Correlates of calcaneal quantitative ultrasound parameters in patients with diabetes: the study on the assessment of determinants of muscle and bone strength abnormalities in diabetes

OBJECTIVE: Quantitative ultrasound (QUS) provides an estimate of bone mineral density (BMD) and also evaluates bone quality, which has been related to increased fracture risk in people with diabetes. This study aimed at assessing the correlates of calcaneal QUS parameters in diabetic subjects encompassing various degrees of micro and macrovascular complications and a wide-range of peripheral nerve function. METHODS: Four hundred consecutive diabetic patients were examined by QUS to obtain values of broadband ultrasound attenuation (BUA), the speed of sound (SOS), quantitative ultrasound index (QUI), and BMD. RESULTS: Among surrogate measures of complications, sensory and motor nerve amplitude and heart rate response to cough test and standing correlated with QUS parameters at univariate analysis, together with age, body mass index (BMI), waist circumference, lipid profile, and renal function. Multivariate analysis revealed that BUA, SOS, QUI, and BMD were independently associated with age, male gender, hemoglobin A1c, BMI (or fat, but not fat-free mass), and somatic and autonomic nerve function parameters. CONCLUSIONS: These data indicate that peripheral nerve dysfunction is associated with worse QUS parameters, possibly contributing to increased fracture risk in diabetes. The positive relation of QUS measures with adiposity needs further investigation. This trial is registered with ClinicalTrials.gov (NCT01600924)

Level and correlates of physical activity and sedentary behavior in patients with type 2 diabetes: a cross-sectional analysis of the italian diabetes and exercise study-2

OBJECTIVE: Patients with type 2 diabetes usually show reduced physical activity (PA) and increased sedentary (SED)-time, though to a varying extent, especially for low-intensity PA (LPA), a major determinant of daily energy expenditure that is not accurately captured by questionnaires. This study assessed the level and correlates of PA and SED-time in patients from the Italian Diabetes and Exercise Study_2 (IDES_2). METHODS: Three-hundred physically inactive and sedentary patients with type 2 diabetes were enrolled in the IDES_2 to be randomized to an intervention group, receiving theoretical and practical exercise counseling, and a control group, receiving standard care. At baseline, LPA, moderate-to-vigorous-intensity PA (MVPA), and SED-time were measured by accelerometer. Physical fitness and cardiovascular risk factors and scores were also assessed. RESULTS: LPA was 3.93±1.35 hours∙day-1, MVPA was 12.4±4.6 min∙day-1, and SED-time was 11.6±1.2 hours∙day-1, with a large range of values (0.89-7.11 hours∙day-1, 0.6-21.0 min∙day-1, and 9.14-15.28 hours∙day-1, respectively). At bivariate analysis, LPA and MVPA correlated with better cardiovascular risk profile and fitness parameters, whereas the opposite was observed for SED-time. Likewise, values of LPA, MVPA, and SED-time falling in the best tertile were associated with optimal or acceptable levels of cardiovascular risk factors and scores. At multivariate analysis, age, female gender, HbA1c, BMI or waist circumference, and high-sensitivity C reactive protein (for LPA and SED-time only) were negatively associated with LPA and MPA and positively associated with SED-time in an independent manner. CONCLUSIONS: Physically inactive and sedentary patients with type 2 diabetes from the IDES_2 show a low level of PA, though values of LPA, MVPA, and SED-time vary largely. Furthermore, there is a strong correlation of these measures with glycemic control, adiposity and inflammation, thus suggesting that even small improvements in LPA, MVPA, and SED-time might be associated with significant improvement in cardiovascular risk profile

Sustained increase in physical fitness independently predicts improvements in cardiometabolic risk profile in type 2 diabetes

Aims: To investigate the relationship between changes in physical fitness and cardiovascular risk factors and scores in patients with type 2 diabetes receiving either a behavioural counselling intervention to increase moderate-to-vigorous-intensity physical activity (MVPA) and decrease sedentary-time (SED-time) or standard care. Materials and methods: This is a pre-specified ancillary analysis of the Italian Diabetes and Exercise Study_2, a 3-year randomized clinical trial in which 300 physically inactive and sedentary patients were randomized 1:1 to receive either a one-month theoretical and practical counselling each year or standard care. Mean changes from baseline throughout the 3-year period in MVPA, SED-time, cardiorespiratory fitness (VO2max ), muscle strength, flexibility, cardiovascular risk factors and scores were calculated for study completers (n = 267) and considered irrespective of study arm. Results: Haemoglobin (Hb) A1c and coronary heart disease (CHD) risk scores decreased with quartiles of VO2max and lower body muscle strength changes. Multivariable linear regression analysis showed that increases in VO2max independently predicted decreases in HbA1c , blood glucose, diastolic blood pressure (BP), CHD and total stroke 10-year risk and increases in HDL cholesterol, whereas increases in lower body muscle strength independently predicted decreases in body mass index (BMI), waist circumference, triglycerides, systolic BP, CHD and fatal stroke 10-year risk. These associations remained after including changes in BMI, waist circumference, fat mass and fat-free mass, or MVPA and SED-time as covariates. Conclusions: Improvement in physical fitness predicts favourable changes in cardiometabolic risk profile, independent of changes not only in (central) adiposity or body composition but also in MVPA and SED-time. Trial registration: ClinicalTrials.gov; NCT01600937; URL https://clinicaltrials.gov/ct2/show/NCT01600937

Can pancreatic cancer be detected by adrenomedullin in patients with new-onset diabetes? The PaCANOD cohort study protocol

Introduction Pancreatic cancer is a leading cause of cancer-related death. Its diagnosis is often delayed and patients are frequently found to have unresectable disease. Patients diagnosed with new-onset diabetes have an 8-fold risk of harboring pancreatic cancer. Adrenomedullin has been claimed to mediate diabetes in pancreatic cancer. New screening tools are needed to develop an early diagnosis protocol. Methods Patients aged 45-75 years within 2 years of first fulfilling the ADA criteria for diabetes will be prospectively enrolled in this study. Sepsis, renal failure, microangiopathy, pregnancy, acute heart failure and previous malignancies will be considered as exclusion criteria. Results 440 patients diagnosed with new-onset diabetes will be enrolled and divided into 2 groups: one with high adrenomedullin levels and one with low adrenomedullin levels. Patients will undergo 3 years' follow-up to detect pancreatic cancer development. Conclusions Identifying a marker for pancreatic cancer among high-risk patients such as new-onset diabetics might lead to the identification of a subpopulation needing to be screened in order to enable early diagnosis and treatment of a highly lethal tumor. Trial registration This trial was registered at ClinicalTrials.gov on May 25, 2015 under registration number NCT02456051

Can pancreatic cancer be detected by adrenomedullin in patients with new-onset diabetes? The PaCANOD cohort study protocol

Introduction Pancreatic cancer is a leading cause of cancer-related death. Its diagnosis is often delayed and patients are frequently found to have unresectable disease. Patients diagnosed with new-onset diabetes have an 8-fold risk of harboring pancreatic cancer. Adrenomedullin has been claimed to mediate diabetes in pancreatic cancer. New screening tools are needed to develop an early diagnosis protocol. Methods Patients aged 45-75 years within 2 years of first fulfilling the ADA criteria for diabetes will be prospectively enrolled in this study. Sepsis, renal failure, microangiopathy, pregnancy, acute heart failure and previous malignancies will be considered as exclusion criteria. Results 440 patients diagnosed with new-onset diabetes will be enrolled and divided into 2 groups: one with high adrenomedullin levels and one with low adrenomedullin levels. Patients will undergo 3 years' follow-up to detect pancreatic cancer development. Conclusions Identifying a marker for pancreatic cancer among high-risk patients such as new-onset diabetics might lead to the identification of a subpopulation needing to be screened in order to enable early diagnosis and treatment of a highly lethal tumor. Trial registration This trial was registered at ClinicalTrials.gov on May 25, 2015 under registration number NCT02456051

Metastases from renal cell cancer to the thyroid gland. a systematic review of 175 cases between 1964 and 2016

Abstract \u2013 Background: Renal Cell Cancer (RCC) is the most common extra-thyroid cancer metastasizing to the thyroid gland and has been responsible for 48.1% metastases of Non-Thyroid Malignancies (NTMs) to the thyroid in the past decade. Metastases to the thyroid gland have been reported in 1.4%-3% of patients undergoing thyroid surgery for thyroid malignancies. We systematically reviewed the literature from 1964 to 2016 and herein present our experience. Patients and Methods: The research was systematically performed on Pubmed, EMbase and Cochrane Library databases by entering the strings: \u201crenal carcinoma AND thyroid metastasis\u201d or \u201crenal carcinoma AND thyroid metastases\u201d or \u201chypernephroma AND thyroid metastasis (or metastases)\u201d. Results: 175 cases were retrieved and 90 were included in the study since they fulfilled the inclusion criteria by reporting gender, age, latency of metastases presentation after nephrectomy, jugular vein infiltration and other sites of metastasis (when applicable). The mean age of thyroid metastases presentation is 64.4 years and the mean latency after a nephrectomy is 9.1 years (range 0-24). Fine needle aspiration biopsy (FNAB) failed to provide the correct diagnosis in 28.7% of patients with thyroid metastases from RCC. Conclusions: Given the long latency, RCC follow-up program should be longer than recommended at present and implemented with an ultrasound scan of the neck

Metastases from renal cell cancer to the thyroid gland. a systematic review of 175 cases between 1964 and 2016

Abstract – Background: Renal Cell Cancer (RCC) is the most common extra-thyroid cancer metastasizing to the thyroid gland and has been responsible for 48.1% metastases of Non-Thyroid Malignancies (NTMs) to the thyroid in the past decade. Metastases to the thyroid gland have been reported in 1.4%-3% of patients undergoing thyroid surgery for thyroid malignancies. We systematically reviewed the literature from 1964 to 2016 and herein present our experience. Patients and Methods: The research was systematically performed on Pubmed, EMbase and Cochrane Library databases by entering the strings: “renal carcinoma AND thyroid metastasis” or “renal carcinoma AND thyroid metastases” or “hypernephroma AND thyroid metastasis (or metastases)”. Results: 175 cases were retrieved and 90 were included in the study since they fulfilled the inclusion criteria by reporting gender, age, latency of metastases presentation after nephrectomy, jugular vein infiltration and other sites of metastasis (when applicable). The mean age of thyroid metastases presentation is 64.4 years and the mean latency after a nephrectomy is 9.1 years (range 0-24). Fine needle aspiration biopsy (FNAB) failed to provide the correct diagnosis in 28.7% of patients with thyroid metastases from RCC. Conclusions: Given the long latency, RCC follow-up program should be longer than recommended at present and implemented with an ultrasound scan of the neck

Abnormalities of retinal ganglion cell complex at optical coherence tomography in patients with type 2 diabetes: a sign of diabetic polyneuropathy, not retinopathy

Aims: To compare optical coherence tomography (OCT)-derived neuro-retinal parameters in patients with type 2 diabetes and non-diabetic controls and to evaluate their correlation with diabetic retinopathy (DR) and polyneuropathy (DPN). Methods: One-hundred consecutive patients with type 2 diabetes were examined by spectral–domain (SD) OCT for evaluating ganglion cell complex (GCC) and retinal nerve fibre layer (RNFL) thickness and two new pattern-based quantitative measures of GCC damage, global and focal loss volume (GLV and FLV). Fifty sexand age-matched non-diabetic subjects served as control. Results: RNFL thickness (101.0 ± 10.6 vs. 106.4 ± 10.3 μm, P = 0.003) was significantly lower and GLV (6.58 ± 4.98 vs. 4.52 ± 3.10 %, P = 0.008) and FLV (1.90 ± 1.97 vs. 0.89 ± 0.84 %, P b 0.0001) were significantly higher in diabetic versus control subjects. The OCT parameters did not differ significantly according to DR grade. Conversely, RNFL thickness was lower and GLV and FLV were higher in patients with versus those without DPN, and the extent of changes increased significantly with quartiles of DPN score. At both bivariate and multivariate analysis, OCT parameters, especially FLV, correlated significantly with DPN measures. Conclusions: The GCC is significantly affected in patients with type 2 diabetes and SD-OCT might represent a useful tool to detect DPN, but not DR in these individuals

Sustained decreases in sedentary time and increases in physical activity are associated with preservation of estimated β-cell function in individuals with type 2 diabetes

Aims: In the Italian Diabetes and Exercise Study_2, a counselling intervention produced modest but sustained increments in moderate-to vigorous-intensity physical activity (MVPA), with reallocation of sedentary-time (SED-time) to light-intensity physical activity (LPA). This post hoc analysis evaluated the impact of intervention on estimated β-cell function and insulin sensitivity. Methods: Patients with type 2 diabetes were randomized to one-month counselling once-a-year or standard care for 3 years. The HOmeostatic Model Assessment-2 (HOMA-2) method was used for estimating indices of β-cell function (HOMA-B%), insulin sensitivity (HOMA-S%), and insulin resistance (HOMA-IR); the disposition index (DI) was estimated as HOMA-β%/HOMA-IR; MVPA, LPA, and SED-time were objectively measured by accelerometer. Results: HOMA-B% and DI decreased in control group, whereas HOMA-B% remained stable and DI increased in intervention group. Between-group differences were significant for almost all insulin secretion and sensitivity indices. Changes in HOMA-B% and DI correlated with SED-time, MVPA and LPA. Changes in HOMA-B%, DI, and all indices were independently predicted by changes in SED-time (or LPA), MVPA, and BMI (or waist circumference), respectively. Conclusions: In individuals with type 2 diabetes, increasing MVPA, even without achieving the recommended target, is effective in maintaining estimated β-cell function if sufficient amounts of SED-time are reallocated to LPA

Volume-dependent effect of supervised exercise training on fatty liver and visceral adiposity index in subjects with type 2 diabetes The Italian Diabetes Exercise Study (IDES)

Aims: This study evaluated the effect of supervised exercise training on liver enzymes and two surrogate measures of non-alcoholic fatty liver disease (NAFLD) in subjects with type 2 diabetes. Methods: Sedentary patients from 22 outpatient diabetes clinics were randomized by center, age and treatment to twice-a-week supervised aerobic and resistance training plus structured exercise counseling (exercise group, EXE; n=. 303) versus counseling alone (control group, CON; n=. 303) for 12 months. EXE participants were further randomized to low-to-moderate (. n=. 142) or moderate-to-high (. n=. 161) intensity training of equal energy cost. Baseline and end-of-study levels of liver enzymes, fatty liver index (FLI) and visceral adiposity index (VAI) were obtained. Results: Enzyme levels did not change, whereas FLI and VAI decreased significantly in EXE, but not CON participants. Physical activity (PA) volume was an independent predictor of both FLI and VAI reductions, the extent of which increased from the 1st to the 4th quintile of PA volume and baseline to end-of-study changes in fitness parameters. Differences in the effect of LI versus HI training were negligible. Conclusions: Data from this large cohort of subjects with type 2 diabetes indicate that FLI and VAI decrease with supervised training in a volume-dependent manner