Clinical Features, Cardiovascular Risk Profile, and Therapeutic Trajectories of Patients with Type 2 Diabetes Candidate for Oral Semaglutide Therapy in the Italian Specialist Care

Introduction: This study aimed to address therapeutic inertia in the management of type 2 diabetes (T2D) by investigating the potential of early treatment with oral semaglutide. Methods: A cross-sectional survey was conducted between October 2021 and April 2022 among specialists treating individuals with T2D. A scientific committee designed a data collection form covering demographics, cardiovascular risk, glucose control metrics, ongoing therapies, and physician judgments on treatment appropriateness. Participants completed anonymous patient questionnaires reflecting routine clinical encounters. The preferred therapeutic regimen for each patient was also identified. Results: The analysis was conducted on 4449 patients initiating oral semaglutide. The population had a relatively short disease duration (42%  60% of patients, and more often than sitagliptin or empagliflozin. Conclusion: The study supports the potential of early implementation of oral semaglutide as a strategy to overcome therapeutic inertia and enhance T2D management

Cardiovascular risk factors in postmenopausal women: effects of estrogen therapy on glucose and lipid profiles

The menopause is associated with unfavorable changes in the lipid profile as well as in glucose metabolism, which may help to increase the incidence of cardiovascular diseases. The metabolic impact of hormone replacement therapy differs in relation to the dose of the estrogen component, the type of progestin, and the route of administration used. Since most studies analyze the effect of combined estro-progestin therapy, the impact of the estrogen component alone is not always differentiable, however the main results are generally consistent. A review of the recent literature was conducted to analyze the impact of estrogen replacement therapy (ERT) on glucose and lipid metabolism and the differences linked to different doses, associations and routes of administration. Studies were selected on the basis of quality of data and relevance to the present topic. Many studies showed that both oral and transdermal estrogen therapy induced positive effects on glucose metabolism, with minimal changes and differences between treatments. A considerable amount of data documented increases in HDL and decreases in LDL cholesterol. Low-dose estrogen therapy showed no negative effect on triglycerides and a neutral effect on the whole lipid panel. In conclusion, low-dose ERT may prevent the physiological worsening of glucose and lipid metabolism in menopausal women without showing any significant negative effect

Changes in bone mineral density in HIV-positive, virologically suppressed patients switching to lamivudine/dolutegravir dual therapy: preliminary results from clinical practice

Bone toxicity is a well-known side effect of several antiviral agents. In a cohort of virologically suppressed HIV-infected patients, we investigated the effects of a lamivudine/dolutegravir dual therapy on bone mineral density (BMD). We observed a significant improvement in lumbar spine BMD as well as T-score after 12 months of observation with concomitant bisphosphonate therapy independently predicting a greater improvement. These preliminary data show a favorable effect of this 2-drug regimen on bone health

Low levels of 25(OH)D and insulin-resistance: 2 unrelated features or a cause-effect in PCOS?

BACKGROUND & AIMS: Recent investigations have identified low vitamin D status as a hypothetical mechanism of insulin-resistance in Polycystic Ovary Syndrome (PCOS). Instead, some authors supported the hypothesis that low vitamin D levels and insulin-resistance are 2 unrelated features of body size in PCOS. Hence, we aimed to explore the association of 25-hydroxyvitamin D (25(OH)D) with anthropometric, metabolic and hormonal features in PCOS. METHODS: We assessed the association of low 25(OH)D levels with endocrine parameters, insulin-sensitivity evaluated by hyperinsulinemic euglycemic clamp (HEC) and body composition measured by DEXA in 38 women affected by PCOS. RESULTS: Low 25(OH)D (25(OH)D\ua0<\ua050\ua0nmo/L) was detected in 37% of the entire cohort of patients. Body Mass Index (BMI), in particular total fat mass (p\ua0<\ua00.001), resulted to be the most predictor factor of 25(OH)D levels whereas Sex Hormone Binding Globulin (SHBG), Free Androgen Index (FAI), glucose uptake and fat free mass were not. CONCLUSIONS: Our data demonstrated that in PCOS low 25(OH)D levels are significantly determined by the degree of adiposity

A non-invasive prevention program model for the assessment of osteoporosis in the early postmenopausal period: a pilot study on FRAX(®) and QUS tools advantages

The study analyses the performances of FRAX algorithm and quantitative ultrasound (QUS) tool in relationship to the dual-energy X-ray absorptiometry (DXA) categorization to identify patients at risk of osteoporosis during menopause and to reach new thresholds for recommending the first DXA examination

Impact of aromatase inhibitor treatment on vertebral morphology and bone mineral density in postmenopausal women with breast cancer

Objective: The aim of this study was to evaluate the impact of aromatase inhibitor (AI) treatment on vertebral morphology by vertebral fracture assessment in postmenopausal women with early-stage breast cancer. Methods: A clinical cross-sectional study was conducted. A group of 156 postmenopausal women with breast cancer (mean [SD] age, 60.4 [10.1] y; mean [SD] time since menopause, 11.7 [9.2] y) was included in the study. Eighty-two women received AI treatment, whereas 74 women did not. Women underwent extensive medical history check and risk factor assessment together with vertebral morphology and bone mineral density (BMD) evaluation. Results: In the studied population, the prevalence of vertebral fractures identified by vertebral fracture assessment was 16.6%. Multivariate analysis showed that AI treatment was significantly associated with vertebral fractures (adjusted P<0.04). Women receiving AI treatment had a higher prevalence of vertebral fractures than women not treated with AIs (25.6% vs 4%). The risk of vertebral fractures in women treated with AIs was significantly higher than in non-AI-treated women (adjusted odds ratio, 4.7; P<0.005). Vertebral fractures of the highest grade were identified at the lumbar spine. Women treated with AIs had a significantly lower BMD than women not treated with AIs (P<0.01). Reduction of BMD was significantly associated with length of therapy, whereas there was no association between length of treatment and risk of vertebral fractures. Conclusions: AI treatment severely impacts vertebral morphology. Our study demonstrates a high prevalence of asymptomatic vertebral fractures in women treated with AIs

High-normal TSH values in obesity depends on adipose tissue rather than insulin resistance

Clinical evidences reported subclinical alterations of thyroid function in obesity, although the relationship between thyroid status and obesity remains unclear. We cross-sectionally investigated the influence of metabolic features on hypothalamic-pituitary- thyroid axis in obesity. We enrolled 60 euthyroid subjects with no history of type 2 diabetes mellitus and assessed the relationship of thyroid function with insulin-resistance, measured using euglycemic clamp, and abdominal fat volume, quantified by CT-Scan. TSH correlated with BMI (r=0.46;p=0.02), both visceral (r=0.58;p=0.02) and subcutaneous adipose tissue volumes (r=0.43;p=0.03) and insulin-resistance (inverse relationship with insulin-sensitivity - glucose uptake: r=-0.40 p=0.04). After performing multivariate regression, visceral adipose tissue volume was found to be the most powerful predictor of TSH (\u3b2=3.05;p=0.01), whereas glucose uptake, HDL cholesterol, LDL cholesterol, subcutaneous adipose tissue volume and triglycerides were not. To further confirm the hypothesis that high-normal TSH values could be dependent on adipose tissue, and not on insulin-resistance, we restricted our analyses to moderately obese subjects BMI ranging 30-35 kg/ m2. This subgroup was then divided in insulin-resistant and insulinsensitive according to the glucose uptake ( 64 or > 5 mg\ub7kg-1\ub7min-1, respectively). We did not find any statistical difference in TSH (insulin-resistant: 1.62\ub10.65 \u3bcU/mL vs. insulin-sensitive:1.46 \ub1 0.48;p=NS) and BMI (insulin-resistant: 32.2 \ub1 1.6 kg/m2 vs. insulin-sensitive:32.4 \ub1 1.4;p=NS), thus confirming absence of correlation between thyroid function and insulin-sensitivity per se. Our study suggests that the increase in visceral adipose tissue is the best predictor of subclinical thyroid dysfunction in obesity, independently from the eventual concurrent presence of insulin resistance

High-normal TSH values in obesity: is it insulin resistance or adipose tissue's guilt?

Clinical evidences reported subclinical alterations of thyroid function in obesity, although the relationship between thyroid status and obesity remains unclear. We cross-sectionally investigated the influence of metabolic features on hypothalamic-pituitary-thyroid axis in obesity

The treatment of neuroendocrine tumors with long-acting somatostatin analogs: A single center experience with lanreotide autogel

The aim of this retrospective study was to evaluate the efficacy, safety, and tolerability of lanreotide autogel given to metastatic well-differentiated (WD) neuroendocrine tumors (NET) patients observed in our Institute between 2005 and 2008. Patients with metastatic NET referred to our tertiary referral center were given lanreotide autogel 120 mg/month by deep sc injection for a period of at least 24 months. The efficacy was evaluated by the relief of disease symptoms, behavior of tumor markers and response rate in terms of time to tumor progression. Safety and tolerability were evaluated by assessing the onset of adverse events and treatment feasibility. Twenty-three patients (13 males), median age 62 yr (range 32-87) were considered for the study. All patients were affected by WD metastatic NET and had tumor progression in the last 6 months before the enrolment in the study. Median duration of response was 28 months (range 6-50 months). Fourteen patients (60.9%) showed flushing and diarrhea which improved by 85.7% and 55.6%, respectively, bronchoconstrinction and abdominal pain also ameliorated. A complete, partial or no-changed response in the tumor markers behavior was observed, respectively, in 42.9%, 22.9%, and 17.1% of cases. According to RECIST (Response Evaluation Criteria In Solid Tumors) criteria (version 1.1), there were 2 partial regression (8.7%) and 15 stable disease (65.3%); 6 patients (26.0%) progressed. No patient complained from any severe adverse reaction. The results of our study suggest that lanreotide autogel is effective in the symptoms, biochemical markers, and tumor progression control of WD metastatic NET and confirm that the treatment is well tolerated