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Formichi C, Baronti W, de Gennaro G, Cerrai Ceroni M, Nigi L, Rizzo L, Dotta F. Real-world use of oral versus subcutaneous semaglutide in a cohort of type 2 diabetic patients: which option to which patient? J Endocrinol Invest 2024:10.1007/s40618-024-02369-4. [PMID: 38683498 DOI: 10.1007/s40618-024-02369-4] [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: 09/24/2023] [Accepted: 03/29/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE To evaluate the variables influencing the therapeutic choice toward oral versus subcutaneous semaglutide in a cohort of diabetic subjects. METHODS We retrospectively collected data of 292 patients followed at the Diabetes Unit of the University Hospital of Siena and the Hospital of Grosseto, who were prescribed oral (n = 115) or subcutaneous (n = 177) semaglutide between October 2021 and October 2022. RESULTS Oral semaglutide was preferentially prescribed in older subjects with longer disease duration in replacement of other antidiabetic drugs, while subcutaneous semaglutide was preferentially prescribed in add-on to metformin in subjects with higher body weight and BMI. After 6 months, both formulations significantly improved glycemic control and body weight, however injectable semaglutide showed a greater efficacy on A1c levels, weight loss, BMI and waist circumference reduction. No differences were found in terms of adverse events. CONCLUSION In our experience, injectable semaglutide is preferred in patients with excess weight and shorter disease duration, while the oral formulation was used later and especially after therapeutic failure of previous therapies. Follow-up data indicate similar tolerability and efficacy of both formulations, despite subcutaneous semaglutide demonstrated greater efficacy.
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Affiliation(s)
- C Formichi
- Diabetes and Metabolic Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy.
- Fondazione Umberto Di Mario, Toscana Life Science, 53100, Siena, Italy.
| | - W Baronti
- Metabolic Diseases and Diabetes Unit, Misericordia Hospital, USL Toscana sud est, 58100, Grosseto, Italy
| | - G de Gennaro
- Metabolic Diseases and Diabetes Unit, Misericordia Hospital, USL Toscana sud est, 58100, Grosseto, Italy
| | - M Cerrai Ceroni
- Fondazione Umberto Di Mario, Toscana Life Science, 53100, Siena, Italy
| | - L Nigi
- Diabetes and Metabolic Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy
- Fondazione Umberto Di Mario, Toscana Life Science, 53100, Siena, Italy
| | - L Rizzo
- Metabolic Diseases and Diabetes Unit, Misericordia Hospital, USL Toscana sud est, 58100, Grosseto, Italy
| | - F Dotta
- Diabetes and Metabolic Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy
- Fondazione Umberto Di Mario, Toscana Life Science, 53100, Siena, Italy
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2
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Bianchi C, Brocchi A, Baronti W, Nicolì F, Citro F, Aragona M, Cela V, Del Prato S, Bertolotto A. Assisted reproductive technology, risk of gestational diabetes, and perinatal outcomes in singleton pregnancies. Diabetes Metab Res Rev 2023:e3625. [PMID: 36806857 DOI: 10.1002/dmrr.3625] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/30/2022] [Accepted: 02/05/2023] [Indexed: 02/22/2023]
Abstract
AIMS To evaluate the impact of assisted reproductive technology (ART) on the risk of gestational diabetes mellitus (GDM) in single pregnancies. MATERIALS AND METHODS We retrospectively collected clinical and anthropometric data of 219ART- and 256 age- and body mass index (BMI)-matched women with spontaneous conception screened for GDM. The primary outcome was to evaluate GDM prevalence in ART women. RESULTS There were no differences in age, BMI, and family history of diabetes in the two groups of women. ART-women were more frequently primiparous, whereas the prevalence of previous GDM was higher in SC-women. The prevalence of GDM in the whole cohort was 36.1% and was higher in ART-women (52.3% vs. 23.4%; p < 0.0001). In the whole cohort, on multivariate analysis, family history of diabetes (OR 1.67; 95% CI: 1.03-2.69), previous GDM (OR 7.05; 95% CI: 2.92-17.04), pre-pregnancy obesity (OR 2.72; 95% CI 1.21-6.13), and ART (OR 4.14; 95% CI 2.65-6.48) were independent risk factors for GDM. Among ART-women, age over 40 years was associated with GDM. Preterm delivery was more common in ART-women; gestational week at delivery, birth weight, ponderal index, and Apgar score were lower in ART-women than in SC-women, both in the whole cohort and in GDM women. CONCLUSIONS Among women undergoing ART treatment, at least one in two develops GDM. ART appears to be an independent risk factor for GDM in single pregnancies, particularly above the age of 40. ART treatment seems to be associated with an increased rate of preterm delivery and lower neonatal birth weight and Apgar score, especially in GDM women. CLINICAL TRIAL REGISTRATION The study was not registered as it is an observational retrospective evaluation.
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Affiliation(s)
- Cristina Bianchi
- Department of Medicine, University Hospital of Pisa, Pisa, Italy
| | - Alex Brocchi
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Walter Baronti
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Francesca Nicolì
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Fabrizia Citro
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Michele Aragona
- Department of Medicine, University Hospital of Pisa, Pisa, Italy
| | - Vito Cela
- Maternal-Infant Department, University Hospital of Pisa, Pisa, Italy
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
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Boggi U, Baronti W, Amorese G, Pilotti S, Occhipinti M, Perrone V, Marselli L, Barsotti M, Campani D, Gianetti E, Insilla AC, Bosi E, Kaufmann E, Terrenzio C, Vistoli F, Marchetti P. Treating Type 1 Diabetes by Pancreas Transplant Alone: A Cohort Study on Actual Long-term (10 Years) Efficacy and Safety. Transplantation 2022; 106:147-157. [PMID: 33909390 DOI: 10.1097/tp.0000000000003627] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Physiologically regulated insulin secretion and euglycemia are achievable in type 1 diabetes (T1D) by islet or pancreas transplantation. However, pancreas transplant alone (PTA) remains a debated approach, with uncertainties on its relative benefits and risks. We determined the actual long-term (10 y) efficacy and safety of PTA in carefully characterized T1D subjects. METHODS This is a single-center, cohort study in 66 consecutive T1D subjects who received a PTA between April 2001 and December 2007, and were then all followed until 10 y since transplant. Main features evaluated were patient survival, pancreas graft function, C-peptide levels, glycemic parameters, and the function of the native kidneys. RESULTS Ten-year actual patient survival was 92.4%. Optimal (insulin independence) or good (minimal insulin requirement) graft function was observed in 57.4% and 3.2% of patients, respectively. Six (9.0%) patients developed stage 5 or 4 chronic kidney disease. In the remaining individuals bearing a successful PTA, estimated glomerular filtration rate (eGFR) decline per year was -2.29 ± 2.69 mL/min/1.73 m2. Reduction of eGFR at 1 y post-PTA was higher in those with pre-PTA hyperfiltration and higher HbA1c concentrations; eGFR changes afterward significantly correlated with diabetes duration. In recipients with normoglycemia at 10 y, 74% of normoalbuminuric or microalbuminuric subjects pre-PTA remained stable, and 26% progressed toward a worse stage; conversely, in 62.5% of the macroalbuminuric individuals albuminuria severity regressed. CONCLUSIONS These long-term effects of PTA on patient survival, graft function, and the native kidneys support PTA as a suitable approach to treat diabetes in selected T1D patients.
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Affiliation(s)
- Ugo Boggi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy
| | - Walter Baronti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriella Amorese
- Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy
| | - Silvia Pilotti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Margherita Occhipinti
- Diabetes Unit, Versilia Hospital, Azienda ASL Area Vasta Nord-Ovest, Lido di Camaiore, Lucca, Italy
| | - Vittorio Perrone
- Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy
| | - Lorella Marselli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Departmental Section of Endocrinology and Metabolism of Organ and Cellular Transplantation, Cisanello University Hospital, Pisa, Italy
| | | | - Daniela Campani
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, Pisa University Hospital, Pisa, Italy
| | - Elena Gianetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Cacciato Insilla
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, Pisa University Hospital, Pisa, Italy
| | - Emanuele Bosi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Emanuele Kaufmann
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Chiara Terrenzio
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Vistoli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy
| | - Piero Marchetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Departmental Section of Endocrinology and Metabolism of Organ and Cellular Transplantation, Cisanello University Hospital, Pisa, Italy
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Boggi U, Vistoli F, Andres A, Arbogast HP, Badet L, Baronti W, Bartlett ST, Benedetti E, Branchereau J, Burke GW, Buron F, Caldara R, Cardillo M, Casanova D, Cipriani F, Cooper M, Cupisti A, Davide J, Drachenberg C, de Koning EJP, Ettorre GM, Fernandez Cruz L, Fridell JA, Friend PJ, Furian L, Gaber OA, Gruessner AC, Gruessner RW, Gunton JE, Han D, Iacopi S, Kauffmann EF, Kaufman D, Kenmochi T, Khambalia HA, Lai Q, Langer RM, Maffi P, Marselli L, Menichetti F, Miccoli M, Mittal S, Morelon E, Napoli N, Neri F, Oberholzer J, Odorico JS, Öllinger R, Oniscu G, Orlando G, Ortenzi M, Perosa M, Perrone VG, Pleass H, Redfield RR, Ricci C, Rigotti P, Paul Robertson R, Ross LF, Rossi M, Saudek F, Scalea JR, Schenker P, Secchi A, Socci C, Sousa Silva D, Squifflet JP, Stock PG, Stratta RJ, Terrenzio C, Uva P, Watson CJ, White SA, Marchetti P, Kandaswamy R, Berney T. First World Consensus Conference on pancreas transplantation: Part II - recommendations. Am J Transplant 2021; 21 Suppl 3:17-59. [PMID: 34245223 PMCID: PMC8518376 DOI: 10.1111/ajt.16750] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 02/07/2023]
Abstract
The First World Consensus Conference on Pancreas Transplantation provided 49 jury deliberations regarding the impact of pancreas transplantation on the treatment of diabetic patients, and 110 experts' recommendations for the practice of pancreas transplantation. The main message from this consensus conference is that both simultaneous pancreas-kidney transplantation (SPK) and pancreas transplantation alone can improve long-term patient survival, and all types of pancreas transplantation dramatically improve the quality of life of recipients. Pancreas transplantation may also improve the course of chronic complications of diabetes, depending on their severity. Therefore, the advantages of pancreas transplantation appear to clearly surpass potential disadvantages. Pancreas after kidney transplantation increases the risk of mortality only in the early period after transplantation, but is associated with improved life expectancy thereafter. Additionally, preemptive SPK, when compared to SPK performed in patients undergoing dialysis, appears to be associated with improved outcomes. Time on dialysis has negative prognostic implications in SPK recipients. Increased long-term survival, improvement in the course of diabetic complications, and amelioration of quality of life justify preferential allocation of kidney grafts to SPK recipients. Audience discussions and live voting are available online at the following URL address: http://mediaeventi.unipi.it/category/1st-world-consensus-conference-of-pancreas-transplantation/246.
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Bianchi C, de Gennaro G, Romano M, Baronti W, Aragona M, Battini L, Bottone P, Del Prato S, Bertolotto A. Exercise during pregnancy: how much active are pregnant women at risk of gestational diabetes despite few contraindications? Gynecol Endocrinol 2021; 37:101-104. [PMID: 32490696 DOI: 10.1080/09513590.2020.1775196] [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] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Diet and physical activity are cornerstones in prevention and treatment of Gestational Diabetes (GDM) though some caution may be required under specific circumstances. The aims of this study were to evaluate activity habits during pregnancy and contraindications to physical activity in women at risk for GDM. METHODS 536 pregnant women (age 35 ± 5 years; gestation week 25 ± 4; pre-pregnancy BMI 24.6 ± 12.9 kg/m2), selective screened for GDM, filled out a standardized questionnaire recording physical activity during pregnancy. RESULTS Of 536 women, 73.4% reported regular exercise before pregnancy and 95.5% of them continued during pregnancy. 8.2% had absolute contraindications to exercise, such as placenta praevia /vaginal bleeding and incompetent cervix/cerclage. Physical activity during the last month was reported by 66.2% of women; frequency was 1-2 times/week (44%); intensity was light (83%) and duration on average (44%) 20-40 min/day. 48% of women spent most of their time in sedentary behaviors (sitting). Among women with GDM, physical activity was associated with better metabolic profile and lower needed of insulin therapy. CONCLUSION Women at risk for GDM spent most of their time in sedentary behaviors, despite a low prevalence of contraindications to exercise. Therefore, our data call for the need of motivational counseling aimed to implement physical activity during pregnancy.
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Affiliation(s)
- Cristina Bianchi
- Department of Medicine, University Hospital of Pisa, Pisa, Italy
| | - Giovanni de Gennaro
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Matilde Romano
- Maternal-Infant Department, University Hospital of Pisa, Pisa, Italy
| | - Walter Baronti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michele Aragona
- Department of Medicine, University Hospital of Pisa, Pisa, Italy
| | - Lorella Battini
- Maternal-Infant Department, University Hospital of Pisa, Pisa, Italy
| | - Pietro Bottone
- Maternal-Infant Department, University Hospital of Pisa, Pisa, Italy
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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6
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de Gennaro G, Bianchi C, Aragona M, Battini L, Baronti W, Brocchi A, Del Prato S, Bertolotto A. Postpartum screening for type 2 diabetes mellitus in women with gestational diabetes: Is it really performed? Diabetes Res Clin Pract 2020; 166:108309. [PMID: 32650034 DOI: 10.1016/j.diabres.2020.108309] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/19/2020] [Accepted: 07/02/2020] [Indexed: 12/24/2022]
Abstract
AIMS This study evaluates the adherence to postpartum type 2 diabetes mellitus (T2DM) screening in women with previous gestational diabetes (GDM) and identifies elements associated with poor attendance. METHODS We retrospectively collected data from 650 consecutive women with GDM between 2016 and 2018, who should had 75 g-OGTT, 4-12 weeks after delivery. Impaired glucose regulation (IGR) was defined according with ADA criteria. RESULTS Only 41% of women had postpartum OGTT. Of these, 1.9% received T2DM diagnosis, with IGR prevalence of 18%. After introducing a recommendation letter, adherence to screening increased (47% in 2017 and 43% in 2018 vs. 32% in 2016). Screening procedure was less common in women with: no-family history of T2DM (38% vs. 46%; p < 0.05), age <35 (33% vs. 47%; p < 0.01), lower level of education (32% no-high-school-diploma vs. 35% high-school-diploma vs. 49% university-degree; p < 0.01) and unstable employment (35% vs. 44%; p < 0.05). At multivariate logistic regression analysis, age <35 years (OR 1.61; 95%CI: 1.14-2.28) and lowest educational level (OR 1.64; 95% CI: 1.13-2.37, compared to University degree) were independently associated with non-adherence. CONCLUSION Only 41% of women had postpartum T2DM screening. Women with lower attendance are those with age <35 years or low educational level. Further strategies are needed to implement postpartum test.
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Affiliation(s)
| | - C Bianchi
- Diabetes Center - University Hospital of Pisa, Italy.
| | - M Aragona
- Diabetes Center - University Hospital of Pisa, Italy
| | - L Battini
- Maternal-Infant Department- University Hospital of Pisa, Italy
| | - W Baronti
- Diabetes Center - University of Pisa, Italy
| | - A Brocchi
- Diabetes Center - University of Pisa, Italy
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Affiliation(s)
- Silke Krol
- Laboratory for Personalized Medicine, IRCCS Ospedale Specializzato in Gastroenterologia 'Saverio de Bellis', Castellana Grotte (BA), Italy
| | - Walter Baronti
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Piero Marchetti
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
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8
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Marchetti P, Suleiman M, De Luca C, Baronti W, Bosi E, Tesi M, Marselli L. A direct look at the dysfunction and pathology of the β cells in human type 2 diabetes. Semin Cell Dev Biol 2020; 103:83-93. [PMID: 32417220 DOI: 10.1016/j.semcdb.2020.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 01/24/2020] [Revised: 03/27/2020] [Accepted: 04/09/2020] [Indexed: 12/25/2022]
Abstract
β cells uniquely produce and secrete insulin under the control of several, integrated signals, to maintain blood glucose concentrations within a narrow physiological interval. β cell failure is key to the onset and progression of type 2 diabetes, due to impaired function and reduced mass. In this review we focus on several features of human β cell dysfunction and pathology in type 2 diabetes, as revealed by direct assessment of isolated islet traits and examination of pancreatic tissue from organ donors, surgical samples or autoptic specimens. Insulin secretion defects and pathology findings are discussed in relation to some of the major underlying mechanisms, to also provide clues for conceiving better prevention and treatment of type 2 diabetes by targeting the pancreatic β cells.
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Affiliation(s)
- Piero Marchetti
- Department of Clinical and Experimental Medicine - University of Pisa, Via Savi 10, Pisa, Italy.
| | - Mara Suleiman
- Department of Clinical and Experimental Medicine - University of Pisa, Via Savi 10, Pisa, Italy
| | - Carmela De Luca
- Department of Clinical and Experimental Medicine - University of Pisa, Via Savi 10, Pisa, Italy
| | - Walter Baronti
- Department of Clinical and Experimental Medicine - University of Pisa, Via Savi 10, Pisa, Italy
| | - Emanuele Bosi
- Department of Clinical and Experimental Medicine - University of Pisa, Via Savi 10, Pisa, Italy
| | - Marta Tesi
- Department of Clinical and Experimental Medicine - University of Pisa, Via Savi 10, Pisa, Italy
| | - Lorella Marselli
- Department of Clinical and Experimental Medicine - University of Pisa, Via Savi 10, Pisa, Italy
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Matrone A, Torregrossa L, Sensi E, Cappellani D, Baronti W, Ciampi R, Molinaro E, Ugolini C, Aghababyan A, De Napoli L, Latrofa F, Materazzi G, Basolo F, Vitti P, Elisei R. The Molecular Signature More Than the Site of Localization Defines the Origin of the Malignancy. Front Oncol 2019; 9:1390. [PMID: 31921647 PMCID: PMC6928194 DOI: 10.3389/fonc.2019.01390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/25/2019] [Indexed: 12/11/2022] Open
Abstract
The diagnosis of the primary origin of metastases to the thyroid gland is not easy, in particular in case of concomitant lung adenocarcinoma which shares several immunophenotypical features. Although rare, these tumors should be completely characterized in order to set up specific therapies. This is the case of a 64-years-old woman referred to our institution for a very advanced neoplastic disease diagnosed both as poorly differentiated/anaplastic thyroid cancer (PDTC/ATC) for the huge involvement of the neck and concomitant lung adenocarcinoma (LA). Neither the clinical features and the imaging evaluation nor the tumor markers allowed a well-defined diagnosis. Moreover, the histologic features of the thyroid and lung biopsies confirmed the synchronous occurrence of two different tumors. The molecular analysis showed a c.34G>T (p.G12C) mutation in the codon 12 of K-RAS gene, in both tissues. Since, this mutation is highly prevalent in LA and virtually absent in PDTC/ATC the lung origin of the malignancy was assumed, and the patient was addressed to the correct therapeutic strategy.
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Affiliation(s)
- Antonio Matrone
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, Pisa University Hospital, Pisa, Italy
| | - Liborio Torregrossa
- Anatomic Pathology Section, Department of Surgical, Medical, Molecular Pathology and Critical Area, Pisa University Hospital, Pisa, Italy
| | - Elisa Sensi
- Anatomic Pathology Section, Department of Surgical, Medical, Molecular Pathology and Critical Area, Pisa University Hospital, Pisa, Italy
| | - Daniele Cappellani
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, Pisa University Hospital, Pisa, Italy
| | - Walter Baronti
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, Pisa University Hospital, Pisa, Italy
| | - Raffaele Ciampi
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, Pisa University Hospital, Pisa, Italy
| | - Eleonora Molinaro
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, Pisa University Hospital, Pisa, Italy
| | - Clara Ugolini
- Anatomic Pathology Section, Department of Surgical, Medical, Molecular Pathology and Critical Area, Pisa University Hospital, Pisa, Italy
| | - Aleksandr Aghababyan
- Unit of Endocrine Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, Pisa University Hospital, Pisa, Italy
| | - Luigi De Napoli
- Unit of Endocrine Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, Pisa University Hospital, Pisa, Italy
| | - Francesco Latrofa
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, Pisa University Hospital, Pisa, Italy
| | - Gabriele Materazzi
- Unit of Endocrine Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, Pisa University Hospital, Pisa, Italy
| | - Fulvio Basolo
- Anatomic Pathology Section, Department of Surgical, Medical, Molecular Pathology and Critical Area, Pisa University Hospital, Pisa, Italy
| | - Paolo Vitti
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, Pisa University Hospital, Pisa, Italy
| | - Rossella Elisei
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, Pisa University Hospital, Pisa, Italy
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Bianchi C, Aragona M, Rodia C, Baronti W, de Gennaro G, Bertolotto A, Del Prato S. Freestyle Libre trend arrows for the management of adults with insulin-treated diabetes: A practical approach. J Diabetes Complications 2019; 33:6-12. [PMID: 30446477 DOI: 10.1016/j.jdiacomp.2018.10.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/13/2018] [Accepted: 10/16/2018] [Indexed: 11/24/2022]
Abstract
Freestyle Libre (FSL) system is a new method to detect glucose enabling a new paradigm in glucose monitoring and self-management. The sensor, reading the interstitial fluid glucose concentration, provides a numerical data of glucose level and a trend arrow that add context to static measurement of glucose level. Therefore, patients could easily follow the progression of their glucose levels over the time, allowing early detection and timely treatment of deviations from targeted glucose level range, thus preventing extreme fluctuations. In order to take full advantage of the system both the caregiver and the person with diabetes must appreciate the need of careful interpretation of the data generated by the FSL. To this purpose we have generated recommendations that are based on methods suggested for CGM, our clinical experience and discussion with experienced patients using FSL, to provide a pragmatic approach to use FSL trend arrow data for managing diabetes in adults.
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Affiliation(s)
- Cristina Bianchi
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
| | - Michele Aragona
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Cosimo Rodia
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Walter Baronti
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giovanni de Gennaro
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Alessandra Bertolotto
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa - Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Lombardo C, Perrone VG, Amorese G, Vistoli F, Baronti W, Marchetti P, Boggi U. Update on pancreatic transplantation on the management of diabetes. Minerva Med 2017; 108:405-418. [PMID: 28466634 DOI: 10.23736/s0026-4806.17.05224-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pancreas transplantation is the only therapy that can restore insulin independence in beta-cell penic diabetic recipients. Because of the need for life-long immunosuppression and the intial surgical risk associated with the transplant procedure, Pancreas transplantation is a therapeutic option only in selected diabetic patients. Based on renal function, three main populations of diabetic recipients of a pancreas transplant can be identified: uremic patients, posturemic patients (following successful kidney transplantation), and non-uremic patients. Uremic patients are best treated by simultaneous kidney-pancreas transplantation with grafts obtained from the same deceased donor. Posturemic patients can receive a pancreas after kidney transplantation, if the previous renal graft has a good functional reserve. Non-uremic patients can receive a pancreas alone transplant if their diabetes is poorly controlled, despite optimal insulin therapy, suffer from unawareness hypoglycemia events and/or develop progressive chronic complications of diabetes. The results of pancreas transplantation have improved over the years and are currently not inferior to those of renal transplantation in non-diabetic recipients. A functioning pancreatic graft can prolong the life of diabetic recipients, improves their quality of life, and can halt, or reverse, the progression of chronic complications of diabetes. Unfortunately, because of ageing of donor population and lack of timely referral of potential recipients, the annual volume of pancreas transplants is declining. Considering that the results of pancreas transplantation depend on center volume, and that adequate center volume is required also for training of newer generations of transplant physcians and surgeons, centralization of pancreas transplantation activity should be considered.
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Affiliation(s)
- Carlo Lombardo
- Division of General and Transplant Surgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Vittorio G Perrone
- Division of General and Transplant Surgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Gabriella Amorese
- Division of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Fabio Vistoli
- Division of General and Transplant Surgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Walter Baronti
- Division of Metabolism and Cell Transplantation, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Piero Marchetti
- Division of Metabolism and Cell Transplantation, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy -
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Occhipinti M, Rondinini L, Mariotti R, Vistoli F, Baronti W, Barsotti M, Amorese G, Boggi U, Marchetti P. Amelioration of cardiac morphology and function in type 1 diabetic patients with sustained success of pancreas transplant alone. Diabetes Care 2014; 37:e171-2. [PMID: 25061145 DOI: 10.2337/dc14-0061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 02/03/2023]
Affiliation(s)
| | | | - Rita Mariotti
- Department of Cardiology, University of Pisa, Pisa, Italy
| | - Fabio Vistoli
- Department of Oncology and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Walter Baronti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Gabriella Amorese
- Department of Oncology and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Ugo Boggi
- Department of Oncology and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Piero Marchetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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