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Militello in Val di Catania, Italy

Terzolo M.,Medicina Interna I | Reimondo G.,Medicina Interna I | Chiodini I.,Ospedale Maggiore Policlinico Instituto Of Ricovero E Cura A Carattere Scientifico | Giordano R.,University of Turin | And 15 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2012

Context: Cushing's syndrome may remain unrecognized among patients referred for metabolic syndrome; thus, a proactive screening has been suggested in certain patient populations with features of the disorder. However, conflicting data have been reported on the prevalence of Cushing's syndrome in patients with type 2 diabetes. Objective: Our aim was to evaluate the prevalence of unsuspected Cushing's syndrome among outpatients with type 2 diabetes. Design and Setting: This was a cross-sectional prospective study in 24 diabetes clinics across Italy. Patients: Between June 2006 and April 2008, 813 patients with known type 2 diabetes without clinically overt hypercortisolism were evaluated. Follow-up of the study was closed in September 2010. Patients were not selected for characteristics conferring a higher pretest probability of hypercortisolism. Patients underwent a first screening step with the 1-mg overnight dexamethasone suppression test. Results: Forty patients failed to suppress serum cortisol less than 5.0 μg/dl (138 nmol/liter) and underwent a standard 2-d, 2-mg dexamethasone suppression test, after which six patients (0.6% of the overall series) failed to suppress cortisol less than 1.8 μg/dl (50 nmol/liter), receiving a definitive diagnosis of Cushing's syndrome that was adrenal dependent in five patients. Four patients were cured, being able to discontinue, or reduce, the glucose-lowering agents. Conclusions: The present data do not support widespread screening of patients with type 2 diabetes for Cushing's syndrome; however, the disorder is less rare than previously thought when considering epidemiology of type 2 diabetes. Our results support a case-finding approach in patients with uncontrolled diabetes and hypertension despite appropriate treatment. Copyright © 2012 by The Endocrine Society.

Terzano C.,University of Rome La Sapienza | Cremonesi G.,Chiesi Farmaceutici S.p.A. | Girbino G.,Messina University | Ingrassia E.,Chiesi Farmaceutici S.p.A. | And 51 more authors.
Respiratory Research | Year: 2012

Objectives: The study aimed at prospectively evaluating the evolution of asthma control in Italy, to evaluate the reasons for lack of asthma control, perceived quality of life (QoL) and association with level of asthma control, the impact of pharmacological treatment, the number of exacerbations and the healthcare resource consumption.Methods: PRISMA (PRospectIve Study on asthMA control) was an observational study performed in asthmatic patients including a cross-sectional phase and a 12-month prospective phase. Asthma control was assessed with the Asthma Control Test™ (ACT) and QoL was evaluated with EuroQoL-5D questionnaire filled in and collected during 5 clinic visits together with all the other data.Results: The prospective phase included 1017 patients with uncontrolled (55.7%) or partly controlled asthma (44.3%). Out of the 739 patients evaluable after 12 months, 22.2% achieved full asthma control (ACT score = 25) and 58.7% reached a good control (ACT score: 20-24). The improvement in asthma control was associated with improved QoL and reduced hospital visits. The main reasons for lack of asthma control were comorbidities, continued exposure to irritants/triggers and poor adherence to therapy. The frequency of exacerbations was lower in patients with controlled asthma.A fixed combination therapy with an inhaled corticosteroid and a long-acting β2 agonist was reported by 77.0% of patients. A better asthma control and improved QoL were achieved with extrafine beclomethasone/formoterol compared to either budesonide/formoterol or fluticasone/salmeterol.Conclusions: An improvement in asthma control and QoL can be achieved during a 1-year monitoring in a real life setting. Extrafine beclomethasone/formoterol was associated with significant benefit in terms of asthma control and QoL compared to large-particles combinations.ClinicalTrials.gov number NCT01110460. © 2012 Terzano et al.; licensee BioMed Central Ltd.

Aim. To study baseline insulin infusion patterns in young adults with type 1 diabetes switching from multiple daily injection (MDI) to continuous subcutaneous insulin infusion (CSII). Methods. We studied 19 patients with type 1 diabetes who were admitted to our clinic during the period between 1 January and 30 November 2009 and who switched from MDI to CSII. Initially the patients were treated with a basal rate of insulin that remained unchanged throughout the day, then modified in accordance with the results of frequent glycemic monitoring. The average hospital stay was of 5.5 days. Results. After the switch from MDI to CSII the average dosage of basal insulin went from 19.3 UI a day to 16.2 UI a day with a decrease of 16%. The average daily dose per kilo taken by patients was 0.25 (±0.10) UI/kg. The mean basal insulin administered made up 46% of the total insulin used (54% administered as bolus). The graph showing the profile of basal insulin describes a typical "dawn-dusk" pattern with an insulin peak that was higher in the morning than in the afternoon. Conclusion. Our study shows that young adults with type 1 diabetes have a similar insulin profile to that found in children but with a morning peak that is later by an hour (at 6-7 am rather than at 5-6 am).

Papa G.,Centro Catanese Of Medicina E Chirurgia | Degano C.,Centro Catanese Of Medicina E Chirurgia | Iurato P.,Centro Catanese Of Medicina E Chirurgia | Licciardello C.,Centro Catanese Of Medicina E Chirurgia | And 2 more authors.
Giornale Italiano di Diabetologia e Metabolismo | Year: 2011

Aim. This 24-week randomised, open-label, parallel-group trial compared efficacy (with glycaemic variability) and safety (with body weight) following supplementation of oral glucose-lowering drugs with basal insulin analogues detemir and glargine in type 2 patients. Patients and methods. Insulin-naive type 2 diabetics (n = 70, HbA 1c 10.4 ± 1.6%, BMI 31.3 ± 5.6) current oral antidiabetic drugs regimen with poor glycaemic control were randomized 1:1 to receive insulin detemir or glargine once daily (evening) actively titrated to target fasting plasma glucose < 126 mg/dl. All patients continued metformin (at pre-study dosage until a max of 3000 mg/die); secretagogues were replaced by repaglinide (± acarbose) (titrated to target post-prandial glucose < 160 mg/dl, until a max dosage of 6 mg/die for repaglinide and 300 mg/die for acarbose). Results. The reduction in HbA 1c from baseline to study end was 2.9% and 2.7% (mean between-group difference 0.26%, p = ns) and that in FPG (fasting plasma glucose) was -97 ± 68.3 and -78.3 ± 66.7 mg/dl (mean between-group difference 21.9 mg/dl, p = ns) with detemir and glargine, respectively. Overall, 58 and 32% of participants achieved HbA 1c ≤ 7.5 and ≤ 7.0% with detemir and 50 and 25% with glargine (difference betweengroup not significant); values of HBGI (hyperglycaemic risk) and DS (glycaemic variability) was similar at study end between two groups. Overall, during the 24-week observation period, hypoglycaemic episodes were comparable between groups (4.1 vs 4.9 per patient-year with glargine and detemir, p = ns). No significant differences in LBGI were relieved between groups. Modest weight gain was seen with glargine (0.3 ± 4.4 kg), instead a little reduction in weight was relieved with detemir (-0.8 ± 3.5 kg) (no significant difference between groups, p = ns). Mean daily insulin dose was slightly higher with detemir (0.20 U/kg) than glargine (0.17 U/kg) (p = ns). Conclusions. Supplementation of oral agents (repaglinide + metformin in this study) with detemir or glargine achieves significant improvements in glycaemic control with low risk of hypoglycaemia; weight gain was reduced with detemir (even a modest weight loss was seen in this study) with a slightly higher insulin dose.

Papa G.,Centro Catanese Of Medicina E Chirurgia | Maiorana R.,Centro Catanese Of Medicina E Chirurgia | Licciardello C.,Centro Catanese Of Medicina E Chirurgia | Degano C.,Centro Catanese Of Medicina E Chirurgia | And 3 more authors.
Giornale Italiano di Diabetologia e Metabolismo | Year: 2011

Background and aim. Diabetic foot ulcers are a notable cause of morbidity and mortality. They can be roughly subdivided into cases of simple neuropathic ulcers and ischemic or neuroischemic ulcers if there is a peripheral vascular disease (PVD) in addition to the (almost always present) peripheral neuropathy. Aim of this study was to evaluate anthropometric, laboratory and clinical parameters and prevalence of micro- and macrovascular complications in diabetic patients with neuropathic or neuroischemic ulcers. Methods. 112 patients with ulceration of the lower limbs admitted to our ward between 01/01/2009 and 31/12/2009 were studied. Regardless of whether there was infection present and of the depth of the wound, the patients were classified as having either neuropathic or neuroischemic ulcers after neurological and vascular examinations. The entire group was screened for micro- and macrovascular complications. Results. 53 patients were diagnosed with "simple" neuropathic ulcers (47.3%) (group N) while the remaining 59 (52.7%) were diagnosed with ischemic or neuroischemic ulcers (group I). Patients in group I were significantly older than those in group N (71.9 vs 64.4 years, p ≤ 0.0001), had a longer duration of diabetes (21.1 vs 14.9 years, p = 0.0004). With regards to anthropometric data, the weight and BMI of group I were significantly lower (74.7 vs 87.6 kg and 29.3 vs 34.6 kg/m2, p = 0.004 and p = 0.0002 respectively) as were the WC (waist circumference) measurements (100.8 vs 110.3 cm, p = 0.004). Glycaemic control of group N was significantly worse than that of group I (HbA1c 8.6 vs 7.9%). We did not find significant differences in the prevalence of retinopathy (64.2% in the group N and 67.9% in the group I, p = ns); about nefropathy, we did not find differences between the two groups when patients were divided for AER/24 h, however present for eGFR values (p = 0.003). We did however encounter a highly significant difference between the two groups when we examined for the presence of macrovascular complications, indeed of the 53 patients with neuropathic ulcers 81% did not have vascular pathologies, 11.3% had myocardial ischemia or a history of myocardial infarction, 5.7% had previous transient ischemic attack/stroke or carotid stenosis and only1.9% had polyvascular atherosclerotic disease. Conversely of the 59 patients in group I, 35.6% had only a PVD whilst the remaining 64.4% had polyvascular atherosclerotic disease. Conclusions. Unlike simple neuropathic ulcers, ischemic/neuroischemic ulcers are frequently linked to polyvascular atherosclerotic disease. These latter thus require careful macrovascular evaluation of the patient and an aggressive treatment of all risk factors, as such patients are at extremely high risk for cardiovascular events.

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