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Maddaloni E, Naciu AM, Mignogna C, Galiero R, Amendolara R, Fogolari M, Satta C, Serafini C, Angeletti S, Cavallo MG, Cossu E, Sasso FC, Buzzetti R, Pozzilli P. Saxagliptin/dapagliflozin is non-inferior to insulin glargine in terms of β-cell function in subjects with latent autoimmune diabetes in adults: A 12-month, randomized, comparator-controlled pilot study. Diabetes Obes Metab 2024; 26:1670-1677. [PMID: 38297915 DOI: 10.1111/dom.15469] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
AIM To compare the efficacy and safety of saxagliptin/dapagliflozin and insulin glargine in people with latent autoimmune diabetes in adults (LADA). METHODS In this phase 2b multicentre, open-label, comparator-controlled, parallel-group, non-inferiority study, we randomly assigned 33 people with LADA who had a fasting C-peptide concentration ≥0.2 nmol/L (0.6 ng/mL) to receive 1-year daily treatment with either the combination of saxagliptin (5 mg) plus dapagliflozin (10 mg) or insulin glargine (starting dose: 10 IU), both on top of metformin. The primary outcome was the 2-h mixed meal-stimulated C-peptide area under the curve (AUC), measured 12 months after randomization. Secondary outcomes were glycated haemoglobin (HbA1c) levels, change in body mass index (BMI), and hypoglycaemic events. RESULTS In the modified intention-to-treat analysis, the primary outcome was similar in participants assigned to saxagliptin/dapagliflozin or to insulin glargine (median C-peptide AUC: 152.0 ng*min/mL [95% confidence interval {CI} 68.2; 357.4] vs. 122.2 ng*min/mL [95% CI 84.3; 255.8]; p for noninferiority = 0.0087). Participants randomized to saxagliptin/dapagliflozin lost more weight than those randomized to insulin glargine (median BMI change at the end of the study: -0.4 kg/m2 [95% CI -1.6; -0.3] vs. +0.4 kg/m2 [95% CI -0.3; +1.1]; p = 0.0076). No differences in HbA1c or in the number of participants experiencing hypoglycaemic events were found. CONCLUSIONS Saxagliptin/dapagliflozin was non-inferior to glargine in terms of β-cell function in this 12-month, small, phase 2b study, enrolling people with LADA with still viable endogenous insulin production. Weight loss was greater with saxagliptin/dapagliflozin, with no differences in glycaemic control or hypoglycaemic risk.
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Affiliation(s)
- Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Anda M Naciu
- Unit of Metabolic Bone and Thyroid Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carmen Mignogna
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Rocco Amendolara
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, Campus Bio-Medico University of Rome, Rome, Italy
- Laboratory Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Chiara Satta
- Diabetology Unit, Policlinico Universitario of Cagliari, Cagliari, Italy
| | - Chiara Serafini
- Diabetology Unit, Policlinico Universitario of Cagliari, Cagliari, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, Campus Bio-Medico University of Rome, Rome, Italy
- Laboratory Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | - Efisio Cossu
- Diabetology Unit, Policlinico Universitario of Cagliari, Cagliari, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Paolo Pozzilli
- Diabetes, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Centre of Immunobiology, Blizard Institute, St. Bartholomew's and London School of Medicine, London, UK
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Lee Jia Jia I, Buzzetti R, Leslie RD, Pozzilli P. LADA 30th anniversary: A growing form of diabetes with persistent unresolved questions. Diabetes Metab Res Rev 2024; 40:e3800. [PMID: 38581397 DOI: 10.1002/dmrr.3800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Affiliation(s)
- Ivy Lee Jia Jia
- Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Richard David Leslie
- Centre of Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Paolo Pozzilli
- Centre of Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
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Fadini GP, Buzzetti R, Pitocco D, Tortato E, Scatena A, Lamacchia O, Lastoria G, Simoni L, Consoli A. IDegLira for the real-world treatment of type 2 diabetes in Italy. Final results from the REX observational study. Diabetes Obes Metab 2024; 26:1746-1756. [PMID: 38327240 DOI: 10.1111/dom.15486] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/09/2024]
Abstract
AIM The study was designed to generate real-world evidence on IDegLira in the Italian clinical practice in two groups of patients with type 2 diabetes (T2D), switching to IDegLira either from a basal only (basal group) or basal-bolus insulin regimen (BB group). MATERIALS AND METHODS This was a non-interventional, multicentre, single-cohort, prospective study assessing the long-term glycaemic control in patients with T2D, who switched to IDegLira from a basal insulin ± glucose-lowering medication regimen with or without a bolus insulin component for approximately 18 months, conducted in 28 Italian diabetes centres. The primary endpoint was the change in glycated haemoglobin (HbA1c) levels from baseline to 6 months after IDegLira initiation. RESULTS The study included 358 patients with a mean age 67.2 years and diabetes duration of 15.7 years. HbA1c significantly decreased from IDegLira start to all study time points in the overall population (basal group -1.19%; BB group -0.60% at the end of observation). Patients achieving HbA1c <7% levels increased from 12.9% (n = 43) to 40.3% (n = 110) at 18 months. Fasting blood glucose and body weight also significantly decreased in both groups, although more in the BB group. Overall, 14.3% of completed patients had an intensification of treatment (mainly in the basal group) and 48.6% had a simplification of treatment (mainly in the BB group). CONCLUSIONS Switching to IDegLira in a real-world clinical setting is a valid therapeutic option for patients with T2D with inadequate glycaemic control on basal or BB insulin regimen and/or need to simplify their insulin therapy, with specific reasons and therapeutic goals according to different T2D management trajectories.
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Affiliation(s)
- Gian Paolo Fadini
- Department of Medicine, University of Padova, Padua, Italy
- Division of Metabolic Diseases, Padova Hospital, Padua, Italy
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Dario Pitocco
- Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elena Tortato
- Metabolic Diseases and Diabetology Department, IRCCS INRCA, Ancona, Italy
| | | | - Olga Lamacchia
- Endocrinology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giusi Lastoria
- Clinical Medical & Regulatory Department, Novo Nordisk SpA, Rome, Italy
| | - Lucia Simoni
- Medineos Observational Research, an IQVIA Company, Modena, Italy
| | - Agostino Consoli
- Department of Medicine and Aging Sciences (DMSI) and Center for Advanced Studies and Technology (CAST), University G. D'Annunzio, Chieti, Italy
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Maddaloni E, Amendolara R, Balena A, Latino A, Sessa RL, Buzzetti R. Immune checkpoint modulators in early clinical development for the treatment of type 1 diabetes. Expert Opin Investig Drugs 2024; 33:303-318. [PMID: 38427915 DOI: 10.1080/13543784.2024.2326036] [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] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/28/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Despite the improvements of insulin therapy, people with type 1 diabetes (T1D) still suffer from a decreased quality of life and life expectancy. The search toward a cure for T1D is therefore still a scorching open field of research. AREAS COVERED Tackling the immune checkpoint signaling pathways has gained importance in the field of cancer immunotherapy. The same pathways can be targeted in autoimmunity with an opposite principle: to dampen the exaggerated immune response. In this review, we report a comprehensive excursus on the cellular and molecular mechanisms that lead to loss of immunological tolerance, and recent evidence on the role of immune checkpoint molecules in the development of T1D and their potential application for the mitigation of autoimmune diabetes. EXPERT OPINION Contrasting results about the efficacy of immune checkpoint modulators for T1D have been published, with very few molecules from preclinical studies eligible for use in humans. The heterogeneous and complex pathophysiology of T1D may explain the conflicting evidence. Designing clinical trials that acknowledge the pathophysiological and clinical complexity of T1D and that forecast the need of simultaneously tackling different disease pathways will be crucial to enhance the benefits which may be gained by such compounds.
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Affiliation(s)
- Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Rocco Amendolara
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Angela Balena
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandro Latino
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Rosario Luigi Sessa
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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Copetti M, Baroni MG, Buzzetti R, Cavallo MG, Cossu E, D'Angelo P, Cosmo SD, Leonetti F, Morano S, Morviducci L, Napoli N, Prudente S, Pugliese G, Savino AF, Trischitta V. Validation in type 2 diabetes of a metabolomic signature of all-cause mortality. Diabetes Metab Res Rev 2024; 40:e3734. [PMID: 37839040 DOI: 10.1002/dmrr.3734] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/29/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023]
Abstract
CONTEXT Mortality in type 2 diabetes is twice that of the normoglycemic population. Unravelling biomarkers that identify high-risk patients for referral to the most aggressive and costly prevention strategies is needed. OBJECTIVE To validate in type 2 diabetes the association with all-cause mortality of a 14-metabolite score (14-MS) previously reported in the general population and whether this score can be used to improve well-established mortality prediction models. METHODS This is a sub-study consisting of 600 patients from the "Sapienza University Mortality and Morbidity Event Rate" (SUMMER) study in diabetes, a prospective multicentre investigation on all-cause mortality in patients with type 2 diabetes. Metabolic biomarkers were quantified from serum samples using high-throughput proton nuclear magnetic resonance metabolomics. RESULTS In type 2 diabetes, the 14-MS showed a significant (p < 0.0001) association with mortality, which was lower (p < 0.0001) than that reported in the general population. This difference was mainly due to two metabolites (histidine and ratio of polyunsaturated fatty acids to total fatty acids) with an effect size that was significantly (p = 0.01) lower in diabetes than in the general population. A parsimonious 12-MS (i.e. lacking the 2 metabolites mentioned above) improved patient discrimination and classification of two well-established mortality prediction models (p < 0.0001 for all measures). CONCLUSIONS The metabolomic signature of mortality in the general population is only partially effective in type 2 diabetes. Prediction markers developed and validated in the general population must be revalidated if they are to be used in patients with diabetes.
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Affiliation(s)
- Massimiliano Copetti
- Fondazione IRCCS Casa Sollievo della Sofferenza, Unit of Biostatistics, San Giovanni Rotondo, Italy
| | - Marco Giorgio Baroni
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences (MeSVA), University of L'Aquila, L'Aquila, Italy
- Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli, Italy
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Efiso Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Paola D'Angelo
- Department of Clinical Medicine and Health Service Integration, Diabetology and Nutrition Unit, Sandro Pertini Hospital - aslrm2, Rome, Italy
| | - Salvatore De Cosmo
- Department of Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Frida Leonetti
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Susanna Morano
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Lelio Morviducci
- Unit of Diabetology, Santo Spirito Hospital - ASL RM1, Rome, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-medico University of Rome, Rome, Italy
| | - Sabrina Prudente
- Fondazione IRCCS Casa Sollievo della Sofferenza, Research Unit of Metabolic and Cardiovascular diseases, San Giovanni Rotondo, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonio Fernando Savino
- Fondazione IRCCS Casa Sollievo della Sofferenza, Laboratory of Clinical Chemistry, San Giovanni Rotondo, Italy
| | - Vincenzo Trischitta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Fondazione IRCCS Casa Sollievo della Sofferenza, Research Unit of Diabetes and Endocrine Diseases, San Giovanni Rotondo, 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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Mantovani A, Morieri ML, Aldigeri R, Palmisano L, Masulli M, Bonomo K, Baroni MG, Cossu E, Cimini FA, Cavallo G, Buzzetti R, Mignogna C, Leonetti F, Bacci S, Trevisan R, Pollis RM, Cas AD, de Kreutzenberg SV, Targher G. MASLD, hepatic steatosis and fibrosis are associated with the prevalence of chronic kidney disease and retinopathy in adults with type 1 diabetes mellitus. Diabetes Metab 2024; 50:101497. [PMID: 37992857 DOI: 10.1016/j.diabet.2023.101497] [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: 06/23/2023] [Revised: 10/23/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
AIM We examined whether metabolic dysfunction-associated steatotic liver disease (MASLD) with or without significant fibrosis (assessed by validated non-invasive biomarkers) was associated with an increased risk of prevalent chronic kidney disease (CKD) or diabetic retinopathy in people with type 1 diabetes mellitus (T1DM). METHODS We performed a retrospective multicenter cross-sectional study involving 1,409 adult outpatients with T1DM, in whom hepatic steatosis index (HSI) and fibrosis (FIB)-4 index were calculated for non-invasively detecting hepatic steatosis (defined by HSI > 36), with or without coexisting significant fibrosis (FIB-4 index ≥ 1.3 or < 1.3). CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or urine albumin/creatinine ratio ≥ 3.0 mg/mmol. The presence of diabetic retinopathy was also recorded in all participants. RESULTS Patients with MASLD and significant fibrosis (n = 93) had a remarkably higher prevalence of CKD and diabetic retinopathy than their counterparts with MASLD without fibrosis (n = 578) and those without steatosis (n = 738). After adjustment for sex, diabetes duration, hemoglobin A1c, hypertension, and use of antihypertensive or lipid-lowering medications, patients with SLD and significant fibrosis had a higher risk of prevalent CKD (adjusted-odds ratio 1.76, 95 % confidence interval 1.05-2.96) than those without steatosis. Patients with MASLD without fibrosis had a higher risk of prevalent retinopathy (adjusted-odds ratio 1.49, 95 % CI 1.13-1.46) than those without steatosis. CONCLUSION This is the largest cross-sectional study showing that MASLD with and without coexisting significant fibrosis was associated, independently of potential confounders, with an increased risk of prevalent CKD and retinopathy in adults with T1DM.
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Affiliation(s)
- Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - Mario Luca Morieri
- Metabolic Diseases, Department of Medicine, University of Padua, Padua, Italy
| | | | - Luisa Palmisano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Katia Bonomo
- Diabetes and Metabolic Diseases Unit, San Luigi Gonzaga University Hospital, Turin, Italy
| | - Marco Giorgio Baroni
- Department of Clinical Medicine, Life, Health & Environmental Sciences, University of Aquila, L'Aquila, Italy; Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli, Italy
| | - Efisio Cossu
- Diabetology Unit, Policlinico Universitario of Cagliari, Cagliari, Italy
| | | | - Gisella Cavallo
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | | | - Carmen Mignogna
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Frida Leonetti
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Simonetta Bacci
- Section of Endocrinology, Department of Medicine, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Roberto Trevisan
- Metabolic Diseases, Department of Medicine, University of Padua, Padua, Italy; Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | | | - Alessandra Dei Cas
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Division of Nutritional and Metabolic Sciences, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy; IRCCS Sacro Cuore - Don Calabria Hospital, Negrar di Valpolicella, Italy.
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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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Csermely A, Mantovani A, Morieri ML, Palmisano L, Masulli M, Cossu E, Baroni MG, Bonomo K, Cimini FA, Cavallo G, Buzzetti R, Mignogna C, Leonetti F, Bacci S, Trevisan R, Pollis RM, Aldigeri R, Cas AD, de Kreutzenberg SV, Targher G. Association between different modalities of insulin administration and metabolic dysfunction-associated fatty liver disease in adults with type 1 diabetes mellitus. Diabetes Metab 2023; 49:101477. [PMID: 37708990 DOI: 10.1016/j.diabet.2023.101477] [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] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023]
Abstract
AIM We examined whether different insulin administration modalities, i.e., multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII by insulin pumps), are differently associated with the risk of having metabolic dysfunction-associated fatty liver disease (MAFLD), with or without coexisting significant liver fibrosis (assessed by validated non-invasive biomarkers), in adults with type 1 diabetes mellitus (T1DM). METHODS We conducted a retrospective, multicenter, cross-sectional study involving 1,417 adult individuals with established T1DM treated with MDI or CSII. We calculated hepatic steatosis index (HSI) and fibrosis (FIB)-4 index for non-invasively detecting MAFLD (defined by HSI >36), with or without coexisting significant fibrosis (defined by FIB-4 index ≥ 1.3 or <1.3, respectively). RESULTS Compared to the MDI group (n = 1,161), insulin-pump users (n = 256; 18.1%) were more likely to be younger (mean age: 40 vs. 48 years, P < 0.001), had better glycemic control (mean hemoglobin A1c: 7.7% vs. 7.9%, P = 0.025) and a markedly lower prevalence of MAFLD with coexisting significant fibrosis (2.7% vs. 8.1%, P = 0.010), but a comparable prevalence of MAFLD without fibrosis. In multinomial logistic regression analysis, CSII therapy was associated with a ∼70%-lower risk of MAFLD with significant fibrosis (unadjusted odds ratio 0.32, 95% confidence interval 0.14-0.70; P = 0.004), but this association was no longer significant after adjustment for age, hemoglobin A1c and other potential confounders. CONCLUSION The lower prevalence of MAFLD with coexisting significant fibrosis we observed in adults with T1DM using CSII therapy, compared to those using MDI therapy, is primarily mediated by inter-group differences in age.
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Affiliation(s)
- Alessandro Csermely
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - Mario Luca Morieri
- Metabolic Diseases, Department of Medicine, University of Padua, Padua, Italy
| | - Luisa Palmisano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Efisio Cossu
- Diabetology Unit, Policlinico Universitario of Cagliari, Cagliari, Italy
| | - Marco Giorgio Baroni
- Department of Clinical Medicine, Life, Health and Environmental Sciences, University of Aquila, L'Aquila, Italy; Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli, Italy
| | - Katia Bonomo
- Diabetes and Metabolic Diseases Unit, San Luigi Gonzaga University Hospital, Turin, Italy
| | | | - Gisella Cavallo
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | | | - Carmen Mignogna
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Frida Leonetti
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Simonetta Bacci
- Section of Endocrinology, Department of Medicine, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Roberto Trevisan
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | | | | | - Alessandra Dei Cas
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Division of Nutritional and Metabolic Sciences, Azienda Ospedaliero-Universitaria, Parma, Italy
| | | | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy; Metabolic Diseases Research Unit, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar di Valpolicella, Italy.
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10
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Maddaloni E, Carlone A, Pitocco D, Leanza G, Suraci C, Altomare M, Cavallo MG, Barchetta I, Morano S, Moretti C, Coraggio L, Visalli N, Tramontana F, Schiaffini R, Crinò A, Buzzetti R, Pozzilli P. Glycated haemoglobin in the first year after diagnosis of type 1 diabetes is an independent risk factor for diabetic retinopathy: The IMDIAB 25 years follow-up study. Diabetes Obes Metab 2023; 25:3415-3419. [PMID: 38014612 DOI: 10.1111/dom.15213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Angela Carlone
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Dario Pitocco
- Diabetes unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giulia Leanza
- Research Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | | | | | - Maria G Cavallo
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Ilaria Barchetta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Susanna Morano
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Chiara Moretti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Lucia Coraggio
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Flavia Tramontana
- Research Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Riccardo Schiaffini
- Endocrinology and Diabetes Unit, Bambino Gesù Hospital Research Institute, Rome, Italy
| | - Antonino Crinò
- Endocrinology and Diabetes Unit, Bambino Gesù Hospital Research Institute, Rome, Italy
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Paolo Pozzilli
- Research Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
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11
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D’Onofrio L, Amendolara R, Mignogna C, Leto G, Tartaglione L, Mazzaferro S, Maddaloni E, Buzzetti R. Lack of Association between Serum Chitotriosidase Activity and Arterial Stiffness in Type 2 Diabetes without Cardiovascular Complications. Int J Mol Sci 2023; 24:15809. [PMID: 37958794 PMCID: PMC10648693 DOI: 10.3390/ijms242115809] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Chitotriosidase (CHIT), a mammalian chitinase secreted by neutrophils and activated macrophages, is increased in both cardiovascular disease (CVD) and type 2 diabetes (T2D). Arterial stiffness rises early in T2D and increases the risk of CVD. The aim of this study is to evaluate CHIT activity as an early biomarker of arterial stiffness in people with T2D free from overt vascular complications. In this cross-sectional study, arterial stiffness as measured using standard pulse wave velocity (PWV) was evaluated in 174 people with T2D without overt vascular disease. Then, we measured CHIT serum activity with an electrochemiluminescence assay in two subgroups of participants: 35 with the highest (high-PWV) and 40 with the lowest (low-PWV) PWV values. CHIT activity was no different between the low-PVW and high-PWV groups (12.7 [9.6-17.9] vs. 11.4 [8.8-15.0] nmol/mL/h, respectively). Compared with the low-PWV group, the high-PWV participants were older (p < 0.001); had a longer duration of diabetes (p = 0.03); higher ankle-brachial index ABI (p = 0.04), systolic blood pressure (p = 0.002), diastolic blood pressure (p = 0.005), fasting blood glucose (p = 0.008), and HbA1c (p = 0.005); and lower eGFR (p = 0.03) and body mass index (BMI) (p = 0.01). No association was present with sex, duration of diabetes, age, BMI, peripheral blood pressure, laboratory parameters, and glucose-lowering medications or ongoing antihypertensive therapy. Although no association was found, this study provides novel data about the association of CHIT activity with CVD, focusing on a specific outcome (arterial stiffness) in a well-defined population of subjects with T2D without established CVD.
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Affiliation(s)
- Luca D’Onofrio
- Department of Experimental Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (L.D.); (R.A.); (C.M.); (E.M.)
| | - Rocco Amendolara
- Department of Experimental Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (L.D.); (R.A.); (C.M.); (E.M.)
| | - Carmen Mignogna
- Department of Experimental Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (L.D.); (R.A.); (C.M.); (E.M.)
| | - Gaetano Leto
- Diabetes Unit, Department of Medical-Surgical Sciences and Biotechnologies, Santa Maria Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy;
| | - Lida Tartaglione
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (L.T.); (S.M.)
| | - Sandro Mazzaferro
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (L.T.); (S.M.)
| | - Ernesto Maddaloni
- Department of Experimental Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (L.D.); (R.A.); (C.M.); (E.M.)
| | - Raffaella Buzzetti
- Department of Experimental Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (L.D.); (R.A.); (C.M.); (E.M.)
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12
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Dei Cas A, Aldigeri R, Mantovani A, Masulli M, Palmisano L, Cavalot F, Bonomo K, Baroni MG, Cossu E, Cavallo G, Cimini FA, Buzzetti R, Mignogna C, Leonetti F, Bacci S, Trevisan R, Morieri ML, Pollis RM, Targher G, Vigili de Kreutzenberg S. Sex Differences in Cardiovascular Disease and Cardiovascular Risk Estimation in Patients With Type 1 Diabetes. J Clin Endocrinol Metab 2023; 108:e789-e798. [PMID: 36881927 DOI: 10.1210/clinem/dgad127] [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: 11/17/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
CONTEXT Patients with type 1 diabetes (T1D) have higher cardiovascular disease (CVD) risk than the general population. OBJECTIVE This observational study aims to evaluate sex-related differences in CVD prevalence and CVD risk estimates in a large cohort of T1D adults. METHODS We conducted a multicenter, cross-sectional study involving 2041 patients with T1D (mean age 46 years; 44.9% women). In patients without pre-existing CVD (primary prevention), we used the Steno type 1 risk engine to estimate the 10-year risk of developing CVD events. RESULTS CVD prevalence (n = 116) was higher in men than in women aged ≥55 years (19.2 vs 12.8%, P = .036), but comparable between the 2 sexes in those aged <55 years (P = .91). In patients without pre-existing CVD (n = 1925), mean 10-year estimated CVD risk was 15.4 ± 0.4% without any significant sex difference. However, stratifying this patient group by age, the 10-year estimated CVD risk was significantly higher in men than in women until age 55 years (P < .001), but this risk equalized after this age. Carotid artery plaque burden was significantly associated with age ≥55 years and with a medium and high 10-year estimated CVD risk, without any significant sex difference. Diabetic retinopathy and sensory-motor neuropathy were also associated with higher 10-year CVD risk and female sex. CONCLUSION Both men and women with T1D are at high CVD risk. The 10-year estimated CVD risk was higher in men aged <55 years than in women of similar age, but these sex differences disappeared at age ≥55 years, suggesting that female sex was no longer protective.
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Affiliation(s)
- Alessandra Dei Cas
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Division of Nutritional and Metabolic Sciences, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy
| | - Raffaella Aldigeri
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, 37124 Verona, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Luisa Palmisano
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Franco Cavalot
- Diabetes and Metabolic Diseases Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
| | - Katia Bonomo
- Diabetes and Metabolic Diseases Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
| | - Marco Giorgio Baroni
- Department of Clinical Medicine, Life, Health & Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
- Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Efisio Cossu
- Unit of Diabetology, Policlinico Universitario of Cagliari, 09124 Cagliari, Italy
| | - Gisella Cavallo
- Department of Experimental Medicine, Sapienza University, 00185 Rome, Italy
| | | | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University, 00185 Rome, Italy
| | - Carmen Mignogna
- Department of Experimental Medicine, Sapienza University, 00185 Rome, Italy
| | - Frida Leonetti
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, 00185 Rome, Italy
| | - Simonetta Bacci
- Section of Endocrinology, Department of Medicine, IRCCS, Casa Sollievo della Sofferenza Hospital, 71013 San Giovanni Rotondo (FG), Italy
| | - Roberto Trevisan
- Department of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
| | - Mario Luca Morieri
- Metabolic Diseases, Department of Medicine, University of Padua, 35128 Padua, Italy
| | | | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, 37124 Verona, Italy
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13
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Mantovani A, Morieri ML, Palmisano L, Masulli M, Cossu E, Baroni MG, Bonomo K, Cimini FA, Cavallo G, Buzzetti R, Mignogna C, Leonetti F, Bacci S, Trevisan R, Pollis RM, Aldigeri R, Cas AD, de Kreutzenberg SV, Targher G. Hepatic steatosis with significant fibrosis is associated with an increased 10-year estimated risk of cardiovascular disease in adults with type 1 diabetes mellitus. Cardiovasc Diabetol 2023; 22:204. [PMID: 37563618 PMCID: PMC10416459 DOI: 10.1186/s12933-023-01945-x] [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: 06/26/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND We assessed whether hepatic steatosis with or without significant fibrosis (determined by validated non-invasive biomarkers) is associated with an increased 10-year estimated risk for cardiovascular disease (CVD) in people with type 1 diabetes mellitus (T1DM). METHODS We conducted a retrospective, multicenter, cross-sectional study involving 1,254 adults with established T1DM without pre-existing CVD. We used the hepatic steatosis index (HSI) and fibrosis (FIB)-4 index for non-invasively detecting hepatic steatosis (defined as HSI > 36), with or without coexisting significant fibrosis (defined as FIB-4 index ≥ 1.3 or < 1.3). We calculated the Steno type 1 risk engine and the atherosclerotic CVD (ASCVD) risk score to estimate the 10-year risk of developing a first fatal or nonfatal CVD event. RESULTS Using the Steno type 1 risk engine, a significantly greater proportion of patients with hepatic steatosis and significant fibrosis (n = 91) had a high 10-year estimated CVD risk compared to those with hepatic steatosis alone (n = 509) or without steatosis (n = 654) (75.8% vs. 23.2% vs. 24.9%, p < 0.001). After adjustment for sex, BMI, diabetes duration, hemoglobin A1c, chronic kidney disease, and lipid-lowering medication use, patients with hepatic steatosis and significant fibrosis had an increased 10-year estimated risk of developing a first fatal or nonfatal CVD event (adjusted-odds ratio 11.4, 95% confidence interval 3.54-36.9) than those without steatosis. We observed almost identical results using the ASCVD risk calculator. CONCLUSIONS The 10-year estimated CVD risk is remarkably greater in T1DM adults with hepatic steatosis and significant fibrosis than in their counterparts with hepatic steatosis alone or without steatosis.
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Affiliation(s)
- Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - Mario Luca Morieri
- Metabolic Diseases, Department of Medicine, University of Padua, Padua, Italy
| | - Luisa Palmisano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Efisio Cossu
- Diabetology Unit, Policlinico Universitario of Cagliari, Cagliari, Italy
| | - Marco Giorgio Baroni
- Department of Clinical Medicine, Life, Health and Environmental Sciences, University of Aquila, L'Aquila, Italy
- Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli, Italy
| | - Katia Bonomo
- Diabetes and Metabolic Diseases Unit, San Luigi Gonzaga University Hospital, Turin, Italy
| | | | - Gisella Cavallo
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | | | - Carmen Mignogna
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Frida Leonetti
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Simonetta Bacci
- Section of Endocrinology, Department of Medicine, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Roberto Trevisan
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | | | - Raffaella Aldigeri
- Division of Nutritional and Metabolic Sciences, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Alessandra Dei Cas
- Division of Nutritional and Metabolic Sciences, Azienda Ospedaliero-Universitaria, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy.
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani, 1, Verona, 37126, Italy.
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14
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D'Souza F, Buzzetti R, Pozzilli P. Diabetes, COVID-19, and questions unsolved. Diabetes Metab Res Rev 2023:e3666. [PMID: 37209039 DOI: 10.1002/dmrr.3666] [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: 02/11/2023] [Revised: 04/13/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023]
Abstract
Recent evidence suggests a role for Diabetes Mellitus in adverse outcomes from COVID-19 infection; yet the underlying mechanisms are not clear. Moreover, attention has turned to prophylactic vaccination to protect the population from COVID-19-related illness and mortality. We performed a comprehensive peer-reviewed literature search on an array of key terms concerning diabetes and COVID-19 seeking to address the following questions: 1. What role does diabetes play as an accelerator for adverse outcomes in COVID-19?; 2. What mechanisms underlie the differences in outcomes seen in people with diabetes?; 3. Are vaccines against COVID-19 efficacious in people with diabetes? The current literature demonstrates that diabetes is associated with an increased risk of adverse outcomes from COVID-19 infection, and post-COVID sequelae. Potential mechanisms include dysregulation of Angiotensin Converting Enzyme 2, Furin, CD147, and impaired immune cell responses. Hyperglycaemia is a key exacerbator of these mechanisms. Limited studies are available on COVID-19 vaccination in people with diabetes; however, the current literature suggests that vaccination is protective against adverse outcomes for this population. In summary, people with diabetes are a high-risk group that should be prioritised in vaccination efforts. Glycaemic optimisation is paramount to protecting this group from COVID-19-associated risk. Unsolved questions remain as to the molecular mechanisms underlying the adverse outcomes seen in people with diabetes; the functional impact of post-COVID symptoms on people with diabetes, their persistence, and management; how long-term vaccine efficacy is affected by diabetes, and the antibody levels that confer protection from adverse outcomes in COVID-19.
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Affiliation(s)
- Felecia D'Souza
- University College London Hospitals NHS Trust, London, UK
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Paolo Pozzilli
- Department of Endocrinology & Diabetes, University Campus Bio-Medico, Rome, Italy
- Centre for Immunobiology, Barts and the London School of Medicine, Queen Mary University of London, London, UK
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15
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Buzzetti R, Fadini GP, Nicolucci A, Larosa M, Rossi MC, Cucinotta D. Corrigendum to Comparative effectiveness of Glargine 300 U/mL vs. Degludec 100 U/mL in patients with type 2 diabetes switching from 1° generation basal insulins > Nutr Metab Cardiovasc Dis. 2022 Sep;32(9):2255-2263. Nutr Metab Cardiovasc Dis 2023; 33:920-921. [PMID: 36948942 DOI: 10.1016/j.numecd.2023.02.006] [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: 03/24/2023]
Affiliation(s)
| | | | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
| | | | - Maria Chiara Rossi
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Domenico Cucinotta
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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16
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Maddaloni E, Coraggio L, Amendolara R, Baroni MG, Cavallo MG, Copetti M, Cossu E, D'Angelo P, D'Onofrio L, Cosmo SD, Leonetti F, Morano S, Morviducci L, Napoli N, Prudente S, Pugliese G, Park K, Holman RR, Trischitta V, Buzzetti R. Association of osteocalcin, osteoprotegerin, and osteopontin with cardiovascular disease and retinopathy in type 2 diabetes. Diabetes Metab Res Rev 2023:e3632. [PMID: 36880127 DOI: 10.1002/dmrr.3632] [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: 08/25/2022] [Revised: 12/02/2022] [Accepted: 02/26/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Novel biomarkers of vascular disease in diabetes could help identify new mechanistic pathways. Osteocalcin, osteoprotegerin, and osteopontin are key molecules involved in bone and vascular calcification processes, both of which are compromised in diabetes. We aimed to evaluate possible associations of osteocalcin, osteoprotegerin, and osteopontin with cardiovascular disease (CVD) and diabetic retinopathy (DR) among people with type 2 diabetes (T2D). MATERIALS AND METHODS Osteocalcin, osteoprotegerin, and osteopontin concentrations were measured at enrolment in 848 participants with T2D from the Sapienza University Mortality and Morbidity Event Rate (SUMMER) Study (ClinicalTrials.gov: NCT02311244). Logistic regression models and propensity score matching were used to assess possible associations of osteocalcin, osteoprotegerin, and osteopontin with a history of CVD and with evidence of any grade of DR adjusting for confounders. RESULTS Previous CVD was reported in 139 (16.4%) participants, while 144 (17.0%) had DR. After adjusting for possible confounders, osteocalcin but not osteoprotegerin or osteopontin concentrations were associated with a history of CVD (Odds Ratio [OR] and 95% CI for one standard deviation (SD) increase in osteocalcin concentrations (natural log): 1.35 (1.06-1.72), p = 0.014). Associations with prevalent DR were seen for osteoprotegerin (OR for one SD increase in osteoprotegerin concentrations (natural log): 1.25 (1.01-1.55), p = 0.047) and osteopontin (OR for one SD increase in osteopontin concentrations (natural log): 1.25 (1.02-1.53), p = 0.022), but not osteocalcin. CONCLUSIONS In T2D, higher serum osteocalcin concentrations are associated with macrovascular complications and higher osteoprotegerin and osteopontin concentrations with microvascular complications, suggesting that these osteokines might be involved in pathways directly related to vascular disease.
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Affiliation(s)
- Ernesto Maddaloni
- Sapienza University of Rome, Rome, Italy
- Diabetes Trials Unit, OCDEM, University of Oxford, Oxford, UK
| | | | | | | | | | - Massimiliano Copetti
- Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Rome, Italy
| | | | | | | | - Salvatore De Cosmo
- Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Rome, Italy
| | | | | | | | | | - Sabrina Prudente
- Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Rome, Italy
| | | | - Kyoungmin Park
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Rury R Holman
- Diabetes Trials Unit, OCDEM, University of Oxford, Oxford, UK
| | - Vincenzo Trischitta
- Sapienza University of Rome, Rome, Italy
- Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Rome, Italy
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17
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D’Onofrio L, Fogolari M, Amendolara R, Siena A, De Fata R, Davini F, Coraggio L, Mignogna C, Moretti C, Maddaloni E, Angeletti S, Buzzetti R. Reduced early response to SARS-CoV2 vaccination in people with type 1 and type 2 diabetes, a 6 months follow-up study: The CoVaDiab study I. Diabetes Metab Res Rev 2023; 39:e3601. [PMID: 36533777 PMCID: PMC9877797 DOI: 10.1002/dmrr.3601] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/21/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Diabetes mellitus worsens the prognosis of SARS-CoV-2 infection, and vaccination has been the major tool for reducing the risk of hospitalisation, and mortality. The primary aim of this study was to evaluate the response to the SARS-CoV-2 vaccine in subjects with diabetes and controls. Differences between type 1 (T1D) and type 2 (T2D) diabetes and clinical determinants of vaccination response were also evaluated. METHODS 128 subjects with diabetes (60 with T1D and 62 with T2D) and 202 subjects acting as controls who completed a full vaccination cycle with two doses of mRNA vaccine were enroled. People with previous SARS-CoV-2 infection were excluded. Antibodies (Ab) directed against the spike protein of the SARS-CoV-2 were evaluated at one and 6 months after vaccination. RESULTS In the whole cohort, the Ab level was higher among women than in men (p = 0.011) and negatively correlated with age (rho = -0.155, p = 0.005). Subjects with diabetes showed decreased levels of Ab after one month compared to controls (1217[747-1887]BAU/mL vs. 1477[942-2556]BAU/mL, p = 0.002), even after correction for age and gender (p = 0.002). No difference was found between subjects with T1D and T2D. After 6 months, antibody levels significantly decreased in people with and without diabetes, with no differences between groups, although some subjects were lost at follow-up. In subjects with diabetes, only a significant correlation was found between Ab level and renal function (rho 0.190, p = 0.042). CONCLUSIONS Both T1D and T2D are associated with a reduced early response to vaccination. The serum concentration of Ab significantly reduced over time in both groups, highlighting the relevance of vaccination boosters independently of the presence of diabetes.
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Affiliation(s)
- Luca D’Onofrio
- Department of Experimental Medicine“Sapienza” University of RomeRomeItaly
| | - Marta Fogolari
- Laboratory Unit of Fondazione Policlinico Universitario Campus Bio‐Medico di RomaRomeItaly
- Unit of Clinical Laboratory ScienceUniversity Campus Bio‐Medico of RomeRomeItaly
| | - Rocco Amendolara
- Department of Experimental Medicine“Sapienza” University of RomeRomeItaly
| | - Antonio Siena
- Department of Experimental Medicine“Sapienza” University of RomeRomeItaly
| | - Riccardo De Fata
- Department of Experimental Medicine“Sapienza” University of RomeRomeItaly
| | - Flavio Davini
- Laboratory Unit of Fondazione Policlinico Universitario Campus Bio‐Medico di RomaRomeItaly
- Unit of Clinical Laboratory ScienceUniversity Campus Bio‐Medico of RomeRomeItaly
| | - Lucia Coraggio
- Department of Experimental Medicine“Sapienza” University of RomeRomeItaly
| | - Carmen Mignogna
- Department of Experimental Medicine“Sapienza” University of RomeRomeItaly
| | - Chiara Moretti
- Department of Experimental Medicine“Sapienza” University of RomeRomeItaly
| | - Ernesto Maddaloni
- Department of Experimental Medicine“Sapienza” University of RomeRomeItaly
| | - Silvia Angeletti
- Laboratory Unit of Fondazione Policlinico Universitario Campus Bio‐Medico di RomaRomeItaly
- Unit of Clinical Laboratory ScienceUniversity Campus Bio‐Medico of RomeRomeItaly
| | - Raffaella Buzzetti
- Department of Experimental Medicine“Sapienza” University of RomeRomeItaly
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18
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Maddaloni E, Cavallari I, La Porta Y, Appetecchia A, D'Onofrio L, Grigioni F, Buzzetti R, Holman RR. Impact of baseline kidney function on the effects of sodium-glucose co-transporter-2 inhibitors on kidney and heart failure outcomes: A systematic review and meta-analysis of randomized controlled trials. Diabetes Obes Metab 2023; 25:1341-1350. [PMID: 36700422 DOI: 10.1111/dom.14986] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/11/2023] [Accepted: 01/22/2023] [Indexed: 01/27/2023]
Abstract
AIM To determine whether the magnitude of the cardiorenal benefits of sodium-glucose co-transporter-2 inhibitors (SGLT2is) varies with baseline kidney function. METHODS We searched randomized, placebo-controlled trials testing the effects of SGLT2is on renal and cardiovascular outcomes. Efficacy outcomes, stratified by baseline estimated glomerular filtration rate (eGFR) categories, included renal disease progression, a composite heart failure (HF) outcome and mortality. RESULTS Thirteen trials testing SGLT2is in 90 402 participants with available eGFR data were included. The risk of bias was judged as low for all trials. SGLT2is reduced the relative risks of renal disease progression by 27% to 57% and of HF outcomes by 13% to 32% across different eGFR categories, with an overall low heterogeneity. Meta-regression analyses showed a significant direct relationship between baseline eGFR and the magnitude of SGLT2is' renal protection (P = .003). The greatest risk reduction was in participants with an eGFR of 90 ml/min/1.73m2 or higher (HR 0.43, 95% CI: 0.32-0.58) and the smallest was in those with an eGFR of less than 30 ml/min/1.73m2 (HR 0.73, 95% CI: 0.62-0.86, P < .001). Conversely, for HF, the greatest risk reduction was in those with an eGFR of less than 30 ml/min/1.73m2 (HR 0.68, 95% CI: 0.48-0.96) and the smallest was in those with an eGFR of 90 ml/min/1.73m2 or higher (HR 0.87, 95% CI: 0.56-1.34). CONCLUSIONS SGLT2is reduce the risk of renal and HF outcomes for all eGFR categories. The greatest benefits in terms of kidney protection may be achieved by early initiation of SGLT2is in people with preserved eGFR. The greatest risk reduction for HF outcomes is observed in people with lower eGFR values.
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Affiliation(s)
- Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Ilaria Cavallari
- Department of Cardiovascular Science, Campus Bio-Medico University of Rome, Rome, Italy
| | - Ylenia La Porta
- Department of Cardiovascular Science, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Luca D'Onofrio
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Grigioni
- Department of Cardiovascular Science, Campus Bio-Medico University of Rome, Rome, Italy
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Rury R Holman
- Diabetes Trial Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Veneziano FA, Cavallari I, Grigioni F, Tuccinardi D, Maddaloni E, Indennidate C, Pieralice S, Napoli N, Buzzetti R. 769 EFFECT OF GLUCOSE LOWERING AGENTS ON CARDIAC AUTONOMIC FUNCTION AND STRUCTURE IN TYPE 2 DIABETES MELLITUS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.405] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Effects of novel glucose-lowering agents on cardiac autonomic function and structure in type 2 diabetes
Ilaria Cavallari, Ernesto Maddaloni, Francesco Veneziano, Carla Indennidate, Maria Valeria Giaccari, Dario Tuccinardi, Silvia Pieralice, Nicola Napoli, Raffaella Buzzetti, Francesco Grigioni
Background
Novel glucose-lowering agents, such as sodium glucose co-transporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, have the potential to reduce major adverse cardiovascular events among people with type 2 diabetes. However, mechanisms behind their cardiovascular protection and the implications of positive chronotropic effects of GLP-1 receptor agonists are not fully understood.
Purpose
To elucidate and compare the effects of novel glucose-lowering agents on cardiac autonomic function and structure.
Methods
This prospective observational study included subjects with type 2 diabetes and either a history of established cardiovascular disease or multiple risk factors and early initiation (within 2 weeks) of a SGLT-2 inhibitor or a GLP-1 receptor agonist on top of standard of care. Patients were followed for a median of 2 months. As per study protocol, background medical therapy should have remained stable for the entire duration of the study. Cardiac autonomic reflex tests (heart rate response to a deep breathing and to standing) and echocardiography were performed in all patients at baseline and at the end of follow-up. Endpoints were changes from baseline of E/I ratio, 30:15 ratio and indices of cardiac structure and function.
Results
A total of 37 patients completed follow-up, of whom 20 were on SGLT-2 inhibitors and 17 on GLP-1 receptor agonists. Mean age was 69 years, mean disease duration was 14 years and mean HbA1c value was 7.5%. Cardiac autonomic dysfunction, defined as at least an abnormal test, was found in 19% of patients (n=7). At a median follow-up of 2 months, there were no differences from baseline in heart rate response to a deep breathing test (p=0.92) and to standing (p=0.86). No differences were found when patients were stratified according to drug class. Among echocardiographic parameters, significant reductions of left ventricular mass (300.5±73.3 vs 280.4±68.3 g/m2, p=0.048) and left atrial volume (61.3±29.4 vs 54.7±18.0 ml, p=0.034) were found with no interaction by drug class. Left ventricular end-diastolic and systolic volumes, ejection fraction, filling pressures and pulmonary artery pressure did not substantially change.
Conclusions
In a population of patients with type 2 diabetes, short-term treatment with novel glucose-lowering agents significantly reduced left ventricular mass and left atrial volume but did not affect cardiac autonomic function.
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20
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Fadini GP, Buzzetti R, Nicolucci A, Larosa M, Rossi MC, Cucinotta D. Comparative effectiveness and safety of glargine 300 U/mL versus degludec 100 U/mL in insulin-naïve patients with type 2 diabetes. A multicenter retrospective real-world study (RESTORE-2 NAIVE STUDY). Acta Diabetol 2022; 59:1317-1330. [PMID: 35864262 PMCID: PMC9402723 DOI: 10.1007/s00592-022-01925-9] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/15/2022] [Indexed: 11/01/2022]
Abstract
AIMS This study assessed comparative effectiveness of glargine 300 U/mL (Gla-300) versus degludec 100 U/mL (Deg-100) in insulin-naïve patients with T2D. METHODS This is a retrospective, multicenter, non-inferiority study based on electronic medical records. All patients initiating Gla-300 or Deg-100 were 1:1 propensity score-matched (PSM). Linear mixed models were used to assess the changes in continuous endpoints. Incidence rates (IR) of hypoglycemia were compared using Poisson's regression models. RESULTS Nineteen centers provided data on 357 patients in each PSM cohort. HbA1c after 6 months (primary endpoint) decreased by - 1.70% (95%CI - 1.90; - 1.50) in Gla-300 group and - 169% (95%CI - 1.89; - 1.49) in Deg-100 group, confirming non-inferiority of Gla-300 versus Deg-100. Fasting blood glucose (BG) decreased by ~60 mg/dl in both groups; body weight remained unchanged. In both groups, the mean starting dose was 12U (0.15U/kg) and it was slightly titrated to 16U (0.20U/kg). IR (episodes per patient-months) of BG ≤70 mg/dl was 0.13 in Gla-300 group and 0.14 in Deg-100 group (p=0.87). IR of BG <54 mg/dL was 0.02 in both groups (p=0.49). No severe hypoglycemia occurred. CONCLUSION Initiating Gla-300 or Deg-100 was associated with similar improvements in glycemic control, no weight gain and low hypoglycemia rates, without severe episodes during 6 months of treatment.
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Affiliation(s)
| | | | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
| | | | - Maria Chiara Rossi
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Domenico Cucinotta
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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21
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Buzzetti R, Fadini GP, Nicolucci A, Larosa M, Rossi MC, Cucinotta D. Comparative effectiveness of Glargine 300 U/mL vs. Degludec 100 U/mL in patients with type 2 diabetes switching from 1° generation basal insulins. Nutr Metab Cardiovasc Dis 2022; 32:2255-2263. [PMID: 35961826 DOI: 10.1016/j.numecd.2022.06.003] [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: 03/10/2022] [Revised: 05/23/2022] [Accepted: 06/04/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Data on second generation basal insulin (2BI) in people with type 2 diabetes (T2D) generated by clinical trials still need confirmation in real-world clinical settings. This study aimed at assessing the comparative effectiveness of 2BI [Glargine 300 U/mL (Gla-300) vs. Degludec 100 U/mL (Deg-100)] in T2D Italian patients switching from first generation basal insulins (1BI). METHODS AND RESULTS This was a retrospective, non-inferiority, multicenter study. Patients switching to Gla-300 or Deg-100 from 1BI were 1:1 propensity score matched (PSM). Changes during 6 months in continuous endpoints were assessed through linear mixed models. Incidence rates (IR) of hypoglycemia (episodes per patient-months) were compared using Poisson regression. Each PSM cohort included 593 patients. HbA1c decreased from baseline (8.7%) to 6 months by -0.58% (95%CI -0.69;-0.47) in Gla-300 group and -0.50% (95%CI -0.61;-0.39) in Deg-100 group, confirming the non-inferiority of Gla-300 vs. Deg-100. No between-group differences emerged: FBG was reduced by about 20 mg/dl with both 2BI, mean dose of 2BI (24.5 U, 0.3 U/Kg at the first prescription) was suboptimally titrated during 6 months (+1.34 U in Gla-300 and + 1.76 U in Deg-100), body weight showed minor changes. IR of hypoglycemia <54 mg/dl was 0.32 (95%CI 0.21; 0.49) in Gla-300 group and 0.19 (95%CI 0.11; 0.33) in Deg-100 group (p = 0.14). CONCLUSION In subjects with T2D, switching to 2BI from 1BI was associated with similar improvements in glycemic control, low hypoglycemia rates and no weight gain in real-life setting. Clinical inertia, represented by late treatment intensification and suboptimal titration, represents a major issue in Italy.
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Affiliation(s)
| | | | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
| | | | - Maria Chiara Rossi
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Domenico Cucinotta
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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22
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Leto G, Tartaglione L, Rotondi S, Pasquali M, Maddaloni E, Mignogna C, D'Onofrio L, Zampetti S, Carlone A, Muci ML, Mastroluca D, Fassino V, Buzzetti R, Mazzaferro S. Diastolic Pressure and ACR Are Modifiable Risk Factors of Arterial Stiffness in T2DM Without Cardiovascular Disease. J Clin Endocrinol Metab 2022; 107:e3857-e3865. [PMID: 35595474 DOI: 10.1210/clinem/dgac291] [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: 12/05/2021] [Indexed: 11/19/2022]
Abstract
AIM To evaluate early, before the onset of cardiovascular events and of chronic renal insufficiency, the association between chronic kidney disease (CKD)-mineral bone disorder (MBD) biomarkers and vascular stiffness [Cardio Ankle Vascular Index (CAVI)] in the course of type 2 diabetes (T2DM). METHOD We evaluated 174 T2DM patients [median age 56 years; male/female (M/F) 100/74] with diabetes duration < 10 years and without decreased estimated glomerular filtration rate (eGFR; ≥60 mL/min/1.73 m2) or macrovascular complications. Thirty-four age-matched healthy subjects [M/F 13/21; age 53.5 (50.0-57.7) years; eGFR 107.5 (97.0-119.7) mL/ min1.73 m2] served as local reference control for CAVI (pathological: ≥8) and the novel CKD-MBD biomarkers. RESULTS Albumin-to-creatinine ratio (ACR) averaged 8.5 mg/g (5.6-17.2) with 12.6% of the patients showing pathologic values, indicative of incipient diabetic nephropathy. Serum parathyroid hormone, fibroblast growth factor 23, and sclerostin were higher while 1,25-dihydroxyvitamin D and Klotho were lower than a control group. CAVI was normal (<8) in only 54% and correlated positively with age (P < 0.001), hemoglobin 1A1c (P = 0.036), and systolic (P = 0.021) and diastolic blood pressure (DBP) (P = 0.001) and negatively correlated with 25-hydroxyvitamin D (P = 0.046). In multivariate analysis, age, DBP, ACR, and serum Klotho were independent positive predictors of CAVI. CONCLUSION In the absence of overt cardiovascular disease and of chronic renal insufficiency, CAVI is frequently pathologic in T2DM. DBP and ACR are modifiable risk factors of vascular stiffness in T2DM, thus warranting optimal assessment.
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Affiliation(s)
- Gateano Leto
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Lida Tartaglione
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
- Nephrology and Dialysis Unit, San Giovanni Evangelista Hospital, Tivoli, Italy
| | - Silverio Rotondi
- Nephrology and Dialysis Unit, ICOT Hospital, Polo Pontino Sapienza University of Rome, Rome, Italy
| | | | - Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Carmen Mignogna
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Luca D'Onofrio
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Simona Zampetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Angela Carlone
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Luisa Muci
- Nephrology and Dialysis Unit, ICOT Hospital, Polo Pontino Sapienza University of Rome, Rome, Italy
| | - Daniela Mastroluca
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Valeria Fassino
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Sandro Mazzaferro
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
- Nephrology Unit, Policlinico Umberto I, Rome, Italy
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23
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Fadini GP, Buzzetti R, Fittipaldi MR, D’Incau F, Da Porto A, Girelli A, Simoni L, Lastoria G, Consoli A. IDegLira for the Real-World Treatment of Type 2 Diabetes in Italy: Protocol and Interim Results from the REX Observational Study. Diabetes Ther 2022; 13:1483-1497. [PMID: 35717487 PMCID: PMC9309107 DOI: 10.1007/s13300-022-01287-z] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION IDegLira was shown to maintain glycemic control while reducing risk of hypoglycemia and body weight gain. The REX study was designed to generate real-world evidence on the use of IDegLira in Italian clinical practice in two different subgroups of patients, those switching to IDegLira from a basal insulin-supported oral therapy (BOT group) and those from a basal plus bolus insulin regimen (BB group). METHODS Adult patients with T2D diagnosed for at least 12 months and having started IDegLira 2-3 months prior to enrolment, coming from a BOT or BB regimen, were enrolled in this multicenter observational prospective cohort study conducted in 28 Italian centers. This paper presents the methodological framework of the REX study and provides the interim analysis results describing the patients' baseline characteristics and the clinical reasons for IDegLira treatment initiation. RESULTS Of the 360 patients enrolled in the REX study, 331 were considered eligible for this interim analysis, 76.4% in the BOT and 23.6% in the BB group. Mean (SD) HbA1c was 8.5% (1.4) in the BOT and 8.2% (1.7) in the BB group. The most common T2D complications were diabetic macroangiopathy and diabetic nephropathy in both groups. The median (interquartile range) insulin daily dose before IDegLira was 15.0 (10.0-20.0) units in the BOT group and 42 (30.0-52.0) in the BB group. Oral antidiabetics were taken by 98% and 51.3% of patients, respectively. The main reason for switching to IDegLira was the inadequate glycemic control in the BOT group (86% of patients), and the intent to simplify the treatment in the BB group (66.7%). CONCLUSIONS IdegLira is initiated after BOT in inadequately controlled patients to improve glycemic control, whereas in BB patients it is used to simplify the therapeutic regimen. Final results of the REX study will shed light on patients' outcomes after IdegLira treatment under routine clinical care.
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Affiliation(s)
- Gian Paolo Fadini
- Division of Metabolic Diseases, Department of Medicine, Padova Hospital, University of Padova, Padua, Italy
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome - Policlinico Umberto I Hospital, Rome, Italy
| | - Maria Rosa Fittipaldi
- Internal Medicine Unit, San Francesco d’Assisi Hospital, Oliveto Citra, Salerno Italy
| | - Ferruccio D’Incau
- Center of Diabetology, S. Maria del Prato Hospital, Feltre, Belluno Italy
| | - Andrea Da Porto
- Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - Angela Girelli
- Diabetes Care Unit, Spedali Civili Hospital, Brescia, Italy
| | - Lucia Simoni
- MediNeos Observational Research, IQVIA Company, Modena, Italy
| | | | - Agostino Consoli
- Department of Medicine and Aging Sciences, Centro Scienze Dell’Invecchiamento-Medicina Traslazionale (CeSI-MeT), University G. D’Annunzio, Chieti, Italy
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24
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Pieralice S, D’Onofrio L, Pozzilli P, Buzzetti R. Third dose of COVID-19 vaccine in diabetes: Relevance of good metabolic control to improve its efficacy. Diabetes Metab Res Rev 2022; 38:e3533. [PMID: 35468252 PMCID: PMC9087402 DOI: 10.1002/dmrr.3533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Silvia Pieralice
- Unit of Endocrinology & DiabetesCampus Bio‐Medico University of RomeRomeItaly
| | - Luca D’Onofrio
- Department Experimental MedicineUOD DiabetesSapienza University of RomeRomeItaly
| | - Paolo Pozzilli
- Unit of Endocrinology & DiabetesCampus Bio‐Medico University of RomeRomeItaly
- Centre of ImmunobiologyBlizard InstituteBarts and The London School of MedicineQueen MaryUniversity of LondonLondonUK
| | - Raffaella Buzzetti
- Department Experimental MedicineUOD DiabetesSapienza University of RomeRomeItaly
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25
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Alhamar G, Maddaloni E, Al Shukry A, Al‐Sabah S, Al‐Haddad M, Al‐Youha S, Jamal M, Almazeedi S, Al‐Shammari AA, Abu‐Farha M, Abubaker J, Alattar AT, AlOzairi E, Alessandri F, D’Onofrio L, Leto G, Mastroianni CM, Mignogna C, Pascarella G, Pugliese F, Ali H, Al Mulla F, Buzzetti R, Pozzilli P. Development of a clinical risk score to predict death in patients with COVID-19. Diabetes Metab Res Rev 2022; 38:e3526. [PMID: 35262260 PMCID: PMC9087367 DOI: 10.1002/dmrr.3526] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To build a clinical risk score to aid risk stratification among hospitalised COVID-19 patients. METHODS The score was built using data of 417 consecutive COVID-19 in patients from Kuwait. Risk factors for COVID-19 mortality were identified by multivariate logistic regressions and assigned weighted points proportional to their beta coefficient values. A final score was obtained for each patient and tested against death to calculate an Receiver-operating characteristic curve. Youden's index was used to determine the cut-off value for death prediction risk. The score was internally validated using another COVID-19 Kuwaiti-patient cohort of 923 patients. External validation was carried out using 178 patients from the Italian CoViDiab cohort. RESULTS Deceased COVID-19 patients more likely showed glucose levels of 7.0-11.1 mmol/L (34.4%, p < 0.0001) or >11.1 mmol/L (44.3%, p < 0.0001), and comorbidities such as diabetes and hypertension compared to those who survived (39.3% vs. 20.4% [p = 0.0027] and 45.9% vs. 26.6% [p = 0.0036], respectively). The risk factors for in-hospital mortality in the final model were gender, nationality, asthma, and glucose categories (<5.0, 5.5-6.9, 7.0-11.1, or 11.1 > mmol/L). A score of ≥5.5 points predicted death with 75% sensitivity and 86.3% specificity (area under the curve (AUC) 0.901). Internal validation resulted in an AUC of 0.826, and external validation showed an AUC of 0.687. CONCLUSION This clinical risk score was built with easy-to-collect data and had good probability of predicting in-hospital death among COVID-19 patients.
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Affiliation(s)
- Ghadeer Alhamar
- Endocrinology & Diabetes UnitCampus Biomedico University of RomeRomeItaly
- Dasman Diabetes InstituteKuwait CityKuwait
| | - Ernesto Maddaloni
- Department of Experimental MedicineSapienza University of RomeRomeItaly
| | - Abdullah Al Shukry
- Department of Otolaryngology & Head and Neck SurgeryJaber Al‐Ahmad HospitalMinistry of HealthSafatKuwait
| | - Salman Al‐Sabah
- COVID‐19 Research GroupJaber Al‐Ahmad Al‐Sabah HospitalKuwait CityKuwait
- College of MedicineKuwait UniversityKuwait CityKuwait
| | - Mohannad Al‐Haddad
- COVID‐19 Research GroupJaber Al‐Ahmad Al‐Sabah HospitalKuwait CityKuwait
| | - Sarah Al‐Youha
- COVID‐19 Research GroupJaber Al‐Ahmad Al‐Sabah HospitalKuwait CityKuwait
| | - Mohammed Jamal
- COVID‐19 Research GroupJaber Al‐Ahmad Al‐Sabah HospitalKuwait CityKuwait
- College of MedicineKuwait UniversityKuwait CityKuwait
| | - Sulaiman Almazeedi
- COVID‐19 Research GroupJaber Al‐Ahmad Al‐Sabah HospitalKuwait CityKuwait
| | - Abdullah A. Al‐Shammari
- Dasman Diabetes InstituteKuwait CityKuwait
- Department of MathematicsKuwait University College of ScienceSafatKuwait
| | | | | | - Abdulnabi T. Alattar
- Dasman Diabetes InstituteKuwait CityKuwait
- Diabetes UnitAl‐Amiri HospitalMinistry of HealthSafatKuwait
| | | | | | - Luca D’Onofrio
- Umberto I “Policlinico” General HospitalSapienza University of RomeRomeItaly
| | - Gaetano Leto
- Santa Maria Goretti HospitalPolo Pontino Sapienza UniversityLatinaItaly
| | | | - Carmen Mignogna
- Umberto I “Policlinico” General HospitalSapienza University of RomeRomeItaly
| | - Giuseppe Pascarella
- Department of Anesthesia, Intensive Care and Pain ManagementCampus Bio‐Medico University of RomeRomeItaly
| | - Francesco Pugliese
- Umberto I “Policlinico” General HospitalSapienza University of RomeRomeItaly
| | - Hamad Ali
- Dasman Diabetes InstituteKuwait CityKuwait
- Department of Medical Laboratory SciencesHealth Sciences CenterKuwait UniversityKuwait CityKuwait
| | | | | | - Paolo Pozzilli
- Endocrinology & Diabetes UnitCampus Biomedico University of RomeRomeItaly
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Cavallari I, Maddaloni E, Nusca A, Tuccinardi D, Buzzetti R, Pozzilli P, Grigioni F. SGLT-2 Inhibitors on Top of Current Pharmacological Treatments for Heart Failure: A Comparative Review on Outcomes and Cost Effectiveness. Am J Cardiovasc Drugs 2022; 22:263-270. [PMID: 34786655 DOI: 10.1007/s40256-021-00508-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 10/19/2022]
Abstract
Heart failure (HF) represents a major global health and economic burden with still unacceptably high morbidity and mortality rates. In recent decades, novel therapeutic opportunities with a significant impact on HF outcomes have been introduced in addition to angiotensin-converting enzyme (ACE) inhibitors, β-blockers, and mineralocorticoid receptor antagonists. These include drugs such as ivabradine, sacubitril-valsartan, and sodium-glucose cotransporter-2 (SGLT-2) inhibitors. The availability of an extremely large pharmacological armamentarium to face this chronic global disease highlights the importance of assessing cost effectiveness to promote sustainable healthcare. In light of the recent approval of SGLT-2 inhibitors for the treatment of HF with reduced ejection fraction, including in individuals without type 2 diabetes mellitus, the aim of this review was to provide an updated comparative evaluation of the efficacy and cost effectiveness of different pharmacological treatments for the prevention (stage A) and treatment of asymptomatic (stage B) and symptomatic (stages C-D) left ventricular dysfunction.
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27
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Pezzilli S, Mazza T, Scarale MG, Tang Y, Andreozzi F, Baroni MG, Buzzetti R, Cavallo MG, Cossu E, D'Angelo P, De Cosmo S, Lamacchia O, Leonetti F, Morano S, Morviducci L, Penno G, Pozzilli P, Pugliese G, Sesti G, Doria A, Trischitta V, Prudente S. Pathogenic variants of MODY-genes in adult patients with early-onset type 2 diabetes. Acta Diabetol 2022; 59:747-750. [PMID: 35112188 DOI: 10.1007/s00592-021-01847-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/27/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Serena Pezzilli
- Research Unit of Metabolic and Cardiovascular Diseases, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Tommaso Mazza
- Unit of Bioinformatics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Maria Giovanna Scarale
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Yaling Tang
- Research Division, Joslin Diabetes Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Marco Giorgio Baroni
- Department of Clinical Medicine, Health & Environmental Sciences, University of L'Aquila, L' Aquila, Italy
- IRCCS Neuromed, Pozzilli (Is), Italy
| | | | | | - Efisio Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Paola D'Angelo
- Unit of Diabetology, Sandro Pertini Hospital, Rome, Italy
| | - Salvatore De Cosmo
- Department of Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Olga Lamacchia
- Unit of Endocrinology, Department of Medical and Surgical Sciences, University Hospital of Foggia, Foggia, Italy
| | - Frida Leonetti
- Diabetes Unit, Department of Medical-Surgical Sciences and Biotechnologies, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Susanna Morano
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | | | - Giuseppe Penno
- Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Pozzilli
- Department of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Alessandro Doria
- Research Division, Joslin Diabetes Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Vincenzo Trischitta
- Research Unit of Metabolic and Cardiovascular Diseases, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
- IRCCS Neuromed, Pozzilli (Is), Italy
| | - Sabrina Prudente
- Research Unit of Metabolic and Cardiovascular Diseases, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
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Pezzilli S, Tohidirad M, Biagini T, Scarale MG, Alberico F, Mercuri L, Mannino GC, Garofolo M, Filardi T, Tang Y, Giuffrida F, Mendonca C, Andreozzi F, Baroni MG, Buzzetti R, Cavallo MG, Cossu E, D'Angelo P, De Cosmo S, Lamacchia O, Leonetti F, Morano S, Morviducci L, Penno G, Pozzilli P, Pugliese G, Sesti G, Mazza T, Doria A, Trischitta V, Prudente S. Contribution of rare variants in monogenic diabetes-genes to early-onset type 2 diabetes. Diabetes Metab 2022; 48:101353. [PMID: 35487478 DOI: 10.1016/j.diabet.2022.101353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/14/2022] [Accepted: 04/22/2022] [Indexed: 11/30/2022]
Abstract
AIM This study investigated whether rare, deleterious variants in monogenic diabetes-genes are associated with early-onset type 2 diabetes (T2D). METHODS A nested case-control study was designed from 9,712 Italian patients with T2D. Individuals with age at diabetes onset ≤35 yrs (n=300; cases) or ≥65 yrs (n=300; controls) were selected and screened for variants in 27 monogenic diabetes-genes by targeted resequencing. Rare (minor allele frequency-MAF <1%) and possibly deleterious variants were collectively tested for association with early-onset T2D. The association of a genetic risk score (GRS) based on 17 GWAS-SNPs for T2D was also tested. RESULTS When all rare variants were considered together, each increased the risk of early-onset T2D by 65% (allelic OR =1.64, 95% CI: 1.08-2.48, p=0.02). Effects were similar when the 600 study participants were stratified according to their place of recruitment (Central-Southern Italy, 182 cases vs. 142 controls, or Rome urban area, 118 vs. 158, p for heterogeneity=0.53). Progressively less frequent variants showed increasingly stronger effects in the risk of early-onset T2D for those with MAF <0.001% (OR=6.34, 95% CI: 1.87-22.43, p=0.003). One unit of T2D-GRS significantly increased the risk of early-onset T2D (OR 1.09, 95% CI: 1.01-1.18; p=0.02). This association was stronger among rare variants carriers as compared to non-carriers (p=0.02). CONCLUSION Rare variants in monogenic-diabetes genes are associated with an increased risk of early-onset T2D, and interact with common T2D susceptibility variants in shaping it. These findings might help develop prediction tools to identify individuals at high risk of developing T2D in early adulthood.
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Affiliation(s)
- Serena Pezzilli
- Research Unit of Metabolic and Cardiovascular Diseases, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Manoush Tohidirad
- Research Unit of Metabolic and Cardiovascular Diseases, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Tommaso Biagini
- Unit of Bioinformatics, Fondazione IRCSS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Maria Giovanna Scarale
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCSS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Federica Alberico
- Research Unit of Metabolic and Cardiovascular Diseases, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Luana Mercuri
- Research Unit of Metabolic and Cardiovascular Diseases, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Gaia Chiara Mannino
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Monia Garofolo
- Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tiziana Filardi
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Yaling Tang
- Research Division, Joslin Diabetes Center, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA
| | | | | | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy; Research Center for the Prevention and Treatment of Metabolic Diseases (CR METDIS), University Magna Grecia, Catanzaro, Italy
| | - Marco Giorgio Baroni
- Department of Clinical Medicine, Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy; Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli, Italy
| | | | | | - Efisio Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Paola D'Angelo
- Unit of Diabetology, Sandro Pertini Hospital, Rome, Italy
| | - Salvatore De Cosmo
- Department of Medicine, Fondazione IRCSS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Olga Lamacchia
- Unit of Endocrinology, Department of Medical and Surgical Sciences, University Hospital of Foggia, Foggia, Italy
| | - Frida Leonetti
- Diabetes Unit, Department of Medical-Surgical Sciences and Biotechnologies, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Susanna Morano
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | | | - Giuseppe Penno
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Paolo Pozzilli
- Department of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Tommaso Mazza
- Unit of Bioinformatics, Fondazione IRCSS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Alessandro Doria
- Research Division, Joslin Diabetes Center, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA
| | - Vincenzo Trischitta
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCSS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy; Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Sabrina Prudente
- Research Unit of Metabolic and Cardiovascular Diseases, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
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Buzzetti R, Bonadonna RC, Giaccari A, Perseghin G, Cucinotta D, Fanelli C, Avogaro A, Aimaretti G, Larosa M, Pacchetti I, Bolli GB. Underestimation of hypoglycaemia using patients' diaries compared with downloaded glucometer data: an ITAS post hoc analysis. Diabetes Obes Metab 2022; 24:327-331. [PMID: 34595824 PMCID: PMC9297992 DOI: 10.1111/dom.14560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/09/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Riccardo C. Bonadonna
- Department of Medicine and SurgeryUniversity of ParmaParmaItaly
- Division of Endocrinology and Metabolic DiseasesAzienda Ospedaliera‐Universitaria di ParmaParmaItaly
| | - Andrea Giaccari
- Fondazione Policlinico Universitario A. Gemelli IRCCSRome and Università Cattolica del Sacro CuoreRomeItaly
| | | | | | - Carmine Fanelli
- Section of Endocrinology and Metabolism, Department of MedicinePerugia University Medical SchoolPerugiaItaly
| | | | | | | | | | - Geremia B. Bolli
- Section of Endocrinology and Metabolism, Department of MedicinePerugia University Medical SchoolPerugiaItaly
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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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Tiberti C, D’Onofrio L, Panimolle F, Zampetti S, Maddaloni E, Buzzetti R. Immunoreactivities Against Different Tyrosine-Phosphatase 2 (IA-2)(256-760) Protein Domains Characterize Distinct Phenotypes in Subjects With LADA. Front Endocrinol (Lausanne) 2022; 13:921886. [PMID: 35813648 PMCID: PMC9263087 DOI: 10.3389/fendo.2022.921886] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Antibodies (Abs) against intracellular epitopes of the tyrosine-phosphatase 2 (IA-2) are detected in type 1 diabetes. Abs directed against the IA-2(256-760) portion, with both intra- and extracellular epitopes, are present in people with latent autoimmune diabetes in adults (LADA) and in obese subjects with normal glucose tolerance (NGT). We aim to characterize distribution and clinical features of intra- and extra-cellular IA-2(256-760) immunoreactivities in people with LADA compared to obese people with NGT. The intracellular immunoreactivity represented by immune response against two intracellular IA-2 constructs (IA-2JM(601-630) and IA-2IC(605-979)) was analyzed and related to clinical and biochemical features in 101 people with LADA and in 20 NGT obese subjects, all testing positive for IA-2(256-760) Abs. IA-2 intracellular immunoreactivity showed a frequency of 40.6% in LADA while it was not detected among NGT obese (p<0.001). Amongst LADA, the presence of immunoreactivity against the IA-2 intracellular domains was associated with lower BMI, waist circumference, higher HDL cholesterol and lower triglycerides, lower prevalence of hypertension and higher prevalence of other autoimmune disorders. Immunoreactivity against IA-2 does not involve intracellular domains in the majority of LADA and in obese people with NGT. This study shows that there is heterogeneity in the IA-2 epitopes, associated with different clinical features.
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Mignogna C, Maddaloni E, D'Onofrio L, Buzzetti R. Investigational therapies targeting CD3 for prevention and treatment of type 1 diabetes. Expert Opin Investig Drugs 2021; 30:1209-1219. [PMID: 34936848 DOI: 10.1080/13543784.2022.2022119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/17/2022]
Abstract
INTRODUCTION Immunotherapies for type 1 diabetes mellitus (T1D) have been the focus of intense research over the past few decades; nevertheless, the results of clinical trials have not matched expectations. However, thanks to the recent and promising results on T1D prevention, among all the different immune-intervention tested strategies, clinical evidence on anti-CD3 monoclonal antibodies (mAb) deserve particular attention and in-depth evaluation. AREAS COVERED In this narrative review, we introduce the role of T-cells and their co-receptor CD3 in the pathogenesis of T1D and examine the potential of anti-CD3 mAbs as a treatment for preventing or curing T1D. We discuss pre-clinical studies, phase II/III clinical trials, testing the anti-CD3 mAb teplizumab in subjects at T1D high risk, and testing teplizumab and otelixizumab in T1D recent onset patients. In this work we discuss the current evidence gathered on anti-CD3 therapy to offer insights on the treatment strengths, limitations and unmet needs. EXPERT OPINION Recent phase II clinical trials with teplizumab in recent-onset T1D seem encouraging, but benefits associated with the use of anti-CD3 mAb in recent-onset T1D are still controversial. A better patient selection, based on immunological profiles and specific biomarkers, is crucial to improve clinical outcomes in T1D immunotherapies.
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Affiliation(s)
- Carmen Mignogna
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Luca D'Onofrio
- Department of Experimental Medicine, Sapienza University of Rome, Italy
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Leslie RD, Evans-Molina C, Freund-Brown J, Buzzetti R, Dabelea D, Gillespie KM, Goland R, Jones AG, Kacher M, Phillips LS, Rolandsson O, Wardian JL, Dunne JL. Adult-Onset Type 1 Diabetes: Current Understanding and Challenges. Diabetes Care 2021; 44:2449-2456. [PMID: 34670785 PMCID: PMC8546280 DOI: 10.2337/dc21-0770] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/12/2021] [Indexed: 02/03/2023]
Abstract
Recent epidemiological data have shown that more than half of all new cases of type 1 diabetes occur in adults. Key genetic, immune, and metabolic differences exist between adult- and childhood-onset type 1 diabetes, many of which are not well understood. A substantial risk of misclassification of diabetes type can result. Notably, some adults with type 1 diabetes may not require insulin at diagnosis, their clinical disease can masquerade as type 2 diabetes, and the consequent misclassification may result in inappropriate treatment. In response to this important issue, JDRF convened a workshop of international experts in November 2019. Here, we summarize the current understanding and unanswered questions in the field based on those discussions, highlighting epidemiology and immunogenetic and metabolic characteristics of adult-onset type 1 diabetes as well as disease-associated comorbidities and psychosocial challenges. In adult-onset, as compared with childhood-onset, type 1 diabetes, HLA-associated risk is lower, with more protective genotypes and lower genetic risk scores; multiple diabetes-associated autoantibodies are decreased, though GADA remains dominant. Before diagnosis, those with autoantibodies progress more slowly, and at diagnosis, serum C-peptide is higher in adults than children, with ketoacidosis being less frequent. Tools to distinguish types of diabetes are discussed, including body phenotype, clinical course, family history, autoantibodies, comorbidities, and C-peptide. By providing this perspective, we aim to improve the management of adults presenting with type 1 diabetes.
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Affiliation(s)
- R David Leslie
- Centre for Immunobiology, Blizard Institute, Queen Mary University of London, London, U.K.
| | - Carmella Evans-Molina
- Departments of Pediatrics and Medicine and Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN
- Richard L. Roudebush VA Medical Center, Indianapolis, IN
| | | | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity & Diabetes Center, Colorado School of Public Health, and Departments of Epidemiology and Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kathleen M Gillespie
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, U.K
| | - Robin Goland
- Naomi Berrie Diabetes Center, Columbia University, New York, NY
| | - Angus G Jones
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | - Lawrence S Phillips
- Atlanta VA Medical Center and Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Olov Rolandsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jana L Wardian
- College of Medicine, University of Nebraska Medical Center, Omaha, NE
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Maddaloni E, D'Onofrio L, Siena A, Luordi C, Mignogna C, Amendolara R, Cavallari I, Grigioni F, Buzzetti R. Impact of cardiovascular disease on clinical outcomes in hospitalized patients with Covid-19: a systematic review and meta-analysis. Intern Emerg Med 2021; 16:1975-1985. [PMID: 34273056 PMCID: PMC8285708 DOI: 10.1007/s11739-021-02804-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/06/2021] [Indexed: 01/18/2023]
Abstract
Contrasting data have been published about the impact of cardiovascular disease on Covid-19. A comprehensive synthesis and pooled analysis of the available evidence is needed to guide prioritization of prevention strategies. To clarify the association of cardiovascular disease with Covid-19 outcomes, we searched PubMed up to 26 October 2020, for studies reporting the prevalence of cardiovascular disease among inpatients with Covid-19 in relation to their outcomes. Pooled odds-ratios (OR) for death, for mechanical ventilation or admission in an intensive care unit (ICU) and for composite outcomes were calculated using random effect models overall and in the subgroup of people with comorbid diabetes. Thirty-three studies enrolling 52,857 inpatients were included. Cardiovascular disease was associated with a higher risk of death both overall (OR 2.58, 95% confidence intervals, CI 2.12-3.14, p < 0.001, number of studies 24) and in the subgroup of people with diabetes (OR 2.91, 95% CI 2.13-3.97, p < 0.001, number of studies 4), but not with higher risk of ICU admission or mechanical ventilation (OR 1.35, 95% CI 0.73-2.50, p = 0.34, number of studies 4). Four out of five studies reporting OR adjusted for confounders failed to show independent association of cardiovascular disease with Covid-19 deaths. Accordingly, the adjusted-OR for Covid-19 death in people with cardiovascular disease dropped to 1.31 (95% CI 1.01-1.70, p = 0.041). Among patients hospitalized for Covid-19, cardiovascular disease confers higher risk of death, which was highly mitigated when adjusting the association for confounders.
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Affiliation(s)
- Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Luca D'Onofrio
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Antonio Siena
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Cecilia Luordi
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Carmen Mignogna
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Rocco Amendolara
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Ilaria Cavallari
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Francesco Grigioni
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
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Lee JL, Foschini L, Kumar S, Juusola J, Liska J, Mercer M, Tai C, Buzzetti R, Clement M, Cos X, Ji L, Kanumilli N, Kerr D, Montanya E, Müller-Wieland D, Ostenson CG, Skolnik N, Woo V, Burlet N, Greenberg M, Samson SI. Digital intervention increases influenza vaccination rates for people with diabetes in a decentralized randomized trial. NPJ Digit Med 2021; 4:138. [PMID: 34535755 PMCID: PMC8448887 DOI: 10.1038/s41746-021-00508-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/04/2021] [Accepted: 08/25/2021] [Indexed: 11/09/2022] Open
Abstract
People with diabetes (PWD) have an increased risk of developing influenza-related complications, including pneumonia, abnormal glycemic events, and hospitalization. Annual influenza vaccination is recommended for PWD, but vaccination rates are suboptimal. The study aimed to increase influenza vaccination rate in people with self-reported diabetes. This study was a prospective, 1:1 randomized controlled trial of a 6-month Digital Diabetes Intervention in U.S. adults with diabetes. The intervention group received monthly messages through an online health platform. The control group received no intervention. Difference in self-reported vaccination rates was tested using multivariable logistic regression controlling for demographics and comorbidities. The study was registered at clinicaltrials.gov: NCT03870997. A total of 10,429 participants reported influenza vaccination status (5158 intervention, mean age (±SD) = 46.8 (11.1), 78.5% female; 5271 control, Mean age (±SD) = 46.7 (11.2), 79.4% female). After a 6-month intervention, 64.2% of the intervention arm reported influenza vaccination, vers us 61.1% in the control arm (diff = 3.1, RR = 1.05, 95% CI [1.02, 1.08], p = 0.0013, number needed to treat = 33 to obtain 1 additional vaccination). Completion of one or more intervention messages was associated with up to an 8% increase in vaccination rate (OR 1.27, 95% CI [1.17, 1.38], p < 0.0001). The intervention improved influenza vaccination rates in PWD, suggesting that leveraging new technology to deliver knowledge and information can improve influenza vaccination rates in high-risk populations to reduce public health burden of influenza. Rapid cycle innovation could maximize the effects of these digital interventions in the future with other populations and vaccines.
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Affiliation(s)
- J L Lee
- Evidation Health, San Mateo, CA, USA.,Emory University, Atlanta, GA, USA
| | | | - S Kumar
- Evidation Health, San Mateo, CA, USA
| | - J Juusola
- Evidation Health, San Mateo, CA, USA
| | | | - M Mercer
- Sanofi Pasteur, Swiftwater, PA, USA
| | - C Tai
- Evidation Health, San Mateo, CA, USA
| | - R Buzzetti
- Sapienza University of Rome, Rome, Italy
| | - M Clement
- University of British Columbia, Armstrong, British Columbia, Canada
| | - X Cos
- Grup de Recerca Epidemiològica en Diabetis des de l'Atenció Primària (DAP-CAT) Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Primary and Hospital Innovation Department, Innovation Office at Institut Català de la Salut, Barcelona, Spain
| | - L Ji
- Peking University People's Hospital, Beijing, China
| | | | - D Kerr
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | - E Montanya
- Hospital Universitari Bellvitge-IDIBELL, CIBERDEM and University of Barcelona, Barcelona, Spain
| | | | | | - N Skolnik
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - V Woo
- University of Manitoba, Winnipeg, Canada
| | - N Burlet
- Sanofi, Paris, France.,Kyowa Kirin International, Marlow, United Kingdom
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D'Onofrio L, Coraggio L, Zurru A, Carlone A, Mignogna C, Moretti C, Maddaloni E, Buzzetti R. Short-term safety profile of Sars-Cov2 vaccination on glucose control: Continuous glucose monitoring data in people with autoimmune diabetes. Diabetes Res Clin Pract 2021; 179:109022. [PMID: 34450248 PMCID: PMC8383474 DOI: 10.1016/j.diabres.2021.109022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Received: 07/13/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 11/22/2022]
Abstract
In patients with autoimmune diabetes no significant differences were observed in glucose control, expressed as time in range evaluated by continuous glucose monitoring comparing the 3 days after Sars-Cov2 vaccine with the 14 days preceding the vaccine.
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Affiliation(s)
- Luca D'Onofrio
- Experimental Medicine Department, Sapienza University of Rome, Italy.
| | - Lucia Coraggio
- Experimental Medicine Department, Sapienza University of Rome, Italy
| | - Annalisa Zurru
- Experimental Medicine Department, Sapienza University of Rome, Italy
| | - Angela Carlone
- Experimental Medicine Department, Sapienza University of Rome, Italy
| | - Carmen Mignogna
- Experimental Medicine Department, Sapienza University of Rome, Italy
| | - Chiara Moretti
- Experimental Medicine Department, Sapienza University of Rome, Italy
| | - Ernesto Maddaloni
- Experimental Medicine Department, Sapienza University of Rome, Italy
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Del Toro R, Cavallari I, Tramontana F, Park K, Strollo R, Valente L, De Pascalis M, Grigioni F, Pozzilli P, Buzzetti R, Napoli N, Maddaloni E. Association of bone biomarkers with advanced atherosclerotic disease in people with overweight/obesity. Endocrine 2021; 73:339-346. [PMID: 33948786 DOI: 10.1007/s12020-021-02736-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/27/2020] [Accepted: 04/19/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND A growing body of evidence suggests a potential link between bone metabolism and cardiovascular disease. Aim of this study was to investigate the relationship between levels of circulating bone turnover biomarkers and advanced atherosclerosis. METHODS Klotho (KL), sclerostin (SOST), osteopontin (OPN) and osteoprotegerin (OPG) were measured in patients undergoing elective coronary angiography and carotid Doppler ultrasound. The primary outcome was the difference in bone biomarkers levels between participants with and without advanced atherosclerosis, defined as the presence of a critical coronary (≥70%) and/or carotid (≥50%) stenosis. RESULTS A total of 80 subjects (32.5% females) with a mean age of 68 ± 10 years were included. Advanced atherosclerosis was detected in 55 (68.8%) patients. Subjects with advanced atherosclerosis showed higher serum levels of OPG (p = 0.0015) and SOST (p = 0.017) and similar levels of KL (p = 0.62) and OPN (p = 0.06) compared to patients without. After adjustment for age and sex, only elevated levels of OPG remained significantly associated with advanced atherosclerosis (p = 0.011). CONCLUSIONS Higher serum levels of OPG are independently associated with advanced atherosclerosis confirming a common bond between bone metabolism and vascular disease. Further investigations on the role of selected bone biomarkers in the pathogenesis of cardiovascular disease are needed.
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Affiliation(s)
- Rossella Del Toro
- Endocrinology and Diabetes Unit, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Ilaria Cavallari
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Flavia Tramontana
- Endocrinology and Diabetes Unit, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Kyoungmin Park
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Rocky Strollo
- Endocrinology and Diabetes Unit, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Luciana Valente
- Endocrinology and Diabetes Unit, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Mariangela De Pascalis
- Endocrinology and Diabetes Unit, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Francesco Grigioni
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Paolo Pozzilli
- Endocrinology and Diabetes Unit, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Raffaella Buzzetti
- Experimental Medicine Department, Sapienza University of Rome, Rome, Italy
| | - Nicola Napoli
- Endocrinology and Diabetes Unit, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Ernesto Maddaloni
- Experimental Medicine Department, Sapienza University of Rome, Rome, Italy
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D'Onofrio L, Pieralice S, Maddaloni E, Mignogna C, Sterpetti S, Coraggio L, Luordi C, Guarisco G, Leto G, Leonetti F, Manfrini S, Buzzetti R. Effects of the COVID-19 lockdown on glycaemic control in subjects with type 2 diabetes: the glycalock study. Diabetes Obes Metab 2021; 23:1624-1630. [PMID: 33764666 PMCID: PMC8251001 DOI: 10.1111/dom.14380] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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] [Received: 02/03/2021] [Revised: 03/03/2021] [Accepted: 03/19/2021] [Indexed: 12/16/2022]
Abstract
AIM To assess the effect of the coronavirus disease 2019 (COVID-19) lockdown on glycaemic control in subjects with type 2 diabetes (T2D). MATERIALS AND METHODS In this observational, multicentre, retrospective study conducted in the Lazio region, Italy, we compared the differences in the HbA1c levels of 141 subjects with T2D exposed to lockdown with 123 matched controls with T2D who attended the study centres 1 year before. Basal data were collected from 9 December to 9 March and follow-up data from 3 June to 10 July in 2020 for the lockdown group, and during the same timeframes in 2019 for the control groups. Changes in HbA1c (ΔHbA1c) and body mass index (ΔBMI) during lockdown were compared among patients with different psychological well-being, as evaluated by tertiles of the Psychological General Well-Being Index (PGWBS). RESULTS No difference in ΔHbA1c was found between the lockdown and control groups (lockdown group -0.1% [-0.5%-0.3%] vs. control group -0.1% [-0.4%-0.2%]; p = .482). Also, no difference was found in ΔBMI (p = .316) or ΔGlucose (p = .538). In the lockdown group, subjects with worse PGWBS showed a worsening of HbA1c (p = .041 for the trend among PGWBS tertiles) and BMI (p = .022). CONCLUSIONS The COVID-19 lockdown did not significantly impact glycaemic control in people with T2D. People with poor psychological well-being may experience a worsening a glycaemic control because of restrictions resulting from lockdown. These findings may aid healthcare providers in diabetes management once the second wave of COVID-19 has ended.
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Affiliation(s)
- Luca D'Onofrio
- Experimental Medicine DepartmentSapienza University of RomeLatinaItaly
| | - Silvia Pieralice
- Endocrinology and Diabetes UnitCampus Bio‐Medico University of RomeRomeItaly
| | - Ernesto Maddaloni
- Experimental Medicine DepartmentSapienza University of RomeLatinaItaly
| | - Carmen Mignogna
- Experimental Medicine DepartmentSapienza University of RomeLatinaItaly
| | - Sara Sterpetti
- Experimental Medicine DepartmentSapienza University of RomeLatinaItaly
| | - Lucia Coraggio
- Experimental Medicine DepartmentSapienza University of RomeLatinaItaly
| | - Cecilia Luordi
- Experimental Medicine DepartmentSapienza University of RomeLatinaItaly
| | - Gloria Guarisco
- Diabetes Unit, Department of Medical‐Surgical Sciences and Biotechnologies, Santa Maria Goretti HospitalSapienza University of RomeLatinaItaly
| | - Gaetano Leto
- Diabetes Unit, Department of Medical‐Surgical Sciences and Biotechnologies, Santa Maria Goretti HospitalSapienza University of RomeLatinaItaly
| | - Frida Leonetti
- Diabetes Unit, Department of Medical‐Surgical Sciences and Biotechnologies, Santa Maria Goretti HospitalSapienza University of RomeLatinaItaly
| | - Silvia Manfrini
- Endocrinology and Diabetes UnitCampus Bio‐Medico University of RomeRomeItaly
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Giaccari A, Bonadonna RC, Buzzetti R, Perseghin G, Cucinotta D, Fanelli C, Avogaro A, Aimaretti G, Larosa M, Pagano V, Bolli GB. Similar glycaemic control and risk of hypoglycaemia with patient- versus physician-managed titration of insulin glargine 300 U/mL across subgroups of patients with T2DM: a post hoc analysis of ITAS. Acta Diabetol 2021; 58:789-796. [PMID: 33586058 PMCID: PMC8110495 DOI: 10.1007/s00592-021-01675-0] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/09/2021] [Indexed: 12/02/2022]
Abstract
AIMS The Italian Titration Approach Study (ITAS) demonstrated comparable HbA1c reductions and similarly low hypoglycaemia risk at 6 months in poorly controlled, insulin-naïve adults with T2DM who initiated self- or physician-titrated insulin glargine 300 U/mL (Gla-300) in the absence of sulphonylurea/glinide. The association of patient characteristics with glycaemic and hypoglycaemic outcomes was assessed. METHODS This post hoc analysis investigated whether baseline patient characteristics and previous antihyperglycaemic drugs were associated with HbA1c change and hypoglycaemia risk in patient- versus physician-managed Gla-300 titration. RESULTS HbA1c change, incidence of hypoglycaemia (any type) and nocturnal rates were comparable between patient- and physician-managed arms in all subgroups. Hypoglycaemia rates across subgroups (0.03 to 3.52 events per patient-year) were generally as low as observed in the full ITAS population. Small increases in rates of 00:00-pre-breakfast and anytime hypoglycaemia were observed in the ≤ 10-year diabetes duration subgroup in the patient- versus physician-managed arm (heterogeneity of effect; p < 0.05). CONCLUSIONS Comparably fair glycaemic control and similarly low hypoglycaemia risk were achieved in almost all patient subgroups with patient- versus physician-led Gla-300 titration. These results reinforce efficacy and safety of Gla-300 self-titration across a range of phenotypes of insulin-naïve people with T2DM. CLINICAL TRIAL REGISTRATION EudraCT 2015-001167-39.
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Affiliation(s)
- Andrea Giaccari
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome and Università Cattolica del Sacro Cuore, Rome, Italy
| | - R. C. Bonadonna
- Division of Endocrinology and Metabolic Diseases and Department of Medicine and Surgery, University of Parma and AOU of Parma, Parma, Italy
| | - R. Buzzetti
- Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185 Rome, RM Italy
| | - G. Perseghin
- University of Milan Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI Italy
| | - D. Cucinotta
- University of Messina, Piazza Pugliatti, 1, 98122 Messina, Italy
| | - C. Fanelli
- Section of Endocrinology and Metabolism, Department of Medicine, Perugia University Medical School, Piazzale Gambuli, 1, 06129 Perugia, PG Italy
| | - A. Avogaro
- University of Padua, Via 8 Febbraio 1848, 2, 35122 Padua, PD Italy
| | - G. Aimaretti
- University of the Eastern Piedmont, Via del Duomo, 6, 13100 Vercelli, VC Italy
| | | | - V. Pagano
- OPIS s.r.l., Palazzo Aliprandi, Via Matteotti, 10, 20832 Desio, Italy
| | - G. B. Bolli
- Section of Endocrinology and Metabolism, Department of Medicine, Perugia University Medical School, Piazzale Gambuli, 1, 06129 Perugia, PG Italy
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D'Onofrio L, Kalteniece A, Ferdousi M, Azmi S, Petropoulos IN, Ponirakis G, Alam U, Asghar O, Marshall A, Boulton AJM, Efron N, Buzzetti R, Soran H, Malik RA. Small Nerve Fiber Damage and Langerhans Cells in Type 1 and Type 2 Diabetes and LADA Measured by Corneal Confocal Microscopy. Invest Ophthalmol Vis Sci 2021; 62:5. [PMID: 33944892 PMCID: PMC8107645 DOI: 10.1167/iovs.62.6.5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose Increased corneal and epidermal Langerhans cells (LCs) have been reported in patients with diabetic neuropathy. The aim of this study was to quantify the density of LCs in relation to corneal nerve morphology and the presence of diabetic neuropathy and to determine if this differed in patients with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and latent autoimmune diabetes of adults (LADA). Methods Patients with T1DM (n = 25), T2DM (n = 36), or LADA (n = 23) and control subjects (n = 23) underwent detailed assessment of peripheral neuropathy and corneal confocal microscopy. Corneal nerve fiber density (CNFD), branch density (CNBD), length (CNFL) and total, immature and mature LC densities were quantified. Results Lower CNFD (P < 0.001), CNBD (P < 0.0001), and CNFL (P < 0.0001) and higher LC density (P = 0.03) were detected in patients with T1DM, T2DM, and LADA compared to controls. CNBD was inversely correlated with mature (r = –0.5; P = 0.008), immature (r = –0.4; P = 0.02) and total (r = –0.5; P = 0.01) LC density, and CNFL was inversely correlated with immature LC density (r = –0.4; P = 0.03) in patients with T1DM but not in patients with T2DM and LADA. Conclusions This study shows significant corneal nerve loss and an increase in LC density in patients with T1DM, T2DM, and LADA. Furthermore, increased LC density correlated with corneal nerve loss in patients with T1DM.
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Affiliation(s)
- Luca D'Onofrio
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Alise Kalteniece
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Maryam Ferdousi
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Shazli Azmi
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Ioannis N Petropoulos
- Weill Cornell Medicine-Qatar, Research Division, Qatar Foundation, Education City, Doha, Qatar
| | - Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Research Division, Qatar Foundation, Education City, Doha, Qatar
| | - Uazman Alam
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Omar Asghar
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Andrew Marshall
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Andrew J M Boulton
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Nathan Efron
- Queensland University of Technology, School of Optometry and Vision Science, Brisbane, Australia
| | | | - Handrean Soran
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Rayaz A Malik
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom.,Weill Cornell Medicine-Qatar, Research Division, Qatar Foundation, Education City, Doha, Qatar
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Abstract
PURPOSE Angiotensin converting enzyme 2 (ACE2) is the door for SARS-CoV-2, expressed in critical metabolic tissues. So, it is rational that the new virus causes pleiotropic alterations in glucose metabolism, resulting in the complication of pre-existing diabetes's pathophysiology or creating new disease mechanisms. However, it seems that less attention has been paid to this issue. This review aimed to highlight the importance of long-term consequences and pleiotropic alterations in glucose metabolism following COVID-19 and emphasize the need for basic and clinical research in metabolism and endocrinology. RESULTS SARS-CoV-2 shifts cellular metabolism from oxidative phosphorylation to glycolysis, which leads to a decrease in ATP generation. Together with metabolic imbalance, the impaired immune system elevates the susceptibility of patients with diabetes to this deadly virus. SARS-CoV-2-induced metabolic alterations in immune cells can result in hyper inflammation and a cytokine storm. Metabolic dysfunction may affect therapies against SARS-CoV-2 infection. The effective control of metabolic complications could prove useful therapeutic targets for combating COVID-19. It is also necessary to understand the long-term consequences that will affect patients with diabetes who survived COVID-19. CONCLUSIONS Since the pathophysiology of COVID-19 is still mostly unknown, identifying the metabolic mechanisms contributing to its progression is essential to provide specific ways to prevent and improve this dangerous virus's detrimental effects. The findings show that the new virus may induce new-onset diabetes with uncertain metabolic and clinical features, supporting a potential role of COVID-19 in the development of diabetes.
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Affiliation(s)
- Abdolkarim Mahrooz
- Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
- Diabetes Research Center, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Giovanna Muscogiuri
- Sezione di Endocrinologia, Dipartimento di Medicina Clinica e Chirurgia, Università Federico II Napoli, Napoli, Italy
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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D'Onofrio L, Mignogna C, Carlone A, Bellizzi E, Di Guida M, Moretti C, Zampetti S, Leto G, Maddaloni E, Buzzetti R. Decrease of coronary heart disease risk with GLP1-receptor agonists or SGLT2 inhibitors therapy in patients with type 2 diabetes in primary cardiovascular prevention: A 24 months follow-up study. Diabetes Res Clin Pract 2021; 173:108681. [PMID: 33516784 DOI: 10.1016/j.diabres.2021.108681] [Citation(s) in RCA: 6] [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: 10/28/2020] [Revised: 12/30/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
AIMS The aim of this real-world study is to evaluate the effect of glucagon-like peptide1 receptor-agonist (GLP1 RA) and sodium-glucose co-transporter2 inhibitor (SGLT2i) on coronary heart disease (CHD) risk, in patients with type 2 diabetes (T2D) in primary cardiovascular prevention. METHODS Data from 312 patients with T2D, without CHD history, starting treatment with GLP1 RA (n = 174) or SGLT2i (n = 138), were retrospectively collected. UKPDS-RE score was used to estimate 10-years risk for CHD before and 6, 12 and 24 months after prescription. RESULTS The 10-year CHD risk significantly decreased over 24 months in both GLP1 RA and SGLT2i groups (p = 0.037 and p < 0.001, respectively), with 3% and 7% CHD risk reduction already obtained after the first 6 months of GLP1 RA and SGLT2i therapy respectively (p < 0.001 in both groups. Analyses by categories of baseline CHD risk showed significant reductions of CHD risk in the severe risk categories of both groups (p < 0.001). CHD risk reduction obtained with SGLT2i was higher than with GLP1 RA at 6 and 12 months but not at 24 months. CONCLUSION This real-world study shows that both GLP1 RA and SGLT2i reduce the 10-year risk for cardiovascular disease in patients with T2D in primary cardiovascular prevention.
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Affiliation(s)
- Luca D'Onofrio
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Carmen Mignogna
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Angela Carlone
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Ermanno Bellizzi
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Michela Di Guida
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Chiara Moretti
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Simona Zampetti
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Gaetano Leto
- Santa Maria Goretti Hospital, Polo Pontino Sapienza University, Via Guido Reni, Latina, Italy
| | - Ernesto Maddaloni
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy.
| | - Raffaella Buzzetti
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
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Maddaloni E, Moretti C, Del Toro R, Sterpetti S, Ievolella MV, Arnesano G, Strollo R, Briganti SI, D'Onofrio L, Pozzilli P, Buzzetti R. Risk of cardiac autonomic neuropathy in latent autoimmune diabetes in adults is similar to type 1 diabetes and lower compared to type 2 diabetes: A cross-sectional study. Diabet Med 2021; 38:e14455. [PMID: 33170958 DOI: 10.1111/dme.14455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/16/2020] [Revised: 10/14/2020] [Accepted: 11/04/2020] [Indexed: 12/25/2022]
Abstract
AIMS Microvascular complications' risk differs between people with latent autoimmune diabetes in adults (LADA) and people with type 2 diabetes. We aimed to investigate whether the prevalence of cardiac autonomic neuropathy, a life-threatening complication of diabetes, also varies depending on diabetes type. METHODS In this cross-sectional study, 43 adults with LADA, 80 with type 1 diabetes and 61 with type 2 diabetes were screened for cardiac autonomic neuropathy with recommended tests. Logistic regression models were used to test differences between diabetes types adjusting for confounders. RESULTS Cardiac autonomic neuropathy was diagnosed in 17 (40%) participants with LADA, 21 (26%) participants with type 1 diabetes and 39 (64%) participants with type 2 diabetes (p < 0.001). The odds ratio (OR) for cardiac autonomic neuropathy in type 1 diabetes and in type 2 diabetes compared to LADA were 0.54 (95% CI: 0.25-1.20, p-value: 0.13) and 2.71 (95% CI: 1.21-6.06, p-value 0.015) respectively. Smoking (adj OR 3.09, 95% CI: 1.40-6.82, p-value: 0.005), HDL cholesterol (adj OR 0.29, 95% CI: 0.09-0.93, p-value: 0.037) and hypertension (adj OR 2.11, 95% CI: 1.05-4.24, p-value: 0.037) were independent modifiable risk factors for cardiac autonomic neuropathy. Differences among diabetes types did not change after correction for confounders. CONCLUSIONS This is the first study offering a comparative evaluation of cardiac autonomic neuropathy among LADA, type 1 and type 2 diabetes, showing a lower risk of cardiac autonomic neuropathy in LADA compared to type 2 diabetes and similar compared to type 1 diabetes. This disparity was not due to differences in age, metabolic control or cardiovascular risk factors.
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Affiliation(s)
- Ernesto Maddaloni
- Experimental Medicine Department, Sapienza University of Rome, Rome, Italy
| | - Chiara Moretti
- Experimental Medicine Department, Sapienza University of Rome, Rome, Italy
| | - Rossella Del Toro
- Endocrinology and Diabetes Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sara Sterpetti
- Experimental Medicine Department, Sapienza University of Rome, Rome, Italy
| | | | - Gabriele Arnesano
- Experimental Medicine Department, Sapienza University of Rome, Rome, Italy
| | - Rocky Strollo
- Endocrinology and Diabetes Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Luca D'Onofrio
- Experimental Medicine Department, Sapienza University of Rome, Rome, Italy
| | - Paolo Pozzilli
- Endocrinology and Diabetes Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Raffaella Buzzetti
- Experimental Medicine Department, Sapienza University of Rome, Rome, Italy
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Strollo R, Maddaloni E, Dauriz M, Pedone C, Buzzetti R, Pozzilli P. Use of DPP4 inhibitors in Italy does not correlate with diabetes prevalence among COVID-19 deaths. Diabetes Res Clin Pract 2021; 171:108444. [PMID: 32946854 PMCID: PMC7492144 DOI: 10.1016/j.diabres.2020.108444] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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] [Received: 07/24/2020] [Revised: 08/22/2020] [Accepted: 09/04/2020] [Indexed: 02/06/2023]
Abstract
In a nationwide study of 3818 charts from patients with fatal COVID-19, we found that geographical differences in Dipeptidyl peptidase 4 (DPP4) inhibitors use did not correlate with diabetes prevalence among COVID-19 deaths, thus not supporting the hypothesis of a clinically relevant involvement of DPP4 inhibition in COVID-19 development and progression.
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Affiliation(s)
- Rocky Strollo
- Department of Medicine, Unit of Endocrinology & Diabetes, Campus Bio-Medico University of Rome, Italy
| | - Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Marco Dauriz
- Department of Internal Medicine, Section of Endocrinology and Diabetes, South-Tyrolean Healthcare System, Bolzano General Hospital, Bolzano, Italy
| | - Claudio Pedone
- Department of Medicine, Unit of Geriatrics, Campus Bio-Medico University of Rome, Italy
| | | | - Paolo Pozzilli
- Department of Medicine, Unit of Endocrinology & Diabetes, Campus Bio-Medico University of Rome, Italy.
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Maddaloni E, D'Onofrio L, Alessandri F, Mignogna C, Leto G, Coraggio L, Sterpetti S, Pascarella G, Mezzaroma I, Lichtner M, Pozzilli P, Agrò FE, Rocco M, Pugliese F, Mastroianni CM, Buzzetti R. Clinical features of patients with type 2 diabetes with and without Covid-19: A case control study (CoViDiab I). Diabetes Res Clin Pract 2020; 169:108454. [PMID: 32971157 PMCID: PMC7505069 DOI: 10.1016/j.diabres.2020.108454] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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] [Received: 07/05/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 01/08/2023]
Abstract
AIMS To evaluate whether subjects with diabetes hospitalized for Coronavirus disease-19 (Covid-19) represent a subgroup of patients with high-risk clinical features compared to patients with diabetes without Covid-19. METHODS In this case-control study 79 patients with type 2 diabetes out of 354 adults hospitalized for Covid-19 and 158 controls with type 2 diabetes but without Covid-19, matched for age and gender, were enrolled. Medical history and concomitant therapies were retrieved from medical charts and compared between cases and controls, controlling for confounders. RESULTS Fully-adjusted multivariate logistic regression model showed that previous CVD history did not differ between patients with and without Covid-19 (odds ratio 1.40, 95% confidence interval [CI]: 0.59-3.32, p = 0.45). A higher prevalence of chronic obstructive pulmonary disease (COPD) (OR 3.72, 95%CI: 1.42-9.72, p = 0.007) and of chronic kidney disease (CKD) (OR 3.08, 95%CI: 1.18-8.06, p = 0.022) and a lower prevalence of ever smokers (OR 0.30, 95%CI: 0.13-0.67, p = 0.003), of users of lipid lowering agents (OR 0.26, 95%CI: 0.12-0.54, p < 0.001), and of anti-hypertensive drugs (OR 0.39, 95%CI: 0.16-0.93, p = 0.033) were found among cases. CONCLUSIONS CVD prevalence does not differ between people with diabetes with and without Covid-19 requiring hospitalization. An increased prevalence of COPD and of CKD in Covid-19 patients with type 2 diabetes is suggested. These findings aid to clarify the relationship between underlying conditions and SARS-CoV-2 infection in the high-risk group of patients with diabetes.
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MESH Headings
- Aged
- Aged, 80 and over
- COVID-19/complications
- COVID-19/transmission
- COVID-19/virology
- Case-Control Studies
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/pathology
- Diabetes Mellitus, Type 2/virology
- Female
- Hospitalization
- Humans
- Incidence
- Italy/epidemiology
- Male
- Pulmonary Disease, Chronic Obstructive/epidemiology
- Pulmonary Disease, Chronic Obstructive/pathology
- Pulmonary Disease, Chronic Obstructive/virology
- Renal Insufficiency, Chronic/epidemiology
- Renal Insufficiency, Chronic/pathology
- Renal Insufficiency, Chronic/virology
- SARS-CoV-2/isolation & purification
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Affiliation(s)
- Ernesto Maddaloni
- Umberto I "Policlinico" General Hospital, Sapienza University of Rome, Italy
| | - Luca D'Onofrio
- Umberto I "Policlinico" General Hospital, Sapienza University of Rome, Italy
| | | | - Carmen Mignogna
- Umberto I "Policlinico" General Hospital, Sapienza University of Rome, Italy
| | - Gaetano Leto
- Santa Maria Goretti Hospital, Polo Pontino Sapienza University, Latina, Italy
| | - Lucia Coraggio
- Umberto I "Policlinico" General Hospital, Sapienza University of Rome, Italy
| | - Sara Sterpetti
- Umberto I "Policlinico" General Hospital, Sapienza University of Rome, Italy
| | | | - Ivano Mezzaroma
- Umberto I "Policlinico" General Hospital, Sapienza University of Rome, Italy
| | - Miriam Lichtner
- Santa Maria Goretti Hospital, Polo Pontino Sapienza University, Latina, Italy
| | | | | | - Monica Rocco
- Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Francesco Pugliese
- Umberto I "Policlinico" General Hospital, Sapienza University of Rome, Italy
| | | | - Raffaella Buzzetti
- Umberto I "Policlinico" General Hospital, Sapienza University of Rome, Italy.
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Galosi E, Di Pietro G, La Cesa S, Di Stefano G, Leone C, Fasolino A, Di Lionardo A, Leonetti F, Buzzetti R, Mollica C, Cruccu G, Truini A. Differential involvement of myelinated and unmyelinated nerve fibers in painful diabetic polyneuropathy. Muscle Nerve 2020; 63:68-74. [PMID: 32996600 DOI: 10.1002/mus.27080] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND We aimed at evaluating the differential involvement of large myelinated Aβ-, small myelinated Aδ-, and unmyelinated C-fibers in patients with diabetic polyneuropathy and how they contribute to neuropathic pain. METHODS We collected clinical and diagnostic test variables in 133 consecutive patients with diabetic polyneuropathy. All patients underwent Aβ-fiber mediated nerve conduction study, Aδ-fiber mediated laser-evoked potentials and skin biopsy mainly assessing unmyelinated C-fibers. RESULTS Pure large-fiber and small-fiber polyneuropathy were relatively uncommon; conversely mixed-fiber polyneuropathy was the most common type of diabetic polyneuropathy (74%). The frequency of neuropathic pain was similar in the three different polyneuropathies. Ongoing burning pain and dynamic mechanical allodynia were similarly associated with specific small-fiber related variables. CONCLUSIONS Diabetic polyneuropathy mainly manifests as a mixed-fiber polyneuropathy, simultaneously involving Aβ-, Aδ-, and C-fibers. In most patients, neuropathic pain is distinctly associated with small-fiber damage. The evidence that the frequency of neuropathic pain does not differ across pure large-, pure small-, and mixed-fiber polyneuropathy, raises the possibility that in patients with pure large-fiber polyneuropathy nociceptive nerve terminal involvement might be undetected by standard diagnostic techniques.
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Affiliation(s)
- Eleonora Galosi
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Di Pietro
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Silvia La Cesa
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Giulia Di Stefano
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Caterina Leone
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | | | - Andrea Di Lionardo
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Frida Leonetti
- Diabetes Unit, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Raffaella Buzzetti
- Experimental Medicine Department, Sapienza University of Rome, Rome, Italy
| | - Cristina Mollica
- Dipartimento di Metodi e Modelli per l'Economia, il Territorio e la Finanza, Sapienza University of Rome, Rome, Italy
| | - Giorgio Cruccu
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
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Abstract
A novel RNA betacoronavirus causing coronavirus disease 2019 (Covid-19) has now been declared pandemic disease by WHO. Guo et al published the first report of biochemical features in patients with diabetes and the further risk that this disease can determine to the progression of Covid-19. Among different cytokines found significantly higher in patients with diabetes compared to those without, Interleukin-6 (IL-6), which is already increased in conditions of chronic inflammation, may play a more deleterious role in Covid-19 infection. Targeting the overexpression of Il-6 effects with a monoclonal antibody against IL-6 receptor or using Janus Kinase inhibitors may be particularly helpful for treatment of Covid-19 pneumonia in diabetes.
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Affiliation(s)
- Ernesto Maddaloni
- Department of Experimental MedicineSapienza University of RomeRomeItaly
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Maddaloni E, D'Onofrio L, Alessandri F, Mignogna C, Leto G, Pascarella G, Mezzaroma I, Lichtner M, Pozzilli P, Agrò FE, Rocco M, Pugliese F, Lenzi A, Holman RR, Mastroianni CM, Buzzetti R. Cardiometabolic multimorbidity is associated with a worse Covid-19 prognosis than individual cardiometabolic risk factors: a multicentre retrospective study (CoViDiab II). Cardiovasc Diabetol 2020; 19:164. [PMID: 33004045 PMCID: PMC7528157 DOI: 10.1186/s12933-020-01140-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cardiometabolic disorders may worsen Covid-19 outcomes. We investigated features and Covid-19 outcomes for patients with or without diabetes, and with or without cardiometabolic multimorbidity. METHODS We collected and compared data retrospectively from patients hospitalized for Covid-19 with and without diabetes, and with and without cardiometabolic multimorbidity (defined as ≥ two of three risk factors of diabetes, hypertension or dyslipidaemia). Multivariate logistic regression was used to assess the risk of the primary composite outcome (any of mechanical ventilation, admission to an intensive care unit [ICU] or death) in patients with diabetes and in those with cardiometabolic multimorbidity, adjusting for confounders. RESULTS Of 354 patients enrolled, those with diabetes (n = 81), compared with those without diabetes (n = 273), had characteristics associated with the primary composite outcome that included older age, higher prevalence of hypertension and chronic obstructive pulmonary disease (COPD), higher levels of inflammatory markers and a lower PaO2/FIO2 ratio. The risk of the primary composite outcome in the 277 patients who completed the study as of May 15th, 2020, was higher in those with diabetes (Adjusted Odds Ratio (adjOR) 2.04, 95%CI 1.12-3.73, p = 0.020), hypertension (adjOR 2.31, 95%CI: 1.37-3.92, p = 0.002) and COPD (adjOR 2.67, 95%CI 1.23-5.80, p = 0.013). Patients with cardiometabolic multimorbidity were at higher risk compared to patients with no cardiometabolic conditions (adjOR 3.19 95%CI 1.61-6.34, p = 0.001). The risk for patients with a single cardiometabolic risk factor did not differ with that for patients with no cardiometabolic risk factors (adjOR 1.66, 0.90-3.06, adjp = 0.10). CONCLUSIONS Patients with diabetes hospitalized for Covid-19 present with high-risk features. They are at increased risk of adverse outcomes, likely because diabetes clusters with other cardiometabolic conditions.
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Affiliation(s)
- Ernesto Maddaloni
- Umberto I "Policlinico" General Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
- Diabetes Trial Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Luca D'Onofrio
- Umberto I "Policlinico" General Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Francesco Alessandri
- Umberto I "Policlinico" General Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Carmen Mignogna
- Umberto I "Policlinico" General Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Gaetano Leto
- Santa Maria Goretti Hospital, Polo Pontino Sapienza University, Latina, Italy
| | | | - Ivano Mezzaroma
- Umberto I "Policlinico" General Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Miriam Lichtner
- Santa Maria Goretti Hospital, Polo Pontino Sapienza University, Latina, Italy
| | | | | | - Monica Rocco
- Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Francesco Pugliese
- Umberto I "Policlinico" General Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Andrea Lenzi
- Umberto I "Policlinico" General Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Rury R Holman
- Diabetes Trial Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Claudio Maria Mastroianni
- Umberto I "Policlinico" General Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Raffaella Buzzetti
- Umberto I "Policlinico" General Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
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49
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Buzzetti R, Tuomi T, Mauricio D, Pietropaolo M, Zhou Z, Pozzilli P, Leslie RD. Management of Latent Autoimmune Diabetes in Adults: A Consensus Statement From an International Expert Panel. Diabetes 2020; 69:2037-2047. [PMID: 32847960 PMCID: PMC7809717 DOI: 10.2337/dbi20-0017] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
Abstract
A substantial proportion of patients with adult-onset diabetes share features of both type 1 diabetes (T1D) and type 2 diabetes (T2D). These individuals, at diagnosis, clinically resemble T2D patients by not requiring insulin treatment, yet they have immunogenetic markers associated with T1D. Such a slowly evolving form of autoimmune diabetes, described as latent autoimmune diabetes of adults (LADA), accounts for 2-12% of all patients with adult-onset diabetes, though they show considerable variability according to their demographics and mode of ascertainment. While therapeutic strategies aim for metabolic control and preservation of residual insulin secretory capacity, endotype heterogeneity within LADA implies a personalized approach to treatment. Faced with a paucity of large-scale clinical trials in LADA, an expert panel reviewed data and delineated one therapeutic approach. Building on the 2020 American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) consensus for T2D and heterogeneity within autoimmune diabetes, we propose "deviations" for LADA from those guidelines. Within LADA, C-peptide values, proxy for β-cell function, drive therapeutic decisions. Three broad categories of random C-peptide levels were introduced by the panel: 1) C-peptide levels <0.3 nmol/L: a multiple-insulin regimen recommended as for T1D; 2) C-peptide values ≥0.3 and ≤0.7 nmol/L: defined by the panel as a "gray area" in which a modified ADA/EASD algorithm for T2D is recommended; consider insulin in combination with other therapies to modulate β-cell failure and limit diabetic complications; 3) C-peptide values >0.7 nmol/L: suggests a modified ADA/EASD algorithm as for T2D but allowing for the potentially progressive nature of LADA by monitoring C-peptide to adjust treatment. The panel concluded by advising general screening for LADA in newly diagnosed non-insulin-requiring diabetes and, importantly, that large randomized clinical trials are warranted.
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Affiliation(s)
- Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Tiinamaija Tuomi
- Division of Endocrinology, Abdominal Center, Helsinki University Hospital, Institute for Molecular Medicine Finland FIMM and Research Program for Clinical and Molecular Metabolism, University of Helsinki, and Folkhälsan Research Center, Helsinki, Finland
- Lund University Diabetes Center, University of Lund, Malmo, Sweden
| | - Didac Mauricio
- Department of Endocrinology & Nutrition, CIBERDEM, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Autonomous University of Barcelona, Barcelona, Spain
| | - Massimo Pietropaolo
- Division of Endocrinology, Diabetes and Metabolism, Diabetes Research Center, Baylor College of Medicine, Houston, TX
| | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University and Key Laboratory of Diabetes Immunology, Central South University, Ministry of Education, National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Paolo Pozzilli
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University, Rome, Italy
- Blizard Institute, Barts and The London School of Medicine and Dentistry, University of London, London, U.K
| | - Richard David Leslie
- Blizard Institute, Barts and The London School of Medicine and Dentistry, University of London, London, U.K.
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50
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Cavallari I, Maddaloni E, Pieralice S, Mulè MT, Buzzetti R, Ussia GP, Pozzilli P, Grigioni F. The Vicious Circle of Left Ventricular Dysfunction and Diabetes: From Pathophysiology to Emerging Treatments. J Clin Endocrinol Metab 2020; 105:5866664. [PMID: 32615596 DOI: 10.1210/clinem/dgaa427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/22/2020] [Accepted: 06/27/2020] [Indexed: 12/25/2022]
Abstract
CONTEXT Diabetes and heart failure (HF) are 2 deadly and strictly related epidemic disorders. The aim of this review is to present an updated discussion of the epidemiology, pathophysiology, clinical presentation and treatment options for HF in diabetes. EVIDENCE ACQUISITION Relevant references published up to February 2020 were identified through searches in PubMed. Quality was graded using the Newcastle-Ottawa score in observational studies and the Cochrane Collaboration tool in randomized studies. EVIDENCE SYNTHESIS Metabolic and neurohumoral derangements, oxidative stress, inflammation, micro- and macroangiopathy all contribute through complex molecular and cellular mechanisms to cardiac dysfunction in diabetes, which in turn, results as one the most frequent underlying conditions affecting up to 42% of patients with HF and causing a 34% increased risk of cardiovascular death. On top of traditional guideline-based HF medical and device therapies, equally effective in patients with and without diabetes, a new class of glucose-lowering agents acting through the sodium-glucose cotransporter 2 (SGLT2) inhibition showed impressive results in reducing HF outcomes in individuals with diabetes and represents an active area of investigation. CONCLUSIONS Diabetes and HF are strictly linked in a bidirectional and deadly vicious circle difficult to break. Therefore, preventive strategies and a timely diagnosis are crucial to improve outcomes in such patients. SGLT2 inhibitors represent a major breakthrough with remarkably consistent findings. However, it is still not clear whether their benefits may be definitely extended to patients with HF with preserved ejection fraction, to those without diabetes and in the acute setting.
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Affiliation(s)
- Ilaria Cavallari
- Department of Medicine, Unit of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Italy
| | - Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Silvia Pieralice
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Italy
| | - Maria Tea Mulè
- Department of Medicine, Unit of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Italy
| | | | - Gian Paolo Ussia
- Department of Medicine, Unit of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Italy
| | - Paolo Pozzilli
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Italy
| | - Francesco Grigioni
- Department of Medicine, Unit of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Italy
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