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1.
Clin Ter ; 163(5): 403-9, 2012.
Article in Italian | MEDLINE | ID: mdl-23099971

ABSTRACT

Hyperglycaemia in patients with Acute Coronary Syndrome (ACS)is common, and is an independent predictor of mortality and morbidity in patients both with and without diabetes mellitus. Hyperglycaemia may be a marker of pre-existing diabetes or glucose intolerance or may also represent a transient stress response mediated through the autonomic nervous system with release of adrenal corticosteroids and catecholamines. Several evidences suggest that an intensive control of hyperglycaemia results in a significant improvement of the adverse outcomes in the short and long term. In fact, an intensive metabolic treatment can counteract the negative effects of hyperglycaemia. However, the main difficulty to intensive glucose control in patients with ACS remains hypoglycaemia that is associated with an increased risk of mortality and myocardial re-infarction. No definitive data are available about the beneficial effects of insulin intensive treatment. Therefore, randomized multicenter clinical trials will be needed to definitively establish whether intensive glucose control will reduce the associated increased mortality rate and higher rates of complications in hospitalized ACS patients with hyperglycaemia.


Subject(s)
Acute Coronary Syndrome/complications , Hyperglycemia/complications , Acute Coronary Syndrome/mortality , Acute Disease , Decision Trees , Humans , Hyperglycemia/diagnosis , Hyperglycemia/physiopathology , Hyperglycemia/therapy , Risk Factors
2.
Nutr Metab Cardiovasc Dis ; 21(9): 713-8, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21764272

ABSTRACT

BACKGROUND AND AIMS: Glucose-tolerant subjects who have 1-h post-load glucose levels ≥155 mg dl(-1) (normal glucose tolerance (NGT)-1h-high) are at an increased risk of developing type 2 diabetes. Prospectively conducted studies indicated that high levels of liver enzymes are predictors of a tendency to develop type 2 diabetes; however, it is unknown whether the NGT-1h-high subjects are at increased risk for secreting higher levels of liver biomarkers. METHODS AND RESULTS: In this study, oral glucose tolerance tests (OGTTs) were performed in a cohort of 1000 non-diabetic Caucasians and levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT) were measured in these subjects. The NGT-1h-high subjects had increased levels of ALT and GGT, but not AST, as compared with the NGT-1h-low. Following adjustment for age and gender, the ALT, AST and GGT levels were all found to be significantly correlated with body mass index (BMI), waist circumference, blood pressure, triglycerides as well as fasting and post-challenge glucose and insulin levels. In a logistic regression analysis adjusted for age and gender, NGT-1h-high subjects were found to be at increased risk of having ALT levels in the highest quartile as compared with NGT-1h-low subjects (odds ratio (OR) = 1.71; 95% confidence interval (CI): 1.16-2.52). In addition, NGT-1 h-high subjects exhibited an increased risk for having GGT levels in the highest quartile (OR = 1.50; 95%CI: 1.02-2.17). These associations remained significant after adjustment for BMI, blood pressure and lipids, but were not significant following further adjustment for an insulin sensitivity index. NGT-1h-high subjects were at increased risk of having AST levels in the highest quartile as compared with NGT-1h-low subjects (OR = 1.51; 95%CI: 1.04-2.22). This association ceased to be significant following adjustment for BMI, blood pressure and lipids. CONCLUSIONS: These data suggest that a 1hPG ≥ 155 mg dl(-1) cut-off may facilitate the identification of NGT individuals at risk of developing liver abnormalities.


Subject(s)
Blood Glucose/analysis , Liver/enzymology , Adult , Alanine Transaminase/blood , Aspartate Aminotransferases/blood , Biomarkers/blood , Body Mass Index , Cross-Sectional Studies , Diabetes Mellitus, Type 2/metabolism , Female , Humans , Insulin/blood , Insulin Resistance , Logistic Models , Male , Middle Aged , Odds Ratio , Prospective Studies , Triglycerides/blood , White People , gamma-Glutamyltransferase/blood
3.
Clin Ter ; 161(5): 461-4, 2010.
Article in Italian | MEDLINE | ID: mdl-20949245

ABSTRACT

Chronic fatigue syndrome (CFS) is a clinical syndrome characterized by profound disabling chronic fatigue associated with a wide array of other physical symptoms. Its etiology is currently unknown. Among the various hypotheses, considerable interest has been placed in the hypothalamus-pituitary-adrenal axis as a possible target of the pathogenesis of CFS. This article reviews the available scientific evidence about a role of hypothalamic-pituitary-adrenal axis in the pathogenesis of chronic fatigue syndrome.


Subject(s)
Fatigue Syndrome, Chronic/etiology , Hypothalamo-Hypophyseal System , Pituitary-Adrenal System , Humans , Hypothalamo-Hypophyseal System/physiopathology , Pituitary-Adrenal System/physiopathology
4.
Int J Immunopathol Pharmacol ; 23(3): 961-3, 2010.
Article in English | MEDLINE | ID: mdl-20943070

ABSTRACT

We present the case of a 45-year-old man with psoriasis and psoriatic arthritis and concomitant impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). In this patient, refractory to DMARD's, infliximab was started to control the arthritis. After achieving clinical remission of the disease, infliximab was discontinued and a 75 g- oral glucose tolerance test (OGTT) was performed. After the test, we observed a conversion from IFG/IGT glucose tolerance status to type 2 diabetes. No diet, lifestyle or therapy modifications were made during the observation period. Autoimmune diabetes was ruled out by serum antibodies determination and body weight remained constant, sustaining a protective role in infliximab in the worsening of glucose tolerance.


Subject(s)
Antibodies, Monoclonal/therapeutic use , Antirheumatic Agents/therapeutic use , Diabetes Mellitus, Type 2/pathology , Glucose Intolerance/pathology , Arthritis, Psoriatic/complications , Arthritis, Psoriatic/drug therapy , Disease Progression , Glucose Tolerance Test , Humans , Hypertension/complications , Infliximab , Insulin Resistance , Male , Middle Aged , Tumor Necrosis Factor-alpha/immunology
5.
Atherosclerosis ; 207(1): 245-9, 2009 Nov.
Article in English | MEDLINE | ID: mdl-19410252

ABSTRACT

OBJECTIVE: To examine whether individuals with normal glucose tolerance (NGT), whose 1-h post-load plasma glucose is >or=155 mg/dl, or with impaired glucose tolerance (IGT) have an increased carotid intima-media thickness (IMT), as compared with NGT individuals with 1-h post-load plasma <155 mg/dl. METHODS: Atherosclerosis risk factors, oral glucose tolerance test (OGTT), and ultrasound manual measurement of IMT were analyzed in 400 non-diabetic Caucasians. RESULTS: As compared with individuals with a 1-h post-load plasma glucose <155 mg/dl, NGT individuals with a 1-h post-load plasma glucose >or=155 mg/dl exhibited higher hsCRP (2.0+/-1.5 vs. 1.5+/-1.0, P=0.008), and IMT (0.82+/-0.20 vs. 0.71+/-0.16; P=0.006), and lower insulin sensitivity (71+/-39 vs. 105+/-57; P<0.0001), and IGF-1 levels (214+/-88 vs. 176+/-49; P<0.03). No significant differences were observed in metabolic and cardiovascular risk factors between IGT and NGT subjects with a 1-h post-load glucose >or=155 mg/dl. Of the three glycemic parameters, 1-h and 2-h post-load glucose, but not fasting glucose, were significantly correlated with IMT. In a stepwise multivariate regression analysis in a model including age, gender, and a variety of atherosclerosis risk factors, the three variables that remained significantly associated with IMT were age (P<0.0001), BMI (P<0.0001), and 1-h post-load glucose (P=0.02) accounting for 20.2% of its variation. CONCLUSIONS: NGT subjects with a 1-h post-load glucose >or=155 mg/dl have an atherogenic profile similar to IGT individuals. These data suggest that a cutoff point of 155 mg/dl for the 1-h post-load glucose during OGTT may be helpful in the identification of NGT subjects at increased risk for cardiovascular disease.


Subject(s)
Blood Glucose/metabolism , Carotid Arteries/diagnostic imaging , Carotid Artery Diseases/blood , Glucose Tolerance Test , Adult , Age Factors , Aged , Biomarkers/blood , Body Mass Index , C-Reactive Protein/metabolism , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/etiology , Cross-Sectional Studies , Female , Humans , Insulin/blood , Linear Models , Male , Middle Aged , Predictive Value of Tests , Risk Assessment , Risk Factors , Time Factors , Tunica Intima/diagnostic imaging , Tunica Media/diagnostic imaging , Ultrasonography , Up-Regulation , White People , Young Adult
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