Hyperglycemia, hypoglycemia and glycemic variability in the elderly: a fatal triad?

Diabetes mellitus is one of the most important causes of cardiovascular morbidity and mortality; the incidence of chronic complications of diabetes appears to be closely related to the degree of hyperglycaemia. However, results of clinical trials showed that intensive treatment of hyperglycaemia prevents microvascular complications, but has little or no effect on the incidence of cardiovascular events. Different hypoglycaemic drugs show different effects on cardiovascular risk. However, those trials have shown a neutral effect on cardiovascular mortality. This paradoxical result could be explained with the frequent use, in the past, of glucose-lowering agents capable of increasing the risk of hypoglicemia, glycemic variability and weight gain. In conclusion, an adequate glycemic control, in particular in elderly patients, should be achieved, whenever possible, using agents not inducing hypogycemia, glucose fluctuations, and weight gain. In fact, hypoglycaemia and glucose variability should be considered as independent cardiovascular risk factors to a similar extent to hyperglycemia. In this article, the author will review literature supporting the hypothesis that hyperglycemia, hypoglycaemia and glycemic variability are a fatal triad capable of increasing morbidity and mortality in patients with diabetes mellitus.  Riassunto Il diabete mellito è una delle più importanti cause di morbilità e mortalità cardiovascolare, ed è stata dimostrata una stretta correlazione tra compenso glicometabolico ed incidenza di complicanze croniche del diabete mellito. Tuttavia, negli studi di intervento, il controllo accurato dell’iperglicemia sembra poter prevenire le complicanze microvascolari, ma ha effetti soltanto marginali sull’incidenza di eventi cardiovascolari secondari a malattia macrovascolare. Inoltre, i grandi trial di intervento hanno mostrato come la riduzione degli eventi cardiovascolari non si accompagni ad una riduzione della mortalità cardiovascolare. Tale paradosso potrebbe essere spiegato dal fatto che spesso, in passato, per ottenere un miglioramento glicometabolico si sono utilizzati farmaci ipoglicemizzanti in grado di aumentare il rischio ipoglicemico, la variabilità glicemica ed il peso corporeo. In conclusione, il miglioramento del compenso glicemico, specie nel paziente anziano, dovrebbe essere ottenuto, quando possibile, con farmaci a basso rischio ipoglicemico e non inducenti aumenti di peso, per evitare gli effetti negativi di ipoglicemie e eccessive fluttuazioni della glicemia che di per sé costituiscono dei fattori di rischio cardiovascolari al pari dell’iperglicemia. In questo articolo, si esplorerà l’ipotesi che iperglicemia, ipoglicemia e variabilità glicemica costituiscano una triade fatale in grado di aumentare morbilità e mortalità nei pazienti affetti da diabete mellito

DiTEMP: Digital Transformation and Employability: acquiring transversal competences in curricular education

DiTEMP is a European project co-funded by the Erasmus+ Programme of the European Union. It is a joint effort of four Universities, a University Business Foundation and an SME, aiming to explore the impact of Digital Transformation on field-specific markets. The project will provide a model of intervention, completed with tools, to integrate important and critical aspects of Digital transformation into curricular education in Higher education, promoting this way students\u2019 employability. Digital transformation (DX) is a technology-driven continuous change process affecting companies and the entire society, it is about adopting disruptive technologies to increase productivity, value creation, and social welfare. Automation had and has greatly impacted on the labour market in terms of labour savings. Although this phenomenon has so far affected in particular low skilled workers, new business processes affect job positions for middle and highly skilled professionals, which are typical graduate jobs. Moreover, being an entrepreneur or self-employed in the digital era requires a higher level of digital skills and a sound understanding of digital transformation trends over time, in business and society. The DiTEMP project is bridging this gap and mismatch by developing relevant tools and learning material at two levels: That of the educators, teachers and career consultants to make them aware of the impact of digital transformation in their knowledge and labour-market fields. That of the students, in order to increase their capability to manage the rapid changes in their future career fields, as caused by digital transformation, supporting this way their employability. The project will develop Guidelines for integrating digital transformation competences in further curricula and academic fields in 5 languages (English, Greek, Italian, Romanian and Spanish). The DiTEMP learning provision includes: A framework, demonstrating the learning outcomes related to digital transformation, that can be applied across different study curricula and the most effective teaching methods that go with it. A design model for the participating Universities on how to integrate the framework into their actual curricula, complemented by an open-access, publicly available \u2018How to Guide\u2019. The DiTEMP Toolkit for teachers and educators on how to integrate digital transformation concepts in their regular teaching. A modular learning pack for students to understand what digital transformation is all about and become \u2018digital ready\u2019 in the fields of Psychology, Cultural Heritage and Tourism, Business, and Education. The online learning material is freely accessible in English, Greek, Italian, Romanian and Spanish. The DiTEMP project is running from November 2019 and up to October 2021

Resistin as an Intrahepatic Cytokine : Overexpression during Chronic Injury and Induction of Proinflammatory Actions in Hepatic Stellate Cells

Obesity and insulin resistance accelerate the progression of fibrosis during chronic liver disease. Resistin antagonizes insulin action in rodents, but its role in humans is still controversial. The aims of this study were to investigate resistin expression in human liver and to evaluate whether resistin may affect the biology of activated human hepatic stellate cells (HSCs), key modulators of hepatic fibrogenesis. Resistin gene expression was low in normal human liver but was increased in conditions of severe fibrosis. Up-regulation of resistin during chronic liver damage was confirmed by immunohistochemistry. In a group of patients with alcoholic hepatitis, resistin expression correlated with inflammation and fibrosis, suggesting a possible action on HSCs. Exposure of cultured HSCs to recombinant resistin resulted in increased expression of the proinflammatory chemokines monocyte chemoattractant protein-1 and interleukin-8, through activation of nuclear factor (NF)-κB. Resistin induced a rapid increase in intracellular calcium concentration, mainly through calcium release from intracellular inositol triphosphate-sensitive pools. The intracellular calcium chelator BAPTA-AM blocked resistin-induced NF-κB activation and monocyte chemoattractant protein-1 expression. In conclusion, this study shows a role for resistin as an intrahepatic cytokine exerting proinflammatory actions in HSCs, via a Ca(2+)/NF-κB-dependent pathway and suggests involvement of this adipokine in the pathophysiology of liver fibrosis

RE-ACT - Self-Reflection Tools For Smart Universities Acting Regionally

RE-ACT will develop and test a new online self-reflection tool built-on HEINNOVATE, exploring its added value in the framework of RIS3 and overall regional development. This tool will support HEIs to perform a self-assessment that will kick-off both, an internal analysis \u2013 translated into organisational action plans \u2013 and a collective debate among other HEIs in their regions \u2013 towards the agreement upon a joint positioning, improving their regional engagemen