Antonio Nicolucci

CMNS Consorzio Mario Negri Sud, Chieta, Abruzzo, Italy

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Publications (211)1000.74 Total impact

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    ABSTRACT: The aim of this study was to estimate the incidence of type 2 diabetes (primary objective) and hospitalisation for cardiovascular events (secondary objective) in women with previous gestational diabetes mellitus (GDM) and in those with normal glucose tolerance (NGT) in pregnancy, and to evaluate the role of stillbirth in differentiating the risks.
    Diabetologia 10/2014; · 6.49 Impact Factor
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    ABSTRACT: Background and aims: Women with gestational diabetes mellitus (GDM) are at increased risk for the onset of type 2 diabetes (T2DM) and cardiovascular disease in the years following pregnancy. Aim of the study was to estimate the incidence of T2DM and cardiovascular events in women with previous GDM and in those with normal glucose tolerance in pregnancy and to evaluate the rol e of stillbirth in differentiating the risks. Materials and methods: A population - based cohort study using administrative data of 12 local health authorities in Puglia, Italy, during the index period from January 1, 2002, to December 31, 2010 was conducted . From a population - based sample of 2.1 million women we identified those with a diagnosis of GDM during the index period and they were propensity - matched on a 1 - to - 3 basis with women without GDM or diabetes mellitus. Characteristics that were matched were age, local health authority code, use of antihypertensive and antithrombotic agents. Main outcome measures were T2DM development and hospitalizations for cardiovascular events occurring after a pregnancy complicated by GDM and ended at term or in miscarri age. Results: There were 3851 women with GDM (mean age 37.1±5.9 years) and 11553 matched controls without GDM. During a median follow - up of 5.4 years, the incidence rate of T2DM was of 2.1 per 1000 person - years in women without GDM, of 54.0 per 1000 person - years among women with GDM and pregnancy at term, and 115.0 per 1000 person - years among women with GDM and a pregnancy ended in stillbirth. The cumulative IRs of T2DM development showed that GDM increased the risk of T2DM by 21.7 times, while GDM complica ted by stillbirth increased the risk of T2DM by 46.9 times as compared with women with a normal pregnancy. GDM and stillbirth during GDM were associated with a significantly higher risk of cardiovascular events compared with normal pregnancy (IRR, 2.4;95% CI, 1.5 to 3.8 and IRR, 16.7; 95% CI, 3.7 to 74.7, respectively). Conclusion: Pregnancy complicated by GDM and ended in stillbirth represents a decisive factor in determining the development of T2DM and future cardiovascular events. For this reason these w omen deserve a careful follow - up
    50th Scientific Session, European Association for the Study of Diabetes, Vienna; 09/2014
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    ABSTRACT: Background and aims: In the framework of an EU funded study, the “Safet y Evaluation of Adverse Reactions in Diabetes (SAFEGUARD) project”, a meta- analysis of randomized clinical trials (RCTs) to assess the cardiovascular (CV) safety of dipepti dyl peptidase-4 inhibitors (DPP-4i) was performed. Materials and methods: Trials were identified through searches of MEDLINE , EMBASE and Cochrane databases (January 1966-September 2013) us ing standard search strategies. Reference lists of selected articles were also checked. Eligible st udies included published RCTs that compared DPP- 4i against placebo/no treatment, or another non-ins ulin blood glucose lowering agent in individuals with type 2 diabetes and reported major CV events ( CV mortality, sudden death, myocardial infarction, stroke, or heart failure). Two reviewer s independently assessed trials for inclusion and extracted data. Effect estimates were pooled using fixed or random effects meta-analysis based on exact bivariate non-linear mixed models. Results ar e reported as relative risks (RR) with 95% confidence intervals (CI). Results: The electronic search identified 8,168 citations o n all non-insulin blood glucose lowering agents, of which 334 were selected. Out of 140 RCTs on DPP-4i, 70 reported at least one CV event. When DPP-4i were compared with placebo/no treatment , no association was suggested with CV mortality (27 studies, 43,381 participants; RR=0.85 ; 0.71-1.02), sudden death (15 studies, 23,494 participants; RR=1.17; 0.90-1.51), myocardial infar ction (20 studies, 27,553 participants; RR=0.95; 0.84-1.09), and ischemic stroke (15 studies, 27,224 participants; RR=1.04; 0.84-1.29). There was an increase in the risk of heart failure in patients t reated with DPP-4i compared to placebo (9 studies, 20,349 participants; RR=1.24, 1.03-1.49). For activ e comparator studies no association was found for CV mortality (24 studies, 22,064 participants; RR=0 .92; 0.50-1.70), sudden death (8 studies, 7,130 participants; RR=0.83; 0.23-3.00), myocardial infar ction (12 studies, 5,453 participants; RR=0.70; 0.34-1.43), or heart failure (6 studies, 6180 parti cipants; RR=1.31; 0.50-3.43). DPP-4i reduced the ri sk of ischemic stroke when compared to active comparat or (8 studies, 7,777 participants; RR=0.33; 0.14- 0.79). Conclusion: These results, based on publicly available data, s uggest that DPP-4i did not influence the risk of CV mortality or other CV events in comparis on with placebo/no treatment, except for an increased risk of heart failure. However, the resul ts are driven by the findings from the “Saxagliptin Assessment of Vascular Outcomes Recorded in Patient s with Diabetes Mellitus (SAVOR)- Thrombolysis in Myocardial Infarction (TIMI) 53” st udy and the finding needs to be confirmed by pooling these data with those of other ongoing stud ies specifically designed to assess the effect on C V end-points. Furthermore, DPP-4i showed a lower risk of ischemic stroke than active comparators. Additional trial data are required before definitiv ely draw conclusions on CV safety of DPP-4i. Supported by: EC 7th Framework Programme (FP7/2007- 2013 grant agreement 282521– SAFEGUARD
    50th Scientific Session, European Association for the Study of Diabetes, Vienna; 09/2014
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    ABSTRACT: Background and aims: The prevalence of diabetes in people over 75 years approaches 30%, while at least 25% of all patients attending Italian outpati ents diabetes clinics are older than 75 years. Clinicians who manage older people with diabetes re quire special skills to provide high-quality care. In the context of a continuous quality improvement initiative promoted in Italy by Associazione Medici Diabetologi (AMD Annals initiative), we eval uated the trends over 8 years in the quality of care provided by diabetes clinics to elderly patien ts (i.e. > 75 years). Materials and methods: Overall, 300 diabetes clinics (about half of all c linics in Italy), all using electronic medical record systems, extracted data r elative to the years 2004-2011 . The proportion of patients with at least one value registered during each year (process measures), the percentage of patients reaching specific favorable or unfavorable targets (intermediate outcome measures), and rates of use of drugs were evaluated. In addition, a qual ity of care summary score (Q score) was calculated. The Q score, ranging between 0 and 40, is based on process and outcome indicators (HbA1c, blood pressure, LDL-cholesterol, microalbuminuria) and is closely related to long-term outcomes in diabetic patients. Results: Over the years, there was an increase in the perce ntage of patients aged > 75 years (19.9% in 2004 vs. 27.2% in 2011) and in the prevalence of ma le patients (42% in 2004 vs. 46% in 2011). As compared to 2004 we observed after 8 years a slight increase in the mean age (79.9±3.8 vs. 80.5±4.1) and in the duration of diabetes (13.8±10.5 vs. 14.2 ±10.9). Table 1 shows quality of care indicators. Conclusion: Care provided by diabetes clinics to elderly patie nts shows a significant improvement over the years. Elderly patients are more frequentl y monitored for blood pressure, lipid profile and microalbuminuria, show better intermediate outcomes and are less often treated with sulphonylureas. In addition we observe a better global quality of c are with a significant increase in the Q score thro ugh the years.
    50th Scientific Session, European Association for the Study of Diabetes, Vienna; 09/2014
  • 25° Congresso Nazionale - Società Italiana Diabetologia, Bologna; 05/2014
  • 25° Congresso Nazionale - Società Italiana Diabetologia, Bologna; 05/2014
  • 25° Congresso Nazionale - Società Italiana Diabetologia, Bologna, Bologna; 05/2014
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    ABSTRACT: Appropriate management of hyperglycemia is crucial for patients with type 2 diabetes. Aim of the FADOI-DIAMOND study was to evaluate real-world management of type 2 diabetic patients hospitalized in Internal Medicine wards (IMW) and the effects of a standardized educational intervention for IMW staff. DIAMOND has been carried out in 53 Italian IMW, with two cross-sectional surveys interspersed with an educational program (PRE phase and POST phase). In PRE phase, each center reviewed the charts of the last 30 hospitalized patients with known type 2 diabetes. An educational program was conducted in each center by means of the "outreach visit," a face-to-face meeting between IMW staff and a trained external expert. Six months after, each center repeated the data collection (POST phase), specular to the PRE. A total of 3,167 patients were enrolled (1,588 PRE and 1,579 POST). From PRE phase to POST, patients with registered anthropometric data (54.1 vs. 74.9 %, p < 0.001) and in-hospital/recent measurement of glycated hemoglobin (48.2 vs. 61.4 %, p < 0.005) increased significantly. After educational program, more patients received insulin during hospitalization (68.3 vs. 63.6 %, p = 0.005). A more relevant variation in glycemia during hospitalization was observed in POST phase than PRE (-22.2 vs. -15.5 mg/dL, p < 0.001), without differences as for occurrence of hypoglycemia (12.3 vs. 11.9 %). A one-shot educational intervention led to persistent improvement in the management of hospitalized patients with type 2 diabetes and to significant better glycemic control. Further studies might evaluate the effectiveness of a more aggressive educational program, on both management and outcomes.
    Acta Diabetologica 04/2014; · 4.63 Impact Factor
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    ABSTRACT: Parallel to the increase in obesity, the prevalence of metabolic syndrome (MetS) is continually increasing, with increased risk of diabetes and cardiovascular atherosclerosis diseases. Despite the importance of this public health problem, the relative impact of diet and physical activity on MetS prevalence has yet to be established. We investigated the association between lifestyle, in terms of both habitual dietary pattern and physical activity, and MetS in a cohort of adults without known diabetes and atherosclerotic cardiovascular disease. Four hundred seventy-seven randomly selected adult participants were cross-sectionally investigated. Each participant answered a food frequency questionnaire and a questionnaire on physical activity, and underwent routine laboratory blood measurements. MetS was identified in 24.7 % of the cohort. Dietary patterns were not significantly different (P = 0.31) between the groups (with or without MetS). The habitual physical activity level was significantly lower (P = 0.011) in the group with MetS. In particular, the prevalence of sedentary participants was 58.1 % in the group with MetS, and 43.9 % in the group without MetS. Multivariate analysis revealed that MetS was associated with age (OR = 1.06, 95 % CI 1.03-1.08) and physical activity level (light vs. sedentary: OR = 0.53, 95 % CI 0.32-0.87; moderate/heavy vs. sedentary: OR = 0.31, 95 % CI 0.13-0.75). This study suggests that inadequate physical activity level is associated with MetS. Our results are therefore consonant with the notion of healthier lifestyle changes to counteract the epidemic of diabetes and cardiovascular disease, though adequate interventional trials will be needed in high-risk populations.
    Eating and weight disorders: EWD 04/2014; · 0.53 Impact Factor
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    ABSTRACT: Fish consumption is recommended as part of a healthy diet. However, there is a paucity of data concerning the relation between fish consumption and carotid atherosclerosis. We investigated the association between habitual fish consumption and asymptomatic carotid atherosclerosis, defined as the presence of plaques and/or increased intima-media thickness (>= 0.90 mm), in non-diabetic participants. Nine hundred-sixty-one (range of age: 18-89 yrs; 37.1% males) adult participants without clinically known atherosclerotic disease were randomly recruited among the customers of a shopping mall in Palermo, Italy, and cross-sectionally investigated. Each participant answered a food frequency questionnaire and underwent high-resolution ultrasonographic evaluation of both carotid arteries. Routine laboratory blood measurements were obtained in a subsample of 507 participants. Based on habitual fish consumption, participants were divided into three groups: non-consumers or consumers of less than 1 serving a week (24.0%), consumers of 1 serving a week (38.8%), and consumers of >= 2 servings a week (37.2%). Age-adjusted prevalence of carotid atherosclerosis (presence of plaques or intima media thickness >= 0.9 mm) was higher in the low fish consumption group (13.3%, 12.1% and 6.6%, respectively; P = 0.003). Multivariate analysis evidenced that carotid atherosclerosis was significantly associated with age (OR = 1.12; 95% CI = 1.09-1.14), hypertension on pharmacologic treatment (OR = 1.81; 95% CI = 1.16-2.82), and pulse pressure (OR = 1.03; 95% CI = 1.01-1.04), while consuming >=2 servings of fish weekly was protective compared with the condition of consumption of <1 serving of fish weekly (OR = 0.46; 95% CI = 0.26-0.80). High habitual fish consumption seems to be associated with less carotid atherosclerosis, though adequate interventional trials are necessary to confirm the role of fish consumption in prevention of cardiovascular disease.
    Nutrition Journal 01/2014; 13(1):2. · 2.65 Impact Factor
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    ABSTRACT: Kidney dysfunction is a strong predictor of end-stage renal disease and cardiovascular (CV) events. The main goal was to study the clinical correlates of diabetic kidney disease in a large cohort of patients with type 2 diabetes mellitus (T2DM) attending 236 Diabetes Clinics in Italy. Clinical data of 120 903 patients were extracted from electronic medical records by means of an ad hoc-developed software. Estimated glomerular filtration rate (GFR) and increased urinary albumin excretion were considered. Factors associated with the presence of albuminuria only, GFR < 60 mL/min/1.73 m(2) only or both conditions were evaluated through multivariate analysis. Mean age of the patients was 66.6 ± 11.0 years, 58.1% were male and mean duration of diabetes was 11.1 ± 9.4 years. The frequency of albuminuria, low GFR and both albuminuria and low GFR was 36.0, 23.5 and 12.2%, respectively. Glycaemic control was related to albuminuria more than to low GFR, while systolic and pulse pressure showed a trend towards higher values in patients with normal kidney function compared with those with both albuminuria and low GFR. Multivariate logistic analysis showed that age and duration of disease influenced both features of kidney dysfunction. Male gender was associated with an increased risk of albuminuria. Higher systolic blood pressure levels were associated with albuminuria, with a 4% increased risk of simultaneously having albuminuria and low GFR for each 5 mmHg increase. In this large cohort of patients with T2DM, reduced GFR and increased albuminuria showed, at least in part, different clinical correlates. A worse CV risk profile is associated with albuminuria more than with isolated low GFR.
    Nephrology Dialysis Transplantation 01/2014; · 3.37 Impact Factor
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    ABSTRACT: In the context of the DAWN-2 initiatives, the BENCH-D Study aims to test a model of regional benchmarking to improve not only the quality of diabetes care, but also patient-centred outcomes. As part of the AMD-Annals quality improvement program, 32 diabetes clinics in 4 Italian regions extracted clinical data from electronic databases for measuring process and outcome quality indicators. A random sample of patients with type 2 diabetes filled in a questionnaire including validated instruments to assess patient-centred indicators: SF-12 Health Survey, WHO-5 Well-Being Index, Diabetes Empowerment Scale, Problem Areas in Diabetes, Health Care Climate Questionnaire, Patients Assessment of Chronic Illness Care, Barriers to Medications, Patient Support, Diabetes Self-care Activities, and Global Satisfaction for Diabetes Treatment. Data were discussed with participants in regional meetings. Main problems, obstacles and solutions were identified through a standardized process, and a regional mandate was produced to drive the priority actions. Overall, clinical indicators on 78,854 patients have been measured; additionally, 2,390 patients filled-in the questionnaire. The regional mandates were officially launched in March 2012. Clinical and patient-centred indicators will be evaluated again after 18 months. A final assessment of clinical indicators will take place after 30 months. In the context of the BENCH-D study, a set of instruments has been validated to measure patient well-being and satisfaction with the care. In the four regional meetings, different priorities were identified, reflecting different organizational resources of the different areas. In all the regions, a major challenge was represented by the need of skills and instruments to address psychosocial issues of people with diabetes. The BENCH-D study allows a field testing of benchmarking activities focused on clinical and patient-centred indicators.
    SpringerPlus 01/2014; 3:83.
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    ABSTRACT: Beta-cell dysfunction is an early event in the natural history of type 2 diabetes. However, its progression is variable and potentially influenced by several clinical factors. We report the baseline data of the BetaDecline study, an Italian prospective multicenter study on clinical predictors of beta-cell dysfunction in type 2 diabetes.
    PLoS ONE 01/2014; 9(10):e109702. · 3.53 Impact Factor
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    ABSTRACT: The Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicentre Study is an ongoing observational survey that examines the role of estimated glomerular filtration rate (eGFR) as an independent predictor of cardiovascular and renal outcomes in 15,773 Italian subjects with type 2 diabetes. The analysis of data collected at the enrollment visit has provided a picture of chronic kidney disease (CKD) and its association with other complications, risk factors for cardiovascular disease (CVD) and treatments in a large contemporary cohort. Main results of this analysis were that (a) non-albuminuric renal impairment is the predominant clinical phenotype in patients, particularly women, with reduced eGFR; (b) concordance rate between CKD and diabetic retinopathy is low, with only a minority of patients with renal dysfunction presenting with any or advanced retinal lesions; (c) the non-albuminuric form is associated with a significant prevalence of CVD, especially at the level of coronary vascular bed; (d) CKD is associated with hemoglobin (Hb) A1c variability more than with average HbA1c, whereas retinopathy and CVD are not; (e) in elderly individuals with moderate-to-severe eGFR reduction, use of agents which are not recommended, such as sulphonylureas and metformin, is still frequent ; and (f) though complications are generally more prevalent in men (except non-albuminuric renal impairment) women show a less favourable CVD risk profile and achieve therapeutic targets to a lesser extent than men, despite the fact that treatment intensity is nor lower. These data update existing information on the natural history of CKD in patients with type 2 diabetes. Trial registration number and date NCT00715481; 10.07.2008.
    Nutrition, metabolism, and cardiovascular diseases: NMCD 01/2014; · 3.52 Impact Factor
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    ABSTRACT: The use of diuretics for hypertension has been associated with unfavorable changes in cardiovascular risk factors, such as uric acid and glucose tolerance, though the findings in the literature are contradictory. This study investigated whether diuretic use is associated with markers of metabolic and cardiovascular risk, such as insulin-resistance and uric acid, in a cohort of adults without known diabetes and/or atherosclerotic cardiovascular disease. Nine hundred sixty-nine randomly selected participants answered a questionnaire on clinical history and dietary habits. Laboratory blood measurements were obtained in 507 participants. Previously undiagnosed type 2 diabetes was recognized in 4.2% of participants who were on diuretics (n = 71), and in 2% of those who were not (n = 890; P = 0.53). Pre-diabetes was diagnosed in 38% of patients who were on diuretics, and in 17.4% (P < 0.001) of those who were not. Multivariate analysis showed that insulin-resistance (HOMA-IR) was associated with the use of diuretics (P = 0.002) independent of other well-known predisposing factors, such as diet, physical activity, body mass index, and waist circumference. The use of diuretics was also independently associated with fasting plasma glucose concentrations (P = 0.001) and uric acid concentrations (P = 0.01). The use of diuretics is associated with insulin-resistance and serum uric acid levels and may contribute to abnormal glucose tolerance.
    Diabetology and Metabolic Syndrome 12/2013; 5(1):80. · 1.92 Impact Factor
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    ABSTRACT: The Associazione Medici Diabetologi-annals initiative is a physician-led quality-of-care improvement scheme that has been shown to improve HbA1c concentration, blood pressure, lipid profiles and BMI in enrolled people with Type 2 diabetes. The present analysis investigated the long-term cost-effectiveness of enrolling people with Type 2 diabetes in the Associazione Medici Diabetologi-annals initiative when compared with conventional management. Long-term projections of clinical outcomes and direct costs (in 2010 Euro) were made using a published and validated model of Type 2 diabetes in people with Type 2 diabetes who were either enrolled in the Associazione Medici Diabetologi-annals initiative or who were receiving conventional management. Treatment effects were based on mean changes from baseline seen at 5 years after enrolment in the scheme. Costs and clinical outcomes were discounted at 3% per annum. The Associazione Medici Diabetologi-annals initiative was associated with improvements in mean discounted life expectancy and quality-adjusted life expectancy of 0.55 years (95% CI 0.54-0.57) years and 0.48 quality-adjusted life years (95% CI 0.46-0.49), respectively, compared with conventional management. Whilst treatment costs were higher in the Associazione Medici Diabetologi arm, this was offset by savings as a result of the reduced incidence and treatment of diabetes-related complications. The Associazione Medici Diabetologi-annals initiative was found to be cost-saving over patient lifetimes compared with conventional management [€ 37,289 (95% CI 37,205-37,372) vs € 41,075 (95% CI 40,956-41,155)]. Long-term projections indicate that the physician-led Associazione Medici Diabetologi-annals initiative represents a cost-saving method of improving long-term clinical outcomes compared with conventional management of people with Type 2 diabetes in Italy. This article is protected by copyright. All rights reserved.
    Diabetic Medicine 11/2013; · 3.24 Impact Factor
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    ABSTRACT: To assess the predictive value of the risk factors (RF) for gestational diabetes (GDM) considered by the selective screening (SS), and to identify subgroups of women at higher risk for GDM. Retrospective, single-center study. Data of 1015 women, screened for GDM at 24-28 weeks gestation and diagnosed according to IADPSG criteria, were evaluated. Information on the RF considered by SS was also collected, and their association with GDM was tested. To identify distinct and homogeneous subgroups of patients at higher risk, the RECPAM (RECursive Partitioning and AMalgamation) method was used. Overall, 113 (11.1%) women were diagnosed as having GDM. The application of SS would lead to the performance of an OGTT in 58.3% of women, and 26 (23.0%) cases of GDM would not be detected due to the absence of any RF. RECPAM analysis identified high risk subgroups characterized by fasting plasma glucose >5.1mmol/L (OR=26.5;95%CI 14.3-49.0) and pre-gestational BMI (OR=7.0;95%CI 3.9-12.8 for overweight women). In a final logistic model including RECPAM classes, previous macrosomia (OR=3.6;95%CI 1.1-11.6) and family history of diabetes (OR=1.8;95%CI 1.1-2.8), but not maternal age, were also associated with an increased risk of GDM. A screening approach based on the RECPAM model would reduce by over 50% (23.0% vs. 10.6%) the number of undiagnosed GDM cases as compared with the current SS approach, at the expense of 50 additional OGTTs needed. A screening approach based on our RECPAM model allows a significant reduction of undetected GDM cases compared to current SS procedure.
    European Journal of Endocrinology 10/2013; · 3.14 Impact Factor
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    ABSTRACT: Apart from late motor nerve dysfunction, factors affecting muscle strength in diabetes are largely unknown. This study was aimed at assessing muscle strength correlates in diabetic subjects encompassing a wide range of peripheral nerve function and various degrees of micro and macrovascular complications. Four-hundred consecutive patients with type 1 and 2 diabetes (aged 46.4 ± 13.9 and 65.8 ± 10.3 years, respectively) from the Study on the Assessment of Determinants of Muscle and Bone Strength Abnormalities in Diabetes (SAMBA) were examined for upper and lower body muscle isometric maximal voluntary contraction by dynamometry. Univariate and multivariate regression analyses were applied to identify strength correlates. Isometric force at both the upper and lower limbs was significantly lower in subjects with than in those without any complication. At univariate analysis, it was strongly associated with age, diabetes duration, physical activity (PA) level, cardio-respiratory fitness, anthropometric parameters, surrogate measures of complications, and parameters of sensory and autonomic, but not motor (except amplitude) neuropathy. Multivariate analysis revealed that upper and lower body strength correlated independently with male gender and, inversely, with age, autonomic neuropathy score (or individual autonomic function abnormalities), and vibration perception threshold, but not sensory-motor neuropathy score. Diabetes duration and PA level were excluded from the model. Both upper and lower body muscle strength correlate with measures of diabetic complications and particularly with parameters of sensory and especially autonomic nerve function, independently of diabetes duration and PA level, thus suggesting the involvement of mechanisms other than manifest motor nerve impairment. Trial Registration number and date: NCT01600924; 05.06.2012.
    Nutrition, metabolism, and cardiovascular diseases: NMCD 10/2013; · 3.52 Impact Factor
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    ABSTRACT: BACKGROUND/OBJECTIVES:Dietary habits are important determinants of individual cardiovascular and metabolic risk. This study investigated the association between dietary patterns and asymptomatic carotid atherosclerosis, defined as the presence of plaques and/or increased intima-media thickness, and metabolic biomarkers of insulin resistance, including the homeostasis model assessment of insulin resistance (HOMA-IR) and the trygliceride/high-density lipoprotein (HDL)-cholesterol (Tg/HDL) ratio in a cohort of adults without known diabetes or atherosclerotic cardiovascular disease.SUBJECTS/METHODS:Nine hundred and twenty-nine randomly selected participants were cross-sectionally investigated. Each participant answered a food frequency questionnaire, and underwent high-resolution ultrasonographic evaluation of both carotid arteries. Laboratory blood measurements were obtained in a subsample of 507 participants.RESULTS:A dietary pattern that could be defined as unhealthy (high consumption of soft drinks, fried foods, seed oils, cured meats, butter, red meat and sweets) was identified in 21% of the cohort, whereas 34% of the cohort exhibited a dietary pattern that resembled the Mediterranean diet (high intakes of fruit, milk and cheese, olive oil, vegetables, pasta and bread). Intermediate habits characterized the remaining 45%. After adjusting for age, body mass index (BMI), waist circumference, glycated hemoglobin (HbA1c) and hypertension on treatment, the Mediterranean dietary pattern was associated with significantly lower HOMA-IR (β-coefficient=-0.51; P=0.003). After adjusting for gender, BMI and HbA1c, the unhealthy dietary pattern was associated with a significantly higher Tg/HDL-cholesterol ratio (β-coefficient=0.43; P=0.006). No significant association was found between dietary patterns and carotid atherosclerosis.CONCLUSIONS:This study suggests that, independent of measures of adiposity, a Mediterranean dietary pattern is associated with lower insulin resistance.European Journal of Clinical Nutrition advance online publication, 18 September 2013; doi:10.1038/ejcn.2013.172.
    European journal of clinical nutrition 09/2013; · 3.07 Impact Factor
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    ABSTRACT: To assess patient-reported outcomes associated with initiating insulin glargine among insulin-naïve patients with type 2 diabetes mellitus (T2DM). This was a pooled analysis of patient-level data from phase 3, randomized controlled trials evaluating once-daily insulin glargine versus comparator treatment for ≥24 weeks in previously insulin-naïve adult patients with T2DM and poor glycemic control. Eligible studies utilized strict, predefined insulin titration algorithms with weekly dose-adjustment to achieve fasting plasma glucose (FPG) levels of ≤5.6 mmol/l. Treatment satisfaction was measured using the Diabetes Treatment Satisfaction Questionnaire (DTSQ) change (c) and status (s) versions. A total of 1577 patients from 4 studies were included; 830 patients treated with insulin glargine and 747 with comparators. At Week 24, DTSQc scores improved in both groups with a significantly higher increase in treatment satisfaction for insulin glargine versus comparators (13.5 vs. 12.1; p < 0.0001). Multivariate regression analysis revealed that significant predictors of DTSQc improvement at Week 24 were insulin glargine treatment (p < 0.0001), higher baseline DTSQs (p < 0.0001), and lower baseline body weight (p = 0.0103). Greater improvement in DTSQc at Week 24 was significantly associated with decrease from baseline in glycosylated haemoglobin (p < 0.001) and FPG (p = 0.0001); a numerically more positive change in weight from baseline approached significance (p = 0.07). Initiation of insulin glargine in insulin-naïve patients with T2DM is associated with greater improvements in treatment satisfaction than alternative interventions, with perceived improvements in glycaemic control and baseline weight likely to be important factors.
    Diabetes Obesity and Metabolism 09/2013; · 5.18 Impact Factor

Publication Stats

3k Citations
1,000.74 Total Impact Points

Institutions

  • 1989–2014
    • CMNS Consorzio Mario Negri Sud
      • Department of Clinical Pharmacology and Epidemiology
      Chieta, Abruzzo, Italy
  • 2013
    • University of Alberta
      Edmonton, Alberta, Canada
    • University of California, San Diego
      San Diego, California, United States
  • 2011–2013
    • Università di Pisa
      • Department of Clinical and Experimental Medicine
      Pisa, Tuscany, Italy
  • 2010–2013
    • University of Otago
      • Department of Medicine (Dunedin)
      Dunedin, Otago, New Zealand
    • Sant'Andrea Medical Hospital
      Spezia, Liguria, Italy
  • 2012
    • Hospital Alemán
      Buenos Aires, Buenos Aires F.D., Argentina
  • 2011–2012
    • Sapienza University of Rome
      • Department of Clinical and Molecular Medicine
      Roma, Latium, Italy
  • 2007
    • Centro Studi e Ricerche in Medicina Generale
      Milano, Lombardy, Italy
  • 1988–2005
    • Mario Negri Institute for Pharmacological Research
      • • Unit of Pharmacoepidemiology Unit
      • • Laboratory of Clinical Epidemiology
      Milano, Lombardy, Italy
  • 2000–2002
    • Alexandria University
      • Medical Research Institute
      Alexandria, Alexandria, Egypt
  • 1996
    • Università degli Studi G. d'Annunzio Chieti e Pescara
      Chieta, Abruzzo, Italy