1,721,100 research outputs found
Impatto clinico della metodica del counting dei carboidrati sul management di pazienti affetti da diabete tipo 1 in terapia multiniettiva e con microinfusore
Full text linkOGGETTO Il counting dei carboidrati rappresenta l’approccio nutrizionale più efficace nel DM1 nell’ottimizzare la terapia insulinica sulla base dell’intake dei carboidrati. La finalità di questo metodo educativo è il miglioramento della qualità di vita del paziente in trattamento insulinico intensivo che si realizza attraverso il raggiungimento di un’aumentata flessibilità alimentare. Lo scopo di questo studio è stato quello di valutare l’impatto della metodica del counting su variabili cliniche, biochimiche e antropometriche e sulla variabilità glicemica in una popolazione di soggetti con DM1 in un follow-up di 3 mesi.
DISEGNO DELLO STUDIO E METODI In questo studio osservazionale prospettico della durata di 3 mesi sono stati arruolati consecutivamente 30 pazienti affetti da DMT1, afferenti alla U.O.D. di Diabetologia del Policlinico Umberto I di Roma tra Marzo e Maggio 2018. I pazienti hanno seguito il corso di counting dei carboidrati, articolato in 4 incontri pomeridiani della durata di 2 ore ciascuno, per un arco temporale totale di 1 mese. Ai pazienti è stato applicato per una settimana all’inizio del corso (T0) e a 3 mesi (T3) un sensore glicemico (CGM) retrospettivo modello Medtronic Enlite. Di tutti i soggetti sono stati raccolti dati clinici, antropometrici e glicemici al basale (T0) e a 3 mesi (T3).
RISULTATI Si evidenza un miglioramento significativo del valore del BMI medio (24,67±3,60 vs 23,55±3,32 kg/m2 – p<.001) e della circonferenza della vita (87,42±9,57 vs 82,72±8,12 cm – p<.001). Il valore medio dell’HbA1c è passato da un valore di 8,52±1,20 a 7,40±0,61 % (p<.001), mentre il fabbisogno insulinico giornaliero si è significativamente ridotto (39,59±11,80 vs 32,20±8,90 UI/die – p<.001). La popolazione al T3 è caratterizzata da una riduzione significativa del valore di glicemia media (198,23±55,57 vs 143,50±27,16 mg/dl- p<.001) ed il valore medio dell’area sotto la curva (AUC) della glicemia sopra il limite è passato da un valore di 73,21±42,42 a 24,49±16,74 mg/dL x min (p<.001), mentre quello dell’area sotto la curva (AUC) della glicemia sotto il limite ha avuto una riduzione significativa (0,42±0,53 vs 0,21±0,57 mg/dL x min- p<.001).
A T3 la media della percentuale delle glicemie in target è significativamente aumentata (27,36±17,87 vs 49,06±20,59 % - p<.001), contestualmente il valore medio delle glicemie sopra il target si è significativamente ridotto (70,16±16,48 vs 44,63±20,21 % - p<.001), così come quello delle glicemie sotto il target (2,86±2,96 vs 2,20±4,13 % - p=0.046).
CONCLUSIONI In questo studio il counting si è dimostrato efficace nel raggiungimento di un migliore controllo glicometabolico, confermando quindi l’importanza di questa metodica sia come strumento per gestire in modo più consapevole la terapia insulinica sia come percorso educativo che porta a scelte nutrizionali più corrette
SMART diabetes: the way to go (Safe and Multifactorial Approach to reduce the Risk for Therapy in diabetes)
No full textPrevalence of type 2 diabetes is increasing worldwide. and management of diabetes is becoming increasingly complex because of the complexity of pathophysiology and the wide therapeutic options. The management of this complexity is difficult because of the different cardiometabolic features of patients. Thus, personalized approaches have been claimed by the most important international societies. Safety, Multifactorial-Approach and reduction of Risk are the three ingredients to get the best Therapy for Diabetes, abbreviated in SMART, as every physician involved in the management of type 2 diabetes should be
Buccal spray insulin (Oralgen) for type 2 diabetes: what evidence?
No full textINTRODUCTION:
The achievement of a good glycemic control and, in particular, the management of postprandial hyperglycemia represent the most significant treatment target for the management of diabetes. Multiple daily insulin injections are often still required to gain the treatment goals. Since the noncompliance with injected insulin therapy causes a slowdown in the process of glycemic compensation, novel non-injectable insulin formulations have been developed. Oral spray insulin (Oralgen) is a tasteless liquid formulation that provides insulin absorption via buccal mucosa.
AREAS COVERED:
To elucidate the current status of Oralgen in type 2 diabetes patients, studies of pharmacodynamic and pharmacokinetic and clinical trials are reviewed.
EXPERT OPINION:
The 'psychological insulin resistance,' represented by the reluctance of both patients and health-care professionals to initiate insulin therapy, could be won by alternative routes of insulin administration, improving patients' compliance. In particular, Oralgen seems to be suitable to manage the postprandial hyperglycemia without hypoglycemic risk, although no comparative studies with rapid-acting insulin analogs and no randomized controlled trials in large cohort subjects with type 2 diabetes are available to dat
Cycloergometric stress test, coronarography and metabolic parameters in high risk patients [PROVA DA SFORZO AL CICLOERGOMETRO, CORONAROGRAFIA E PARAMETRI METABOLICI NEI PAZIENTI AD ALTO RISCHIO CORONARICO]
No full textWhy China guidelines for type 2 diabetes represent an opportunity for treating this disease
No full textMore than one quarter of people affected by type 2 diabetes worldwide live in China, where an alarming increase in diabetes incidence is taking place. However, most of the evidence about diabetes management derives from studies conducted on non-Asian people, raising concerns about their validity in other ethnic groups, including the Chinese. The guidelines proposed by the Chinese Diabetes Society suggest tools for medical doctors in China and worldwide to appropriately face diabetes in Chinese people, whose number in non-Chinese countries is continuously increasing. However, additional efforts are still needed to achieve an evidence-based tailored therapy for type 2 diabetes in Chinese people. Copyright © 2016 John Wiley & Sons, Ltd
Diabetes and disordered bone metabolism (diabetic osteodystrophy): time for recognition
No full textDiabetes and osteoporosis are rapidly growing diseases. The link between the high fracture incidence in diabetes as compared with the non-diabetic state has recently been recognized. While this review cannot cover every aspect of diabetic osteodystrophy, it attempts to incorporate current information from the First International Symposium on Diabetes and Bone presentations in Rome in 2014. Diabetes and osteoporosis are fast-growing diseases in the western world and are becoming a major problem in the emerging economic nations. Aging of populations worldwide will be responsible for an increased risk in the incidence of osteoporosis and diabetes. Furthermore, the economic burden due to complications of these diseases is enormous and will continue to increase unless public awareness of these diseases, the curbing of obesity, and cost-effective measures are instituted. The link between diabetes and fractures being more common in diabetics than non-diabetics has been widely recognized. At the same time, many questions remain regarding the underlying mechanisms for greater bone fragility in diabetic patients and the best approach to risk assessment and treatment to prevent fractures. Although it cannot cover every aspect of diabetic osteodystrophy, this review will attempt to incorporate current information particularly from the First International Symposium on Diabetes and Bone presentations in Rome in November 2014
Type 2 diabetes in children and adolescents: Challenges for treatment and potential solutions
No full text: Historically perceived as a disease mainly affecting adults, the prevalence of type 2 diabetes mellitus (T2DM) among children and adolescents has been rising, mirroring the increasing rates of childhood obesity. Currently, youth-onset T2DM poses a significant public health challenge globally. Treating youth-onset T2DM poses numerous critical challenges, namely limited and inadequate therapeutic options, and difficulties with conducting therapeutic studies. As a result, current treatment guidelines are based on adult studies and expert consensus. Few prominent guidelines on the treatment of youth-onset T2DM have been published recently, i.e., by the American Diabetes Association (ADA) 2024, National Institute for Healthcare and Excellence United Kingdom (NICE UK) 2023, International Society Paediatric and Adolescents Diabetes (ISPAD) 2022, Australasian Paediatric Endocrine Group (APEG) 2020 and Diabetes Canada 2018. This review first explores the unique aspects of youth-onset T2DM. It then summarises the different treatment guidelines, discusses the different treatment modalities based on available evidence and identifies any gaps. The review also explores challenges in the treatment of youth-onset T2DM with potential solutions and discusses recent trials on the treatment of youth-onset T2DM. Continued research aims to optimise treatment, improve outcomes, and alleviate the burden of T2DM on youths
Combination immunotherapies for type 1 diabetes mellitus
No full textImmunotherapies for type 1 diabetes mellitus (T1DM) have been the focus of intense basic and clinical research over the past few decades. Restoring β-cell function is the ultimate goal of intervention trials that target the immune system in T1DM. In an attempt to achieve this aim, different combination therapies have been proposed over the past few years that are based on treatments tackling the various mechanisms involved in the destruction of β cells. The results of clinical trials have not matched expectations based on the positive results from preclinical studies. The heterogeneity of T1DM might explain the negative results obtained, but previous trials have not addressed this issue. However, novel promising combination therapies are being developed, including those that couple immunomodulators with drugs that stimulate β-cell regeneration in order to restore normoglycaemia. This strategy is an encouraging one to pursue the goal of finding a cure for T1DM. This Review summarizes the available data about combination immunotherapies in T1DM, particularly addressing their clinical importance. The available data supporting the use of registered drugs, such as proton pump inhibitors and incretin-based agents, that have been shown to induce β-cell regeneration will also be discussed.Immunotherapies for type 1 diabetes mellitus (T1DM) have been the focus of intense basic and clinical research over the past few decades. Restoring β-cell function is the ultimate goal of intervention trials that target the immune system in T1DM. In an attempt to achieve this aim, different combination therapies have been proposed over the past few years that are based on treatments tackling the various mechanisms involved in the destruction of β cells. The results of clinical trials have not matched expectations based on the positive results from preclinical studies. The heterogeneity of T1DM might explain the negative results obtained, but previous trials have not addressed this issue. However, novel promising combination therapies are being developed, including those that couple immunomodulators with drugs that stimulate β-cell regeneration in order to restore normoglycaemia. This strategy is an encouraging one to pursue the goal of finding a cure for T1DM. This Review summarizes the available data about combination immunotherapies in T1DM, particularly addressing their clinical importance. The available data supporting the use of registered drugs, such as proton pump inhibitors and incretin-based agents, that have been shown to induce β-cell regeneration will also be discussed
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