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Miglioramento dell'insulino-sensibilità e dell'insulino-secrezione dopo switch da terapia con glucocorticoidi tradizionali a idrocortisone "dual release" in pazienti affetti da iposurrenalismo
No full textBackground: La terapia sostitutiva con glucocorticoidi (GC) non riflette la fisiologica secrezione endogena di cortisolo per cui è spesso associata a numerose complicanze croniche, fra cui quelle metaboliche con tendenza all’aumento della glicemia e riduzione dell’insulino-sensibilità con secondario iperinsulinismo.
Obiettivi: Valutare gli effetti metabolici dello switch da terapia con GC a rapido rilascio (idrocortisone e cortisone acetato) somministrati 2-3 volte/die alla monosomministrazione giornaliera di idrocortisone “dual release” (IDR) mantenendo la stessa dose bioequivalente.
Metodi: Abbiamo valutato, oltre ai classici parametri clinici e metabolici, l’indice di insulino-sensibilità ISI Matsuda e gli indici di insulino-secrezione AUC-insulinemia (durante OGTT) e Oral Disposition Index (Dio) in 34 pz. (23 F, 11 M, range età 23-73 aa) con iposurrenalismo (N 24 secondario, N 10 primitivo) durante terapia con GC tradizionali e dopo 12 mesi di terapia con IDR.
Risultati: Dopo 12 mesi di IDR si è evidenziata una riduzione significativa di circonferenza vita (CV) (96 ± 2.4 vs. 98.5 ± 2.4 cm; p=0.001), con contestuale aumento di ISI Matsuda (12.2 ± 3.3 vs. 7.3 ± 1.3 cm; p=0.040) e di DIo (3.8 ± 0.7 vs. 1.4 ± 0.1; p=0.003), senza differenze significative nei livelli basali e nelle AUC di glicemia e insulinemia. ISI Matsuda a 12 mesi correla significativamente sia con il peso (Rho -0.758; p=0.011) che con la CV (Rho -0.645; p=0.017). Nessuna differenza si è evidenziata dividendo i pazienti in base al tipo di iposurrenalismo.
Conclusioni: Lo switch terapeutico da GC tradizionali a IDR in pazienti con iposurrenalismo è associato ad un miglioramento del profilo clinico e metabolico, sia in termini di insulino-sensibilità che di insulino-secrezione
One 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
Erratum to: Liraglutide Improves Cardiovascular Risk as an Add-on to Metformin and Not to Insulin Secretagogues in Type 2 Diabetic Patients: A Real-life 48-Month Retrospective Study (Diabetes Therapy, (2018), 9, 1, (363-371), 10.1007/s13300-017-0338-4)
No full textIn the original publication, the funding statement was incorrectly published and the Editorial Assistant information was missed in the published version. The correct funding statement and the Editorial Assistant statement should read as below. Funding. The study and article processing charges were funded by Novo Nordisk S.p.A. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and the accuracy of the data analysis. Editorial Assistance. Editorial assistance was provided by Paolo de Gennaro of Airon Communication. Support for this assistance was funded by Novo Nordisk S.p.A
Corneal thickness in children with growth hormone deficiency: The effect of GH treatment.
Full text linkAbstract
OBJECTIVE:
The eye represents a target site for GH action, although few data are available in patients with GH deficiency (GHD). Our aim was to evaluate central corneal thickness (CCT) and intraocular pressure (IOP) values in GHD children to assess the role played by GHD or GH treatment on these parameters.
DESIGN:
In 74 prepubertal GHD children (51M, 23F, aged 10.4±2.4years) we measured CCT and IOP before and after 12months of treatment. A baseline evaluation was also made in 50 healthy children matched for age, gender and body mass index. The study outcome considered CCT and IOP during treatment and their correlations with biochemical and auxological data.
RESULTS:
No difference in CCT and IOP between GHD children at baseline and controls was found (all p>0.005). GHD children after 12months of therapy showed greater CCT (564.7±13.1μm) than both baseline values (535.7±17μm; p<0.001) and control subjects (536.2±12.5μm; p<0.001), with a concomitantly higher corrected mean IOP (15.6±0.7mmHg; p<0.001) than both baseline (12.5±0.8mmHg; p<0.001) and controls (12.3±0.5mmHg; p<0.001), without correlation with auxological and biochemical parameters.
CONCLUSIONS:
12months of GH treatment in children with GHD, regardless of auxological and biochemical data, affect CCT and IOP. Our findings suggest careful ocular evaluation in these patients to prevent undesirable side effects during the follow-up
The visceral adiposity index is associated with insulin sensitivity and IGF-I levels in adults with growth hormone deficiency
Full text linkThe visceral adiposity index, based on anthropometric and metabolic parameters, has been shown to be related to adipose tissue function and insulin sensitivity. We aimed to evaluate the performance of the visceral adiposity index in adult patients with growth hormone deficiency. We enrolled 52 patients(mean age 51 ± 13 years) with newly diagnosed growth hormone deficiency and 50 matched healthy subjects as controls at baseline. At baseline and after 12 and 24 months of treatment we evaluated anthropometric measures, lipid profile, glucose and insulin during an oral glucose tolerance test, hemoglobin A1c, homeostasis model assessment estimate of insulin resistance, quantitative insulin sensitivity check index, insulin sensitivity index Matsuda, insulin-like growth factor-I and visceral adiposity index. At baseline growth hormone deficiency patients showed higher waist circumference (p < 0.001), low-density lipoprotein cholesterol (p < 0.001) and visceral adiposity index (p = 0.003) with lower insulin sensitivity index (p = 0.007) and high-density lipoprotein cholesterol (p = 0.001) than controls. During growth hormone treatment we observed a significant increase in insulin-like growth factor-I (p < 0.001), high-density lipoprotein (p < 0.001) with a trend toward increase in insulin sensitivity index (p = 0.055) and a significant decrease in total cholesterol (p < 0.001) and visceral adiposity index (p < 0.001), while no significant changes were observed in other clinical and metabolic parameters. The visceral adiposity index was the only parameter that significantly correlated with growth hormone peak at diagnosis (p < 0.001) and with insulin-like growth factor-I and insulin sensitivity index both at diagnosis (p = 0.009 and p < 0.001) and after 12 (p = 0.026 and p = 0.001) and 24 months (p < 0.001 and p = 0.001) of treatment. The visceral adiposity index, which has shown to be associated with both insulin-like growth factor-I and insulin sensitivity, proved to be the most reliable index of metabolic perturbation, among the most common indexes of adiposity assessment and a marker of benefit during treatment in adult growth hormone deficiency patients
Utility of C-peptide for a reliable estimate of insulin secretion in children with growth hormone deficiency.
Full text linkOBJECTIVE:
GH treatment (GHT) can lead to glucose metabolism impairment through decreased insulin sensitivity and impaired pancreatic β-cell function, which are the two key components of the pathogenesis of diabetes. Therefore, in addition to insulin sensitivity, during GHT it is very important to perform a reliable evaluation of insulin secretion. However, conflicting data exist regarding the insulin secretion in children during GHT. C-peptide provides a more reliable estimate of β-cell function than insulin, but few studies evaluated it during GHT. Our aim was to assess the usefulness of C-peptide in the evaluation of insulin secretion in GH deficiency (GHD) children.
DESIGN:
In 48 GHD children, at baseline and after 12 and 24months of GHT, and in 56 healthy subjects we evaluated fasting and glucagon-stimulated (AUCCpep) C-peptide levels in addition to other commonly used secretion indexes, such as fasting and oral glucose tolerance test-stimulated insulin levels (AUCINS), Homa-β, and insulinogenic index. The main outcomes were the change in C-peptide during GHT and its correlation with the auxological and hormonal parameters.
RESULTS:
At baseline GHD children showed a significant lower AUCCpep (p=0.006), while no difference was found for the other indexes. Both fasting C-peptide (beta 0.307, p=0.016) and AUCCpep (beta 0.379, p=0.002) were independently correlated with IGF-I SDS, while no correlation was found for all other indexes. After 12months an increase in Homa-β (p<0.001), fasting C-peptide (p=0.002) and AUCCpep (p<0.001) was found. At multivariate analysis, only fasting C-peptide (beta 0.783, p=0.001) and AUCCpep (beta 0.880, p<0.001) were independently correlated with IGF-I SDS.
CONCLUSIONS:
C-peptide, rather than the insulin-derived indexes, has proved to be the most useful marker of insulin secretion correlated to IGF-I levels in GHD children. Therefore, we suggest the use of glucagon test both as diagnostic test for the GH assessment and as a useful tool for the evaluation of insulin secretion during GHT in children
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 linkDiversa efficacia clinica e biochimica della terapia con liraglutide in una popolazione di diabetici di tipo 2 in relazione ai valori basali di HbA1c
No full textBackground: I criteri AIFA di rimborsabilità dei farmaci ad azione incretino-mimetica limitano notevolmente l’utilizzo degli stessi ad un range molto ristretto di HbA1c alla prima prescrizione(7,5-8,5%), escludendone quindi dal loro utilizzo i pazienti con più severo scompenso glicometabolico.
Obiettivi: Valutare la diversa efficacia di liraglutide durante i primi 12 mesi di terapia in relazione ai valori di HbA1c di partenza.
Metodi: Sono stati retroattivamente valutati i dati clinici e metabolici di 62 pazienti diabetici di tipo 2 (38 M, 24 F, range età 29-74 aa, range durata di malattia 0-30 aa) trattati in un periodo antecedente l’entrata in vigore dei limiti di rimborsabilità AIFA, in terapia stabile per 12 mesi con liraglutide 1,2 mg/die, suddivisi in base all’HbA1c di partenza in gruppo A (n° 34 pz. con Hba1c ≤8,5%; media 7.3 ± 0.7%) e gruppo B (n° 28 pz. con Hba1c >8,5%; media 9.8 ± 1.2%). I due gruppi sono risultati appaiati per età, sesso, BMI, durata di malattia e terapia associata (n° 29 pz. in duplice con metformina, n° 33 pz. in triplice con metformina e sulfanilurea).
Risultati: In tutti i pazienti, indipendentemente dalla terapia associata, dopo 12 mesi si osserva una riduzione significativa di HbA1c (p<0,01), BMI (p<0,01), circonferenza vita (CV) (p<0,01), pressione sistolica (p<0,01) e diastolica (p<0,01) e il ∆-HbA1c a 12 mesi correla significativamente con il ∆-BMI (p=0.007) e ∆-CV (p=0.023). Il gruppo B mostra un ∆-BMI a 6 mesi (-1.8 ± 1.5 vs. -1 ± 1.4 Kg/m2; p=0.032) e un ∆-HbA1c sia a 6 (-2.9 ± 1.7 vs. -0.7 ± 0.7%; p<0.001) che a 12 mesi (-2.9 ± 1.7 vs. -0.5 ± 0.7%; p<0.001) significativamente superiore al gruppo A. Inoltre, un maggiore ∆-HbA1c sia a 6 (-2.3 ± 2 vs. -1.1 ± 1.1%; p=0.006) che a 12 mesi (-2.2 ± 2 vs. -1 ± 1.1%; p=0.010) si verifica nel gruppo in duplice terapia rispetto a quello in triplice.
Conclusioni: Liraglutide dimostra una migliore efficacia sia clinica che biochimica nei pazienti con scompenso glicometabolico più severo e verosimilmente in fase più precoce di malattia (duplice vs. triplice terapia)
Alta prevalenza di Sindrome dell’ovaio policistico in donne diabetiche di tipo 1 in età fertile.
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