1,721,076 research outputs found
Prediction of diabetes mellitus induced by steroid overtreatment in adrenal insufficiency.
Full text linkTo assess the differences between patients with normal glucose tolerance (NGT) and prediabetes/diabetes mellitus (DM) in secondary adrenal insufficiency (SAI). We cross-sectionally evaluated 102, out of a total of 140, patients with SAI, who were on hydrocortisone (HC) (n = 50) and cortisone acetate (n = 52) replacement therapy. Clinical, anthropometric, and metabolic parameters were compared in patients with NGT (n = 60) and DM (n = 42). Patients with prediabetes/DM have a more marked family history of DM (p = 0.002), BMI (p < 0.001), higher waist circumference (p < 0.001), total cholesterol (p = 0.012), LDL-cholesterol (p = 0.004), triglycerides (p = 0.031), fasting glucose (p = 0.002), fasting insulin (p = 0.035), glutamate pyruvate transaminase (p = 0.018), HOMA-IR (p = 0.039), area under curves of glucose (p = 0.001) and insulin (p = 0.002), HbA1c (p < 0.001), Visceral adiposity index (VAI) (p = 0.038) and lower ISI-Matsuda (p = 0.008) and oral disposition index (p < 0.001) than patients with NGT. Multivariate analysis showed that family history of DM and VAI are independent predictive facAdrenal Insufficiencytors for DM in patients with SAI. Family history of DM and VAI can be predictors of the development of DM in patients with SAI and need to be investigated during steroid replacement therapy. Interestingly, the type and the dose of replacement steroid do not impact on diabetes mellitus
Long-term outcomes of conventional and novel steroid replacement therapy on bone health in primary adrenal insufficiency
Full text linkSteroids affect bone health causing osteoporosis and fractures. The study aims to compare dual-release hydrocortisone (DR-HC) and conventional steroids on bone metabolism in patients with primary adrenal insufficiency (PAI). Thirty-five patients with PAI on conventional steroids (group A) and 35 patients switched to DR-HC (group B), consecutively referred at our hospital, were evaluated at baseline and after 18, 36 and 60 months of treatment. After 60 months of follow-up, patients in group A had a significant increase in body mass index (p = 0.004) and waist circumference (WC) (p = 0.026) and a significant decrease in osteocalcin (p = 0.002), bone alkaline phosphatase (p = 0.029), lumbar spine bone mass density (BMD) T and Z scores (p < 0.001 and p = 0.001, respectively) and vertebral fractures rate (p = 0.021) than baseline. By contrast, patients in group B had a significant decrease in WC (p = 0.047) and increase in bone alkaline phosphatase (p = 0.019), lumbar spine BMD T score (p = 0.032), femoral neck BMD T and Z scores (p = 0.023 and p = 0.036, respectively) than baseline. Long-term conventional steroid replacement therapy is associated with a decrease in BMD, notably at lumbar spine, and increase in vertebral fractures rate. By contrast, DR-HC treatment is associated with improvement of BMD
Metabolic comorbidities of adrenal insufficiency: Focus on steroid replacement therapy and chronopharmacology.
No full textAdrenal insufficiency (AI) is characterized by higher mortality and morbidity compared with the general population. Conventional replacement steroid therapy, currently recommended for the treatment of AI, is associated with increased frequency of metabolic comorbidities due to daily overexposure. By contrast, dual-release hydrocortisone is associated with a decreased risk of metabolic comorbidities, providing an adequate release of hydrocortisone and mimicking the physiological profile of cortisol. These favorable effects are due to a reduced daily steroid exposure that does not affect the expression of the clock genes which are involved in metabolic pathways and are regulated by the normal physiological circadian rhythm of endogenous cortisol. This narrative review focuses on the possible metabolic comorbidities of AI due to steroid replacement therapy, which evaluates the effects of conventional and novel drugs with attention to chronopharmacology
Correction to: One Year of Dapaglifozin Add-On Therapy Ameliorates Surrogate Indexes of Insulin Resistance and Adiposity in Patients with Type 2 Diabetes Mellitus
Full text linkOne Year of Dapaglifozin Add-On Therapy Ameliorates Surrogate Indexes of Insulin Resistance and Adiposity in Patients with Type 2 Diabetes Mellitus
Full text linkIntroduction: This study investigates the effects of dapagliflozin on the visceral adiposity index (VAI), lipid accumulation product (LAP), product of triglycerides and glucose (TyG) and triglycerides to HDL-cholesterol ratio (TG/HDL-C) in patients with type 2 diabetes mellitus (T2D).
Methods: In this real-life study, dapaglifozin was added to metformin alone (group 1, no. 42) or insulin plus metformin (group 2, no. 58) in 100 T2D patients.
Results: In group 1, after 6 months of dapaglifozin addition, a significant decrease in BMI (p < 0.001), waist circumference (WC) (p < 0.001), systolic blood pressure (SBP) (p = 0.009), diastolic blood pressure (DBP) (p = 0.012), mean fasting blood glucose (FBG), post-breakfast glucose (PBG), post-lunch glucose (PLG) and post-dinner glucose (PDG) (all p < 0.001), HbA1c (p < 0.001), VAI (p = 0.020), LAP (p = 0.028), Tyg (p < 0.001), TG/HDL-C (p = 0.020) and glutamate pyruvate transaminase (GPT) (p < 0.001) was observed compared to baseline. After 12 months a significant decrease in BMI (p < 0.001), WC (p = 0.006), SBP (p = 0.023), DBP (p = 0.005), mean FPG, PBG, PLG and PDG (all p < 0.001), HbA1c (p < 0.001), total cholesterol (p = 0.038), triglycerides (p = 0.026), VAI (p = 0.013), GPT (p < 0.001), LAP index (p = 0.024), Tyg index (p < 0.001) and TG/HDL-c ratio (p = 0.016) was observed compared to baseline. In group 2, after 6 months of dapaglifozin addition, a significant decrease in BMI (p < 0.001), WC (p < 0.001), SBP (p = 0.015), DBP (p = 0.007), mean FPG, PBG, PLG and PDG (all p < 0.001), HbA1c (p < 0.001), VAI (p = 0.040), LAP (p = 0.047), Tyg (p < 0.001), TG/HDL-C (p = 0.048) and GPT (p < 0.001) was observed compared to baseline. By contrast, after 12 months a significant decrease in BMI (p < 0.001), WC (p < 0.001), SBP (p = 0.001), DBP (p = 0.002), mean FPG, PBG, PLG and PDG (all p < 0.001), HbA1c (p < 0.001), GPT (p < 0.001) and Tyg index (p = 0.003) was observed compared to baseline.
Conclusions: Dapagliflozin treatment significantly reduced surrogate indexes of insulin resistance and adiposity in patients with T2D
Maggiore rischio cardiometabolico in pazienti di razza non caucasica affetti da diabete mellito di tipo 1 idiopatico rispetto alla forma autoimmune in pazienti caucasici.
No full textIntroduzione: Il diabete mellito di tipo 1 idiopatico (DM1b) è caratterizzato da un esordio con insulinopenia, chetoacidosi, assenza di marcatori di autoimmunità β-cellulare e HLA-correlati. Scopo dello studio è stato confrontare i parametri metabolici e clinici, le complicanze micro e macroangiopatiche, la disfunzione adiposa viscerale e gli indici di insulino-secrezione e sensibilità nei pazienti con DM1b ed autoimmune (DM1a) all’esordio clinico.
Metodi: 25 pazienti non caucasici con DM1b and 25 caucasici con DM1a, appaiati per età e genere, sono stati retrospettivamente inclusi nello studio. Abbiamo valutato BMI, circonferenza vita, assetto lipidico, glicemia, HbA1c, I.R., GOT e GPT, C-peptide dopo stimolo con glucagone (GSC-pep), M-value valutato durante clamp euglicemico iperinsulinemico e il Visceral Adiposity Index (VAI).
Risultati: I pazienti con DM1b hanno mostrato valori significativamente più alti di BMI (p 0.020), circonferenza vita (p 0.02), VAI (p 0.01), colesterolo LDL (p 0.03), GOT (p 0.025), GPT (p 0.021), M-value (p 0.006) e GSC-pep (p 0.036) e più bassi di HDL-colesterolo (p 0.001), rispetto ai pazienti con DM1a. Inoltre, i pazienti con DM1b presentavano una maggiore familiarità per diabete di tipo 2 (p 0.005) e una maggiore percentuale di steatosi epatica (p 0.001), obesità viscerale (p 0.032) e ipercolesterolemia (p 0.007) rispetto ai pazienti con DM1a.
Conclusioni: I pazienti con DM1b mostrano maggiori complicanze metaboliche all’esordio, quali obesità centripeta, steatosi epatica e ipercolesterolemia e un maggiore rischio cardiometabolico, rispetto ai pazienti con DM1a
Maternal-foetal complications in pregnancy: a retrospective comparison between type 1 and type 2 diabetes mellitus.
Full text linkBackground: The aim of the study was a retrospective comparison of the differences in maternal-foetal outcomes between women with type 1 and type 2 diabetes mellitus (T1DM and T2DM).
Methods: A cohort of 135 patients with pregestational diabetes, 73 with T1DM (mean age 29 ± 5 years) and 62 with T2DM (mean age 33 ± 6 years), in intensive insulin treatment throughout pregnancy were evaluated. Clinical and metabolic parameters and the prevalence of maternal and foetal complications were assessed.
Results: Women with T1DM showed lower pregestational BMI (p < 0.001), pregestational weight (p < 0.001), weight at delivery (p < 0.001), ∆_total_insulin requirement (IR) at the first, second and third trimesters (all p < 0.001) and higher weight gain during pregnancy (p < 0.001), pregestational HbA1c (p = 0.040), HbA1c in the first (p = 0.004), second (p = 0.020) and third (p = 0.010) trimesters compared to T2DM. Women with T1DM had a higher risk of macrosomia (p = 0.005) than T2DM, while women with T2DM showed higher prevalence of abortion (p = 0.037) than T1DM. At multivariate analysis, pregestational BMI and ∆_total_IR of the first trimester were independently associated with abortion in T2DM, while weight gain during pregnancy was independently associated with macrosomia in T1DM.
Conclusion: Women with T1DM have a higher risk of macrosomia than T2DM due to weight gain throughout pregnancy. By contrast, women with T2DM have a higher risk of spontaneous abortion than T1DM, due to pregestational BMI and ∆_total_IR in the first trimester
Myoinositol supplementation in the treatment of gestational diabetes mellitus: effects on glycaemic control and maternal-foetal outcomes
Full text linkBackground Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset during pregnancy. It is characterized by high risk of adverse outcomes for the mother and the foetus, if not adequately controlled. The aim of the study was to evaluate the effects of 4000 mg of myoinositol supplementation in women with GDM on maternal-foetal outcomes, compared to controls. Methods A cohort of 330 women with GDM, 150 supplemented with myoinositol and 180 controls were enrolled. Clinical and metabolic parameters and the prevalence of maternal and foetal complications were assessed. Results The same number of women in the two groups started insulin as additional therapy. Women treated with myoinositol more frequently had a long-acting insulin scheme of treatment than those untreated (p<0.001), while women untreated with myoinositol more frequently had a basal-bolus insulin regimen (p<0.001) compared to women on myoinositol. Patients treated with myoinositol had significantly lower fasting plasma glucose (p=0.032), post-prandial dinner glucose (p=0.014), insulin requirement both in the 2nd and in the 3rd trimesters (p=0.001 and p<0.001, respectively), than those not treated with myoinositol. With regard to maternal/foetal outcomes, lower birth weight (p=0.043) and frequency of hypoglycaemic events (p=0.001) were observed in women treated with myoinositol compared to controls. Conclusions Women with GDM treated with myoinositol showed an improved glycaemic control in the 3(rd) trimester of pregnancy and a lower insulin requirement, when insulin was added to the treatment, compared to controls. In addition, they showed lower preterm birth weight and neonatal hypoglycaemia, compared to women not supplemented with myoinositol
Very Low-Calorie Ketogenic Diet: A Potential Application in the Treatment of Hypercortisolism Comorbidities
No full textA very low-calorie ketogenic diet (VLCKD) is characterized by low daily caloric intake (less than 800 kcal/day), low carbohydrate intake (<50 g/day) and normoproteic (1-1.5 g of protein/kg of ideal body weight) contents. It induces a significant weight loss and an improvement in lipid parameters, blood pressure, glycaemic indices and insulin sensitivity in patients with obesity and type 2 diabetes mellitus. Cushing's syndrome (CS) is characterized by an endogenous or exogenous excess of glucocorticoids and shows many comorbidities including cardiovascular disease, obesity, type 2 diabetes mellitus and lipid disorders. The aim of this speculative review is to provide an overview on nutrition in hypercortisolism and analyse the potential use of a VLCKD for the treatment of CS comorbidities, analysing the molecular mechanisms of ketogenesis
Modificazioni di insulino-secrezione, insulino-sensibilità e funzione adiposa durante terapia con pasireotide in un gruppo di pazienti con malattia di Cushing
No full textBackground: La terapia con pasireotide (PAS) è efficace nel miglioramento del quadro clinico e biochimico dei soggetti con Malattia di Cushing (MC) da adenoma ipofisario ACTH-secernente, ma una della principali cause di interruzione della stessa è l’insorgenza di eventi avversi, tra i quali l’iperglicemia è il più frequente.
Obiettivi: Valutare l’effetto della terapia con PAS su metabolismo glucidico, insulino-secrezione e sensibilità.
Metodi: Abbiamo valutato in 8 pazienti con MC recidivata post-chirurgia durante un follow-up terapeutico di 12 mesi, oltre ai parametri clinici ed ormonali, l’insulino-secrezione tramite HOMAβ e area sotto la curva del C-peptide (AUC2hc-peptide) durante MMTT, l’insulino-sensibilità tramite HOMA-IR e clamp euglicemico iperinsulinemico, e una serie di adipocitochine con ruolo metabolico.
Risultati: 12 mesi di terapia con PAS determinano riduzione significativa di BMI (p=0.012), circonferenza vita (p=0.011) e colesterolo totale (p=0.017), con contestuale incremento della glicemia a digiuno (p=0.012), dell’AUC della glicemia durante MMTT (p=0.036) e di HbA1c (p=0.027). L’insulino-secrezione è ridotta, come dimostrato dalla riduzione di HOMA-β [72.8 (56.1-221.7) vs.36.3 (29.2-105.6)%; p= 0.036] e AUC2h c-peptide [205.7 (196.4-348.1) vs. 160.9 (149.5-284.5) nmol/l; p = 0.017], senza alcuna modifica nell’insulino-sensibilità, come dimostrato dagli immodificati valori di HOMA-IR e M-value durante clamp (p=NS). Si osserva inoltre un aumento dei livelli del recettore solubile della leptina (ObR) [(15.4 (7.1-40.5) vs. (23.9 (11.9-51) p=0.028)] e della retinol binding protein 4 (RBP4) [26.4 (18.1-36.5) vs. 41.3 (26.2-63.5); p= 0.017)], con contestuale riduzione del rapporto leptina/ObR [(2.5 (0.25-7.54) vs. 0.66 (0.32-3.82); p=0.017)] e della fatty acid binding protein (FABP) [(82.9 (11.2-137.3) vs. 41.7 (18.6-66.3); p=0.036)].
Conclusioni: PAS determina un peggioramento del metabolismo glucidico dovuto alla significativa riduzione dell’insulino-secrezione, controbilanciato da un miglioramento clinico generale e della funzione adiposa, probabilmente come diretta conseguenza della significativa riduzione ponderale
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