Phenotypes of prediabetes and metabolic risk in Caucasian youths with overweight or obesity.

PURPOSE: To assess the prevalence of pre-diabetes phenotypes, i.e., impaired fasting glucose (IFG), impaired glucose tolerance (IGT), increased HbA1c (IA1c), and their association with metabolic profile and atherogenic lipid profile in youths with overweight/obesity (OW/OB). METHODS: This cross-sectional study analyzed data of 1549 youths (5-18 years) with OW/OB followed in nine Italian centers between 2016 and 2020. Fasting and post-load measurements of glucose, insulin, and HbA1c were available. Insulin resistance (IR) was estimated by HOMA-IR and insulin sensitivity (IS) by reciprocal of fasting insulin. The atherogenic lipid profile was assessed by triglycerides-to-HDL ratio or cholesterol-to-HDL ratio. Insulinogenic index was available in 939 youths, in whom the disposition index was calculated. RESULTS: The prevalence of overall pre-diabetes, IFG, IGT and IA1c was 27.6%, 10.2%, 8% and 16.3%, respectively. Analyzing each isolated phenotype, IGT exhibited two- to three-fold higher odds ratio of family history of diabetes, and worse metabolic and atherogenic lipid profile vs normoglycemic youths; IFG was associated only with IR, while IA1c showed a metabolic and atherogenic lipid profile intermediate between IGT and IFG. CONCLUSION: Prevalence of pre-diabetes was high and IA1c was the most prevalent phenotype in Italian youths with OW/OB. The IGT phenotype showed the worst metabolic and atherogenic lipid profile, followed by IA1c. More studies are needed to assess whether HbA1c may help improving the prediction of diabetes.

Relationships between thyroid function and autoimmunity with metabolic derangement at the onset of type 1 diabetes: a cross-sectional and longitudinal study.

BACKGROUND: Type 1 diabetes (T1DM) is an autoimmune disease often associated with thyroid abnormalities. PURPOSE: We investigated the correlation between thyroid function and metabolic derangement at onset and the influence of autoimmunity on thyroid function at onset and subsequently. METHODS: We evaluated 152 patients diagnosed with T1DM between 2000 and 2012 at onset and during a mean follow-up of 5.45 ± 2.8 years. Thyroid function at onset was correlated with metabolic derangement (degree of acidosis, metabolic control and adrenal function) and compared with that of 78 healthy children. Follow-up consisted of regular evaluation of thyroid function and autoimmunity. RESULTS: Thyroid hormonal pattern was not influenced at onset by thyroid autoimmunity, but only by metabolic derangement: pH and base excess in fact were significantly lower in patients with impaired thyroid function (p < 0.0001). Patients presenting normal thyroid function at onset showed a reduced conversion from FT4 to FT3 compared to nondiabetic children (FT3/FT4 0.3 ± 0.4 in the control group, 0.24 ± 0.4 in diabetic patients, p < 0.0001). Multiple regression analysis showed the highest correlation (negative) between FT3 levels at onset and base excess (p < 0.005). Thyroid abnormalities related to metabolic derangement disappeared during follow-up. Patients with thyroid antibodies at T1DM onset were at higher risk to require levothyroxine treatment during follow-up (p < 0.05). CONCLUSIONS: Thyroid function at T1DM onset is mainly influenced by metabolic derangement, irrespective of thyroid autoimmunity. Antithyroid antibodies evaluation at T1DM onset may be helpful to define which patients are at higher risk of developing hypothyroidism.

Safety of closed-loop therapy during reduction or omission of meal boluses in adolescents with type 1 diabetes: a randomized clinical trial.

We evaluated the safety and efficacy of closed-loop therapy with meal announcement during reduction and omission of meal insulin boluses in adolescents with type 1 diabetes (T1D). Twelve adolescents with T1D [six male; mean (s.d.) age 15.9 (1.8) years; mean (s.d.) glycated haemoglobin (HbA1c) 77 (27) mmol/mol] were studied in a randomized crossover study comparing closed-loop therapy with meal announcement with conventional pump therapy over two 24-h stays at a clinical research facility. Identical meals were given on both occasions. The evening meal insulin bolus was calculated to cover half of the carbohydrate content of the meal and no bolus was delivered for lunch. Plasma glucose levels were in the target range of 3.9-10 mmol/l for a median [interquartile range (IQR)] of 74 (55,86)% of the time during closed-loop therapy with meal announcement and for 62 (49,75)% of the time during conventional therapy (p = 0.26). Median (IQR) time spent with plasma glucose levels > 10 mmol/l [23 (13,39) vs. 27 (10,50)%; p = 0.88] or < 3.9 mmol/l [1(0,4) vs. 5 (1,10)%; p = 0.24] and mean [standard deviation (SD)] glucose levels [8.0 (7.6,9.3) vs. 7.7 (6.6,10.1) mmol/l, p = 0.79] were also similar. In conclusion, these results assist home testing of closed-loop delivery with meal announcement in adolescents with poorly controlled T1D who miscalculate or miss meal insulin boluses.

Transition from pediatric to adult care. eight years after the transition from pediatric to adult diabetes care: metabolic control, complications and associated diseases.

BACKGROUND: Transition from pediatric to adult care is a critical process in the life of patients with diabetes. AIM: Primary aim of the study was to compare the metabolic control between pediatric care and adult care at least 5 years in a group of patients with type 1 diabetes mellitus (T1DM). Secondary aim was to evaluate the presence of complications, associated diseases and psychological-psychiatric disorders. SUBJECTS AND METHODS: We obtained data from 73 % (69/94) patients (current mean age 34 years) transferred to local adult centers between 1985 and 2005 at a mean age of 23.8 years. Data were collected for HbA1c, diabetic complications and associated diseases. RESULTS: Mean HbA1c did not change during the pediatric, transition and adult period [8.4 ± 1.8 % (68 ± 18 mmol/mol), 8.3 ± 1.4 % (67 ± 15 mmol/mol) and 8.4 ± 1.3 % (68 ± 14 mmol/mol), respectively]. 13 patients dropped out, after 2-12 years since transition, and their HbA1c mean value at transition was 10.4 %. After a mean of 25.9 years of disease, 35/69 patients (50.7 %) showed retinopathy, and 12/69 patients (17.3 %) nephropathy. Thyroid diseases were the most frequent associated diseases (18.3 %), followed by depression (11.2 %) and benign neoplasms (9.8 %). Drug or alcohol addictions were present in four cases (5.6 %). CONCLUSIONS: After a mean follow-up of 8 years metabolic control after transition did not change significantly in patients constantly attending to adult care centre. Patients with diabetes onset between 20 and 40 years ago were free from complications in 50 % of cases when considering retinopathy and in more than 80 % considering nephropathy. Thyroid problems were the most common associated diseases. Poor metabolic control at transition is associated with higher risk of drop-out and psychosocial morbidity.

Severe hypoglycemic episodes: a persistent threat for children with Type 1 diabetes mellitus and their families.

BACKGROUND: As lowering glycated hemoglobin (HbA1c) levels is still the main goal of insulin treatment, severe hypoglycemia (SH) remains a common experience in children with Type 1 diabetes mellitus (T1DM) and their families. AIM: This study aims to evaluate the incidence and the clinical features of SH episodes in our Centre in the last 20 yr. SUBJECTS AND METHODS: We analyzed SH incidence in 269 patients (pts) diagnosed from 1990 to 2010 (total follow-up 2212.9 pts/yr). Inclusion criteria were at least 3 visits/yr and 1-yr follow- up. SH episode was defined as any condition of low blood glucose requiring third-party assistance. RESULTS: 50.2% of patients experienced at least 1 SH episode for a total of 345 episodes. Whole incidence was 15.6/100 pts/yr, slightly different between first and second decade (12.6 vs 16.5, p=0.047). HbA1c at the time of SH was lower in the non-basal bolus group (7.4±1.3 vs 8.2±1.4; p=0.0001) and worsened 3 months later (p=0.0001). Impaired awareness was the main or only symptom in 43.5%. SH occurred at night in 32% of patients; they were significantly younger than those with SH at other times. Five SH episodes or more occurred in 8.1% of patients who presented a lower HbA1c, a younger age and shorter disease duration than the other patients. HbA1c at first SH was negatively correlated with number of SH (r=-0.20; p=0.05). CONCLUSIONS: Despite the advent of new insulin regimens, we confirm that SH still represents a relevant risk and a current threat for patients with T1DM and their families.

Neck motion evaluation after whiplash: a radiographic and kinematic protocol.

Evaluation of functional damage is the main aspect in the diagnosis of whiplash injury, therefore some type of instrumental testing is strongly needed. We describe an instrumental protocol to test subjects with whiplash, to support clinical evaluation, in order to solve the difficulty of evaluating the functional injury and the lack of fixed parameters capable of identifying this kind of injury. Eighty subjects suffering from after effects of whiplash and seventy five normal subjects undergo two instrumental tests: kinematic examination of neck mobility, and measurements of extension-flexion X-rays of the cervical spine. The results exhibited by the traumatized patients have been compared with the normal range of motion obtained from the data bank of the normal subjects. This is a report in progress of a larger research on whiplash evaluation in a clinical setting.

Radon measurements in the Gran Sasso Underground Laboratory.

Systematic radon monitoring in the Gran Sasso Underground Laboratory was performed in order to determine the background radon contribution to the sophisticated experimental apparatus and to check health physics standards for the personnel. As expected, the radon concentrations were found to depend strongly on the ventilation in the three experimental halls. Considerable reductions in the radon concentrations were obtained in 1993, when fresh air was drawn into the laboratory through a pipe and exhaust air was routed into the highway tunnel.

Beta-human chorionic gonadotropin and alpha-fetoprotein in central and peripheral venous blood of patients with testicular tumors.

From January 1989 to June 1991, 18 patients ranging in age from 19 to 41 (mean 34) years with testicular tumor were examined. 14 patients had seminoma (11 typical and 3 spermatocytic) and 4 patients had a mixed form (2 seminoma + embryonal tumor and 2 seminoma + teratocarcinoma). Serum levels of beta-human chorionic gonadotropin and alpha-fetoprotein from peripheral venous blood and from spermatic venous vessel were evaluated in every patient. All patients with seminoma and in a patient with mixed tumor (seminoma + embryonal tumor) the markers were regular. The increase of the markers was found in the peripheral and in spermatic blood of 3 patients (2 seminoma + embryonal carcinoma and 1 seminoma + teratocarcinoma). For these reasons the values of spermatic vessels are an important confirmation of the level of peripheral markers.

Sexual dysfunction after excision of the rectum.

From January 1986 up January 1988 a series of 18 patients--age average 49--were studied. All of them had undergone the amputation of the rectum for carcinoma with the Miles resection technique (15 p.), or for ulcerous rectumcolitis (3 p.). Six months after operation the patients were given a questionnaire in order to obtain information about their sexual activity. Exams on the liverkidney functioning, the hormone dosage (FSH, LH, prolactin, testosterone), penile Doppler flowmetry, and the sacral latency test were performed. The patients were also given a Jonas erectiometer to be used at home. The procedures followed have shown in most patients normal hormonal, vascular, and neurologic parameters, thus confirming the absence of relevant erectile deficits. Only one patient no longer had erections after the surgical intervention. It was reported a decrease and some sort of difficulty in the sexual intercourse owing to the presence of colostomy conditioning the physical and psychological relations with the partner. Spermatic fluid results altered after operation: absent in 8 cases, backwards in 3, diminished in 6, and normal in 4.

Chemical prosthesis.

The approach to patients suffering from erectile failure includes medical and sexual anamnesis, Doppler ultrasound, Jonas erectiometer and Sacral Latency Test. At present, the use of papaverine directly in corpora cavernosa seems indicated in performance anxiety dysfunctions used together with psycotherapy and in slight arterial deficiencies, diabetes, after destructive pelvic surgery and in neurological lesions. From January 1986 we have performed 150 I.C. injections of papaverine. Experience in 60 patients is described. Seven patients are now self-injecting.

A case-control study of the efficacy of a non-randomized breast cancer screening program in Florence (Italy).

In a rural area near Florence a population-based screening program for breast cancer was started in 1970, offering a mammography test every 2.5 years to all women between 40 and 70 years of age. In order to evaluate the efficacy of this program a case-control study has been carried out comparing the screening history of all women who died from breast cancer in this area in the years 1977-1984, and who had been diagnosed after the start of the program, with that of a matched group of living controls. The case-control study showed that the overall O.R. of dying from breast cancer in the study period for "screened" versus "never-screened" women was 0.53 (95% C.I. = 0.29-0.95). After evaluation of other variables as potential confounders the adjusted O.R. estimates were respectively 0.57 (95% C.I. = 0.35-0.92) and 0.32 (95% C.I. = 0.20-0.52) for women screened only once or at least twice. No significant protective effect was shown for women below the age of 50 years.

[Screening for colo-rectal neoplasms by the study of fecal occult blood]. / Screening delle neoplasie colorettali mediante la ricerca del sangue occulto fecale.

Occult blood testing has been proposed as a screening tool for colorectal cancer. At the present time guaiac testing is considered the most suitable for mass screening. The specificity of the test is affected by diet. For this reason it is necessary to adhere to a meat-free diet while the necessity of eliminating peroxidase containing foods as uncooked vegetables and fruit is controversial. The sensitivity of guaiac test is affected by the intermittence of colorectal cancer bleeding, by the quantity of ascorbic acid and fibers in the diet and by the development modality of the test. The experience of the authors is based on a screening protocol applied on some populations in the province of Florence (Italy). The protocol is based on guaiac test and an anamnestic selection of high-risk patients. 6029 patients have performed guaiac test. In 1159 patients, the results of occult blood testing and sigmoidoscopy have been compared. This analysis accounts for a predictive value of 50%, a specificity of 95.6%, and a sensitivity of 68% for carcinomas and 21.3% for adenomas. In conclusion, guaiac testing seems to warrant a good cost/benefit ratio but because its sensitivity is too low, it is necessary to include other selective tools (the anamnestic questionnaire) as well as an over-all major effort in the research of more sensitive ways of testing.

Gastric carcinoma: preliminary data of a cooperative program for early diagnosis.

The results of a program of early gastric cancer detection, carried out in the Oncologic Institutes of Genoa, Forlì and Florence, are evaluated. General practitioners screened subjects, according to possible anamnestic and clinical risk indicators (age, family history, previous gastric lesions, digestive complaints, etc.). The diagnostic consisted of medical examinations, endoscopy with cytology and/or directed biopsy, and possibly air contrast barium X-ray. Of 3,180 subjects examined, 224 had gastric cancers (7 %), 29 of which were early cancers, and 688 had high risk lesions; 1,478 cases of other pathology were detected. The authors stress that the proportion of early cancer is clearly higher than that found in routine diagnosis, yet still lower compared to the results of screening programs carried on the general population. Moreover, the high diagnostic sensitivity of each method in early gastric cancer detection and, on the other hand, the difficulties in the detection of high risk lesions, which require systematic multiple biopsies, are emphasized.

Mass screening for early breast cancer detection.

In 1969 the Center for Social Diseases of Florence started a screening program for early breast cancer detection. The female population over 40 years of age of a group of outlying towns of the District was invited. From January 1969 till March 1977, 21,725 women have been examined in the program. Mammography was the diagnostic procedure of choice, followed by physical examination if necessary. Negative cases were controlled with biennial mammography. This paper summarizes and evaluates the results of this screening program. At first mammography, 67 cancers were detected, 37% of which were clinically unapparent, 62.3% staged T1A, and 52% N--. The average stage at diagnosis is certainly better than the average stage of cancers diagnosed in unscreened women, thus a better prognosis is expected. Actuarial survival rate of detected cancers was 94 +/- 3.7% at 5 years. False negative and false positive cases are reported. The possibility of hazards in the use of repeated mammography in mass screening is discussed. According to reported data the value of this screening program in terms of secondary prevention (early diagnosis) is confirmed.

Critical evaluation of several years' activity aimed at the diagnosis of asymptomatic diabetes in the Province of Florence. Revision of method.

The authors have based this critical evaluation on the methods at present adopted for mass screening for symptomatic diabetes in a group of 39,405 subjects, in full working activity. The results obtained from these tests confirm the social importance of this illness in the active population. However, the authors suggest that the glycosuria test be abandoned as the primary discriminating criterium and suggest that blood glucose assay in specimens drawn two hours after a standard glucose and load (50 g as proposed by WHO) and the singling out of potential diabetic individuals by reason of their family and physiological background be adopted for this purpose. The relationship between diabetes, obesity, dysmetabolism and cardiovascular alterations lead us to stress once more the importance of primary prevention, aimed at correcting the eating habits and life style of patients with a potential predisposition to the illness.