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

Free triiodothyronine is assciated with smoking habit, independently of obesity, body fat distribution, insulin, and metabolic parameters METABOLIC PARAMETERS

OBJECTIVE: To examine whether obesity, body fat distribution and insulin resistance have an independent effect on serum TSH and free thyroid hormones (FT3 and FT4) in a cohort of euthyroid women, represented by overweight and obese patients. DESIGN AND PATIENTS: A total of 201 women, aged 18-68 years, with body mass index (BMI) > or = 25.0 kg/m(2) and TSH levels < 4.0 mU/l were investigated. MEASUREMENTS: Fasting TSH, FT3, FT4, insulin, glucose, and serum lipid concentrations, and the level of insulin resistance, estimated by the homeostasis model assessment for insulin resistance (HOMA-IR). Waist circumference was measured as an indirect parameter of central fat accumulation. RESULTS: FT3 was directly associated with BMI (P < 0.01) and waist circumference (P < 0.01), and negatively correlated with age (P < 0.001). FT4 was negatively associated with HOMA-IR (P < 0.05) and fasting insulin levels (P < 0.05). TSH was positively correlated with waist circumference (P < 0.05) and negatively associated with age (P < 0.05). When multiple regression analysis was performed with FT3 as the dependent variable, and waist circumference, HOMA-IR, blood pressure levels and serum lipid concentrations as independent variables, FT3 maintained an independent association only with waist circumference (positive, P < 0.05) and age (negative, P < 0.001). When multiple regression analysis was performed with TSH as the dependent variable, and the above parameters as independent variables, TSH maintained an independent association only with waist circumference (positive, P < 0.05) and age (negative, P < 0.05). By contrast, when multiple regression analysis was performed with FT4 as the dependent variable, FT4 did not maintain an independent association with any of the independent parameters. CONCLUSIONS: Progressive central fat accumulation is associated with an increase in both FT3 and TSH serum levels, independently of insulin sensitivity, metabolic parameters and blood pressure. These results suggest that (1) progressive central fat accumulation is associated with a parallel increase in FT3 levels, possibly as an adaptive thermogenic phenomenon, and (2) the control of TSH secretion by free thyroid hormones is possibly impaired in obesity

Higher Waist Circumference, Fasting Hyperinsulinemia And Insulin Resistance Characterize Hypertensive Patients With Impaired Glucose Metabolism

Hypertensive patients are at higher risk of pre-diabetes (impaired fasting glucose IFG and impaired glucose tolerance IGT) and type 2 DM. This study was done to examine whether some general, anthropometric, hormone, and metabolic parameters are different between subjects with normal and impaired glucose metabolism (IGM) in hypertensive subjects, thus possibly identifying some variable characterizing glucose metabolism derangement in these patients. A cohort of 134 hypertensive patients, 55 women and 79 men, aged 37-70 years, were examined. IGM patients were considered those showing IFG and/or IGT or type 2 DM after an oral glucose tolerance test (OGTT), and/or HbA1c &gt; 48 mmol/l (6.5%) and/or glucose levels &gt;155 mg/dL after 1 hour of the OGTT. Body mass index (BMI), waist circumference, and fasting insulin, TSH, FT3, FT4, glucose, and lipid (cholesterol, HDL-cholesterol and triglycerides) plasma concentrations were measured. Insulin resistance was also assessed by the homeostasis model assessment (HOMAIR). Results: Waist circumference (p &lt; 0.05), fasting glucose (p &lt; 0.05) and insulin levels (p &lt; 0.05) and HOMAIR (p &lt; 0.05) were significantly higher in patients with IGM than in control group. All other investigated parameters, as well as the number of antihypertensive drugs per single patient, were not different between the two groups. Conclusions: The present study, performed in a selected population of hypertensive subjects, shows that derangement of glucose metabolism is associated to central fat accumulation, hyperinsulinemia and insulin resistance

Efficacy and Safety of Everolimus in Extrapancreatic Neuroendocrine Tumor: A Comprehensive Review of Literature

Everolimus, an oral mTOR (mammalian target of rapamycin) inhibitor, is currently approved for the treatment of progressive pancreatic neuroendocrine tumors (NETs). Although promising, only scattered data, often from nondedicated studies, are available for extrapancreatic NETs