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Milano, Italy

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 | Valentini U.,U.O. Diabetologia | Di Bartolo P.,U.O. 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.

Sacchi L.,University of Pavia | D'Ancona G.,Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT | Bertuzzi F.,SSD Diabetologia | Bellazzi R.,University of Pavia
Studies in Health Technology and Informatics | Year: 2010

Blood Glucose (BG) analysis and control in critically ill patients became an important research challenge in the last few years. Despite the big improvements that have been achieved both in research and in clinical practice, there are still many aspects that need to be elucidated. A first step towards a better comprehension of the phenomena underlying BG dynamics is represented by the study of retrospectively collected data. In this paper we propose an analysis of blood glucose time series through a combined temporal clustering and standard statistical analysis approach. The ultimate goal of the analysis is the identification of groups of patients showing different BG dynamics and evaluate their risk profiles, which is a very important issue in the Intensive Care Units. The method is applied to a set of patients treated at the Mediterranean Institute for Transplantation and Advanced Specialized Therapies in Palermo, Italy. We show that it is possible to identify two groups based on the initial blood glucose trends, and that the two groups significantly differ in terms of their future BG behaviour. © 2010 IMIA and SAHIA. All rights reserved.

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.

Russo L.,Laboratory of Mendelian Diabetes | Marsella C.,Laboratory of Mendelian Diabetes | Nardo G.,Mario Negri Institute for Pharmacological Research | Massignan T.,Mario Negri Institute for Pharmacological Research | And 8 more authors.
Acta Diabetologica | Year: 2013

Transglutaminase 2 (TG2) is a multifunctional protein with Ca 2+-dependent transamidating and G protein activity. Previously, we reported that tgm2 -/- mice have an impaired insulin secretion and that naturally occurring TG2 mutations associated with familial, early-onset type 2 diabetes, show a defective transamidating activity. Aim of this study was to get a better insight into the role of TG2 in insulin secretion by identifying substrates of TG2 transamidating activity in the pancreatic beta cell line INS-1E. To this end, we labeled INS-1E that are capable of secreting insulin upon glucose stimulation in the physiologic range, with an artificial acyl acceptor (biotinamido-pentylamine) or donor (biotinylated peptide), in basal condition and after stimulus with glucose for 2, 5, and 8 min. Biotinylated proteins were analyzed by two-dimensional electrophoresis and mass spectrometry. In addition, subcellular localization of TG2 in human endocrine pancreas was studied by electron microscopy. Among several TG2's transamidating substrates in INS-1E, mass spectrometry identified cytoplasmic actin (a result confirmed in human pancreatic islet), tropomyosin, and molecules that participate in insulin granule structure (e.g., GAPDH), glucose metabolism, or [Ca2+] sensing (e.g., calreticulin). Physical interaction between TG2 and cytoplasmic actin during glucose-stimulated first-phase insulin secretion was confirmed by co-immunoprecipitation. Electron microscopy revealed that TG2 is localized close to insulin and glucagon granules in human pancreatic islet. We propose that TG2's role in insulin secretion may involve cytoplasmic actin remodeling and may have a regulative action on other proteins during granule movement. A similar role of TG2 in glucagon secretion is also suggested. © 2012 Springer-Verlag.

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