Diabetic Unit

Brescia, Italy

Diabetic Unit

Brescia, Italy
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PubMed | Fondazione Salvatore Maugeri Instituto Of Ricovero E Cura A Carattere Scientifico, Diabetic Unit and Endocrine and Metabolic Unit
Type: Journal Article | Journal: Hormones (Athens, Greece) | Year: 2014

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.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 TSH-suppression and in 31 control patients with SHT.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 TSH.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.


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.


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.


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.


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).

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