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Irace C, Acmet E, Cutruzzolà A, Parise M, Ponzani P, Scarpitta AM, Candido R. Digital technology and healthcare delivery in insulin-treated adults with diabetes: a proposal for analysis of self-monitoring blood glucose patterns using a dedicated platform. Endocrine 2024; 84:441-449. [PMID: 37996773 DOI: 10.1007/s12020-023-03605-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE A remote platform for diabetes care (Roche Diabetes® Care Platform, RDCP) has been developed that allows combined face-to-face consultations and remote patient monitoring (RPM). METHODS A dedicated flowchart is proposed as a clinical approach to help healthcare professionals in the appropriate interpretation of structured self-monitoring blood glucose data, as visualized on the RDCP during the visits, and in the optimal management of patients using the integrated RDCP-RPM tools. RESULTS The platform organizes patterns in different blocks: (i) hypoglycemia; (ii) hyperglycemia; (iii) blood glucose variability; (iv) treatment adherence, which identifies a possible individual pattern according to glycemic control challenges, potential causal factors, and behavioral type patterns. The flowchart proposed for use of the RDCP-RPM is self-explanatory and entails 3 steps: (1) evaluation of quality and quantity of self-monitoring blood glucose data; (2) pattern analysis; (3) personalized suggestions and therapy changes. CONCLUSION The main aim of the remote treatment flowchart proposed is to support healthcare professionals in the identification of hypoglycemic and hyperglycemic patterns using the RDCP regardless of the HbA1c value and ongoing treatment, which however, become crucial in combination with pattern analysis in the therapeutical choice.
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Affiliation(s)
- Concetta Irace
- Department of Health Science, University Magna Graecia, Catanzaro, Italy.
| | - Elena Acmet
- Medical Affairs Director, Roche Diabetes Care, Monza, Italy
| | - Antonio Cutruzzolà
- Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
| | - Martina Parise
- Department of Health Science, University Magna Graecia, Catanzaro, Italy
| | - Paola Ponzani
- Unit of Diabetology and Metabolism, ASL 4, Chiavari, GE, Italy
| | | | - Riccardo Candido
- Diabetes Centre, University of Trieste, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
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Silverii GA, Gabutti G, Tafuri S, Sarti F, Pratesi A, Clerico A, Fornengo R, Greco C, Irace C, Sordi V, Sorice GP, Cavallo M, Ponziani MC, Mannucci E, Dicembrini I. Diabetes as a risk factor for pneumococcal disease and severe related outcomes and efficacy/effectiveness of vaccination in diabetic population. Results from meta-analysis of observational studies. Acta Diabetol 2024:10.1007/s00592-024-02282-5. [PMID: 38684540 DOI: 10.1007/s00592-024-02282-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/23/2024] [Indexed: 05/02/2024]
Abstract
AIMS To collect all available evidence on the effect of diabetes mellitus (DM) as a risk factor for pneumococcal disease incidence and related complications, and on the efficacy/effectiveness of vaccines in patients with DM. METHODS Two distinct systematic searches on MEDLINE, Cochrane, ClinicalTrials.gov and EMBASE databases were performed, one for each meta-analysis, collecting all observational (cohort and case-control) studies and randomized clinical trials performed on humans up to June 1st, 2023. RESULTS We retrieved 36 observational studies comparing risk for pneumococcal disease and related complications in people with or without DM, and 11 studies (1 randomized clinical trial and 10 observational studies) assessing conjugated and polysaccaridic vaccines efficacy/effectiveness on preventing such outcomes. People with DM were at higher risk for Invasive Pneumococcal Disease (unadjusted OR 2.42 [2.00; 2.92]); Case-Fatality Rate (unadjusted OR 1.61 [1.25; 2.07], Pneumococcal pneumonia (unadjusted OR 2.98 [2.76; 3.22), and Intensive care unit admission for pneumococcal disease (unadjusted OR 2.09 [1.20; 3.66]). In diabetic individuals vaccinated with conjugated vaccine, incidence of pneumonia specific for vaccine type in a clinical trial (OR 0.237 [0.008; 0.704]), and hospitalization for overall pneumonia during the year following the polysaccharide vaccination in observational studies (unadjusted OR 0.63 [0.45-0.89]) were significantly lower in comparison with unvaccinated DM subjects, with no significant differences for other outcomes. CONCLUSIONS People with diabetes mellitus are at higher risk for less favourable course of pneumococcal disease and should be therefore targeted in vaccination campaigns; more evidence needs to be collected on vaccination outcomes in people with diabetes.
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Affiliation(s)
- Giovanni Antonio Silverii
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, 50139, Florence, Italy
| | - Giovanni Gabutti
- Coordinator Working Group "Vaccines and Immunization Policies", Italian Scientific Society of Hygiene, Preventive Medicine and Public Health (SItI), Terni, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, Aldo Moro, University of Bari, Bari, Italy
| | - Francesca Sarti
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, 50139, Florence, Italy
| | - Anna Pratesi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, 50139, Florence, Italy
| | | | | | - Carla Greco
- Biomedical and Metabolic Department, Modena and Reggio Emilia University, Modena, Italy
| | - Concetta Irace
- Health Sciences Department, Catanzaro "Magna Graecia" University, Catanzaro, Italy
| | - Valeria Sordi
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | | | - Edoardo Mannucci
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, 50139, Florence, Italy
| | - Ilaria Dicembrini
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, 50139, Florence, Italy.
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Cutruzzolà A, Parise M, Cozza P, Moraru S, Gnasso A, Irace C. Elevated blood flow in people with type 1 and type 2 diabetes. Diabetes Res Clin Pract 2024; 208:111110. [PMID: 38278495 DOI: 10.1016/j.diabres.2024.111110] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
AIMS The study aimed to evaluate blood flow (BF) and microvascular function in the forearm of people with type 1 and type 2 diabetes at rest and after ischemia. Microvascular function plays a crucial role in regulating BF in peripheral tissues based on metabolic demand. METHODS People with diabetes and sex-matched healthy controls were recruited. Brachial artery diameter and blood velocity were continuously measured at rest and after ischemia by an automatic tracking system. BF and vascular conductance were then calculated. RESULTS Forty-nine people with diabetes and 49 controls were enrolled. BF at rest and after ischemia was significantly higher in people with diabetes than controls: Type 1, 243 ± 116 and 631 ± 233 ml/min; controls, 180 ± 106 and 486 ± 227 ml/min; Type 2, 332 ± 149 and 875 ± 293 ml/min; controls 222 ± 106 and 514 ± 224 ml/min. Vascular conductance was significantly higher in Type 2 than in controls at rest and after ischemia. CONCLUSIONS People with diabetes exhibited significantly increased BF, with Type 2 also showing heightened vascular conductance. Activating metabolic pathways triggered by hyperglycemia may lead to distinct vascular redistribution, potentially impairing blood flow over time. These findings of the study underscore the importance of understanding overall vascular dynamics in diabetes and its implications for vascular health.
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Affiliation(s)
- Antonio Cutruzzolà
- Department of Clinical and Experimental Medicine, University Magna Græcia, Catanzaro, Italy
| | - Martina Parise
- Department of Health Science, University Magna Græcia, Catanzaro, Italy
| | - Pasquale Cozza
- School of Medicine, University Magna Græcia, Catanzaro, Italy
| | - Stefan Moraru
- School of Medicine, University Magna Græcia, Catanzaro, Italy
| | - Agostino Gnasso
- Department of Clinical and Experimental Medicine, University Magna Græcia, Catanzaro, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Græcia, Catanzaro, Italy.
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Maiorino MI, Buzzetti R, Irace C, Laviola L, Napoli N, Pitocco D, Esposito K. Correction: An updated algorithm for an effective choice of continuous glucose monitoring for people with insulin-treated diabetes. Endocrine 2024:10.1007/s12020-023-03635-w. [PMID: 38291319 DOI: 10.1007/s12020-023-03635-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Maria Ida Maiorino
- Unit of Endocrinology and Metabolic Diseases, University Hospital Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy.
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy.
| | - Raffaella Buzzetti
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, Viale Europa, 88100, Catanzaro, Italy
| | - Luigi Laviola
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Nicola Napoli
- Fondazione Policlinico Universitario Campus Bio-Medico, Research Unit of Endocrinology and Diabetes, Department of Medicine and Surgery, Università Campus Bio-Medico of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Dario Pitocco
- Diabetes Care Unit, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Katherine Esposito
- Unit of Endocrinology and Metabolic Diseases, University Hospital Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy
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Russell-Jones D, Babazono T, Cailleteau R, Engberg S, Irace C, Kjaersgaard MIS, Mathieu C, Rosenstock J, Woo V, Klonoff DC. Once-weekly insulin icodec versus once-daily insulin degludec as part of a basal-bolus regimen in individuals with type 1 diabetes (ONWARDS 6): a phase 3a, randomised, open-label, treat-to-target trial. Lancet 2023; 402:1636-1647. [PMID: 37863084 DOI: 10.1016/s0140-6736(23)02179-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/24/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND ONWARDS 6 compared the efficacy and safety of once-weekly subcutaneous insulin icodec (icodec) and once-daily insulin degludec (degludec) in adults with type 1 diabetes. METHODS This 52-week (26-week main phase plus a 26-week safety extension), randomised, open-label, treat-to-target, phase 3a trial was done at 99 sites across 12 countries. Adults with type 1 diabetes (glycated haemoglobin [HbA1c] <10·0% [86 mmol/mol]) were randomly assigned (1:1) to once-weekly icodec or once-daily degludec, both in combination with insulin aspart (two or more daily injections). The primary endpoint was change in HbA1c from baseline to week 26, tested for non-inferiority (0·3 percentage point margin) in all randomly assigned participants. This trial is registered with ClinicalTrials.gov, NCT04848480, and is now complete. FINDINGS Between April 30 and Oct 15, 2021, of 655 participants screened, 582 participants were randomly assigned to icodec (n=290) or degludec (n=292). At week 26, from baseline values of 7·59% (icodec) and 7·63% (degludec), estimated mean changes in HbA1c were -0·47 percentage points and -0·51 percentage points, respectively (estimated treatment difference 0·05 percentage points [95% CI -0·13 to 0·23]), confirming non-inferiority of icodec to degludec (p=0·0065). Overall rate of combined clinically significant or severe hypoglycaemia (baseline to week 26) was statistically significantly higher with icodec than degludec (19·9 vs 10·4 events per patient-year of exposure; estimated rate ratio 1·9 [95% CI 1·5 to 2·3]; p<0·0001). The rate was also statistically significantly higher with icodec than degludec when evaluated over 57 weeks (52 weeks plus a 5-week follow-up period). 39 serious adverse events were reported in 24 (8%) participants receiving icodec, and 25 serious adverse events were reported in 20 (7%) participants receiving degludec. One participant in the icodec group died; this was judged unlikely to be due to the trial product. INTERPRETATION In adults with type 1 diabetes, once-weekly icodec showed non-inferiority to once-daily degludec in HbA1c reduction at week 26, with statistically significantly higher rates of combined clinically significant or severe hypoglycaemia. For icodec, time below 3·0 mmol/L (<54 mg/dL) was at the threshold of the internationally recommended target (<1%) during weeks 22-26 and below target during weeks 48-52. FUNDING Novo Nordisk.
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Affiliation(s)
- David Russell-Jones
- The Cedar Centre, Royal Surrey Foundation Trust, Guildford, UK; Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
| | - Tetsuya Babazono
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | | | | | - Concetta Irace
- Department of Health Science, University Magna Græcia, Viale Europa, Località Germaneto, Catanzaro, Italy
| | | | - Chantal Mathieu
- Clinical and Experimental Endocrinology, University of Leuven, Leuven, Belgium
| | | | - Vincent Woo
- University of Manitoba, Winnipeg, MB, Canada
| | - David C Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
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Maiorino MI, Buzzetti R, Irace C, Laviola L, Napoli N, Pitocco D, Esposito K. An updated algorithm for an effective choice of continuous glucose monitoring for people with insulin-treated diabetes. Endocrine 2023; 82:215-225. [PMID: 37676398 PMCID: PMC10543826 DOI: 10.1007/s12020-023-03473-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/25/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Continuous Glucose Monitoring (CGM) is a key tool for insulin-treated people with diabetes (PwD). CGM devices include both real-time CGM (rtCGM) and intermittently scanned CGM (isCGM), which are associated with an improvement of glucose control and less hypoglycemia in clinical trials of people with type 1 and type 2 diabetes. METHODS This is an expert position to update a previous algorithm on the most suitable choice of CGM for insulin-treated PwD in light of the recent evidence and clinical practice. RESULTS We identified six different clinical scenarios, including type 1 diabetes, type 2 diabetes, pregnancy on intensive insulin therapy, regular physical exercise, new onset of diabetes, and frailty. The use of rtCGM or isCGM is suggested, on the basis of the predominant clinical issue, as suboptimal glucose control or disabling hypoglycemia, regardless of baseline HbA1c or individualized HbA1c target. CONCLUSION The present algorithm may help to select the best CGM device based on patients' clinical characteristics, needs and clinical context, offering a further opportunity of a "tailored" therapy for people with insulin-treated diabetes.
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Affiliation(s)
- Maria Ida Maiorino
- Unit of Endocrinology and Metabolic Diseases, University Hospital Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy.
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Naples, Italy.
| | - Raffaella Buzzetti
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, Viale Europa, 88100, Catanzaro, Italy
| | - Luigi Laviola
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Nicola Napoli
- Fondazione Policlinico Universitario Campus Bio-Medico, Research Unit of Endocrinology and Diabetes, Department of Medicine and Surgery, Università Campus Bio-Medico of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Dario Pitocco
- Diabetes Care Unit, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Katherine Esposito
- Unit of Endocrinology and Metabolic Diseases, University Hospital Luigi Vanvitelli, Piazza Miraglia 2, 80138, Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Naples, Italy
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Irace C, Coluzzi S, Di Cianni G, Forte E, Landi F, Rizzo MR, Sesti G, Succurro E, Consoli A. Continuous glucose monitoring (CGM) in a non-Icu hospital setting: The patient's journey. Nutr Metab Cardiovasc Dis 2023; 33:2107-2118. [PMID: 37574433 DOI: 10.1016/j.numecd.2023.06.021] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/28/2023] [Indexed: 08/15/2023]
Abstract
AIMS Although consistent data support the outpatient use of continuous glucose monitoring (CGM) to improve glycemic control and reduce hypoglycemic burden, and clinical outcomes, there are limited data regarding its use in the hospital setting, particularly in the non-intensive care unit (non-ICU) setting. The emerging use of CGM in the non-critical care setting may be useful in increasing the efficiency of hospital care and reducing the length of stay for patients with diabetes while improving glycemic control. DATA SYNTHESIS The purpose of this Expert Opinion paper was to evaluate the state of the art and provide a practical model of how CGM can be implemented in the hospital. SETTING A patient's CGM journey from admission to the ward to the application of the sensor, from patient education on the device during hospitalization until discharge of the patient to maintain remote control. CONCLUSIONS This practical approach for the implementation and management of CGM in patients with diabetes admitted to non-ICUs could guide hospitals in their diabetes management initiatives using CGM, helping to identify patients most likely to benefit and suggesting how this technology can be implemented to maximize clinical benefits.
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Affiliation(s)
- Concetta Irace
- Department of Health Science, University Magna Graecia of Catanzaro, Catanzaro, Italy.
| | - Sara Coluzzi
- Endocrinology and Metabolism Unit, ASL, Pescara, Italy
| | - Graziano Di Cianni
- ASL Tuscany Northwest, Diabetes and Metabolic Disease, Livorno Hospital, Livorno, Italy
| | | | - Francesco Landi
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Rosaria Rizzo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Agostino Consoli
- Endocrinology and Metabolism Unit, ASL, Pescara, Italy; Department of Medicine and Aging Sciences DMSI and Center for Advanced Studies and Technology CAST, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
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Bruttomesso D, Irace C, Pozzilli P. A sub-analysis of the SAGE study in Italy indicates good glycemic control in type 1 diabetes. Nutr Metab Cardiovasc Dis 2023; 33:631-639. [PMID: 36670006 DOI: 10.1016/j.numecd.2022.11.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Intensive glycemic control minimizes the risk of micro- and macrovascular complications in patients with type 1 diabetes (T1D). We report glycemic control in Italian participants (age groups: 26-44, 45-64, and ≥65 years) of the global SAGE study. METHODS AND RESULTS The primary endpoint was proportion of participants who achieved an HbA1c <7% in predefined age groups. In the 523 patients with T1D, mean age was 44.6 years and mean body mass index (BMI) was 25 kg/m2. Mean HbA1c was 7.5% and 29.4% had HbA1c <7.0%, with the highest percentage in those 26-45 years (31.7%) and the lowest in those ≥65 years (20%). Altogether, 22.9% of patients achieved their physician-established individualized HbA1c target. Most patients had ≥1 symptomatic hypoglycemic episode in the previous 3 months (≤70 mg/dL 82.5%; ≤54 mg/dL 61%). Severe hypo- and hyperglycemia were experienced by 16.3% and 12% of patients, of which 7.1 and 9.5%, respectively, required hospitalization/emergency visits. More patients achieved HbA1c <7% with CSII (30%) than with multiple daily insulin injections (27.9%). In multivariate analysis, BMI (OR 0.94, 95% CI 0.89-0.99, p = 0.032) and adherence to diet (OR 0.36, 95% CI 0.18-0.70, p = 0.0028) were significantly associated with HbA1c <7.0%. CONCLUSIONS Glycemic control can be considered good in the Italian SAGE cohort, especially in younger patients, who more frequently use pumps/continuous glucose monitoring. Greater patient education and use of technology may further support this achievement. Patients should be encouraged to maintain a low BMI and adhere to their diet.
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Affiliation(s)
- D Bruttomesso
- University of Padova, Department of Medicine (DIMED), Italy; University Hospital of Padova, Division of Metabolic Diseases, Italy.
| | - C Irace
- Department of Health Science, University Magna Graecia Catanzaro, Italy
| | - P Pozzilli
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
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Parise M, Di Molfetta S, Graziano RT, Fiorentino R, Cutruzzolà A, Gnasso A, Irace C. A Head-to-Head Comparison of Two Algorithms for Adjusting Mealtime Insulin Doses Based on CGM Trend Arrows in Adult Patients with Type 1 Diabetes: Results from an Exploratory Study. Int J Environ Res Public Health 2023; 20:3945. [PMID: 36900956 PMCID: PMC10002216 DOI: 10.3390/ijerph20053945] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/27/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) users are encouraged to consider trend arrows before injecting a meal bolus. We evaluated the efficacy and safety of two different algorithms for trend-informed bolus adjustments, the Diabetes Research in Children Network/Juvenile Diabetes Research Foundation (DirectNet/JDRF) and the Ziegler algorithm, in type 1 diabetes. METHODS We conducted a cross-over study of type 1 diabetes patients using Dexcom G6. Participants were randomly assigned to either the DirectNet/JDRF or the Ziegler algorithm for two weeks. After a 7-day wash-out period with no trend-informed bolus adjustments, they crossed to the alternative algorithm. RESULTS Twenty patients, with an average age of 36 ± 10 years, completed this study. Compared to the baseline and the DirectNet/JDRF algorithm, the Ziegler algorithm was associated with a significantly higher time in range (TIR) and lower time above range and mean glucose. A separate analysis of patients on CSII and MDI revealed that the Ziegler algorithm provides better glucose control and variability than DirectNet/JDRF in CSII-treated patients. The two algorithms were equally effective in increasing TIR in MDI-treated patients. No severe hypoglycemic or hyperglycemic episode occurred during the study. CONCLUSIONS The Ziegler algorithm is safe and may provide better glucose control and variability than the DirectNet/JDRF over a two-week period, especially in patients treated with CSII.
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Affiliation(s)
- Martina Parise
- Department of Health Science, University Magna Graecia, 88100 Catanzaro, Italy
| | - Sergio Di Molfetta
- Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70121 Bari, Italy
| | | | | | - Antonio Cutruzzolà
- Department of Clinical and Experimental Medicine, University Magna Graecia, 88100 Catanzaro, Italy
| | - Agostino Gnasso
- Department of Clinical and Experimental Medicine, University Magna Graecia, 88100 Catanzaro, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, 88100 Catanzaro, Italy
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Cutruzzolà A, Carnevali A, Gatti V, Latella G, Lamonica L, Oliverio F, Borelli M, Parise M, Di Molfetta S, Scorcia V, Irace C, Gnasso A. Continuous Glucose Monitoring-Derived Metrics and Capillary Vessel Density in Subjects with Type 1 Diabetes without Diabetic Retinopathy. J Diabetes Res 2023; 2023:9516059. [PMID: 37096234 PMCID: PMC10122598 DOI: 10.1155/2023/9516059] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/15/2022] [Revised: 03/13/2023] [Accepted: 03/30/2023] [Indexed: 04/26/2023] Open
Abstract
Optical coherence tomography angiography (OCTA) is an innovative and reliable technique detecting the early preclinical retinal vascular change in patients with diabetes. We have designed our study to evaluate whether an independent relationship exists between continuous glucose monitoring (CGM)-derived glucose metrics and OCTA parameters in young adult patients with type 1 diabetes without diabetic retinopathy (DR). Inclusion criteria were age ≥ 18 years, diagnosis of type 1 diabetes from ≥ 1 year, stable insulin treatment in the last three months, use of real-time CGM, and CGM wear time ≥ 70%. Each patient underwent dilated slit lamp fundus biomicroscopy to exclude the presence of DR. A skilled operator performed OCTA scans in the morning to avoid possible diurnal variation. CGM-derived glucose metrics from the last 2 weeks were collected through the dedicated software during OCTA. Forty-nine patients with type 1 diabetes (age 29 [18; 39] years, HbA1c 7.7 ± 1.0%) and 34 control subjects participated in the study. Vessel density (VD) of the whole image and parafoveal retina in the superficial (SCP) and deep capillary plexus (DCP) was significantly lower in patients with type 1 diabetes compared to controls. The coefficient of variation of average daily glucose, evaluated by CGM, significantly correlated with foveal and parafoveal VD in SCP and with foveal VD in DCP. High glucose variability might be responsible for the early increase of VD in these areas. Prospective studies may help understand if this pattern precedes DR. The difference we detected between patients with and without diabetes confirms that OCTA is a reliable tool for detecting early retinal abnormalities.
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Affiliation(s)
- Antonio Cutruzzolà
- Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
| | - Adriano Carnevali
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Valentina Gatti
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Giovanni Latella
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Luca Lamonica
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Flavia Oliverio
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Massimo Borelli
- UMG School of Ph.D. Programmes Life Sciences and Technologies, University “Magna Græcia”, Catanzaro, Italy
| | - Martina Parise
- Department of Health Science, University Magna Graecia, Catanzaro, Italy
| | - Sergio Di Molfetta
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Vincenzo Scorcia
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, Catanzaro, Italy
| | - Agostino Gnasso
- Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
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11
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Pitocco D, Laurenzi A, Tomaselli L, Assaloni R, Consoli A, Di Bartolo P, Guardasole V, Lombardo F, Maffeis C, Rossi A, Gesuita R, Di Molfetta S, Rigamonti A, Scaramuzza A, Irace C, Cherubini V. Health care organization and use of technological devices in people with diabetes in Italy: Results from a survey of the Working Group on Diabetes and Technology. Nutr Metab Cardiovasc Dis 2022; 32:2392-2398. [PMID: 35970683 DOI: 10.1016/j.numecd.2022.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/27/2022] [Revised: 06/13/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIM The use of technology offers recognized benefits to persons with diabetes. The aim of this study was to evaluate the organization of healthcare facilities, the composition of the diabetes team, and the use of Continuous Subcutaneous Insulin Infusion (CSII) and Continuous Glucose Monitoring (CGM) in Italy. METHODS AND RESULTS Diabetes care centers were asked to complete a web survey based on information collected in 2018. Sixty-one pediatric and 243 adult centers participated in the survey, accounting for 507,386 patients, mostly with type 2 diabetes (86.4%). Fifty-three percent of pediatric centers and 11% of adult centers reported a team composed of diabetologists, nurses, and psychologists. Overall, 13,204 patients (2.6%) were using CSII (95% with type 1 diabetes), and 28,936 (5.7%), were using CGM (74% with type 1 diabetes). When stratifying for the type of diabetes, 24% and 40.8% of patients with type 1 were using CSII and CGM, respectively, whereas low use of technology was reported for patients with type 2 and women with gestational diabetes. The percentage of adult and pediatric patients with type 1 diabetes on CSII and CGM was respectively 21% and 32%, and 35% and 57%. CONCLUSIONS The spread of CGM and CSII increased in Italy between 2013 and 2018. However, the percentage of users is still lower than what is expected based on clinical indications for use of technology. The inadequate number of professionals in the diabetes care team and insufficient economic resources are relevant barriers to disseminating technology for diabetes management.
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Affiliation(s)
- Dario Pitocco
- Diabetes Care Unit, UOSD Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Andrea Laurenzi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Roberta Assaloni
- Diabetes Unit ASS2 Bassa-Friulana Isontina, Udine, Monfalcone [GO], Italy
| | - Agostino Consoli
- Endocrinology and Metabolic Diseases, University of Chieti-Pescara, Chieti, Italy
| | | | - Vincenzo Guardasole
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Claudio Maffeis
- Regional Center for Pediatric Diabetes, University City Hospital of Verona, Verona, Italy
| | - Antonio Rossi
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Sergio Di Molfetta
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Andrea Rigamonti
- Division of Pediatrics, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Andrea Scaramuzza
- Division of Pediatrics, ASST Cremona, "Ospedale Maggiore di Cremona", Cremona, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, Catanzaro, Italy.
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
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12
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Cutruzzolà A, Parise M, Fiorentino R, Romano A, Molinaro V, Gnasso A, Di Molfetta S, Irace C. The Effect of Two Different Insulin Formulations on Postprandial Hyperglycemia after High and Low Glycemic-Index Meal in Type 1 Diabetes. Nutrients 2022; 14:nu14163316. [PMID: 36014822 PMCID: PMC9414780 DOI: 10.3390/nu14163316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/22/2022] [Revised: 08/06/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Despite multiple pharmacological options, including rapid-acting insulin analogs, postprandial hyperglycemia is still highly prevalent in patients with type 1 and type 2 diabetes. We hypothesize that the new rapid-acting insulin formulation, the so-called faster-acting Aspart, may have a different effect in controlling postprandial hyperglycemic burden according to the quality of the meal compared to the traditional Aspart. Twenty-five patients with type 1 diabetes were consecutively recruited at the diabetes care center of the University Hospital affiliate of the Magna Græcia University of Catanzaro. Each patient performed four meal tests one week apart, two with a predefined high glycemic index (HGI) food and two with a low glycemic index (LGI) food using insulin Aspart once and Faster Aspart the other time. The 0–30 min, 0–60 min, and 0–120 min glucose Area Under the Curve (AUC) of postprandial glycemic excursion, calculated from continuous glucose monitoring data, were significantly lower with Faster Aspart administered before the HGI test meal as compared to Aspart. A significant difference in favor of Faster Aspart was also found when comparing the 0–60 min and 0–120 min AUC after the LGI meal. Faster Aspart may provide better postprandial glucose control than Aspart regardless of the glycemic index of the meal.
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Affiliation(s)
- Antonio Cutruzzolà
- Department of Clinical and Experimental Medicine, University Magna Graecia Catanzaro, 88100 Catanzaro, Italy
| | - Martina Parise
- Department of Health Science, University Magna Graecia Catanzaro, 88100 Catanzaro, Italy
| | | | - Agata Romano
- Medical School, University Magna Graecia Catanzaro, 88100 Catanzaro, Italy
| | - Viviana Molinaro
- Medical School, University Magna Graecia Catanzaro, 88100 Catanzaro, Italy
| | - Agostino Gnasso
- Department of Clinical and Experimental Medicine, University Magna Graecia Catanzaro, 88100 Catanzaro, Italy
| | - Sergio Di Molfetta
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia Catanzaro, 88100 Catanzaro, Italy
- Correspondence: ; Tel.: +39-09613647039
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13
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Cutruzzolà A, Cozza P, De Rosa S, Moraru S, Parise M, Gnasso A, Irace C. Type 2 diabetes, HFpEF, and endothelial dysfunction: An observational study. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.790] [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: 11/28/2022]
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14
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Parise M, Cutruzzolà A, Scavelli FB, Carallo C, Gnasso A, Irace C. Autoimmune thyroiditis and celiac disease do not worsen endothelial function in subjects with type 1 diabetes: an observational study. Diabetol Metab Syndr 2022; 14:103. [PMID: 35870966 PMCID: PMC9308025 DOI: 10.1186/s13098-022-00877-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) is frequently associated with autoimmune thyroiditis (AT) and coeliac disease (CD). Whether the coexistence of multiple autoimmune diseases increases cardiovascular risk is uncertain. We evaluated the effects of AT and CD on arterial wall thickening and endothelial function in patients with T1D. METHODS This observational study analyzed data from T1D patients regularly followed by the Diabetes Care Centre. Clinical and biochemical characteristics and micro and macrovascular complications were collected from the electronic medical records. All subjects performed Echo-Doppler to evaluate Intima-Media Thickness (IMT) of the common carotid artery (CCA) and endothelial function by the flow-mediated dilation (FMD) technique. The statistical analyses were performed by SPSS for Macintosh. Comparison between means was performed using the t-test for unpaired data and the Mann-Whitney U test. The ANalysis Of VAriance and the Tukey posthoc test were applied to compare patients with and without other autoimmune diseases, and control subjects. The p-value for statistical significance was set at p < 0.05. RESULTS A total of 110 patients were enrolled. Among these, 69 had T1D and 41 T1D and AT and or CD, of whom 33 AT, 7 CD, and 1 both AT and CD. The mean age was 35 years, mean HbA1c was 7.6%, and mean diabetes duration 18 years. The IMT of the CCA was not significantly different between T1D patients with and without concomitant autoimmune diseases (with AT and CD: right CCA 603 ± 186 µ, left 635 ± 175 µ; without AT and CD: right CCA 611 ± 176 µ, left CCA 631 ± 200 µ). FMD was also comparable between T1D groups, with AT and CD 7.9 ± 4.2%; without AT and CD 8.8 ± 4.4%. CONCLUSION Patients with T1D and concomitant AT and or CD show no worse morphological or functional vascular damage, evaluated by CCA IMT and brachial artery flow-mediated dilation, than patients with T1D alone.
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Affiliation(s)
- Martina Parise
- Department of Health Science, University Magna Græcia, Viale Europa, Località Germaneto, Catanzaro, Italy
| | - Antonio Cutruzzolà
- Department of Clinical and Experimental Medicine, University Magna Græcia, Catanzaro, Italy
| | | | - Claudio Carallo
- Azienda Ospedaliero-Universitaria Mater Domini, Catanzaro, Italy
| | - Agostino Gnasso
- Department of Clinical and Experimental Medicine, University Magna Græcia, Catanzaro, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Græcia, Viale Europa, Località Germaneto, Catanzaro, Italy.
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15
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Cutruzzolà A, Parise M, Scavelli FB, Barone M, Gnasso A, Irace C. Time in Range Does Not Associate With Carotid Artery Wall Thickness and Endothelial Function in Type 1 Diabetes. J Diabetes Sci Technol 2022; 16:904-911. [PMID: 33615850 PMCID: PMC9264437 DOI: 10.1177/1932296821993178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with Type 1 diabetes (T1D) have an increased risk of developing atherosclerosis and complications as myocardial infarction and peripheral artery disease. The thickening of the carotid wall and the brachial artery dysfunction are early and preclinical manifestations of atherosclerosis. The standard marker of care for assessment of glycemic control, glycated hemoglobin, does not associate with early atherosclerosis. We have hypothesized that the emerging metric of glycemic control, as the time spent in the target range (TIR), might be associated with carotid thickening and endothelial dysfunction. According to the hypothesis, we have designed the present research with the aim to evaluate the association between TIR collected in the short and long term and the measures of arterial morphology and function in patients with T1D. METHODS In our study, 70 patients and 35 healthy controls underwent ultrasound vascular study to measure carotid artery intima-media thickness (IMT) and brachial artery endothelial function by the flow-mediated dilation (FMD) technique. TIR was collected by a continuous glucose monitoring system for 2 weeks, 3 months, and 6 months before the vascular study. RESULTS Patients with T1D showed a significantly higher carotid IMT (mean±SE, 644±19 vs. 568±29 µ; p= 0.04) and a significantly lower FMD (mean±SE, 7.6±0.4 vs. 9.8±0.6%; p=0.01) compared with control subjects. No significant relationship between IMT, FMD, and TIR collected in the short and long term emerged. CONCLUSIONS Young patients with T1D have early vascular abnormalities. The percent of TIR does not correlate with preclinical atherosclerosis. This finding underlines the complexity of the interplay between diabetes and atherosclerosis.
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Affiliation(s)
- Antonio Cutruzzolà
- Dipartimento di Medicina Sperimentale e
Clinica, Università degli Studi Magna Græcia di Catanzaro, Italy
| | - Martina Parise
- Dipartimento di Medicina Sperimentale e
Clinica, Università degli Studi Magna Græcia di Catanzaro, Italy
| | - Faustina B Scavelli
- Azienda Ospedaliero-Universitaria Mater
Domini, Università degli Studi Magna Græcia di Catanzaro, Italy
| | - Milena Barone
- Dipartimento di Medicina Sperimentale e
Clinica, Università degli Studi Magna Græcia di Catanzaro, Italy
| | - Agostino Gnasso
- Dipartimento di Medicina Sperimentale e
Clinica, Università degli Studi Magna Græcia di Catanzaro, Italy
| | - Concetta Irace
- Dipartimento di Scienze della Salute,
Università degli Studi Magna Græcia di Catanzaro, Italy
- Concetta Irace, Dipartimento di Scienze
della Salute, Università degli Studi Magna Græcia di Catanzaro, Viale Europa,
Località Germaneto, Catanzaro 88100, Italy.
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16
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Di Molfetta S, Rossi A, Assaloni R, Cherubini V, Consoli A, Di Bartolo P, Guardasole V, Laurenzi A, Lombardo F, Maffeis C, Scaramuzza A, Irace C. A guide for the use of LibreView digital diabetes platform in clinical practice: Expert paper of the Italian Working Group on Diabetes and Technology. Diabetes Res Clin Pract 2022; 187:109867. [PMID: 35405166 DOI: 10.1016/j.diabres.2022.109867] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/16/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022]
Abstract
Wider access to continuous glucose monitoring systems, including flash glucose monitoring, has enabled people with diabetes to achieve lower HbA1c levels and reduce the amount of time they spend in hypoglycaemia or hyperglycaemia, and has improved their quality of life. An International Consensus Panel proposed different target glucose ranges and recommendations according to different ages and situations (adults, young people and children with type 1 or type 2 diabetes, as well as elderly people who are at higher risk of hypoglycaemia, and women with diabetes during pregnancy). In this expert opinion, we interpret the international recommendations in the context of established clinical practice for diabetes care, and propose three different step-by-step algorithms to help the healthcare professionals use the most innovative glucose metrics, including time in glucose ranges, glucose management indicator, coefficient of variation, and ambulatory glucose profile. In detail, we focus on glucose metrics as measured by the FreeStyle Libre system and as visualized on the LibreView digital diabetes platform to support appropriate interpretation of flash glucose monitoring data. This is specifically structured for healthcare professionals and general practitioners who may have a low level of confidence with diabetes technology, with the aim of optimizing diabetes management, ensuring effective use of healthcare resources and to maximise outcomes for people with diabetes.
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Affiliation(s)
- Sergio Di Molfetta
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Rossi
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Roberta Assaloni
- Diabetes Unit ASS2 Bassa-Friulana Isontina, Udine, Monfalcone, GO, Italy
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
| | - Agostino Consoli
- Endocrinology and Metabolic Diseases, University of Chieti-Pescara, Chieti, Italy
| | | | - Vincenzo Guardasole
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Andrea Laurenzi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital of Verona, Verona, Italy
| | - Andrea Scaramuzza
- Division of Pediatrics, ASST Cremona, "Ospedale Maggiore di Cremona", Cremona, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, Catanzaro, Italy
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17
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Gomez-Peralta F, Choudhary P, Cosson E, Irace C, Rami-Merhar B, Seibold A. Understanding the clinical implications of differences between glucose management indicator and glycated haemoglobin. Diabetes Obes Metab 2022; 24:599-608. [PMID: 34984825 DOI: 10.1111/dom.14638] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [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: 09/29/2021] [Revised: 12/20/2021] [Accepted: 01/01/2022] [Indexed: 12/18/2022]
Abstract
Laboratory measured glycated haemoglobin (HbA1c) is the gold standard for assessing glycaemic control in people with diabetes and correlates with their risk of long-term complications. The emergence of continuous glucose monitoring (CGM) has highlighted limitations of HbA1c testing. HbA1c can only be reviewed infrequently and can mask the risk of hypoglycaemia or extreme glucose fluctuations. While CGM provides insights in to the risk of hypoglycaemia as well as daily fluctuations of glucose, it can also be used to calculate an estimated HbA1c that has been used as a substitute for laboratory HbA1c. However, it is evident that estimated HbA1c and HbA1c values can differ widely. The glucose management indicator (GMI), calculated exclusively from CGM data, has been proposed. It uses the same scale (% or mmol/mol) as HbA1c, but is based on short-term average glucose values, rather than long-term glucose exposure. HbA1c and GMI values differ in up to 81% of individuals by more than ±0.1% and by more than ±0.3% in 51% of cases. Here, we review the factors that define these differences, such as the time period being assessed, the variation in glycation rates and factors such as anaemia and haemoglobinopathies. Recognizing and understanding the factors that cause differences between HbA1c and GMI is an important clinical skill. In circumstances when HbA1c is elevated above GMI, further attempts at intensification of therapy based solely on the HbA1c value may increase the risk of hypoglycaemia. The observed difference between GMI and HbA1c also informs the important question about the predictive ability of GMI regarding long-term complications.
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Affiliation(s)
| | - Pratik Choudhary
- Leicester Diabetes Centre - Bloom, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Emmanuel Cosson
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Université Paris 13, Bobigny, France
- Paris 13 University, Sorbonne Paris Cité, UMR U557 INSERM/U11125 INRAE/CNAM/Université Paris13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, Catanzaro, Italy
| | - Birgit Rami-Merhar
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
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18
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Bosi E, Gregori G, Cruciani C, Irace C, Pozzilli P, Buzzetti R. The use of flash glucose monitoring significantly improves glycemic control in type 2 diabetes managed with basal bolus insulin therapy compared to self-monitoring of blood glucose: A prospective observational cohort study. Diabetes Res Clin Pract 2022; 183:109172. [PMID: 34883185 DOI: 10.1016/j.diabres.2021.109172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/25/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/19/2022]
Abstract
AIM This prospective, observational cohort study aimed to measure HbA1c change over 3-6 months in type 2 diabetes managed with basal-bolus insulin and FreeStyle Libre® Flash Glucose Monitoring System (FSL) use compared to self-monitored blood glucose (SMBG). METHODS Sixteen Italian hospitals enrolled patients with type 2 diabetes (n = 322, [109 FSL, 213 SMBG users]) using basal-bolus insulin therapy for ≥ 1 year, HbA1c 8.0-12.0% (64-108 mmol/mol), new to FSL use (<3 months) or continuing with SMBG (controls). Eligible FSL and SMBG users were matched (1:2 ratio) for baseline HbA1c (within ± 0.5%, recorded ≤ 3 months previously), study site and baseline data collection date. RESULTS Overall, baseline HbA1c was 8.9 ± 0.8% (74 ± 9 mmol/mol), age 67.2 ± 10.0 years, BMI 30.5 ± 6.5 kg/m2 and insulin use duration 8.6 ± 6.6 years (mean ± SD), 56.2% were males. After 3-6 months, 234 complete cases (83 FSL, 151 SMBG users) demonstrated significantly reduced HbA1c for FSL use compared to SMBG (0.3% ± 0.12 [3 mmol/mol ± 1.3, (mean ± SE)], p = 0.0112). The difference remained statistically significant after adjusting for confounders. CONCLUSIONS HbA1c significantly improved in basal-bolus treated type 2 diabetes after flash glucose monitoring use for 3-6 months compared to SMBG.
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Affiliation(s)
- E Bosi
- Diabetes Research Institute, IRCCS San Raffaele Hospital and San Raffaele Vita Salute University, Milan, Italy.
| | - G Gregori
- ASL Toscana Nord Ovest (ATNO), SS Diabetologia Massa Carrara, Carrara, Italy.
| | - C Cruciani
- USL Umbria2 URP Terni, Diabetology Terni, Narni, Amelia, Orvieto, Terni, Italy.
| | - C Irace
- University Magna Graecia Catanzaro, Department of Health Science, Catanzaro, Italy.
| | - P Pozzilli
- Campus Bio-Medico University of Rome, Endocrinology and Diabetes, Rome, Italy.
| | - R Buzzetti
- Dept. of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
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Rapisarda L, Irace C, Nisticò R, Giugno A, Barone S, Parise M, Crasà M, Nicoli D, Gambardella A, Valentino P. PRECLINICAL MARKERS OF NEUROPATHIC DAMAGE IN TYPE 1 DIABETES MELLITUS. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118542] [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: 11/28/2022]
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Irace C, Cutruzzolà A, Tweden K, Kaufman FR. Device profile of the eversense continuous glucose monitoring system for glycemic control in type-1 diabetes: overview of its safety and efficacy. Expert Rev Med Devices 2021; 18:909-914. [PMID: 34528851 DOI: 10.1080/17434440.2021.1982380] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Continuous glucose monitoring (CGM) systems offer real-time data to facilitate diabetes management. The novel Eversense CGM has been approved in Europe and the US. The unique characteristics are the fully implantable sensor and the sensor life up to 180 days. AREAS COVERED This expert review describes the results of clinical trials, and the accuracy and safety of the Eversense system. The overall MARD ranges from 8.5% to 9.4%, the 20/20% agreement rate ranges from 84% to 94%, and the percent of values in zones A and B on the Clarke Error Grid is 99.2%. No device-related serious adverse events have been described during pivotal trial studies. The most frequently reported device- or procedure-related adverse events are sensor adhesive patch location site irritation (0.66%), inability to remove the sensor upon first attempt (0.76%), and location site infection (0.96%). Mean A1c reduction is about 0.4% from pivotal trials and real-world studies. EXPERT OPINION The Eversense system is novel and differentiated from transcutaneous CGM systems. The long life, the removable transmitter, and the on-body vibration alerts offer opportunities to properly manage diabetes with both MDI and insulin pump therapy.
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Affiliation(s)
- Concetta Irace
- Department of Health Science, University Magna Graecia, Catanzaro, Italy
| | - Antonio Cutruzzolà
- Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
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21
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Cutruzzola A, Parise M, Battaglia C, Cozza P, Gnasso A, Irace C. Endothelial function in type 1 diabetes: Gender differences. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.131] [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: 11/28/2022]
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22
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Cutruzzolà A, Parise M, Vallelunga R, Lamanna F, Gnasso A, Irace C. Effect of Extra Virgin Olive Oil and Butter on Endothelial Function in Type 1 Diabetes. Nutrients 2021; 13:nu13072436. [PMID: 34371945 PMCID: PMC8308536 DOI: 10.3390/nu13072436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 12/13/2022] Open
Abstract
Post-prandial hyperglycemia can be relevant in developing early manifestations of atherosclerosis. EVOO (Extra Virgin Olive Oil), rich in saturated fatty acids and commonly used in the Mediterranean diet, seems to control post-prandial hyperglycemia better than butter. Subjects with type 1 diabetes are at higher risk of developing cardiovascular disease and show endothelial dysfunction, an early manifestation of atherosclerosis in the first years of the disease. Our study aims to evaluate whether EVOO and butter influence endothelial function in subjects with type 1 diabetes when added to a single high glycemic index (HGI) meal. In this exploratory cross-over study, 10 subjects with type 1 diabetes and 6 healthy subjects were scheduled to receive two types of HGI meals: one enriched with EVOO and one with butter. Before and after each test meal at different time points, all subjects underwent the evaluation of endothelial function by flow-mediated dilation technique, glucose and lipids measurements, and gastric emptying assessment by ultrasound. Flow-mediated dilation significantly increased after EVOO-enriched meal compared with butter in subjects with type 1 diabetes (two-way-repeated measurements ANOVA, p = 0.007). In patients with type 1 diabetes, the add-on of EVOO to HGI meal improves vascular function compared to butter, which has detrimental effects.
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Affiliation(s)
- Antonio Cutruzzolà
- Dipartimento di Medicina Sperimentale e Clinica, University Magna Græcia, 88100 Catanzaro, Italy; (A.C.); (R.V.); (F.L.); (A.G.)
| | - Martina Parise
- Dipartimento di Scienze della Salute, University Magna Græcia, 88100 Catanzaro, Italy;
| | - Rosarina Vallelunga
- Dipartimento di Medicina Sperimentale e Clinica, University Magna Græcia, 88100 Catanzaro, Italy; (A.C.); (R.V.); (F.L.); (A.G.)
| | - Francesco Lamanna
- Dipartimento di Medicina Sperimentale e Clinica, University Magna Græcia, 88100 Catanzaro, Italy; (A.C.); (R.V.); (F.L.); (A.G.)
| | - Agostino Gnasso
- Dipartimento di Medicina Sperimentale e Clinica, University Magna Græcia, 88100 Catanzaro, Italy; (A.C.); (R.V.); (F.L.); (A.G.)
| | - Concetta Irace
- Dipartimento di Scienze della Salute, University Magna Græcia, 88100 Catanzaro, Italy;
- Correspondence: ; Tel.: +39-0961-3647039
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Parise M, Tartaglione L, Cutruzzolà A, Maiorino MI, Esposito K, Pitocco D, Gnasso A, Irace C. Teleassistance for Patients With Type 1 Diabetes During the COVID-19 Pandemic: Results of a Pilot Study. J Med Internet Res 2021; 23:e24552. [PMID: 33769945 PMCID: PMC8025914 DOI: 10.2196/24552] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/29/2020] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
Background Telemedicine use in chronic disease management has markedly increased during health emergencies due to COVID-19. Diabetes and technologies supporting diabetes care, including glucose monitoring devices, software analyzing glucose data, and insulin delivering systems, would facilitate remote and structured disease management. Indeed, most of the currently available technologies to store and transfer web-based data to be shared with health care providers. Objective During the COVID-19 pandemic, we provided our patients the opportunity to manage their diabetes remotely by implementing technology. Therefore, this study aimed to evaluate the effectiveness of 2 virtual visits on glycemic control parameters among patients with type 1 diabetes (T1D) during the lockdown period. Methods This prospective observational study included T1D patients who completed 2 virtual visits during the lockdown period. The glucose outcomes that reflected the benefits of the virtual consultation were time in range (TIR), time above range, time below range, mean daily glucose, glucose management indicator (GMI), and glycemic variability. This metric was generated using specific computer programs that automatically upload data from the devices used to monitor blood or interstitial glucose levels. If needed, we changed the ongoing treatment at the first virtual visit. Results Among 209 eligible patients with T1D, 166 completed 2 virtual visits, 35 failed to download glucose data, and 8 declined the visit. Among the patients not included in the study, we observed a significantly lower proportion of continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) users (n=7/43, 16% vs n=155/166, 93.4% and n=9/43, 21% vs n=128/166, 77.1%, respectively; P<.001) compared to patients who completed the study. TIR significantly increased from the first (62%, SD 18%) to the second (65%, SD 16%) virtual visit (P=.02); this increase was more marked among patients using the traditional meter (n=11; baseline TIR=55%, SD 17% and follow-up TIR=66%, SD 13%; P=.01) than among those using CGM, and in those with a baseline GMI of ≥7.5% (n=46; baseline TIR=45%, SD 15% and follow-up TIR=53%, SD 18%; P<.001) than in those with a GMI of <7.5% (n=120; baseline TIR=68%, SD 15% and follow-up TIR=69%, SD 15%; P=.98). The only variable independently associated with TIR was the change of ongoing therapy. The unstandardized beta coefficient (B) and 95% CI were 5 (95% CI 0.7-8.0) (P=.02). The type of glucose monitoring device and insulin delivery systems did not influence glucometric parameters. Conclusions These findings indicate that the structured virtual visits help maintain and improve glycemic control in situations where in-person visits are not feasible.
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Affiliation(s)
- Martina Parise
- Department of Experimental and Clinical Medicine, University Magna Graecia Catanzaro, Catanzaro, Italy
| | | | - Antonio Cutruzzolà
- Department of Experimental and Clinical Medicine, University Magna Graecia Catanzaro, Catanzaro, Italy
| | - Maria Ida Maiorino
- Department of Advanced Medical and Surgical Science, University Vanvitelli, Napoli, Naples, Italy
| | - Katherine Esposito
- Department of Advanced Medical and Surgical Science, University Vanvitelli, Napoli, Naples, Italy
| | | | - Agostino Gnasso
- Department of Advanced Medical and Surgical Science, University Magna Graecia Catanzaro, Naples, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia Catanzaro, Catanzaro, Italy
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Cutruzzolà A, Irace C, Parise M, Fiorentino R, Pio Tripodi PF, Ungaro S, Babinsky V, Gnasso A. Time spent in target range assessed by self-monitoring blood glucose associates with glycated hemoglobin in insulin treated patients with diabetes. Nutr Metab Cardiovasc Dis 2020; 30:1800-1805. [PMID: 32669240 DOI: 10.1016/j.numecd.2020.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/08/2020] [Revised: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIMS Self-monitoring blood glucose (SMBG) remains a widespread tool to monitor blood glucose. The development of diabetes management systems (DMS) allows SMBG to provide additional information as time spent in target range (TIR). This study evaluates the association between HbA1c and TIR, evaluated through DMS, over 2 months, and 2 weeks. METHODS AND RESULTS Type 1 (T1D) and Type 2 (T2D) insulin-treated patients with diabetes were enrolled. We used the term PIR (Points in Range) instead of TIR, since SMBG provides point-in-time glucose values rather than a continuous trend over time. PIR was calculated in 2-month and 2-week time ranges before available HbA1c measurement. One-hundred ninety-seven patients with T1D and 36 with T2D were recruited. HbA1c and PIR were inversely associated (2 months: R -0.72, 2 weeks R -0.70; p < 0.0001) in all subjects. The relationship did not change when T1D and T2D patients were analyzed separately. For every 10% change of PIR, there was a change of HbA1c by 0.4%. CONCLUSIONS Our study, for the first time, demonstrates a significant correlation between HbA1c and PIR calculated by DMS. DMS offers additional information useful in disease management of patients with T1D and T2D performing SMBG.
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Affiliation(s)
- Antonio Cutruzzolà
- Department of Clinical and Experimental Medicine, University Magna Græcia, Viale Europa, 88100, Catanzaro, Italy.
| | - Concetta Irace
- Department of Health Science, University Magna Græcia, Viale Europa, 88100, Catanzaro, Italy.
| | - Martina Parise
- Department of Health Science, University Magna Græcia, Viale Europa, 88100, Catanzaro, Italy.
| | - Raffaella Fiorentino
- Azienda Ospedaliero-Universitaria Mater Domini, Viale Europa, 88100, Catanzaro, Italy.
| | | | - Serena Ungaro
- C.C.P. Policlinico Madonna della Consolazione, Via Cardinale Portanova, 89100, Reggio Calabria, Italy
| | - Valerie Babinsky
- Roche Diabetes Care GmbH, Millenium Tower Handelskai, 1200, Vienna, Austria.
| | - Agostino Gnasso
- Department of Clinical and Experimental Medicine, University Magna Græcia, Viale Europa, 88100, Catanzaro, Italy.
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Cutruzzolà A, Irace C, Frazzetto M, Sabatino J, Gullace R, De Rosa S, Spaccarotella C, Concolino D, Indolfi C, Gnasso A. Functional and morphological cardiovascular alterations associated with neurofibromatosis 1. Sci Rep 2020; 10:12070. [PMID: 32694667 PMCID: PMC7374589 DOI: 10.1038/s41598-020-68908-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/30/2020] [Indexed: 11/26/2022] Open
Abstract
Subjects with Neurofibromatosis 1 (NF1) develop vascular complications. The protein product of the gene affected in NF1, neurofibromin, physiologically modulates endothelial function and preserves vascular and myocardial structure. Our study aimed to verify whether subjects with NF1 have early, preclinical abnormalities of carotid artery structure, brachial artery function, and cardiac function. We recruited 22 NF1 subjects without previous cardiovascular events and 22 healthy control subjects. All subjects underwent measurement of carotid artery intima-media thickness (IMT), evaluation of brachial artery endothelial function after ischemia and exercise, and cardiac function. Mean IMT was 543 ± 115 μ in NF1 subjects and 487 ± 70 μ in Controls (p < 0.01). Endothelial function was significantly dumped in NF1 subjects. The dilation after ischemia and exercise was respectively 7.5(± 4.8)% and 6.7(± 3.0)% in NF1 versus 10.5(± 1.2)% and 10.5(± 2.1)% in control subjects (p < 0.02; p < 0.002). Left ventricular systolic function assessed by Global Longitudinal Strain was significantly different between NF1 subjects and Controls: − 19.3(± 1.7)% versus − 21.5(± 2.7)% (p < 0.008). These findings demonstrate that NF1 patients have early morphological and functional abnormalities of peripheral arteries and systolic cardiac impairment and suggest the need for a tight cardiovascular risk evaluation and primary prevention in subjects with NF1.
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Affiliation(s)
- Antonio Cutruzzolà
- Dipartimento di Medicina Sperimentale e Clinica, University Magna Græcia, Viale Europa Località Germaneto, 88100, Catanzaro, Italy
| | - Concetta Irace
- Dipartimento di Scienze della Salute, University Magna Græcia, Catanzaro, Italy
| | - Marco Frazzetto
- Dipartimento di Scienze della Salute, University Magna Græcia, Catanzaro, Italy
| | - Jolanda Sabatino
- Dipartimento di Scienze Mediche e Chirurgiche, University Magna Græcia, Catanzaro, Italy.,Center of Cardiovascular Research, University Magna Graecia, Mediterranea Cardio Centro, Catanzaro, Napoli, Italy
| | - Rosa Gullace
- Dipartimento di Scienze della Salute, University Magna Græcia, Catanzaro, Italy
| | - Salvatore De Rosa
- Dipartimento di Scienze Mediche e Chirurgiche, University Magna Græcia, Catanzaro, Italy.,Center of Cardiovascular Research, University Magna Graecia, Mediterranea Cardio Centro, Catanzaro, Napoli, Italy
| | - Carmen Spaccarotella
- Center of Cardiovascular Research, University Magna Graecia, Mediterranea Cardio Centro, Catanzaro, Napoli, Italy
| | - Daniela Concolino
- Dipartimento di Scienze della Salute, University Magna Græcia, Catanzaro, Italy
| | - Ciro Indolfi
- Dipartimento di Scienze Mediche e Chirurgiche, University Magna Græcia, Catanzaro, Italy.,Center of Cardiovascular Research, University Magna Graecia, Mediterranea Cardio Centro, Catanzaro, Napoli, Italy
| | - Agostino Gnasso
- Dipartimento di Medicina Sperimentale e Clinica, University Magna Græcia, Viale Europa Località Germaneto, 88100, Catanzaro, Italy.
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Irace C, Cutruzzolà A, Nuzzi A, Assaloni R, Brunato B, Pitocco D, Tartaglione L, Di Molfetta S, Cignarelli A, Laviola L, Citro G, Lovati E, Gnasso A, Tweden KS, Kaufman FR. Clinical use of a 180-day implantable glucose sensor improves glycated haemoglobin and time in range in patients with type 1 diabetes. Diabetes Obes Metab 2020; 22:1056-1061. [PMID: 32037699 PMCID: PMC7317779 DOI: 10.1111/dom.13993] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 12/17/2019] [Revised: 01/25/2020] [Accepted: 02/04/2020] [Indexed: 12/31/2022]
Abstract
AIMS This real-world study evaluated the changes in glycated haemoglobin (HbA1c) and continuous glucose monitoring (CGM) metrics associated with use of the implantable 180-day Eversense CGM System (Eversense) in patients with type 1 diabetes. MATERIALS AND METHODS This was a prospective, multicentre, observational study among adult participants aged ≥18 years with type 1 diabetes across seven diabetes-care centres in Italy who had Eversense inserted for the first time. HbA1c was measured at baseline and at 180 days. Changes in time in range [TIR (glucose 70-180 mg/dL)], time above range [TAR (glucose >180 mg/dL)], time below range [TBR (glucose <70 mg/dL)] and glycaemic variability were also assessed. Data were also analysed by previous CGM use and by mode of insulin delivery. RESULTS One-hundred patients were enrolled (mean age 36 ± 12 years, mean baseline HbA1c 7.4 ± 0.92% [57 ± 10 mmol/mol]). Fifty-six per cent of patients were users of the continuous subcutaneous insulin infusion pump and 45% were previous users of CGM. HbA1c significantly decreased in patients after 180 days of sensor wear (-0.43% ± 0.69%, 5 ± 8 mmol/mol, P < 0.0001). As expected, CGM-naïve patients achieved the greatest reduction in HbA1c (-0.74% ± 0.48%, 8 ± 5 mmol/mol). TIR significantly increased and TAR and mean daily sensor glucose significantly decreased while TBR did not change after 180 days of sensor wear. CONCLUSIONS Real-world clinical use of the Eversense CGM System for 180 days was associated with significant improvements in HbA1c and CGM metrics among adults with type 1 diabetes. The study is registered on clinicaltrials.gov (NCT04160156).
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Affiliation(s)
- Concetta Irace
- Department of Health ScienceUniversity Magna GræciaCatanzaroItaly
| | - Antonio Cutruzzolà
- Department of Clinical and Experimental MedicineUniversity Magna GræciaCatanzaroItaly
| | | | | | | | - Dario Pitocco
- UOSA Diabetologia, Fondazione IRCCSUniversity Agostino GemelliRomeItaly
| | - Linda Tartaglione
- UOSA Diabetologia, Fondazione IRCCSUniversity Agostino GemelliRomeItaly
| | - Sergio Di Molfetta
- Medicina Interna, Endocrinologia, Andrologia e Malattie Metaboliche, D.E.T.O., Università degli Studi di Bari “Aldo Moro”BariItaly
| | - Angelo Cignarelli
- Medicina Interna, Endocrinologia, Andrologia e Malattie Metaboliche, D.E.T.O., Università degli Studi di Bari “Aldo Moro”BariItaly
| | - Luigi Laviola
- Medicina Interna, Endocrinologia, Andrologia e Malattie Metaboliche, D.E.T.O., Università degli Studi di Bari “Aldo Moro”BariItaly
| | | | | | - Agostino Gnasso
- Department of Clinical and Experimental MedicineUniversity Magna GræciaCatanzaroItaly
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Deiss D, Irace C, Carlson G, Tweden KS, Kaufman FR. Real-World Safety of an Implantable Continuous Glucose Sensor Over Multiple Cycles of Use: A Post-Market Registry Study. Diabetes Technol Ther 2020; 22:48-52. [PMID: 31418587 PMCID: PMC6945795 DOI: 10.1089/dia.2019.0159] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Previously, the safety and accuracy of the Eversense continuous glucose monitoring (CGM) system were characterized in three pivotal trials among individuals with type 1 diabetes (T1D) and type 2 diabetes (T2D) with a single 90- or 180-day sensor insertion-removal cycle. The Post-Market Clinical Follow-up (PMCF) registry is a prospective study evaluating the long-term safety and performance of the Eversense CGM system over multiple sensor insertion-removal cycles among adults with T1D and T2D. All patients who had a sensor subcutaneously implanted across 534 participating centers in Europe and South Africa from June 2016 to August 2018 were enrolled. Adverse events (AEs) were recorded at each visit and patients were instructed to inform their clinic if they experienced any AEs between visits. AEs were adjudicated for relatedness to the device, procedure, or drug (dexamethasone acetate). The primary safety endpoint was the rate of related serious adverse events (SAEs) through four sensor insertion-removal cycles. The registry enrolled 3023 patients. As of last follow-up, 5417 sensors had been inserted with a total of 1260 patient-years (PYs) of follow-up: 969 patients had used the system for at least 6 months and 173 patients had used the system for at least 1 year. No related SAEs were reported. The most frequently reported related AEs were sensor location site infection (0.96%; 2.46 events per 100 PYs), inability to remove the sensor upon first attempt (0.76%; 1.90 events per 100 PYs), and adhesive patch location site irritation (0.66%; 1.59 events per 100 PYs). One nonserious allergic reaction to lidocaine was reported, which resolved with administration of an antihistamine. The full intended sensor life was achieved by 91% of 90-day sensors and 75% of 180-day sensors. The PMCF registry provides real-world evidence that the Eversense CGM system is safe over multiple cycles of use.
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Affiliation(s)
- Dorothee Deiss
- Center for Endocrinology and Diabetology, Medicover-Berlin Mitte, Berlin, Germany
| | - Concetta Irace
- Department of Health Science, University Magna Græcia, Catanzaro, Italy
| | | | - Katherine S. Tweden
- Senseonics, Incorporated, Germantown, Maryland
- Address correspondence to: Katherine S. Tweden, PhD, Senseonics, Incorporated, 20451 Seneca Meadows Pkwy, Germantown, MD 20876
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Irace C, Cutruzzolà A, Parise M, Fiorentino R, Frazzetto M, Gnasso C, Casciaro F, Gnasso A. Effect of empagliflozin on brachial artery shear stress and endothelial function in subjects with type 2 diabetes: Results from an exploratory study. Diab Vasc Dis Res 2020; 17:1479164119883540. [PMID: 31726866 PMCID: PMC7510381 DOI: 10.1177/1479164119883540] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Empagliflozin reduces the risk of cardiovascular mortality in subjects with type 2 diabetes. We demonstrated that empagliflozin increases blood viscosity and carotid shear stress and decreases carotid wall thickness. Shear stress is the force acting on the endothelial surface and modulates arterial function. The current study evaluates the influence of empagliflozin on brachial artery shear stress and endothelial function compared to incretin-based therapy. The study is a nonrandomized, open, prospective cohort study including 35 subjects with type 2 diabetes administered empagliflozin or incretin-based therapy. Shear stress was calculated with a validated formula, and endothelial function was evaluated using the flow-mediated dilation technique. Both treatments resulted in comparable reductions in blood glucose and glycated haemoglobin. Brachial artery shear stress significantly increased exclusively in the empagliflozin group (61 ± 20 vs 68 ± 25 dynes/cm2, p = 0.04), whereas no significant difference was detected in the incretin-based therapy group (60 ± 20 vs 55 ± 12 dynes/cm2, p = not significant). Flow-mediated dilation significantly increased in the empagliflozin group (4.8 ± 4.5% vs 8.5 ± 5.6%, p = 0.03). Again, no change was detected in the incretin-based therapy group (5.1 ± 4.5% vs 4.7 ± 4.7%, p = not significant). The present findings demonstrate the beneficial effect of empagliflozin on shear stress and endothelial function in subjects with type 2 diabetes independent of the hypoglycaemic effect.
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Affiliation(s)
- Concetta Irace
- Department of Health Science, Magna
Græcia University, Catanzaro, Italy
- Concetta Irace, Department of Health
Science, Magna Græcia University, 88100 Catanzaro, Italy.
| | | | - Martina Parise
- Department of Clinical and Experimental
Medicine, Magna Græcia University, Catanzaro, Italy
| | | | - Marco Frazzetto
- School of Medicine, Magna Græcia
University, Catanzaro, Italy
| | - Chiara Gnasso
- School of Medicine, Magna Græcia
University, Catanzaro, Italy
| | | | - Agostino Gnasso
- Department of Clinical and Experimental
Medicine, Magna Græcia University, Catanzaro, Italy
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Gnasso A, Cacia M, Cutruzzolà A, Minieri M, Carallo C, Cortese C, Irace C. Influence of acute reduction of blood viscosity on endothelial function. Clin Hemorheol Microcirc 2019; 72:239-245. [PMID: 30909194 DOI: 10.3233/ch-180446] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The relationship between blood viscosity (BV) and endothelial function is rather complex. An increase in BV causes an increase in blood flow resistance, with negative hemodynamic effects; on the other hand, a moderate increase in BV causes an increase in wall stress shear (WSS), and consequent beneficial effects. As a matter of fact, the effect of changes in BV on endothelial function is not yet clear. OBJECTIVES Aim of the present study was to evaluate in-vivo the effects of the acute reduction in BV on endothelial function, in healthy male subjects. METHODS Fourteen healthy male blood donors were studied before and 48 hours after blood donation. Blood and plasma viscosity were measured at 37C° with a cone-plate viscometer. Endothelial function was evaluated through flow mediated vasodilation (FMD). RESULTS Blood viscosity was reduced after blood donation (BV225 (cP) 4.53±0.59 vs.4.18±0.31, p < 0.05). FMD 50 s after cuff deflation was unchanged: 6.23±3.84 vs. 6.62±4.81, p = NS. The vasodilation, however, lasted longer and the area under the curve of FMD was significantly increased: 8.74±8.77 vs.16.14±8.65, p < 0.005. CONCLUSIONS The present results demonstrate that the acute reduction of BV prolongs vasodilation, without affecting the amount of vasodilatation, possibly as adaptive reaction allowing more time for oxygen release.
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Nocera D, Menniti M, Belviso S, Bond HM, Lanzillotta D, Spoleti CB, Guagliardi MR, Malatesta P, Trapasso F, Irace C, Perrotti N, Iuliano R. Functional characterization of p.Pro409His variant in HNF1A, a hypomorphic mutation involved in pancreatic β-cell dysfunction. Acta Diabetol 2019; 56:883-888. [PMID: 30963309 DOI: 10.1007/s00592-019-01298-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/19/2018] [Accepted: 02/05/2019] [Indexed: 12/31/2022]
Abstract
AIMS HNF1A is a gene coding for the transcription factor HNF1-α, mutated in some forms of MODY and type 2 diabetes mellitus characterized by a strong genetic component. The penetrance of HNF1A variants differs considerably; thus, to assess the genetic risk of diabetes in carrier subjects of a HNF1A mutant allele, a functional characterization of mutant forms is of paramount importance. METHODS The HNF1A gene was sequenced in two patients with partly discordant diabetic phenotype, carrying the p.Pro409His variant. To evaluate the pathogenicity of the variant, we measured the transactivation power of the corresponding P408H HNF1-α mutant mouse form on HNF1-α target promoters. RESULTS We found a lower but detectable activity of transactivation of the mutant form compared with the wild-type form and we excluded mechanisms of protein degradation or nuclear mislocalization. CONCLUSIONS The HNF1A mutation p.Pro409His can be considered a mild variant that confers a moderate risk of type 2 diabetes mellitus in heterozygous carriers.
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Affiliation(s)
- Donatella Nocera
- Unit of Medical Genetics, University Hospital Mater Domini, Viale T. Campanella, 115, Catanzaro, Italy
| | - Miranda Menniti
- Department of Human Health, University Magna Graecia of Catanzaro, Campus S. Venuta, Viale Europa, località Germaneto, 88100, Catanzaro, Italy
| | - Stefania Belviso
- Department of Human Health, University Magna Graecia of Catanzaro, Campus S. Venuta, Viale Europa, località Germaneto, 88100, Catanzaro, Italy
| | - Heather Mandy Bond
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Campus S. Venuta, Viale Europa, località Germaneto, 88100, Catanzaro, Italy
| | - Delia Lanzillotta
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Campus S. Venuta, Viale Europa, località Germaneto, 88100, Catanzaro, Italy
| | - Cristina Barbara Spoleti
- Department of Human Health, University Magna Graecia of Catanzaro, Campus S. Venuta, Viale Europa, località Germaneto, 88100, Catanzaro, Italy
| | - Maria Rosaria Guagliardi
- Unit of Medical Genetics, University Hospital Mater Domini, Viale T. Campanella, 115, Catanzaro, Italy
| | - Paola Malatesta
- Unit of Medical Genetics, University Hospital Mater Domini, Viale T. Campanella, 115, Catanzaro, Italy
| | - Francesco Trapasso
- Unit of Medical Genetics, University Hospital Mater Domini, Viale T. Campanella, 115, Catanzaro, Italy
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Campus S. Venuta, Viale Europa, località Germaneto, 88100, Catanzaro, Italy
| | - Concetta Irace
- Department of Human Health, University Magna Graecia of Catanzaro, Campus S. Venuta, Viale Europa, località Germaneto, 88100, Catanzaro, Italy
| | - Nicola Perrotti
- Unit of Medical Genetics, University Hospital Mater Domini, Viale T. Campanella, 115, Catanzaro, Italy.
- Department of Human Health, University Magna Graecia of Catanzaro, Campus S. Venuta, Viale Europa, località Germaneto, 88100, Catanzaro, Italy.
| | - Rodolfo Iuliano
- Unit of Medical Genetics, University Hospital Mater Domini, Viale T. Campanella, 115, Catanzaro, Italy.
- Department of Human Health, University Magna Graecia of Catanzaro, Campus S. Venuta, Viale Europa, località Germaneto, 88100, Catanzaro, Italy.
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Deiss D, Szadkowska A, Gordon D, Mallipedhi A, Schütz-Fuhrmann I, Aguilera E, Ringsell C, De Block C, Irace C. Clinical Practice Recommendations on the Routine Use of Eversense, the First Long-Term Implantable Continuous Glucose Monitoring System. Diabetes Technol Ther 2019; 21:254-264. [PMID: 31021180 PMCID: PMC6532544 DOI: 10.1089/dia.2018.0397] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: The use of real-time continuous glucose monitoring (rtCGM) systems has proved to positively impact the management of type 1 diabetes with the potential to lower HbA1c, reduce frequency and time spent in hypoglycemia, and lower glycemic variability. Nevertheless, the acceptance of rtCGM remains below expectations and the dropout rate within the first year has been reported to be 27%. Besides financial reasons due to limited reimbursement, reasons include the need for frequent sensor replacement, the discomfort of wearing a sensor, the presence of adverse skin reactions, or privacy. Thus, novel approaches to rtCGM are desired to overcome these barriers. The first long-term implantable rtCGM system diversifies the field of glucose monitoring further. However, due to its novelty, there are no published clinical practice guidelines available. Aims: The aim of this article is to set the foundation for a best clinical practice for the everyday clinical care using a long-term implantable CGM system. Methods: An international expert panel for the long-term implantable CGM system developed this best practice guidance. All participants were certified and experienced in the use of the Eversense® long-term implantable CGM system. The workflows from the respective clinics were presented, discussed and are summarized in an ideal care workflow outlined in these practice recommendations. Results: The participants agreed on the following aspects: definition of the patient population that will benefit from a long-term implantable CGM device; real-world experience on safety and accuracy of a long-term CGM; definition of the ideal sensor position; description of the optimal process for sensor insertion, removal, and replacement.
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Affiliation(s)
- Dorothee Deiss
- Center for Endocrinology and Diabetology, Medicover Berlin-Mitte, Berlin, Germany
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Łódź, Poland
| | - Debbie Gordon
- Center for Diabetes and Endocrinology, Johannesburg, South Africa
- Donald Gordon Medical Centre, WITS (University of the Witwatersrand), Johannesburg, South Africa
| | | | - Ingrid Schütz-Fuhrmann
- Division of Endocrinology, Third Department for Internal Medicine, City-Hospital Hietzing Vienna, Vienna, Austria
| | - Eva Aguilera
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Health Sciences Research Institute and University Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Christophe De Block
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Concetta Irace
- Department of Health Science, University Magna Græcia, Catanzaro, Italy
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Tripolino C, Irace C, Cutruzzolà A, Parise M, Barone M, Scicchitano C, Cortese C, Gnasso A. Hepatic Steatosis Index Is Associated with Type 1 Diabetes Complications. Diabetes Metab Syndr Obes 2019; 12:2405-2410. [PMID: 31819566 PMCID: PMC6875487 DOI: 10.2147/dmso.s221969] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of complications in type 1 diabetes (T1DM) patients. To date, several biochemical indexes of NAFLD have been developed. Among these, hepatic steatosis index (HSI) strongly relates with the results of magnetic resonance. AIM The aim of the present study was to evaluate the possible association between HSI and complications in T1DM. METHODS Medical records of patients with T1DM were evaluated. Macro- and micro-vascular complications were evaluated by a combination of instrumental (ECG, carotid artery echo-Doppler, fundus examination, vibration threshold at biothesiometry) and laboratory examination. HSI was calculated based on gender, body mass index and transaminases level. RESULTS Of the 124 patients evaluated, 71 were free of complications and 53 had at least one complication. The prevalence of diabetes complications was: 27% for retinopathy, 15% for carotid atherosclerosis, 16% for neuropathy. HSI was directly correlated with age, disease duration, triglycerides, total daily insulin and inversely with HDL and eGFR. In logistic regression analysis, HSI was independently associated with diabetic complications. CONCLUSION These findings show that HSI is independently associated with the presence of complications in subjects with T1DM. This can be of clinical utility, allowing a better diagnostic classification of the patient and possibly guiding the therapeutic choice.
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Affiliation(s)
- Cesare Tripolino
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, Catanzaro, Italy
| | - Antonio Cutruzzolà
- Department of Health Science, University Magna Graecia, Catanzaro, Italy
| | - Martina Parise
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
| | - Milena Barone
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
| | - Caterina Scicchitano
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
| | - Claudio Cortese
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Agostino Gnasso
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
- Correspondence: Agostino Gnasso Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, Mater Domini Hospital, Magna Græcia University, Catanzaro, ItalyTel +39 9613697039Fax +39 9613697250 Email
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Gnasso A, Cacia M, Cortese C, Succurro E, Andreozzi F, Carallo C, Irace C. No effect on the short-term of a decrease in blood viscosity on insulin resistance. Clin Hemorheol Microcirc 2018; 68:45-50. [PMID: 29036798 DOI: 10.3233/ch-170288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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]
Abstract
BACKGROUND Blood viscosity (BV) might influence glucose delivery to peripheral tissues and play an important role in insulin resistance and diabetes mellitus. However, the exact relationship between BV and insulin resistance is not yet clear. OBJECTIVES Aim of the present study is to evaluate the effects of the acute reduction in BV on insulin resistance, in healthy male subjects. METHODS Fifteen healthy male blood donors have been studied before and 48 hours after blood donation. Blood and plasma viscosity have been measured at 37°C with a cone-plate viscometer. Insulin resistance has been evaluated by euglycemic/hyperinsulinemic clamp in eight subjects, and by iHOMA2 Index in further seven subjects. RESULTS Blood viscosity was markedly reduced after blood donation (BV225 (cP) 4.53 ± 0.59 vs. 4.18 ± 0.31, p < 0.05). Insulin resistance was unchanged: MFFM clamp: 5.6 ± 4.5vs. 4.4 ± 2.2 and iHOMA2 Index 1.2 ± 0.6 vs. 1.2 ± 0.5, before vs. after respectively, p = NS. Blood pressure and lipids were unchanged after blood donation. CONCLUSIONS The present results demonstrate that acute reduction of BV in healthy male subjects does not change the insulin resistance, measured using both euglycemic/hyperinsulinemic clamp and iHOMA2 Index. Further intervention studies are needed to assess the effect that the reduction in BV can have in subjects with insulin resistance.
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Affiliation(s)
- Agostino Gnasso
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Michele Cacia
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Claudio Cortese
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Elena Succurro
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Claudio Carallo
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Concetta Irace
- Department of Health Science, Magna Græcia University of Catanzaro, Catanzaro, Italy
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Irace C, Casciaro F, Scavelli FB, Oliverio R, Cutruzzolà A, Cortese C, Gnasso A. Empagliflozin influences blood viscosity and wall shear stress in subjects with type 2 diabetes mellitus compared with incretin-based therapy. Cardiovasc Diabetol 2018; 17:52. [PMID: 29631585 PMCID: PMC5891980 DOI: 10.1186/s12933-018-0695-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/28/2018] [Indexed: 12/24/2022] Open
Abstract
Background Cardiovascular protection following empagliflozin therapy is not entirely attributable to the glucose lowering effect. Increased hematocrit might influence the shear stress that is the main force acting on the endothelium, regulating its anti-atherogenic function. Objective We designed the study with the aim of investigating the effect of empagliflozin on blood viscosity and shear stress in the carotid arteries. A secondary endpoint was the effect of empagliflozin on carotid artery wall thickness. Methods The study was a non-randomized, open, prospective cohort study including 35 type 2 diabetic outpatients who were offered empagliflozin or incretin-based therapy (7 liraglutide, 8 sitagliptin) in combination with insulin and metformin. Blood viscosity, shear stress and carotid wall thickness were measured at baseline and at 1 and 3 months of treatment. Blood viscosity was measured with a viscometer, and shear stress was calculated using a validated formula. Intima-media thickness (IMT) of the carotid artery was detected by ultrasound and was measured with dedicated software. Results Blood viscosity (4.87 ± 0.57 vs 5.32 ± 0.66 cP, p < 0.02) and shear stress significantly increased in the Empagliflozin group while no change was detected in the Control group (4.66 ± 0.56 vs 4.98 ± 0.73 cP, p = NS). IMT significantly decreased in the Empagliflozin group after 1 and 3 months (baseline: 831 ± 156, 1-month 793 ± 150, 3-month 766 ± 127 μm; p < 0.0001), while in the liraglutide group, IMT significantly decreased only after 3 months (baseline 879 ± 120; 1-month 861 ± 163; 3-month 802 ± 114 μm; p < 0.001). In the sitagliptin group, IMT remained almost unchanged (baseline 901 ± 135; 1-month 902 ± 129; 3-month 880 ± 140 μm; p = NS). Conclusions This study is the first to describe a direct effect of empagliflozin on blood viscosity and wall shear stress. Furthermore, IMT was markedly reduced early on in the Empagliflozin group.
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Affiliation(s)
- Concetta Irace
- Department of Health Science, Magna Græcia University, Viale Europa, 88100, Catanzaro, Italy.
| | - Francesco Casciaro
- Department of Health Science, Magna Græcia University, Viale Europa, 88100, Catanzaro, Italy
| | - Faustina Barbara Scavelli
- Department of Experimental and Clinical Medicine, Magna Græcia University, Viale Europa, 88100, Catanzaro, Italy
| | - Rosa Oliverio
- Department of Experimental and Clinical Medicine, Magna Græcia University, Viale Europa, 88100, Catanzaro, Italy
| | - Antonio Cutruzzolà
- Department of Health Science, Magna Græcia University, Viale Europa, 88100, Catanzaro, Italy
| | - Claudio Cortese
- Department of Experimental Medicine and Surgery, Tor Vergata University, Via Orazio Raimondo 18, Rome, Italy
| | - Agostino Gnasso
- Department of Experimental and Clinical Medicine, Magna Græcia University, Viale Europa, 88100, Catanzaro, Italy
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Irace C, De Rosa S, Tripolino C, Ambrosio G, Covello C, Abramo E, Carallo C, Mongiardo A, Spaccarotella C, Torella D, Gnasso A, Indolfi C. Delayed flow-mediated vasodilation and critical coronary stenosis. J Investig Med 2018; 66:1-7. [PMID: 29550752 DOI: 10.1136/jim-2017-000644] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2018] [Indexed: 11/04/2022]
Abstract
Endothelial dysfunction, wall thickening and plaque are progressive manifestations of atherosclerosis. Delayed or absent brachial artery dilation after ischemic stimulus has been associated with severity of extracoronary and coronary atherosclerosis. In the current study, we aimed to verify if delayed or absent dilation associates with critical coronary stenosis. We also evaluated the association between coronary stenosis, carotid artery wall thickness and peripheral artery disease. Endothelial function was investigated by flow-mediated dilation of the brachial artery up to 3 min after ischemia, and patients classified as early, late or no dilators. Coronary angiography was performed through transradial or femoral artery approach. Computerized quantitative angiography was used to obtain percent stenosis of all lesions, while the Gensini score was used to evaluate the severity of coronary atherosclerosis. Seventy-four patients were enrolled. Carotid wall thickness and plaque, and peripheral artery disease were detected by ultrasound. Subjects with critical coronary stenosis showed a higher prevalence of delayed or absent dilation (coronary stenosis ≥70 per cent: late dilators 50 per cent, no dilators 35 per cent; coronary stenosis ≤70 per cent : late dilators 27 per cent, no dilators 6 per cent). The Gensini score was progressively higher in late dilators and no dilators compared with early dilators (early: 4.5±13.5; late 17.5±27.1; no 39.7±55.0; P<0.02). Carotid atherosclerosis and peripheral artery disease were more prevalent in subjects with critical coronary stenosis. Delayed or absent dilation associates with coronary stenosis and different degree of coronary atherosclerosis. The kinetic of arterial dilation seems to be relevant as the magnitude of dilation.
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Affiliation(s)
- Concetta Irace
- Department of Health Science, Magna Graecia University, Catanzaro, Italy
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Cesare Tripolino
- Department of Clinical and Experimental Medicine, Magna Graecia University, Catanzaro, Italy
| | | | - Caterina Covello
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Ennio Abramo
- Azienda Ospedaliero-universitaria Mater Domini, Catanzaro, Italy
| | - Claudio Carallo
- Azienda Ospedaliero-universitaria Mater Domini, Catanzaro, Italy
| | | | | | - Daniele Torella
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Agostino Gnasso
- Department of Clinical and Experimental Medicine, Magna Graecia University, Catanzaro, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
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Irace C, Schweitzer MA, Tripolino C, Scavelli FB, Gnasso A. Diabetes Data Management System to Improve Glycemic Control in People With Type 1 Diabetes: Prospective Cohort Study. JMIR Mhealth Uhealth 2017; 5:e170. [PMID: 29162560 PMCID: PMC5717448 DOI: 10.2196/mhealth.8532] [Citation(s) in RCA: 8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 09/04/2017] [Indexed: 12/03/2022] Open
Abstract
Background Smartphone and Web technology can improve the health care process, especially in chronic diseases. Objective The aim of this study was to investigate whether the use of blood glucose (BG) data management system, which enables connection to smartphones, the Web, the cloud, and downloading, can improve glycemic control in subjects with type 1 diabetes mellitus (T1DM). Methods This study was a prospective, single-arm, cohort feasibility study with 6 months of duration. T1DM subjects enrolled had experience in self-monitoring blood glucose, but were download data naïve. Fasting BG and glycated hemoglobin (HbA1c) were collected at the enrollment and at follow-up. Subjects were divided into Downloader (DL) and No-downloader (NDL). Results A total of 63 subjects were analyzed, of which 30 were classified as DL and 33 as NDL. At the end of the study, DL had significantly lower HbA1c, mean daily glucose, standard deviation, percentage of BG values above target, and pre- and postprandial (lunch and dinner) values compared with NDL (all P<.05). The percentage of BG values within treatment target was significantly higher in DL compared with NDL (47% [SD 9] vs 37% [SD 13]; P=.001). Conclusions The findings suggest that, in T1DM, downloading of BG from data management system, which enables connection to smartphones, the Web, and the cloud, might be a valuable contributor to improved glycemic control.
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Affiliation(s)
- Concetta Irace
- Metabolic Diseases Unit, Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | | | - Cesare Tripolino
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, University of Catanzaro, Catanzaro, Italy
| | - Faustina Barbara Scavelli
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, University of Catanzaro, Catanzaro, Italy
| | - Agostino Gnasso
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, University of Catanzaro, Catanzaro, Italy
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Irace C, Messiniti V, Tassone B, Cortese C, Barrett EJ, Gnasso A. Evidence for congruent impairment in micro and macrovascular function in type 1 diabetes. PLoS One 2017; 12:e0187525. [PMID: 29131837 PMCID: PMC5683560 DOI: 10.1371/journal.pone.0187525] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 10/21/2017] [Indexed: 01/22/2023] Open
Abstract
Diabetes affects large and small vessels through mechanisms only partially known. In the present study, we evaluated the function of capillaries and large arteries in subjects with type 1 diabetes mellitus (T1DM) to study the effect of chronic hyperglycemia in the absence of other cardiovascular risk factors. Twenty-five subjects with T1DM and 12 healthy age-matched controls were enrolled. Nine patients had mild or moderate retinopathy. Contrast enhanced ultrasound was used to measure perfusion of the deep forearm flexor muscle of the non-dominant arm at rest (baseline) and after an ischemic stimulus (reactive hyperemia). Perfusion was expressed as Video Intensity (VI) in arbitrary unit (a.u.)/mm2. The time to reach peak VI after ischemia was also recorded. The function of large arteries was evaluated using flow-mediated vasodilation (FMD). VI was significantly lower in T1DM compared to control subjects both at baseline (0.22±0.16 vs 0.44±0.35 a.u./mm2, p<0.05), and after ischemia (0.33±0.24 vs 0.68±0.46 a.u./mm2, p<0.05). The time to reach peak VI after ischemia was markedly longer in T1DM (5.6±2.2 vs 4.0±1.7 seconds, p<0.02). These differences were more marked in T1DM subjects with retinopathy. FMD was lower in TIDM patients compared to controls (5.4±6.4 vs 10.7±4.5%, p<0.01). The present findings demonstrate that T1DM patients have defective peripheral skeletal muscle perfusion both at rest and after ischemia compared with control subjects. Low muscle perfusion associates with low FMD of the brachial artery. Furthermore, T1DM subjects with retinopathy have the least muscle perfusion and blunted response to hyperemia compared to T1DM without retinopathy.
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Affiliation(s)
- Concetta Irace
- Department of Health Science, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Valentina Messiniti
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Bruno Tassone
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Claudio Cortese
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Eugene J. Barrett
- Division of Endocrinology, Department of Medicine, University of Virginia, School of Medicine, Charlottesville, Virginia, United States of America
| | - Agostino Gnasso
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
- * E-mail:
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Tripolino C, Irace C, Carallo C, Scavelli FB, Gnasso A. Body fat and blood rheology: Evaluation of the association between different adiposity indices and blood viscosity. Clin Hemorheol Microcirc 2017; 65:241-248. [PMID: 27716654 DOI: 10.3233/ch-16172] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In recent years, new measures of body adiposity have been introduced: lipid accumulation product (LAP), body adiposity index (BAI) and body shape index (ABSI). These indices have been demonstrated to better associate with cardiovascular disease than other measures of adiposity. OBJECTIVES The aim of the present study was to evaluate if LAP or BAI better associate with blood viscosity than other measures of adiposity (body mass index, BMI; waist circumference, WC; waist-to-hip ratio, W/HR; waist-to-height ratio, W/HtR). METHODS 344 subjects were recruited for the present investigation. Exclusion criteria were: diabetes, elevated triglycerides, smoking and drug use. Blood lipids and glucose were measured by routine methods. Blood and plasma viscosity were measured by a cone-plate viscometer. Adiposity measures were computed as previously described. RESULTS In simple correlation analyses, blood viscosity (BV) correlated with BMI, BAI, and LAP in males and with LAP in females. Correlations between plasma viscosity and adiposity indices were weak and not statistically significant. Other variables significantly related with BV were: gender, HDL- and LDL-Cholesterol, and triglycerides (p < 0.05). In multiple regression analysis only LAP was associated with BV. CONCLUSIONS Our data suggest that LAP index is strongly associated to blood viscosity. This result, along with previous evidence, identifies LAP index as a potential cardiovascular risk marker.
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Tripolino C, Irace C, Carallo C, De Franceschi MS, Scavelli FB, Gnasso A. Red blood cell distribution width predicts two-hours plasma glucose levels during OGTT. Clin Hemorheol Microcirc 2016; 62:63-9. [PMID: 26410856 DOI: 10.3233/ch-151947] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Red blood cell distribution width (RDW) is a numerical measure, reported as part of a standard complete blood count, usually employed for differential diagnosis of anemic state. Some lines of evidence demonstrate that RDW associates with type 2 diabetes incidence and its complications. To further explore the role of RDW as predictor of abnormal glucose metabolism, we have analyzed the relationship between RDW and 2-hours plasma glucose concentration during an oral glucose tolerance test (OGTT). METHODS Forty-five outpatients were enrolled for the present study. Participants underwent 75 g OGTT and measurements of hematological parameters. Cardiovascular disease risk factors (blood pressure, blood lipids, cigarette smoking, obesity) were evaluated by routine methods. RESULTS In simple regression analysis 2-hours post-load glucose was directly associated with age (r = 0.36, p = 0.01), fasting glucose levels (r = 0.40, p = 0.002) and RDW (r = 0.31, p = 0.037). In multiple regression analysis fasting glucose, RDW, triglycerides and age significantly and independently predicted 2-hours plasma glucose (p < 0.01 for all coefficients). CONCLUSION The present findings demonstrate that RDW associates with plasma glucose concentration after a 75-g oral glucose tolerance test. Our results highlight the role of RDW as predictor of glucose metabolism disturbance.
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Agra RM, Al-Daghri NM, Badimon L, Bodi V, Carbone F, Chen M, Cubedo J, Dullaart RPF, Eiras S, García-Monzón C, Gary T, Gnoni A, González-Rodríguez Á, Gremmel T, Hafner F, Hakala T, Huang B, Ickmans K, Irace C, Kholová I, Kimer N, Kytö V, März W, Miazgowski T, Møller S, Montecucco F, Niccoli G, Nijs J, Ozben S, Ozben T, Papassotiriou I, Papastamataki M, Reina-Couto M, Rios-Navarro C, Ritsch A, Sabico S, Seetho IW, Severino A, Sipilä J, Sousa T, Taszarek A, Taurino F, Tietge UJF, Tripolino C, Verloop W, Voskuil M, Wilding JPH. Research update for articles published in EJCI in 2014. Eur J Clin Invest 2016; 46:880-94. [PMID: 27571922 DOI: 10.1111/eci.12671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/26/2016] [Accepted: 08/26/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Rosa María Agra
- Department of Cardiology and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Nasser M Al-Daghri
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.,Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Lina Badimon
- Cardiovascular Research Center (CSIC-ICCC), Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Cardiovascular Research Chair, UAB, Barcelona, Spain
| | - Vicente Bodi
- Cardiology Department, Hospital Clinico Universitario, INCLIVA, University of Valencia, Valencia, Spain
| | - Federico Carbone
- First Clinical of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Judit Cubedo
- Cardiovascular Research Center (CSIC-ICCC), Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Robin P F Dullaart
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sonia Eiras
- Health Research Institute, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Carmelo García-Monzón
- Liver Research Unit, Santa Cristina University Hospital, Instituto de Investigación Sanitaria Princesa, CIBEREHD, Madrid, Spain
| | - Thomas Gary
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Antonio Gnoni
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Águeda González-Rodríguez
- Liver Research Unit, Santa Cristina University Hospital, Instituto de Investigación Sanitaria Princesa, CIBEREHD, Madrid, Spain
| | - Thomas Gremmel
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Franz Hafner
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Tommi Hakala
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Baotao Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kelly Ickmans
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Concetta Irace
- Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
| | - Ivana Kholová
- Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
| | - Nina Kimer
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Faculty of Health Sciences, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ville Kytö
- Heart Center, Turku University Hospital, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Winfried März
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.,Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Augsburg, Germany
| | - Tomasz Miazgowski
- Department of Hypertension and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Søren Møller
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Faculty of Health Sciences, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Fabrizio Montecucco
- First Clinical of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS AOU San Martino-IST, Genoa, Italy.,Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | | | - Jo Nijs
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Serkan Ozben
- Department of Neurology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Tomris Ozben
- Department of Medical Biochemistry, Medical Faculty, Akdeniz University, Antalya, Turkey
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Maria Papastamataki
- Department of Clinical Biochemistry, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Marta Reina-Couto
- Departamento de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,MedInUP - Centro de Investigação Farmacológica e Inovação Medicamentosa, Universidade do Porto, Porto, Portugal.,Departamento de Medicina Intensiva, Centro Hospitalar São João, Porto, Portugal
| | - Cesar Rios-Navarro
- Cardiology Department, Hospital Clinico Universitario, INCLIVA, University of Valencia, Valencia, Spain
| | - Andreas Ritsch
- Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Shaun Sabico
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.,Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Ian W Seetho
- Obesity and Endocrinology Research Group, University Hospital Aintree, University of Liverpool, Liverpool, UK
| | | | - Jussi Sipilä
- North Karelia Central Hospital, Joensuu, Finland.,Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.,Department of Neurology, University of Turku, Turku, Finland
| | - Teresa Sousa
- Departamento de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,MedInUP - Centro de Investigação Farmacológica e Inovação Medicamentosa, Universidade do Porto, Porto, Portugal
| | - Aleksandra Taszarek
- Department of Hypertension and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Federica Taurino
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | - Uwe J F Tietge
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Cesare Tripolino
- Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
| | - Willemien Verloop
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - John P H Wilding
- Obesity and Endocrinology Research Group, University Hospital Aintree, University of Liverpool, Liverpool, UK
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Carallo C, Tripolino C, De Franceschi MS, Irace C, Xu XY, Gnasso A. Carotid endothelial shear stress reduction with aging is associated with plaque development in twelve years. Atherosclerosis 2016; 251:63-69. [DOI: 10.1016/j.atherosclerosis.2016.05.048] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 05/15/2016] [Accepted: 05/27/2016] [Indexed: 01/09/2023]
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Tripolino C, Irace C, Carallo C, De Franceschi MS, Scavelli F, Della Valle E, Gnasso A. Association between blood viscosity and common carotid artery elasticity. Clin Hemorheol Microcirc 2016; 62:55-62. [DOI: 10.3233/ch-151946] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Cesare Tripolino
- Department of Clinical and Experimental Medicine, “Magna Græcia” University, Catanzaro, Italy
| | - Concetta Irace
- Department of Clinical and Experimental Medicine, “Magna Græcia” University, Catanzaro, Italy
| | - Claudio Carallo
- Department of Clinical and Experimental Medicine, “Magna Græcia” University, Catanzaro, Italy
| | | | - Faustina Scavelli
- Department of Clinical and Experimental Medicine, “Magna Græcia” University, Catanzaro, Italy
| | - Elisabetta Della Valle
- Department of Clinical and Experimental Medicine, “Magna Græcia” University, Catanzaro, Italy
- Department of Public Health, Federico II University, Naples, Italy
| | - Agostino Gnasso
- Department of Clinical and Experimental Medicine, “Magna Græcia” University, Catanzaro, Italy
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Gallo L, Faniello MC, Canino G, Tripolino C, Gnasso A, Cuda G, Costanzo FS, Irace C. Serum Calcium Increase Correlates With Worsening of Lipid Profile: An Observational Study on a Large Cohort From South Italy. Medicine (Baltimore) 2016; 95:e2774. [PMID: 26937904 PMCID: PMC4779001 DOI: 10.1097/md.0000000000002774] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Despite the well-documented role of calcium in cell metabolism, its role in the development of cardiovascular disease is still under heavy debate. Several studies suggest that calcium supplementation might be associated with an increased risk of coronary heart disease, whereas others underline a significant effect on lowering high blood pressure and hyperlipidemia. The purpose of this study was to investigate, in a large nonselected cohort from South Italy, if serum calcium levels correlate with lipid values and can therefore be linked to higher individual cardiovascular risk.Eight-thousand-six-hundred-ten outpatients addressed to the Laboratory of Clinical Biochemistry, University of Magna Græcia, Catanzaro, Italy from January 2012 to December 2013 for routine blood tests, were enrolled in the study. Total HDL-, LDL- and non-HDL colesterol, triglycerides, and calcium were determined with standard methods.We observed a significant association between total cholesterol, LDL-cholesterol, HDL-cholesterol, non-HDL cholesterol, triglycerides, and serum calcium in men and postmenopause women. Interestingly, in premenopause women, we only found a direct correlation between serum calcium, total cholesterol, and HDL-cholesterol. Calcium significantly increased while increasing total cholesterol and triglycerides in men and postmenopause women.Our results confirm that progressive increase of serum calcium level correlates with worsening of lipid profile in our study population. Therefore, we suggest that a greater caution should be used in calcium supplement prescription particularly in men and women undergoing menopause, in which an increase of serum lipids is already known to be associated with a higher cardiovascular risk.
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Affiliation(s)
- Luigia Gallo
- From the Department of Experimental and Clinical Medicine (LG, MCF, CT, AG, Giovanni Cuda, FSC); Department of Medical and Surgical Sciences (Giovanni Canino); and Department of Health Science (CI), Magna Græcia University of Catanzaro, Catanzaro, Italy
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Tripolino C, Irace C, Scavelli FB, de Franceschi MS, Esposito T, Carallo C, Gnasso A. Triglyceride Glucose Index and Common Carotid Wall Shear Stress. J Investig Med 2015; 62:340-4. [DOI: 10.2310/jim.0000000000000043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Irace C, Tripolino C, Scavelli FB, Carallo C, Gnasso A. Brachial Low-Flow-Mediated Constriction is Associated with Delayed Brachial Flow-Mediated Dilation. J Atheroscler Thromb 2015; 23:355-63. [PMID: 26581241 DOI: 10.5551/jat.32060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Flow-mediated vasodilation (FMD) of the brachial artery measures the ability of the artery to dilate after a forearm ischemia lasting for 5 min. During ischemia, and therefore in conditions of low flow, constriction of the brachial artery (L-FMC) has sometimes been reported. The meaning of L-FMC is still unclear. The aims of our study were to establish the prevalence of subjects with L-FMC, to determine whether the magnitude of L-FMC correlates with magnitude of FMD, and to determine whether L-FMC can be used to predict FMD timing. METHODS A total of 179 outpatients were studied, and the brachial artery diameter was measured every minute during the 5 min forearm ischemia. Subjects who had at least one measurement showing a constriction of > 1% during ischemia were defined as constrictors. FMD was evaluated at 50 s, 2 min, and 3 min after cuff release. On the basis of time, the subjects in whom maximal dilation had occurred were divided into Early, Late, or No dilators. RESULTS The brachial artery diameter of 70 subjects (39%) constricted during ischemia. Higher the constriction during ischemia, lower was the dilation after ischemia. Constrictors were more likely to have Late (OR 2.6; ICs 95% 1.19-5.81, p=0.02) or No dilation (OR 4.8; ICs 95% 1.90-12-16, p=0.02) compared with no constrictors. CONCLUSIONS The present study reveals that almost 40% of the subjects had brachial artery L-FMC and a more pronounced constriction during ischemia correlated with a lower dilation after ischemia. Finally, the prevalence of subjects showing L-FMC was significantly higher among subjects with delayed or no vasodilation, suggesting that L-FMC may be a marker of endothelial dysfunction.
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Affiliation(s)
- Concetta Irace
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine; "Magna Græcia" University
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46
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Tripolino C, Gnasso A, Carallo C, Scavelli FB, Irace C. Difference in carotid artery elasticity in subjects with different brachial artery kinetic of vasodilatation. J Hum Hypertens 2015; 30:493-7. [PMID: 26467820 DOI: 10.1038/jhh.2015.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/02/2015] [Accepted: 09/16/2015] [Indexed: 01/13/2023]
Abstract
Increased carotid stiffness and impaired brachial artery flow-mediated dilatation (FMD) associate with cardiovascular events. We have previously reported three FMD patterns based on the time of maximal dilatation. The aim of the present study was to verify whether different FMD patterns associate with carotid artery stiffness. In all, 133 subjects were enrolled. All participants underwent complete clinical examination, blood sampling and ultrasound study. FMD was used as a measure of endothelial function. Based on the maximal brachial artery FMD, subjects were divided into Early dilators (peak FMD at 50 s), Late dilators (peak FMD over 50 s) and No dilators. Echo-Doppler evaluation of carotid arteries was performed in order to calculate elastic indexes (strain, β-stiffness index and distensibility). In all, 64 subjects were classified as Early FMD, 36 as Late FMD and 33 as No dilators. Age, gender and cardiovascular risk factors were comparable among three groups. Early FMD had higher values of strain compared with both Late and no Dilators (P<0.001). Furthermore, Early dilators showed a significantly lower stiffness and higher distensibility compared with Late and No dilators. No significant differences between Late FMD and No Dilators were detected. Our results demonstrate that common carotid artery elasticity indexes significantly differ among Early, Late and No dilators. Subjects with delayed or absent brachial artery dilatation have stiffer common carotid arteries compared with subjects with early dilatation. In conclusion, our research suggests that the assessment of the kinetics of FMD in a clinical setting might represent a useful screening tool to improve the cardiovascular risk stratification.
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Affiliation(s)
- C Tripolino
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, 'Magna Græcia' University, Catanzaro, Italy
| | - A Gnasso
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, 'Magna Græcia' University, Catanzaro, Italy
| | - C Carallo
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, 'Magna Græcia' University, Catanzaro, Italy
| | - F B Scavelli
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, 'Magna Græcia' University, Catanzaro, Italy
| | - C Irace
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, 'Magna Græcia' University, Catanzaro, Italy
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Carallo C, Franceschi MSD, Tripolino C, Iovane C, Catalano S, Giudice A, Crispino A, Figliuzzi M, Irace C, Fortunato L, Gnasso A. Periodontal Treatment Elevates Carotid Wall Shear Stress in the Medium Term. Medicine (Baltimore) 2015; 94:e1724. [PMID: 26496285 PMCID: PMC4620837 DOI: 10.1097/md.0000000000001724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Periodontal disease is associated with endothelial dysfunction of the brachial artery and hemodynamic alterations of the common carotid artery. Periodontal therapy improves endothelial function. It is not known if it is able also to improve the hemodynamics of the carotid artery. The aim of the current study was to evaluate the efficacy of 2 different periodontal treatments on carotid hemodynamics: scaling and root planing (SRP) alone or together with low-level laser therapy (LLLT). Forty patients were recruited and randomly treated with SRP (n = 20) or SRP + LLLT (n = 20). Periodontal indices (plaque, gingival, and probing depth indices) were measured before and 5 months after treatment. Blood viscosity, common carotid wall shear stress, circumferential wall tension, and Peterson elastic modulus were evaluated before, soon after and 5 months after treatment. It was found that the periodontal indices improved in both groups, but significantly more so for SRP + LLLT than for SRP (decrease in gingival index 69.3% versus 45.4%, respectively, P = 0.04). In the SRP + LLLT group, after a transient reduction by 5% immediately after therapy, shear stress increased by 11% after 5 months. In SRP only group, however, shear stress variations were less marked. No significant changes were found for the other hemodynamic parameters in either of the groups. Periodontal disease treatment by SRP + LLLT can therefore be said to improve common carotid wall shear stress. This suggests a possible mechanism by which the treatment of periodontal disease has beneficial effects on the cardiovascular system.
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Affiliation(s)
- Claudio Carallo
- From the Department of Chemical Engineering, Imperial College London, London, United Kingdom (CC, SC); Department of Clinical and Experimental Medicine, Institute of Dentistry, "Magna Graecia" University (MSDF, CI, AG, AC, MF, LF); and Department of Clinical and Experimental Medicine, Metabolic Disease Unit, "Magna Graecia" University, Catanzaro, Italy (CC, MSDF, CT, CI, AG)
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Tripolino C, Irace C, Carallo C, De Franceschi MS, Della Valle E, Gnasso A. Blood urea impairs brachial artery flow mediated dilation. INT ANGIOL 2015; 34:392-397. [PMID: 25669619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Urea, the main product of protein catabolism, is a biochemical marker of renal function. Though it is known that serum urea impairs vascular health, the relationship between its concentration and vascular reactivity in vivo has not been explored. Our study was undertaken to investigate possible association between serum urea and endothelial function in subjects without chronic kidney disease (CKD). METHODS Eighty free-living subjects with serum creatinine ≤1 mg/dL and without CKD were enrolled for the present study. Serum analyses and evaluation of endothelial function were performed in all subjects. Endothelial function was measured using the flow-mediated dilation (FMD) technique. Simple and multiple regression analyses were used to test the association between FMD and considered variables. RESULTS In correlation analyses FMD was found directly associated with HDL cholesterol (r=0.21; P=0.05) and eGFR (r=0.25; P=0.02) and inversely associated with age (r=-0.26; P=0.02), serum urea (r=-0.37; P<0.01), serum creatinine (r=-0.31; P<0.01) and brachial artery baseline diameter (r=-0.41; P<0.01). In multiple regression analysis only baseline artery diameter and serum urea predicted FMD; age, gender and cardiovascular risk factors did not relate with FMD. CONCLUSION Our study demonstrates the association between serum urea and FMD, suggesting that the accumulation of waste products of protein metabolism may impair vascular health in subjects without CKD.
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Affiliation(s)
- C Tripolino
- Department of Clinical and Experimental Medicine, "Magna Græcia" University, Catanzaro, Italy
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49
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Tripolino C, Carallo C, Irace C, Scavelli F, De Franceschi MS, Gnasso A. Plasma viscosity is increased in subjects with elevated ankle brachial index. Clin Hemorheol Microcirc 2015; 60:291-6. [DOI: 10.3233/ch-131834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Carallo C, Scavelli FB, Cipolla M, Merante V, Medaglia V, Irace C, Gnasso A. Management of Type 2 Diabetes Mellitus through Telemedicine. PLoS One 2015; 10:e0126858. [PMID: 25974092 PMCID: PMC4431796 DOI: 10.1371/journal.pone.0126858] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/08/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus T2DM has a huge and growing burden on public health, whereas new care models are not implemented into clinical practice; in fact the purpose of this study was to test the effectiveness of a program of integrated care for T2DM, compared with ordinary diligence. METHODS "Progetto Diabete Calabria" is a new organizational model for the management of patients with diabetes mellitus, based on General Practitioners (GPs) empowerment and the use of a web-based electronic health record, shared in remote consultations among GPs and Hospital Consultants. One-year change in glucose and main cardiovascular risk factors control in 104 patients (Cases) following this integrated care program has been evaluated and compared with that of 208 control patients (Controls) matched for age, gender, and cardiometabolic profile, and followed in an ordinary outpatient medical management by the Consultants only. Both patient groups had Day Hospitals before and after the study period. RESULTS The mean number of accesses to the Consultants during the study was 0.6 ± 0.9 for Cases, and 1.3 ± 1.5 for Controls (p<0.0001). At follow-up, glycated hemoglobin (HbA1c) significantly decreased from 58 ± 6 to 54 ± 8 mmol/mol in Cases only (p=0.01); LDL cholesterol decreased in both groups; body mass index decreased in Cases only, from 31.0 ± 4.8 to 30.5 ± 4.6 kg/m(2) (p=0.03). CONCLUSIONS The present study demonstrates that a health care program based on GPs empowerment and taking care plus remote consultation with Consultants is at least as effective as standard outpatient management, in order to improve the control of T2DM.
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Affiliation(s)
- Claudio Carallo
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, “Mater Domini” Hospital, “Magna Græcia” University, Catanzaro, Italy
| | - Faustina Barbara Scavelli
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, “Mater Domini” Hospital, “Magna Græcia” University, Catanzaro, Italy
| | - Maurizio Cipolla
- General Practitioners, National Health Service, Catanzaro, Italy
| | - Valentina Merante
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, “Mater Domini” Hospital, “Magna Græcia” University, Catanzaro, Italy
| | - Valeria Medaglia
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, “Mater Domini” Hospital, “Magna Græcia” University, Catanzaro, Italy
| | - Concetta Irace
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, “Mater Domini” Hospital, “Magna Græcia” University, Catanzaro, Italy
| | - Agostino Gnasso
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, “Mater Domini” Hospital, “Magna Græcia” University, Catanzaro, Italy
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