Diabetes technology and sexual health: which role?

Purpose: The aim of this review is to evaluate the effects of new technology used in the management of diabetes mellitus (DM), including the use of continuous glucose monitoring (CGM) and the administration of insulin through continuous subcutaneous insulin infusion (CSII), on male and female sexual function. Methods: This narrative review was performed for all available prospective, retrospective and review articles, published up to June 2023 in PubMed. Data were extracted from the text and from the tables of the manuscript. Results: Sexual dysfunctions are an underestimated comorbidity of DM in both male and female. Although erectile dysfunction (ED) is recognized by the guidelines as a complication of DM, female sexual dysfunction (FSD) is poorly investigated in clinical setting. In addition to the complications of DM, the different types of therapies can also influence male and female sexual response. Furthermore, insulin therapy can be administered through multiple-daily injections (MDI) or a CSII. The new technologies in the field of DM allow better glycemic control which results in a reduction in the occurrence or aggravation of complications of DM. Despite this evidence, few data are available on the impact of new technologies on sexual dysfunctions. Conclusions: The use of DM technology might affect sexual function due to the risk of a worse body image, as well as discomfort related to CSII disconnection during sexual activity. However, the use is related to an improved metabolic control, which, in the long-term associates to a reduction in all diabetes complications, including sexual function

Comparing continuous and intermittent exercise. An "isoeffort" and "isotime" approach

The present study proposes an alternative way of comparing performance and acute physiological responses to continuous exercise with those of intermittent exercise, ensuring similar between-protocol overall effort (isoeffort) and the same total duration of exercise (isotime). This approach was expected to overcome some drawbacks of traditional methods of comparison. Fourteen competitive cyclists (20±3 yrs) performed a preliminary incremental test and four experimental 30-min self-paced protocols, i.e. one continuous and three passive-recovery intermittent exercise protocols with different workto- rest ratios (2 = 40:20s, 1 = 30:30s and 0.5 = 20:40s). A "maximal session effort" prescription was adopted for this experimental design. As expected, a robust perceived exertion template was observed irrespective of exercise protocol. Similar between-protocol pacing strategies further support the use of the proposed approach in competitive cyclists. Total work, oxygen uptake and heart rate mean values were significantly higher (P<0.05) in the continuous compared to intermittent protocols, while lactate values were lower. Manipulating the work-to-rest ratio in intermittent exercise, total work, oxygen uptake and heart rate mean values decreased with the decrease in the work-to-rest ratio, while lactate values increased. Despite this complex physiological picture, all protocols showed similar ventilatory responses and a nearly perfect relationship between respiratory frequency and perceived exertion. In conclusion, our data indicate that overall effort and total duration of exercise are two critical parameters that should both be controlled when comparing continuous with intermittent exercise. On an isoeffort and isotime basis, the work-to-rest ratio manipulation affects physiological responses in a different way from what has been reported in literature with traditional methods of comparison. Finally, our data suggest that during intermittent exercise respiratory frequency reflects physiological strain better than oxygen uptake, heart rate and blood lactate

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

Effect of a Behavioural Intervention for Adoption and Maintenance of a Physically Active Lifestyle on Psychological Well-Being and Quality of Life in Patients with Type 2 Diabetes: The IDES_2 Randomized Clinical Trial

Background: Psychological well-being and quality of life (QoL) are important outcomes of lifestyle interventions, as a positive impact may favour long-term maintenance of behaviour change. Objective: This study investigated the effect of a behavioural intervention for adopting and maintaining an active lifestyle on psychological well-being and health-related QoL in individuals with type 2 diabetes. Methods: Three hundred physically inactive and sedentary patients were randomized 1:1 to receive 1 month’s theoretical and practical counselling once a year (intervention group, INT) or standard care (control group, CON) for 3 years. Psychological well-being and QoL, assessed using the World Health Organization (WHO)-5 and the 36-Item Short Form (SF-36) questionnaire, respectively, were pre-specified secondary endpoints. The primary endpoint was sustained behaviour change, as assessed by accelerometer-based measurement of physical activity (PA) and sedentary time. Results: WHO-5 and SF-36 physical and mental component summary (PCS and MCS) scores increased progressively in the INT group and decreased in the CON group, resulting in significant between-group differences (WHO-5: mean difference 7.35 (95% confidence interval (CI) 3.15–11.55), P = 0.0007; PCS 4.20 (95% CI 2.25–6.15), P 150 min·wk−1 of moderate-to-vigorous intensity PA versus those who did not (13.06 (95% CI 7.51–18.61), P < 0.0001), whereas no relationship was detected for QoL. Conclusion: A counselling intervention that was effective in promoting a sustained change in PA and sedentary behaviour significantly improved psychological well-being and QoL. Trial Registration: ClinicalTrials.gov; NCT01600937; 10 October 2012

Rationale for the use of metformin and exercise to counteract statin-associated side effects

Introduction: Statins are the most widely prescribed drugs for lowering low-density lipoprotein cholesterol (LDL-C) and reducing cardiovascular morbidity and mortality. They are usually well-tolerated, but have two main safety concerns: statin-associated muscle symptoms (SAMS) and new-onset type 2 diabetes (NOD). Methods: A PubMed search was carried out using the following key words were used: statins, statin-associated muscle symptoms, statin myalgia, statin-associated diabetes, metformin and statins, exercise and statins. Results: Mitochondrial damage and muscle atrophy are likely the central mechanisms producing SAMS, whereas decreased glucose transport, fatty acid oxidation and insulin secretion are likely involved in the development of NOD. Metformin and exercise training share many pathways that could potentially contrast SAMS and NOD. Clinical evidence also supports the combination of statins with metformin and exercise. Conclusion: This combination appears attractive both from a clinical and an economical viewpoint, since all three therapies are highly cost-effective and their combination could result in diabetes and cardiovascular disease prevention

Acute Pancreatitis After a Meatless Burger in Familial Chylomicronemia Syndrome

A 62-year-old woman with familial chylomicronemia syndrome (FCS) resulting from documented lipoprotein lipase deficiency presented with pancreatitis 48 hours after eating a plant-based burger with tomato and lettuce at a local restaurant. She had not previously eaten such a burger. She was diagnosed with FCS at age 12 after experiencing chronic pancreatitis since age 4. At this presentation her triglyceride levels were 1493 mg/dL and her lipase was 510 U/L (normal range 13-60). An abdominal computed tomography (CT) scan confirmed acute pancreatitis

Nationale cultuur en de wereldwijde verspreiding van corporate governancecodes

Hoe komen corporate governancecodes tot stand? Er is niet zoiets als een universele corporate governancecode. Alom wordt het idee gedeeld dat de Angelsaksische praktijk de belangrijkste bron is bij de verspreiding van deze codes. Maar dat betekent niet dat de ‘Britse bron’ klakkeloos wordt gekopieerd. Toch tonen codes wereldwijd opvallende overeenkomsten wat betreft de doelstellingen van corporate governance. Welke dynamiek speelt dus een rol bij de totstandkoming van al die afwijkende codes? Een analyse, gebaseerd op het proefschrift ‘Institutional contextuality of business best practices. The persistent cross-national diversity in the creation of corporate governance codes.

Coronary artery disease with normal lipids and low coronary artery calcium in two women with high lipoprotein(a)

We present 2 patients with elevated levels of lipoprotein (a) and significant coronary artery disease despite having little coronary artery calcification. Clinicians should be aware that patients with elevated lipoprotein (a) may have important coronary artery disease with low coronary artery calcification scores