabetes (SAMBA) were examined for upper and lower body muscle isometric maximal voluntary contraction by dynamometry. Univariate and multivariate regression analyses were applied to identify strength correlates. Isometric force at both the upper and lower limbs was significantly lower in subjects with than in those without any complication. At univariate analysis, it was strongly associated with age, diabetes duration, physical activity (PA) level, cardio-respiratory fitness, anthropometric parameters, surrogate measures of complications, and parameters of sensory and autonomic, but not motor (except amplitude) neuropathy. Multivariate analysis revealed that upper and lower body strength correlated independently with male gender and, inversely, with age, autonomic neuropathy score (or individual autonomic function abnormalities), and vibration perception threshold, but not sensory-motor neuropathy score. Diabetes duration and PA level were excluded from the model. CONCLUSIONS Both upper and lower body muscle strength correlate with measures of diabetic complications and particularly with parameters of sensory and especially autonomic nerve function, independently of diabetes duration and PA level, thus suggesting the involvement of mechanisms other than manifest motor nerve impairment.
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Affiliation(s)
- S Balducci
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Diabetes Unit, Sant'Andrea Hospital, Rome, Italy; Metabolic Fitness Association, Monterotondo, Rome, Italy.
| | - M Sacchetti
- Department of Human Movement and Sport Sciences, "Foro Italico" University, Rome, Italy
| | - G Orlando
- Department of Human Movement and Sport Sciences, "Foro Italico" University, Rome, Italy
| | - L Salvi
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
| | - L Pugliese
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
| | - G Salerno
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy
| | - V D'Errico
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy; Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - C Iacobini
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - F G Conti
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
| | - S Zanuso
- School of Science, University of Greenwich, London, UK
| | - A Nicolucci
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, Chieti, Italy
| | - G Pugliese
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Diabetes Unit, Sant'Andrea Hospital, Rome, Italy
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Iori M, Orlandi M, Cagni E, Botti A, Mezzenga E, D'Errico V, Iotti C, Versari A. Voxel-based Dose-painting With a Commercial Treatment Planning System by Using 2 Different Planning Methods. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.553] [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: 11/27/2022]
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Botti A, Cagni E, Mezzenga E, D'Errico V, Ciammella P, Iotti C, Iori M. EP-1501 MINIMISATION OF SECONDARY CANCER RISK IN THE PLANNING PHASE BY AN ON-LINE BIOLOGICAL-ESTIMATOR TOOL (OBE). Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71834-0] [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: 11/27/2022]
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Mezzenga E, Cagni E, Botti A, D'Errico V, Iori M. EP-1385 ANALYSIS OF PATIENT SPECIFIC DELIVERY QUALITY ASSURANCE (DQA) IN HELICAL TOMOTHERAPY (HT). Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71718-8] [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: 11/16/2022]
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