SSD Diabetologia

Milano, Italy

SSD Diabetologia

Milano, Italy

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Vitale M.,University of Naples Federico II | Masulli M.,University of Naples Federico II | Cocozza S.,University of Naples Federico II | Anichini R.,UO di Diabetologia | And 39 more authors.
Nutrition, Metabolism and Cardiovascular Diseases | Year: 2016

Background and aims: Diabetic women have a more adverse plasma lipid profile than men. Sex differences in dietary habits may play a role, but are little investigated. The study evaluates the quality of diet, adherence to the nutritional recommendations of the Diabetes and Nutrition Study Group and their relation with plasma lipid in men and women with diabetes. Methods and results: We studied 2573 people, aged 50-75, enrolled in the TOSCA.IT study (clinicaltrials.gov; NCT00700856). Plasma lipids were measured centrally. Diet was assessed with a semi-quantitative food frequency questionnaire. Women had a more adverse plasma lipid profile than men. Women consumed significantly more legumes, vegetables, fruits, eggs, milk, vegetable oils, and added sugar, whereas men consumed more starchy foods, soft drinks and alcoholic beverages. This stands for a higher proportion (%) of energy intake from saturated fat and added sugar (12.0 ± 2.4 vs 11.5 ± 2.5 and 3.4 ± 3.2 vs 2.3 ± 3.2, P < 0.04), and a higher intake of fiber (11.2 ± 2.8 vs 10.4 ± 2.6 g/1000 Kcal/day) in women. Adherence to the recommendations for saturated fat and fiber consumption was associated with significantly lower LDL-cholesterol regardless of sex. Adherence to the recommendations for added sugars was associated with significantly lower triglycerides and higher HDL-cholesterol in men and women. Conclusions: Men and women with diabetes show significant differences in adherence to nutritional recommendations, but sex differences in plasma lipid profile are unlikely to be explained by nutritional factors. Adherence to the nutritional recommendations is associated with a better plasma lipid profile regardless of sex, thus reinforcing the importance of substituting saturated for unsaturated fat sources, increasing fiber and reducing added sugar intake. © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University.


Cherubini V.,Salesi Hospital | Pintaudi B.,SSD Diabetologia | Iannilli A.,Salesi Hospital | Pambianchi M.,Bartolomeo Eustachio Hospital | And 2 more authors.
Experimental and Clinical Endocrinology and Diabetes | Year: 2015

Background: Growth hormone (GH) secretion is increased in pre-pubertal children with type 1 diabetes and GH excess produces insulin resistance. Early-morning insulinopenia contributes to lower insulin-like growth factor (IGF-I) levels and to GH hypersecretion. Objective: To evaluate differences in GH/IGF-I axis of pre-pubertal children with type 1 diabetes treated with glargine or detemir as long-acting insulin analogues, which was the main outcome measure, and to compare insulin effects in obtaining good metabolic control. Subjects: Children with type 1 diabetes. Methods: This was a 32-week, randomized, open-label, two-period, cross-over comparison between bedtime glargine and twice-daily detemir insulin, involving pre-pubertal children in care at a diabetes pediatric centre. After a 8-week-run-in period subjects were randomized to bedtime glargine or twice-daily detemir insulin administration. After a 12-week period treatments were inverted and continued for additional 12 weeks. Results: Overall, 15 pre-pubertal children (53.3% males, mean age 8.6±1.5 years, duration of diabetes 4.2±1.5 years) completed the study. Groups did not differ for GH/IGF axis and HbA1c levels. Treatment with glargine was associated with lower fasting glucose values than treatment with detemir (8.1±1.5 vs. 8.2±1.7 mmol/L, p=0.01). Incidence rate of hypoglycemia was not different between insulin treatments (IRR=1.18, 95%CI 1.00–1.38; p=0.07). Detemir treatment was associated with a higher increase in body weight (p=0.008) and height (p=0.02) when compared with glargine. Conclusion: Detemir and glargine not show significant differential effects on the GH/IGFI axis. The greater weight gain and height associated with detemir treatment, apparently not related to the level of pubertal growth, deserve further investigation. Copyright © 2015, Georg Thieme Verlag KG. All rights reserved.


PubMed | SSD Diabetologia, Bartolomeo Eustachio Hospital, Salesi Hospital and Center for Outcomes Research and Clinical Epidemiology
Type: Journal Article | Journal: Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association | Year: 2016

Growth hormone (GH) secretion is increased in pre-pubertal children with type 1 diabetes and GH excess produces insulin resistance. Early-morning insulinopenia contributes to lower insulin-like growth factor (IGF-I) levels and to GH hypersecretion.To evaluate differences in GH/IGF-I axis of pre-pubertal children with type 1 diabetes treated with glargine or detemir as long-acting insulin analogues, which was the main outcome measure, and to compare insulin effects in obtaining good metabolic control.Children with type 1 diabetes.This was a 32-week, randomized, open-label, two-period, cross-over comparison between bedtime glargine and twice-daily detemir insulin, involving pre-pubertal children in care at a diabetes pediatric centre. After a 8-week-run-in period subjects were randomized to bedtime glargine or twice-daily detemir insulin administration. After a 12-week period treatments were inverted and continued for additional 12 weeks.Overall, 15 pre-pubertal children (53.3% males, mean age 8.61.5 years, duration of diabetes 4.21.5 years) completed the study. Groups did not differ for GH/IGF axis and HbA1c levels. Treatment with glargine was associated with lower fasting glucose values than treatment with detemir (8.11.5 vs. 8.21.7mmol/L, p=0.01). Incidence rate of hypoglycemia was not different between insulin treatments (IRR=1.18, 95%CI 1.00-1.38; p=0.07). Detemir treatment was associated with a higher increase in body weight (p=0.008) and height (p=0.02) when compared with glargine.Detemir and glargine not show significant differential effects on the GH/IGFI axis. The greater weight gain and height associated with detemir treatment, apparently not related to the level of pubertal growth, deserve further investigation.


Bonomo M.,SSD Diabetologia | Valentini U.,UO Diabetologia | Di Bartolo P.,UO Diabetologia | Corigliano G.,Servizio di Diabetologia AID ASL Naples 1 ANIAD | And 4 more authors.
Giornale Italiano di Diabetologia e Metabolismo | Year: 2012

Type 1 diabetes is commonly considered a contraindication for scuba diving, mainly on account of the risk of hypoglycemia. The Diabete Sommerso (Diabetes Underwater) project was launched in 2004 in Milan. The rationale was that, provided all the necessary safety conditions are satisfied, there are many good reasons for proposing this sport to young people with diabetes mellitus. Our aim was to confirm that, after a thorough, dedicated training program, well-controlled, complication-free diabetic patients can safely dive, without any additional medical and metabolic risks. The project was subsequently extended to others sites in Italy, and between 2004 and 2011 in Numana (AN) and Ravenna, 47 young adults with well-controlled type 1 diabetes obtained their first-level Open Water Diver (OWD) certification. No technical or medical trouble arose during the courses, in either pool or sea dives. This record confirms and reinforces previous reports about safety and well-being for diabetic divers. The training phase seems to offer a further safety feature, especially as regards the prevention of acute metabolic complications, and their management during immersion. As regards long-term effects on metabolic control, as have recently occurred for other "extreme" sports, scuba diving might well have good psychological effects: success in a sport requiring physical efficiency, precision, reliability and self-control in an "alien" environment can be valuable for boosting self-esteem and personal image. This may well also shift the patient's general attitude toward the illness, with encouraging consequences on the clinical course. To respond to coordination and organization requirements, in May 2011 we set up the Diabete Sommerso National As - sociation, with the additional aim of promoting and implement - ing further studies on diabetes and scuba diving. Thanks to close cooperation and the synergy developed with Diabete Italia, and its well-known attention to "all-field" problems of people with diabetes, the project's original mission has been partly modified in recent years, adding new, interesting educational aspects on intensive insulin treatment in particular contexts. This allows the project to be applied in a broader context, as an educational model for conscious self-management of the illness.


Islet transplantation is now a real therapeutic option for selected patients with diabetes mellitus. The common site of transplantation is the liver: the pancreatic islets are transplanted by percutaneous transhepatic injection into the portal vein from which they spread into the liver where they engraft. In the first few days after transplantation the islets suffers an inflammatory reaction that triggers activation of the coagulatory cascade, with a consequent reduction of beta cell viability. Other transplantation sites have been proposed as alternatives to the liver. Clinical trials have been started to study the feasibility of islet transplantation in bone marrow, skeletal muscle and the omentum. Transplanting the islets in one of these sites would avoid the effects of the activation of coagulation. In addition the islets could be monitored better and local immunomodulation or immunosuppression would be possible. In the future other types of beta cells, such as those derived from stem cells, could be transplanted in these sites. © 2016, UTET Periodici Scientifici srl. All rights reserved.


Bonomo M.,SSD Diabetologia
Giornale Italiano di Diabetologia e Metabolismo | Year: 2015

Synthetic glucocorticoids are highly effective anti-inflammatory and immunosuppressive drugs, widely prescribed to treat a variety of acute and chronic illnesses. One of their main side effects, however, is their action on glucose metabolism, resulting in a hyperglycemic and “diabetogenic” effect, mainly due to reduced insulin sensitivity at various levels (liver, muscle, adipose tissue). They also act on the endocrine pancreas, reducing insulin secretion and increasing glucagon, and on the gut-islet axis, interfering with the insulinotropic effect of GLP-1. Almost all the drugs employed for type 2 diabetes mellitus can be used to treat steroid-induced hyperglycemia: secretagogues, such as sulfonyl - ureas and glinides, molecules that boost insulin sensitivity such as metformin and glitazones, insulin and, recently, GLP-1 agonists and oral DPP-4 inhibitors. Insulin remains the first-choice for therapy in most critical situations, with various protocols, and simple algorithms that take into account the pharmacokinetics and pharmacodynamics of glucocorticoids. © 2015, UTET Periodici Scientifici srl. All rights reserved.


Bonomo M.,SSD Diabetologia | Bertuzzi F.,SSD Diabetologia | Disoteo O.,SSD Diabetologia | Mion E.,SSD Diabetologia | Pizzi G.,SSD Diabetologia
Giornale Italiano di Diabetologia e Metabolismo | Year: 2014

In recent years advanced technology has been increasingly used in the care of patients with type 1 diabetes, resulting in significant clinical benefits, but also requiring substantial organizational changes in diabetes centers. Besides the complexity of clinical management of these patients, there are several technical aspects requiring specific experience and expertise that add to the workload for diabetes teams using insulin pumps, sensors, and other recently introduced devices. This has created the need toinvolve different professionals, to complement the medical skills of the diabetes center staff. Hence the idea was born to call in technical staff from companies in the field, setting up a “technical desk” to back up the clinical work, but not overlapping it, in constant contact with the medical and nursing staff. This Desk was activated in 2012 in the diabetes clinic at the Niguarda Ca‘ Granda Hospital in Milan, and since then has steadily developed, with considerable success in terms of interventions, to the satisfaction of patients and the clinic’s specialists. Assessments so far are certainly positive, but it is time to move on from this stage that we still call “experimental”, to clearly define the areas of intervention, and formally recognize this service as part of the assistance provided by the diabetes clinic.

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