21 research outputs found
Insulin requirements and carbohydrate to insulin ratio in normal weight, overweight, and obese women with type 1 diabetes under pump treatment during pregnancy: a lesson from old technologies
No full textAim:The primary aim of this study was to assess insulin requirements and carbohydrateto insulin ratio (CHO/IR) in normal weight, overweight, and obese pregnant women withtype 1 diabetes across early, middle, and late pregnancy.Methods:In this multicenter, retrospective, observational study we evaluated 86 of 101pregnant Caucasian women with type 1 diabetes under pump treatment. The womenwere trained to calculate CHO/IR daily by dividing CHO grams of every single meal byinsulin units injected. Since the purpose of the study was to identify the CHO/IR able toreach the glycemic target, we only selected the CHO/IR obtained when glycemic valueswere at target. Statistics: SPSS 20.Results:We studied 45 normal weight, 31 overweight, and 10 obese women. Insulinrequirements increased throughout pregnancy (p < 0.0001 and <0.001 respectively) inthe normal and overweight women, while it remained unchanged in the obese women.Insulin requirements were different between groups when expressed as an absolute value,but not when adjusted for body weight. Breakfast CHO/IR decreased progressivelythroughout pregnancy in the normal weight women, from 13.3 (9.8–6.7) at thefirst stageof pregnancy to 6.2 (3.8–8.6) (p = 0.01) at the end stage, and in the overweight womenFrontiers in Endocrinology | www.frontiersin.orgFebruary 2021 | Volume 12 | Article 6108771Edited by:Elena Succurro,University of Magna Graecia, ItalyReviewed by:Cristina Bianchi,Azienda Ospedaliero-UniversitariaPisana, ItalyMaria Grazia Dalfra’,University of Padua, Italy*Correspondence:Camilla [email protected] section:This article was submitted toObesity,a section of the journalFrontiers in EndocrinologyReceived:27 September 2020Accepted:14 January 2021Published:25 February 2021Citation:Festa C,Fresa R,Visalli N,Bitterman O,Giuliani C,Suraci C,Bongiovanni M andNapoli A (2021)Insulin Requirements andCarbohydrate to Insulin Ratio inNormal Weight, Overweight, andObese Women With Type 1Diabetes Under Pump TreatmentDuring Pregnancy: A LessonFrom Old Technologies.Front. Endocrinol. 12:610877.doi: 10.3389/fendo.2021.610877ORIGINAL RESEARCHpublished: 25 February 2021doi: 10.3389/fendo.2021.610877
from 8.5 (7.1–12.6) to 5.2 (4.0–8.1) (p = 0.001), while in the obese women it remainedstable, moving from 6.0 (5.0–7.9) to 5.1 (4.1–7.4) (p = 0.7). Likewise, lunch and dinnerCHO/IR decreased in the normal weight and overweight women (p < 0.03) and not in theobese women. The obese women gained less weight than the others, especially in earlypregnancy when they even lost a median of 1.25 (−1−1.1) kg (p = 0.005). In earlypregnancy, we found a correlation between pregestational BMI and insulin requirements(IU/day) or CHO/IR at each meal (p < 0.001 and p = 0.001, respectively). In latepregnancy, a relationship between pre-gestational BMI and CHO/IR change was found(P = 0.004), as well as between weight gain and CHO/IR change (p=0.02). Thesignificance was lost when both variables were included in the multiple regressionanalysis. There was no difference in pregnancy outcomes except for a higher pre-termdelivery rate in the obese women.Conclusion:Pre-gestational BMI and weight gain may play a role in determining CHO/IRduring pregnancy in women with type 1 diabetes under pump treatment
THE PROTEIN TYROSINE PHOSPHATASE NONRECEPTOR 22 (PTPN22)IS ASSOCIATED WITH HIGH GAD ANTIBODY TITER IN LATENT AUTOIMMUNE DIABETES IN ADULT NIRAD STOUDY GROUP
No full textManagement of newly diagnosed patients with type 2 diabetes: What are the attitudes of physicians? A SUBITO!AMD survey on the early diabetes treatment in Italy
No full textEarly intensive therapy in type 2 diabetes can
prevent complications. Nevertheless, metabolic control is
often sub-optimal in newly diagnosed patients. This webbased
survey aimed to evaluate opinions of physicians
about treatment, priorities, and barriers in the care of
patients first referred to diabetes clinics. Data on physician
attitudes toward therapeutic preferences for two clinical
case models (same clinical profile, except HbA1c levels of
8.6 and 7.3% at the first access, respectively) were collected.
Participants were asked to rank from 1 (most
important) to 6 (least important) a list of priorities and
barriers associated with the care of new patients. Overall,
593 physicians participated. In both case models, metformin
and education were primary options, although their
combination with other classes of drugs varied substantially.
Main priorities were ‘‘to teach the patient how to
cope with the disease’’ and ‘‘to achieve HbA1c target’’;
main barriers were ‘‘lack of time’’ and ‘‘long waiting list’’.
At multivariate analyses, physicians from the South of Italy
had a twofold higher likelihood to attribute a rank 1–2 to
organizational barriers than those operating in the North
(South vs. North: OR: 2.4; 95% CI 1.4–4.1; Center vs.
North: OR: 2.4; 95% CI 0.9–3.2). In the absence of a
widely accepted evidence-based therapeutic algorithm
driving the therapeutic choices according to the patient
characteristics, prescriptions vary according to physician
preferences. Education is perceived as a key-strategy, but
organizational barriers and geographic disparities are an
obstacle. These findings can drive new strategies to reduce
clinical inertia, attitudes variability, and geographic
disparities
Position Statement on the management of continuous subcutaneous insulin infusion (CSII): The Italian Lazio experience
No full textThis document has been developed by a group of Italian diabetologists with extensive experience in continuous subcutaneous insulin infusion (CSII) therapy to provide indications for the clinical management of CSII in diabetic patients (both type 1 and type 2) based on delivery mode operating in Italy. Although the potential benefits of pump therapy in achieving glycemic goals is now accepted, such results cannot be obtained without specific knowledge and skills being conveyed to patients during ad hoc educational training. To ensure that these new technologies reach their full effectiveness, as demonstrated theoretically and clinically, a careful assessment of the overall therapeutic and educational process is required, in both qualitative and quantitative terms. Therefore, to ensure the cost-effectiveness of insulin pump therapy and to justify reimbursement of therapy costs by the National Health System in Italy, in this article we present a model for diabetes and healthcare centers to follow that provides for different levels of expertise in the field of CSII therapy. This model will guarantee the provision of excellent care during insulin pump therapies, thus representing the basis for a successful outcome and expansion of this form of insulin treatment in patients with diabetes while also keeping costs under control
Age- and Gender-Related Differences in LDL-Cholesterol Management in Outpatients with Type 2 Diabetes Mellitus
No full textBackground. Dyslipidemia contribute to the excess of coronary heart disease (CHD) risk observed in women with type 2 diabetes (T2DM). Low density lipoprotein-cholesterol (LDL-C) is the major target for CHD prevention, and T2DM women seem to reach LDL-C targets less frequently than men. Aim. To explore age- and gender-related differences in LDL-C management in a large sample of outpatients with T2DM. Results. Overall, 415.294 patients (45.3% women) from 236 diabetes centers in Italy were included. Women were older and more obese, with longer diabetes duration, higher total-cholesterol, LDL-C, and HDL-C serum levels compared to men (P<0.0001). Lipid profile was monitored in ~75% of subjects, women being monitored less frequently than men, irrespective of age. More women did not reach the LDL-C target as compared to men, particularly in the subgroup treated with lipid-lowering medications. The between-genders gap in reaching LDL-C targets increased with age and diabetes duration, favouring men in all groups. Conclusions. LDL-C management is worst in women with T2DM, who are monitored and reach targets less frequently than T2DM men. Similarly to men, they do not receive medications despite high LDL-C. These gender discrepancies increase with age and diabetes duration, exposing older women to higher CHD risk
The protein tyrosine phosphatase nonreceptor 22 (PTPN22) is associated with high GAD antibody titer in latent autoimmune diabetes in adults: Non Insulin Requiring Autoimmune Diabetes (NIRAD) Study 3.
No full textOBJECTIVE: We previously demonstrated the presence of two different populations
among individuals with adult-onset autoimmune diabetes: those having either a
high titer or a low titer of antibodies to GAD (GADAs). Protein tyrosine
phosphatase nonreceptor type 22 (PTPN22) has been identified as a new
susceptibility gene for type 1 diabetes and other autoimmune diseases. The aim of
the present study was to evaluate whether the phenotypic heterogeneity of
adult-onset autoimmune diabetes based on the GADA titer is associated with the
PTPN22 C1858T polymorphism. RESEARCH DESIGN AND METHODS: Analysis for the C1858T
polymorphism using the TaqMan assay was performed in 250 subjects with
adult-onset autoimmune diabetes, divided into two subgroups with low (<or=32
arbitrary units) or high (>32 arbitrary units) GADA titers and 450 subjects with
classic type 2 diabetes (from the Non Insulin Requiring Autoimmune Diabetes
[NIRAD] Study cohort of 5,330 subjects with adult-onset diabetes) and in 558
subjects with juvenile-onset type 1 diabetes and 545 normoglycemic subjects.
RESULTS: Genotype, allele, and phenotype distributions of the PTPN22 C1858T
variant revealed similar frequencies in autoimmune diabetes with high GADA titer
and juvenile-onset type 1 diabetes. An increase in TT and CT genotypes was
observed in individuals with a high GADA titer compared with a low GADA titer,
those with type 2 diabetes, and control subjects (P < 0.002 for all comparisons).
The PTPN22 1858T allele and phenotype frequencies were increased in high GADA
titer compared with a low GADA titer, type 2 diabetic, and control subjects (P <
0.001 for all comparisons, odds ratio 2.6). CONCLUSIONS: In adult-onset
autoimmune diabetes, the PTPN22 1858T variant is associated only with a high GADA
titer, providing evidence of a genetic background to clinical heterogeneity
identified by GADA titer
Risk factors for fragility fractures in type 1 diabetes
No full textOBJECTIVE:
To determine clinical diabetes-related risk factors for fragility fractures in type 1 diabetes (T1D).
RESEARCH DESIGN AND METHODS:
History of bone fragility fractures occurring after T1D diagnosis was assessed by questionnaire in this cross-sectional study in 600 T1D subjects. Glycated hemoglobin A1c (HbA1c) over the previous 5 years was used as an index of long-term glycemic control; complications were adjudicated by physician assessment. Multinomial logistic regression models were used to assess the associations between diabetes-related risk factors and fracture history.
RESULTS:
One-hundred-eleven patients (18.5%) reported at least one fracture; of these 73.8% had only one and 26.2% had more than one fracture. Average age was 41.9 ± 12.8 years, with even gender distribution; disease duration was 19.9 ± 12.0 years; and BMI was 24.4 ± 3.7 kg/m2. The 5-year average HbA1c was 7.6 ± 1.0% (60 mmol/mol). In adjusted models, reduced risk for 1 fracture was found in those with higher creatinine clearance rate (CCr) (RRR 0.22 [95% CI: 0.06-0.83] for 1 unit increase in lnCCr, p = 0.03) and increased risk in those with neuropathy (RRR 2.57 [1.21-5.46], p = 0.01). Increased risk for ≥2 fractures was found in subjects in the highest tertile of HbA1c (≥7.9%) compared with the lowest tertile (≤7.17%) (RRR 3.50 [1.04-11.7], p = 0.04) and of disease duration (≥26 years versus <14 years) (RRR 7.59 [1.60-35.98], p = 0.01).
CONCLUSIONS:
Poor glycemic control and long exposure to the disease are independent diabetes-related risk factors for multiple bone fractures in T1D
No protective effect of calcitriol on Î2-cell function in recent-onset type 1 diabetes: The IMDIAB XIII trial
No full textOBJECTIVE - We investigated whether supplementation of the active form of vitamin D (calcitriol) in recent-onset type I diabetes can protect beta-cell function evaluated by C-peptide and improve glycemic control assessed by A1C and insulin requirement. RESEARCH DESIGN AND METHODS - Thirty-four subjects (aged 11-35 years, median 18 years) with recent-onset type 1 diabetes and high basal C-peptide >0.25 nmol/l were randomized in a double-blind trial to 0.25 mu g/day calcitriol or placebo and followed-up for 2 years. RESULTS - At 6, 12, and 24 months follow-up, A1C and insulin requirement in the calcitriol group did not differ from the placebo group. C-peptide dropped significantly (P < 0.001) but similarly in both groups, with no significant differences at each time point. CONCLUSIONS - At the doses used, calcitriol is ineffective in protecting beta-cell function in subjects (including children) with recent-onset type I diabetes and high C-peptide at diagnosis
Continuous Subcutaneous Insulin Infusion (CSII) in Inpatient Setting: Unmet Needs and the Proposal of a CSII Unit
No full text
