Prevalence of hepatic steatosis in patients with type 2 diabetes and response to glucose-lowering treatments. A multicenter retrospective study in Italian specialist care

Type 2 diabetes (T2D) is a risk factor for metabolic dysfunction-associated fatty liver disease (MAFLD), which is becoming the commonest cause of chronic liver disease worldwide. We estimated MAFLD prevalence among patients with T2D using the hepatic steatosis index (HSI) and validated it against liver ultrasound. We also examined whether glucose-lowering medications (GLM) beneficially affected HSI

Similar effectiveness of dapagliflozin and GLP-1 receptor agonists concerning combined endpoints in routine clinical practice: A multicentre retrospective study

Aims According to cardiovascular outcome trials, some sodium-glucose contransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) are recommended for secondary cardiovascular prevention in type 2 diabetes (T2D). In this real-world study, we compared the simultaneous reductions in HbA1c, body weight and systolic blood pressure after initiation of dapagliflozin or GLP-1RA as second or a more advanced line of therapy. Materials and methods DARWIN-T2D was a retrospective multi-centre study conducted at diabetes specialist clinics in Italy that compared T2D patients who initiated dapagliflozin or GLP-1RA (exenatide once weekly or liraglutide). Data were collected at baseline and at the first follow-up visit after 3 to 12 months. The primary endpoint was the proportion of patients achieving a simultaneous reduction in HbA1c, body weight and systolic blood pressure. To reduce confounding, we used multivariable adjustment (MVA) or propensity score matching (PSM). Results Totals of 473 patients initiating dapagliflozin and 336 patients initiating GLP-1RA were included. The two groups differed in age, diabetes duration, HbA1c, weight and concomitant medications. The median follow-up was 6 months in both groups. Using MVA or PSM, the primary endpoint was observed in 30% to 32% of patients, with no difference between groups. Simultaneous reduction of HbA1c, BP and SBP by specific threshold, as well as achievement of final goals, did not differ between groups. GLP-1RA reduced HbA1c by 0.3% more than the reduction achieved with dapagliflozin. Conclusion In routine specialist care, initiation of dapagliflozin can be as effective as initiation of a GLP-1RA for attainment of combined risk factor goals

DPP-4 inhibitors and cardiovascular disease in type 2 diabetes mellitus. Expectations, observations and perspectives

Aims: Cardiovascular disease (CVD) is the greatest burden of type 2 diabetes mellitus (T2DM) in terms of morbility, mortality and costs for individuals and societies. Therefore, its prevention is a major goal in diabetes care. Optimal treatment of hyperglycemia is certainly instrumental to CVD prevention. Optimal treatment means both establishing the most appropriate glycemic target for the given individual and selecting the medication(s) with the most favourable benefit/safety ratio. CVD safety, if not a clear CVD benefit, is certainly required for all antidiabetic agents.Dipeptidyl-peptidase-4 (DPP-4) inhibitors are among the classes of antidiabetic agents most recently made available for diabetes care. A major question to be addressed is the effect of these compounds on CVD. Expectations were high for their mechanism of action, which targets also post-prandial glucose and minimize hypoglycemia risk, thereby providing a sort of global glucose control, and for some potentially beneficial extra-glycemic effects. This article reviews the existing literature on this issue.Data synthesis: Data published so far document that DPP-4 inhibitors have a wide spectrum of glycemic and extra-glycemic effects potentially reducing the risk of CVD as well as favourable effects on intermediate or surrogate CVD endpoints. These data heralded a better CVD outcome. Accordingly, pooling CVD safety data from phase 3 and 4 studies conducted with DPP-4 inhibitors suggested that their use might translate into a better CVD outcome. Data from three CVD outcome RCTs with alogliptin, saxagliptin and sitagliptin documented no harm but did not show any benefit on major CVD events. A modest but significant increased risk of hospitalization for heart failure was observed with saxagliptin and with alogliptin (only in subjects with no history of heart failure before randomization) but not with sitagliptin. A study currently in progress with linagliptin will provide further insights in the issue of CVD safety and benefit.Conclusions: It should be considered that most alternative oral antidiabetic agents generally do not possess a better CVD risk profile than DPP-4 inhibitors and that some of them, indeed, should be used with caution because of potentially adverse effects on heart and vasculature. Overall, the selection of antidiabetic agent(s) with the most favourable CVD profile is mandatory but still challenging in diabetes care. (C) 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved

Petrogenesis of calc-alkaline and shoshonitic post-collisional Oligocene volcanics of the Cover Series of the Sesia Zone, Western Italian Alps

High-K calc-alkaline and shoshonitic Oligocene volcanics of the Cover Series of the Sesia Zone occur within a volcano-sedimentary unit located in the internal part of the Sesia Zone in proximity of the Canavese Line. High-K calc-alkaline rocks are basaltic andesites to andesites (K2O from 2.0 to 2.6 wt%) with high alumina contents (19.2-20.3 wt% for basaltic andesites). These rocks are enriched in incompatible trace elements of low ionic potential (with Ba ranging from 920 to 1320 ppm, Rb/Sr = 0.11-0.17). High-field-strength elements (HFSE) are within the typical range of orogenic andesites, with Zr ranging from 150 to 180 ppm. Rare Earth Element patterns for high-K intermediate rocks are enriched in LREE (La/Yb ranging 15.2-16.0) and show a small Eu negative anomaly. Shoshonitic rocks are trachyandesites to trachydacites, with K2O ranging from 4.6 to 5.5 wt%. Alumina contents are lower than those of the high-K calc-alkaline rocks ranging from 14.8 to 16.8 wt%. When compared to calc-alkaline andesites,shoshonitic rocks show higher contents in incompatible elements (with Ba higher than 2500 ppm; Rb/Sr = 0.30-0.35; La/Yb = 26.2-28.8; Zr = 380-450 ppm). Thermobarometric data indicate that andesitic s.l. lavas of the Cover Series of the Sesia Zone started to crystallize their phenocrystic phases at pressures between 3.6-4.8 kbar, for temperatures ranging from 1,080 to 1,150 °C, for water contents of at least 2-2.7 wt%. Shoshonitic lavas crystallized at 2-2.6 kbar for temperatures of about 900 °C, and approaching water-saturated conditions. REE patterns and spiderdiagrams, together with Pearce element ratios, indicate comagmatism between the lavas and the rocks of the Valle del Cervo Pluton. In particular there is a close genetic link between the shoshonitic and the high-K calc-alkaline volcanic rocks. Geochemical modelling shows that both suites may derive from a common “parental calc-alkaline basalt” with variable enrichments in terms of incompatible elements and transition metals. This basalt has suffered a different degree of fractionation in the genesis of balsaltic andesites (with F = 0.29) and monzonites of the Valle del Cervo Pluton (F= 0.19). High-K calc-alkaline andesites may be obtained by fractional crystallization of basaltic andesites, whereas shoshonitic lavas result from fractional crystallization of a monzonitic parent. This suggests that these lavas represent a differentiated top of a magma chamber, whose remnants are now represented by the Valle del Cervo Pluton. This is also supported by comparison of the Sr-Nd isotopic signatures of both intrusive and volcanic rock suites (the latter ranging from 0.7094 to 0.71175 in measured 87Sr/86Sr, and 0.51120-0.51228 in measured 143Nd/144Nd). Calculated isotopic parameters(αSm/Nd= 0.46-0.52,δSm/Nd= 0.23 to 0.26 calculated at 2 b.y., and present εNd = –7 to –8.5) indicate that parental basaltic magmas to the high-K calc-alkaline and shoshonitic rocks were derived by low degree of partial melting (5-7%) of a moderately enriched “eclogitic” metasomatised mantle-source (i.e., garnet pyroxenite). This is consistent with the presence of ultrapotassic dykes in this sector of Western Alps (showing high values in radiogenic Sr-Nd isotope ratios). Finally, we point out that the effusive and intrusive rocks of the investigated area represent a volcano-plutonic complex within the “Tertiary Periadriatic Province”

Space- and Ground-Based Geophysical Data Tracking of Magma Migration in Shallow Feeding System of Mount Etna Volcano

After a month-long increase in activity at the summit craters, on 24 December 2018, the Etna volcano experienced a short-lived lateral effusive event followed by a rapid resumption of low-level explosive and degassing activity at the summit vents. By combining space (Moderate Resolution Imaging Spectroradiometer; MODIS and SENTINEL-2 images) and ground-based geophysical data, we track, in near real-time, the thermal, seismic and infrasonic changes associated with Etna’s activity during the September−December 2018 period. Satellite thermal data reveal that the fissural eruption was preceded by a persistent increase of summit activity, as reflected by overflow episodes in New SouthEast Crater (NSE) sector. This behavior is supported by infrasonic data, which recorded a constant increase both in the occurrence and in the energy of the strombolian activity at the same crater sectors mapped by satellite. The explosive activity trend is poorly constrained by the seismic tremor, which shows instead a sudden increase only since the 08:24 GMT on the 24 December 2018, almost concurrently with the end of the infrasonic detections occurred at 06:00 GMT. The arrays detected the resumption of infrasonic activity at 11:13 GMT of 24 December, when tremors almost reached the maximum amplitude. Infrasound indicates that the explosive activity was shifting from the summit crater along the flank of the Etna volcano, reflecting, with the seismic tremor, the intrusion of a gas-rich magma batch along a ~2.0 km long dyke, which reached the surface generating an intense explosive phase. The dyke propagation lasted for almost 3 h, during which magma migrated from the central conduit system to the lateral vent, at a mean speed of 0.15−0.20 m s−1. Based on MODIS and SENTINEL 2 images, we estimated that the summit outflows erupted a volume of lava of 1.4 Mm3 (±0.5 Mm3), and that the lateral effusive episode erupted a minimum volume of 0.85 Mm3 (±0.3 Mm3). The results presented here outline the support of satellite data on tracking the evolution of volcanic activity and the importance to integrate satellite with ground-based geophysical data in improving assessments of volcanic hazard during eruptive crises