Micronized palmitoylethanolamide reduces the symptoms of neuropathic pain in diabetic patients.

The present study evaluated the effectiveness of micronized palmitoylethanolamide (PEA-m) treatment in reducing the painful symptoms experienced by diabetic patients with peripheral neuropathy. PEA-m, a fatty acid amide of the N-acylethanolamine family, was administered (300 mg twice daily) to 30 diabetic patients suffering from painful diabetic neuropathy. Before treatment start, after 30 and 60 days the following parameters were assessed: painful symptoms of diabetic peripheral neuropathy using the Michigan Neuropathy Screening instrument; intensity of symptoms characteristic of diabetic neuropathic pain by the Total Symptom Score; and intensity of different subcategories of neuropathic pain by the Neuropathic Pain Symptoms Inventory. Hematological and blood chemistry tests to evaluate metabolic control and safety were also performed. Statistical analysis (ANOVA) indicated a highly significant reduction in pain severity (P < 0.0001) and related symptoms (P < 0.0001) evaluated by Michigan Neuropathy Screening instrument, Total Symptom Score, and Neuropathic Pain Symptoms Inventory. Hematological and urine analyses did not reveal any alterations associated with PEA-m treatment, and no serious adverse events were reported. These results suggest that PEA-m could be considered as a promising and well-tolerated new treatment for symptomatology experienced by diabetic patients suffering from peripheral neuropathy.

Skin and subcutaneous thickness at injecting sites in children with diabetes: ultrasound findings and recommendations for giving injection.

BACKGROUND: Children who inject insulin need clear guidelines as to the length of needle best for them. We studied the distance from surface to muscle in children in order to make needle choices which are evidence-based. METHODS: One hundred one children with type 1 diabetes were divided into three groups according to age: 2-6, 7-13, and 14-17 yr. The thickness of skin and subcutaneous (SC) tissue was measured by ultrasound in all injection sites. RESULTS: Skin thickness varied from 1.58 mm in the arm of the youngest children to 2.29 mm in the buttocks of the adolescents. Values decreased progressively based on age (2-6 < 7-13 < 14-17) and on body site (arm < thigh < abdomen < buttocks). Skin + SC thickness varied in a similar fashion. The skin surface to muscle distances were <4 mm in nearly 10% of children, especially in the 2-6 yr group. In this group, the rate of intramuscular (IM) injections using the 4-mm pen needle when a pinch-up is not used would be 20.2%. This rate of IM injections doubles when using the 5-mm needle, and when injections are given under similar conditions it triples using the 6-mm needle. CONCLUSIONS: It seems medically appropriate for all children to use short needles where possible to minimize inadvertent IM injections which may increase glycemic variability. Currently, the safest needle for all children appears to be the 4-mm pen needle. However, when used in children aged 2-6 yr, it should be used with a pinched skin fold.

Movement in health: housing a diabetes centre within a gym (and vice versa).

BACKGROUND: In Giarre, Sicily, we have created a diabetes center in which the medical center and exercise gym share the same physical space. When a patient leaves the doctor's office he/she immediately enters a functioning gym. In the present paper, we report on our experiences with this integrated medical/exercise approach. METHODS: Exercise, and the subsequent achievement of physical conditioning, is a cornerstone of treatment for metabolic syndrome and Type 2 diabetes. We initiate each patient on a tailored, phased, and sustainable exercise program administered by experts in sport, diet, and behavioral change with the immediate support of a range of medical disciplines. RESULTS: More than 1100 patients have joined our program since its inception in 2005, with 180 passing through the center each day. Measurable and sustainable improvements in cardiovascular conditioning, quality of life indices, blood glucose control, and weight have been documented. The financial structure permits patients of all socioeconomic strata to access the service. DISCUSSION: We believe that health care workers should teach by doing, and exercise is best taught by doing activities that the patients should do using the same facilities as the instructors. We target one of the most difficult patient groups, people with metabolic syndrome or Type 2 diabetes, and we ask them to do one of the hardest things in life: change it radically at a relatively advanced age by beginning to exercise regularly. Our approach appears to be unique in the world. We invite others who may have similar experiences to share their knowledge with us.

Hyperglycemia in celiac disease: not always pretype 1 diabetes?

Celiac disease (CD) is a T-cell-mediated enteropathy, triggered in genetically susceptible individuals by the ingestion of wheat gluten or related rye and barley proteins, whose clinical picture disease is considerably heterologous. Patients with CD are at high risk of autoimmune disorders; similarly, CD is frequent in patients with type 1 diabetes mellitus (T1DM), a disorder characterized by the immune-mediated beta-cell destruction, with the cooperation of environmental factors in genetically susceptible individuals. The immunological markers of beta-cell destruction are the autoantibodies to insulin, glutamic acid decarboxylase, and the protein tyrosine phosphatase. In absence of these markers, incidental hyperglycemia in children and adolescents appears unlikely to be associated with the progression to T1DM. We report a girl with CD and incidental hyperglycemia, without immunological markers of T1DM, with a family history for hyperglycemia, and diagnosed as maturity-onset diabetes of the young. We present this case as evidence that the possibility of monogenic forms of diabetes must be suspected in children with incidental hyperglycemia, a family history for mild hyperglycemia or diabetes, and absence of markers of beta-cell destruction, even if the patients are affected by an autoimmune disease.

Self monitoring blood glucose and quality of care.

Studies like the DCCT and the UKPDS showed that prevention of Type 1 diabetes mellitus complications can be obtained if glucose level is maintained as close as possible to normal. Consequently management of diabetes has significantly changed in the last two decades since the aim of maintaining a good metabolic control has been pursued through intensive insulin therapy and self-monitoring blood glucose (SMBG). However, although SMBG is extremely helpful in preventing and treating hypoglycaemia and ketoacidosis, its role in maintaining a good metabolic control is controversial. Both the American Diabetes Association and the International Society for Paediatric and Adolescent Diabetes recommend the use of SMBG to maintain specific glycaemic levels but suggest that this is possible only if the patient achieves good skills in interpreting self-monitored data and consequently in self-adjusting insulin therapy and modifying eating and activity. Few studies have addressed this question and almost no data is available on SMBG and metabolic control in children with T1DM. However it can be stated that SMBG, although considered a cornerstone in diabetes care, is a necessary but not sufficient tool for the patient to achieve self-management and that only self-management leads to a good metabolic control. Paediatric diabetologists have a crucial role in providing long-term, continuative education in the use of SMBG and in self-management of diabetes.

Gerstmann-Sträussler-Scheinker disease with P102L-V129 mutation: a case with psychiatric manifestations at onset.

Gerstmann-Sträussler-Scheinker disease (GSS) is an adult onset, rare, genetically determined autosomal dominant prion disease. Clinically, it is characterized predominantly by slowly progressive spino-cerebellar dysfunction with ataxia, absent reflexes in the legs and cognitive impairment. Onset is usually in the fifth decade and in the early phase, ataxia is predominant. Mutations in the prion protein gene (PRNP) had been identified and the most important of these is at codon 129. A genotype-phenotype relationship with genetic polymorphism at residue 129 between methionine and valine has been supposed. We describe a patient with GSS and P102L-V129 mutation in which the onset with prominent psychiatric features characterized by apathy and depression and not with cerebellar sign and the clinical course with seizures, nor observed in P102L-V129 cases, allow us to confirm observations that the GSS caused by the 102 mutation is influenced by the codon 129 polymorphism with a specific genotype-phenotype influence, but probably other additional factors might be considered as background for phenotypic variability.

Reproductive risk factors in unilateral and bilateral renal agenesis.

Renal agenesis (RA) appears to be a multifactorial condition with combined genetic and environmental influences. We performed a retrospective case-control study of reproductive history of 26 isolated RA live births cases referred to Sicilian Registry of Congenital Malformations. A statistical significant association for birth weight if we considered all RA together and for bilateral RA alone, an increasing risk for maternal age only in the bilateral RA subgroup and a male predominance both for unilateral and bilateral RA was found. Our results show that some reproductive risk factors may be associated with RA, moreover differences found between subgroups indicate that some risk factors may be different in unilateral and bilateral RA. The association between reproductive risk factors and RA may reflect pathogenetic interaction between genetic and environmental factors. Nevertheless further studies are needed to clarify these associations and to explore the role of perinatal factors in the etiology of renal agenesis. In fact if prenatal or perinatal risk factors are in a causal chain influencing the risk for developing RA, then these data could have important implications in the prevention or treatment of this condition.