1-Hour OGTT Plasma Glucose as a Marker of Progressive Deterioration of Insulin Secretion and Action in Pregnant Women

Considering old GDM diagnostic criteria, alterations in insulin secretion and action are present in women with GDM as well as in women with one abnormal value (OAV) during OGTT. Our aim is to assess if changes in insulin action and secretion during pregnancy are related to 1-hour plasma glucose concentration during OGTT. We evaluated 3 h/100 g OGTT in 4,053 pregnant women, dividing our population on the basis of 20 mg/dL increment of plasma glucose concentration at 1 h OGTT generating 5 groups (<120 mg/dL, n = 661; 120–139 mg/dL, n = 710; 140–159 mg/dL, n = 912; 160–179 mg/dL, n = 885; and ≥180 mg/dL, n = 996). We calculated incremental area under glucose (AUCgluc) and insulin curves (AUCins), indexes of insulin secretion (HOMA-B), and insulin sensitivity (HOMA-R), AUCins/AUCgluc. AUCgluc and AUCins progressively increased according to 1-hour plasma glucose concentrations (both P < 0.0001 for trend). HOMA-B progressively declined (P < 0.001), and HOMA-R progressively increased across the five groups. AUCins/AUCgluc decreased in a linear manner across the 5 groups (P < 0.001). Analysing the groups with 1-hour value <180 mg/dL, defects in insulin secretion (HOMA-B: −29.7%) and sensitivity (HOMA-R: +15%) indexes were still apparent (all P < 0.001). Progressive increase in 1-hour OGTT is associated with deterioration of glucose tolerance and alterations in indexes of insulin action and secretion

Diabetes, ankle joint mobility, aging, and foot ulcer

In diabetic patients the evaluation of how ankle joint mobility (AJM) can be useful in the identification of connective tissue alteration and risk of foot ulcer (FU). Plantar and dorsal flexion of foot were evaluated using an inclinometer in 87 patients (54 type 2 and 33 type 1), and 35 healthy sex- and age-matched control subjects. Patients with diabetes were followed up for diagnosis of FU over the next 8 years and subsequently, patients were subdivided into: those without a history of FU (18 type 1 and 33 type 2), those who had a history of FU detected before baseline evaluation (14 type 2) and those who had history of first ulceration detected by the 8th year of the evaluation period (7 type 2). Aging and diabetes caused a significant reduction in mobility of each of the movements investigated (p &lt; 0.001), whereas after adjusting for the confounding effect of age, diabetes specifically reduced plantar flexion (p &lt; 0.0001). AJM was significantly lower in those with history of previous FU compared to all the other groups (p &lt; 0.001). The first ulceration was detected in the same foot presenting lower AJM in 17 of the 22 subjects with diabetes with history of ulcer (77.27%). Diabetes and aging reduce AJM although diabetes seems to reduce plantar flexion to a more specific extent. Reduced AJM is mostly associated with a previous history of FU. The evaluation of AJM is a valid and reliable ulcer risk scale that indicates which foot is at higher ulcer risk

The role of ankle plantar flexion in the monitoring of diabetic patients at risk of foot ulcer

Limited ankle joint mobility (AJM) is a major risk factor for ulcers and a useful parameter for monitoring the health of patients with diabetes. The aim of this study was to test the feasibility and usefulness of evaluating AJM for monitoring ulcerative risk. AJM in plantar (PF) and dorsiflexion (DF) was evaluated in 99 patients with diabetes, type1/type2: 50/49, (58/41;M/F), and 59 healthy controls (32:27/M:F). Patients and controls were divided into 6 groups by age and neuropathy: 32 young patients (group YD), mean age 12.4±2.0 yr, 29 young controls (group YC), mean age 11.4 ± 3.3 yr, 38 elderly patients without neuropathy (group ED), mean age 58.5 ±10.3 yr, 15 neuropathic patients without history of foot ulcer (group ND), mean age 62.1 ± 7.9 yr, 14 neuropathic patients with history of foot ulcer (group NUD), mean age 64 ± 8.4 yrs, and 30 elderly healthy controls (group EC), mean age 60.3 ± 6.4 yr. AJM was evaluated by an inclinometer with the patient lying supine, the subtalar joint in neutral position and with the ankle in the position freely taken at the beginning. The knee, corresponding to the evaluated ankle, was extended and put over a rigid 5-cm high support. Diabetes duration was respectively: group YD 5.5 ± 3.5 yr, ED 16.5 ± 10.6 yr; ND 18.2 ± 13.1 yr and NUD 13.7 ± 9.6 yr. The NUD group showed a more significant AJM reduction in DF and PF than all other groups (p < 0.005). The reduction was 40.1% compared to the EC group and 46.9% compared to the YC group (78.1 ± 18.4 vs 147.2 ± 19.1, 130.4 ± 15.1). Only the DF was significantly reduced in the NUD group compared to the ED group (p < 0.001). The YD had more reduced AJM in both movements compared to the young controls (YC) (p < 0.001) with PF more reduced than DF (30.9% vs 15.5%). Among patients and controls the elderly groups had significant reduction of only DF (EC vs YC p < 0.001; ED vs YD p < 0.05). As in previous studies, these results confirm that an AJM reduction of about 40% (28-32) in patients with diabetic neuropathy can be considered as a threshold for ulcer risk. The method used permits direct evaluation of AJM in plantar flexion that seems to show an early reduction in diabetic subjects, thereby providing useful information for patient monitoring

Musculoskeletal manifestations of diabetes mellitus: the role of exercise therapy in the treatment of limited joint mobility, muscle weakness and reduced gait speed

It is well known that limited joint mobility of the ankle and foot, impaired muscular performance and reduced gait speed are risk factors for ulceration in diabetic foot. The aim of this study was to evaluate the effect of an experimental protocol of exercise therapy on joint mobility, muscular strength and gait speed in a group of longterm diabetic subjects. The protocol consisted of a 12-week supervised training program; both joint mobility and muscular strength at the ankle were measured before and after exercise therapy by an inclinometer and isometric dynamometers respectively, in 26 diabetic subjects and compared to 17 healthy controls. Ankle joint mobility in plantar flexion was reduced about 36% and dorsal flexion by about 23% in diabetic subjects compared to controls (p&lt;0.001), but significantly increased after exercise therapy (p&lt;0.001 for both). Ankle muscular strength in plantar flexion was reduced by about 51% and in dorsal flexion by 30% in diabetic patients compared to controls, but these also significantly increased after exercise therapy (p&lt;0.001). Consequently, patients’ walking speed increased after exercise therapy by 0.28 m/s (p&lt;0.001). A 12-week supervised program of exercise therapy significantly improves joint mobility, muscular performance and walking speed in diabetic patients--thus limiting one of the pathogenic factors of diabetic foot and potentially preventing disabilit

Developing the ArchAIDE Application: A digital workflow for identifying, organising and sharing archaeological pottery using automated image recognition

Pottery is of fundamental importance for understanding archaeological contexts, facilitating the understanding of production, trade flows, and social interactions. Pottery characterisation and the classification of ceramics is still a manual process, reliant on analogue catalogues created by specialists, held in archives and libraries. The ArchAIDE project worked to streamline, optimise and economise the mundane aspects of these processes, using the latest automatic image recognition technology, while retaining key decision points necessary to create trusted results. Specifically, ArchAIDE worked to support classification and interpretation work (during both fieldwork and post-excavation analysis) with an innovative app for tablets and smartphones. This article summarises the work of this three-year project, funded by the European Union's Horizon 2020 Research and Innovation Programme under grant agreement N.693548, with a consortium of partners representing both the academic and industry-led ICT (Information and Communications Technology) domains, and the academic and development-led archaeology domains. The collaborative work of the archaeological and technical partners created a pipeline where potsherds are photographed, their characteristics compared against a trained neural network, and the results returned with suggested matches from a comparative collection with typical pottery types and characteristics. Once the correct type is identified, all relevant information for that type is linked to the new sherd and stored within a database that can be shared online. ArchAIDE integrated a variety of novel and best-practice approaches, both in the creation of the app, and the communication of the project to a range of stakeholders

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