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Brescia, Italy

Corrado F.,Messina University | Pintaudi B.,Diabetic Unit | D'Anna R.,Messina University | Santamaria A.,Messina University | And 2 more authors.
Diabetes and Metabolism | Year: 2015

Aim: Our objective was to compare, in a Caucasian population, the perinatal outcomes of pregnancies complicated by pregestational diabetes diagnosed in the first-trimester of pregnancy with those of pregnancies complicated by gestational diabetes. Methods: A retrospective evaluation of maternal and neonatal outcomes was performed for all consecutive pregnancies complicated by gestational or pregestational diabetes that happened between 2005 and 2011. Pregestational diabetes was diagnosed for the first time in pregnancy if the first-trimester fasting glycaemia was. ≥. 126. mg/dL. Gestational diabetes was diagnosed according to Carpenter-Coustan criteria until May 2010, and then according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) panel criteria modified by the American Diabetes Association. A specific diet, self-monitoring of blood glucose and, if required, insulin treatment were prescribed. Results: Overall, 411 pregnant women were considered eligible for the study (379 with gestational diabetes and 32 with pregestational diabetes). Women with pregestational vs. gestational diabetes were diagnosed earlier in pregnancy (11.6. ±. 1.0 weeks vs. 25.9. ±. 1.7 weeks; P = 0.0001), had a higher mean first-trimester fasting glycaemic level (129.5. ±. 3.6. mg/dL vs. 81.6. ±. 10.5. mg/dL; P = 0.0001), more often had a family history of diabetes (46.9% vs. 25.9%; P = 0.02) and more often needed insulin treatment (78.1% vs. 14.0%; P = 0.0001). Furthermore, a higher rate of fetal malformations in women with pregestational diabetes was detected (9.4% vs. 1.6%, P = 0.02). No other differences in neonatal outcomes were identified. Conclusion: In a Caucasian population, the prevalence of fetal malformations and insulin requirements with pregestational diabetes first diagnosed in pregnancy were significantly higher compared with women with gestational diabetes. In any case, glucose impairment in pregnancy needs to be diagnosed in a timely fashion and appropriately treated to improve both maternal and fetal outcomes. © 2015 Elsevier Masson SAS. Source


Pirola I.,University of Brescia | Formenti A.M.,University of Brescia | Gandossi E.,University of Brescia | Mittempergher F.,University of Brescia | And 3 more authors.
Obesity Surgery | Year: 2013

Drug malabsorption is a potential concern after bariatric surgery. We present four case reports of hypothyroid patients who were well replaced with thyroxine tablets to euthyroid thyrotropin (TSH) levels prior to Roux-en-Y gastric bypass surgery. These patients developed elevated TSH levels after the surgery, the TSH responded reversibly to switching from treatment with oral tablets to a liquid formulation. © 2013 The Author(s). Source


Semeraro F.,University of Brescia | Parrinello G.,University of Brescia | Cancarini A.,University of Brescia | Pasquini L.,University of Brescia | And 5 more authors.
Journal of Diabetes and its Complications | Year: 2011

Aims: Diabetic retinopathy (DR) is often asymptomatic even in its more advanced stages. Timely and repeated screening for DR avoids a late diagnosis of DR, but the high number of diabetic patients precludes a frequent screening; thus, the need for a method to identify patients at higher risk for DR becomes crucial. Methods: A prospective analysis of 5034 type 2 diabetic patients followed from 1996 to 2007 and not affected by retinopathy at the time of the recruitment was performed. Patients were randomly divided (ratio 2:1) into two groups: the train data set and the test set (3327 and 1707 patients, respectively). Factors associated with the occurrence of DR were assessed by the Cox's proportional hazard model. Results: Duration of diabetes, glycosylated hemoglobin, systolic blood Pressure, male gender, albuminuria and diabetes therapy other than diet were all significantly associated with the occurrence of DR. Conclusions: The nomogram could help in ranking the type 2 diabetic patients at higher risk to develop DR and thus with a need for more frequent ophthalmologic checks, without enhancing neither the time nor the costs. © 2011 Elsevier Inc. Source


Cappelli C.,University of Brescia | Rotondi M.,University of Pavia | Pirola I.,University of Brescia | Agosti B.,Diabetic Unit | And 5 more authors.
Hormones | Year: 2014

Objective: Metformin treatment may induce a decrease/suppression in serum TSH levels, mimicking sub-clinical hyperthyroidism (SHT). The aim of the present study was to retrospectively evaluate changes in several electrocardiographic indices in euthyroid subjects with diabetes who, after starting metformin treatment, developed a low serum TSH as compared to patients with SHT resulting from an underlying thyroid disease or TSH suppressive treatment with L-thyroxine. Design: Heart rate, P wave duration, P wave dispersion, QTmax, QTmin and QT-dispersion were assessed in 23 patients with diabetes treated with metformin before and after 6 months of TS H-suppression and in 31 control patients with SHT. Results: No significant changes in electrocardiographic parameters were observed from baseline to the TSH-suppression measurement. A significant difference in P wave duration (102.9±7.4 vs. 92.1±5.8 ms, p<0.001), P wave dispersion (13.1±3.4 vs. 7.1±3.5 ms, p<0.001), QTmax (399±18 vs. 388±16 ms, p=0.024), QTmin (341±14 vs. 350±17 ms, p=0.038) and QT dispersion (49.9±9.6 vs. 30.9±9.2 ms, p<0.001) were observed between the control group with SHT and the group of diabetic patients with low serum levels of TS H. ConclusIons: Our results show that the TSH-suppressive effect observed in patients taking metformin is not associated with peripheral markers of thyroid hormone excess, at least at the cardiac level. Source


Cappelli C.,University of Brescia | Rotondi M.,University of Pavia | Pirola I.,University of Brescia | Agosti B.,Diabetic Unit | And 6 more authors.
European Journal of Endocrinology | Year: 2012

Objective: A retrospective study to evaluate the changes in TSH concentrations in diabetic patients treated or not treated with metformin and/or L-thyroxine (L-T4). Methods: Three hundred and ninety three euthyroid diabetic patients were divided into three groups on the basis of metformin and/or L-T4 treatment: Group (M-/L-), 119 subjects never treated with metformin and L-T4; Group (M+/L-), 203 subjects who started metformin treatment at recruitment; and Group (M+/L+), 71 patients on L-T4 who started metformin recruitment. Results: The effect of metformin on serum TSH concentrations was analyzed in relation to the basal value of TSH (below 2.5 mIU/l (Q1) or between 2.51 and 4.5 mIU/l (Q2)). In patients of group M+/L+, TSH significantly decreased independently from the basal level (Q1, from 1.45±0.53 to 1.01±1.12 mU/l (P=0.037); Q2, from 3.60±0.53 to 1.91±0.89 mU/l (P<0.0001)). In M+/L- group, the decrease in TSH was significant only in those patients with a basal high-normal serum TSH (Q2: from 3.24±0.51 to 2.27±1.28 mU/l (P=0.004)); in M-/L- patients, no significant changes in TSH levels were observed. In patients of group M+/L- showing high-normal basal TSH levels, a significant decrease in TSH was observed independently from the presence or absence of thyroid peroxidase antibodies (AbTPO; Q2 AbTPOC: from 3.38±0.48 to 1.87±1.08 mU/l (P<0.001); Q2 AbTPO-: from 3.21±0.52 to 2.34±1.31 mU/l (P<0.001)). Conclusions: These data strengthen the known TSH-lowering effect of metformin in diabetic patients on L-T4 treatment and shows a significant reduction of TSH also in euthyroid patients with higher baseline TSH levels independently from the presence of AbTPO. © 2012 European Society of Endocrinology. Source

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