A Focus on the Impact of Bariatric Surgery on Pregnancy Outcome: Effectiveness, Safety and Clinical Management

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Better Ways to Cope with Increasingly Common Diseases: The Impact of Telemedicine on the Management of Pregnancy Complicated by Diabetes

none3To review the importance of a telemedicine approach in the management of pregnancy complicated by diabetesnoneNino Cristiano;Maria Grazia;Annunziata LapollaNino, Cristiano; Grazia, Maria; Lapolla, Annunziat

Telemedicine in Pregnancy Complicated by Diabetes

none3nononeAnnunziata Lapolla;Nino Cristiano Chilelli ;Maria Grazia DalfràLapolla, Annunziata; Chilelli, NINO CRISTIANO; Maria Grazia, Dalfr

Anti-diabetic combination therapy with pioglitazone or glimepiride added to metformin on the AGE-RAGE axis: a randomized prospective study

Introduction: The ratio between advanced glycation end products (AGEs) and soluble form of receptor (s-RAGE) has been proposed as a risk marker for renal and cardiovascular diseases. The aim of this study was to evaluate in the diabetes condition the influence of two different oral anti-diabetic treatments on the AGE/ s-RAGE ratio, during a 5-year observation period. Methods: Seventy-three patients with type 2 diabetes mellitus were randomly assigned to a drug therapy with pioglitazone or glimepiride, combined to metformin. Each subject was evaluated at baseline and after 5 years of treatment. Results: In both groups s-RAGE levels did not significantly vary, while the levels of AGE and AGE/s-RAGE were both significantly reduced, basal compared to 5-year values. Within pioglitazone group, as well within glimepiride group, significant variations (D, as difference between 5 years of treatment minus basal) were observed for AGE (D= ˗21.1±13.4 μg/ml, P<0.001 for pioglitazone; D= ˗14.4±11.4 μg/ml, P<0.001 for glimepiride) and in AGE/s-RAGE (D= -0.037±0.022 μg/pg, P<0.001 for pioglitazone; D= -0.024±0.020μg/pg, P<0.001 for glimepiride), suggesting an average decrease of the parameters by more than 50% in both treatments. Pioglitazone was more effective than glimepiride in reducing AGE/s- RAGE ratio after 5 years of therapy. Conclusion: These data can help to explain the benefits of oral anti-diabetic therapy in relation to the reduction of cardiovascular risk, as suggested by variations in AGE/s-RAGE ratio as biochemical marker of endothelial function; in particular, treatment with pioglitazone seems to offer greater long-term benefit on AGE-RAGE axis

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

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

Trattamento dell\u2019Iperglicemia Mild nel Soggetto pre-diabetico e nel Paziente con Diabete Tipo 2 Intollerante a Metformina:un nuovo spazio per la nutraceutica

Nel panorama della crescente \u201cepidemia diabetica\u201d, l\u2019impiego dei nutraceutici dovrebbe essere fortemente considerato per fronteggiare due condizioni cliniche, sulle quali attualmente grava una certa inerzia terapeutica. In primo luogo, il trattamento dell\u2019iperglicemia postprandiale mild in soggetti pre-diabetici costituisce un importante obiettivo clinico, che mira a una doppia prevenzione primaria in questi soggetti, ovvero la riduzione del rischio cardiovascolare e dello sviluppo di DMT2 futuro. In secondo luogo, i pazienti affetti da DMT2 spesso non rag-giungono una titolazione adeguata di metformina, in gran parte a causa dei frequenti effetti collaterali, mantenendo un controllo glicemico discreto ma non ottimale. In questi pazienti, il ricorso a integratori nutraceutici pu\uf2 ritardare il fallimento primario della terapia con metformina e costituire una valida alternativa al ricorso di un secondo ipoglicemizzante orale, specie quando quest\u2019ultimo non risulta univoca-mente indicato