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Objective: The coronavirus disease 2019 (COVID-19) pandemic and its associated restrictions have adversely affected clinical and psychological well-being, especially in elderly subjects with type 2 diabetes (T2D). The aim of the stuy was to evaluate the impact of the restrictions imposed by the COVID-19 pandemic on metabolic parameters, diabetes quality of life (DQoL), and locus of control (LOC) in elderly outpatients with T2D, also taking into account potential gender differences. Methods: Major clinical parameters, DQoL, and LOC were evaluated in a group of consecutive elderly T2D patients on oral hypoglycemic drugs before and after 12 months of the lockdown period. Results: The glycemic control of the study subjects (n = 94; age 65-89 years) did not significantly change during the observation period. Overall, QoL slightly improved, mainly due to a reduction in the impact domain, which explores the consequences of diabetes on daily life. Regarding the LOC questionnaire, the internal score increased, and the scores of the external and chance domains decreased, indicating a lower attribution of disease control to chance or other people. These changes were more evident in men than in women. Conclusion: In this group of elderly T2D outpatients with good glycemic control, the restrictions imposed by the COVID-19 pandemic did not negatively impact health-related QoL and increased the awareness of patients’ role, especially in men.

In type 2 diabetes (T2D), several differences have been described between men and women, concerning risk factors, clinical manifestations and chronic complications. The impact of gender on the efficacy and safety of hypoglycaemic drugs is still to be clarified. Some data suggest that GLP1-RAs may have greater efficacy on body weight in women, but comparable efficacy on glycaemic control and cardiovascular risk (CVD) in both sexes. The aim of our study was to evaluate in real-life clinical practice the possible influence of gender on the effectiveness and safety of GLP1-RAs long-acting therapy in T2D outpatients. In this single-centre observational study, we evaluated laboratory parameters, chronic complications, hypoglycaemic episodes, and any adverse events of subjects with T2D who started treatment with GLP1-RAs long-acting between 1 June 2018 and 31 May 2019, in add on to metformin or other hypoglycaemic drugs, and who practiced this therapy for at least two years. In the present analysis, 391 subjects with T2D were included (men 59.3%, women 40.7%), with a mean age of 64.1 years and mean duration of diabetes of 18.4 years. At baseline, patients were on average obese (BMI 32.8 kg/m2) with an inadequate glycaemic control (HbA1c 7.8%). Women had higher BMI values than men; glycaemic control was similar in both genders. After two years of follow-up, therapy with GLP1-RAs long-acting determined a significant reduction of BMI and blood pressure values, HbA1c, fasting glucose and GPT levels and an improvement in lipid profile. The reduction observed in BMI values was significantly greater in T2D women than in men. At stepwise regression analysis, female gender was among the independent predictors of the effectiveness of GLP1-RAs in terms of BMI reduction, together with fasting blood glucose, but not in terms of reduction of HbA1c levels, which was significantly associated with baseline blood glucose levels and metformin use, irrespective of gender. Overall, the treatment with GLP1-RAs was well tolerated, and only mild gastro-intestinal adverse events were observed (n=22; 5.6%, 14 men and 12 women P0.05), in both genders. In conclusion, in real-life clinical practice, the therapy with GLP1-RAs long-acting is safe and effective in both men and women, and it seems to be associated with a more beneficial effect on body weight in women than in men.

An acute metabolic complication of diabetes mellitus, especially type 1, is diabetic ketoacidosis (DKA), which is due to an increase in blood ketone concentrations. Sodium/glucose co-transporter-2 inhibitor (SGLT2-i) drugs have been associated with the occurrence of a particular type of DKA defined as euglycemic (euDKA), characterized by glycemic levels below 300 mg/dL. A fair number of euDKA cases in SGLT2-i-treated patients have been described, especially in the last few years when there has been a significant increased use of these drugs. This form of euDKA is particularly insidious because of its latent onset, associated with unspecific symptomatology, until it evolves (progressing) to severe systemic forms. In addition, its atypical presentation can delay diagnosis and treatment. However, the risk of euDKA associated with SGLT2-i drugs remains relatively low, but it is essential to promptly diagnose and manage it to prevent its serious life-threatening complications. In this narrative review, we intended to gather current research evidence on SGLT2i-associated euDKA from randomized controlled trials and real-world evidence studies, its diagnostic criteria and precipitating factors.

Considering other pharmacological approaches, also in the field of insulin therapy, the use of biosimilar drugs instead of originators could help to reduce the worldwide increasing costs of its related disease, that is, diabetes mellitus (DM), and the subsequent risk of insulin underutilization. Available evidences clearly demonstrate that biosimilar efficacy and safety are superimposable to those of the originator insulin with lower expenditure; despite this, however, their underutilization persists both in Eastern and in Western countries. Specific, regional activities are needed in order to improve biosimilar insulin use and to contribute to a substantial reduction of the costs of DM.

Abstract Background Obesity-associated coronary heart disease (CHD) risk is higher in women than in men with type 2 diabetes (T2DM). Resistin, an adipokine secreted by adispose tissue, may contribute to this higher risk. Aims To explore the relationships among resistin levels and common inflammatory and endothelial dysfunction markers and CHD risk in obese post-menopausal T2DM women. Methods Serum levels of resistin, hsCRP, IL-6, Soluble vascular cell adhesion molecule (sVCAM), homocysteine (tHcy), HOMA-IR and metabolic parameters were determined in a group of 132 T2DM women with and without documented CHD and in 55 non-diabetic women. Results Resistin, sVCAM, IL-6 and tHcy levels were comparable in T2DM and controls. CHD women showed higher resistin, sVCAM and tHcy levels than those without CHD, and for resistin this difference remained significant after age-adjustment (P = 0.013); conversely hsCRP were ~ 2X higher in T2DM women than in controls (P = 0.0132) without any difference according to CHD history. At univariate analysis resistin levels were significantly associated with age, waist circumference, hypertension, tHcy, hsPCR, sVCAM, IL-6, HDL-cholesterol, triglycerides and creatinine levels, but only creatinine, triglycerides, hsCRP, IL-6 and sVCAM were independently associated to resistin levels at stepwise regression analysis. Resistin levels were independently associated to CHD, increasing the risk by 1.15 times (0.986–1.344 95% CI), together with age, tHcy, LDL-C and hypertension. Conclusions Circulating resistin levels were comparable in obese/overweight T2DM and control women. In T2DM women, resistin levels correlated with markers of renal function, systemic inflammation and endothelial dysfunction and were independently associated with a higher CHD risk.

Background: Familial chylomicronemia syndrome (FCS) is a rare inherited condition due to lipoprotein lipase deficiency, characterized by hyperchylomicronemia and severe hypertriglyceridemia. Diagnosis is often delayed, thus increasing the risk of acute pancreatitis and hospitalization. Hypertriglyceridemia is a common finding in patients with type 2 diabetes (T2D), who may harbor FCS among the most severe forms. Aim of the Study: We investigated the prevalence and clinical characteristics associated with severe hypertriglyceridemia in a range indicative of FCS, in a large population of subjects with T2D. Methods: Within the large population of the AMD Annals Initiative, patients with T2D with a lipid profile suggestive of FCS [triglycerides >880 mg/dL and/or high-density lipoprotein (HDL)-cholesterol <22 mg/dL or non-HDL-cholesterol ≤70 mg/dL] and their clinical features have been identified. Results: Overall, 8592 patients had triglyceride values >880 mg/dL in a single examination, 613 in two examinations, and 34 in three or more measurements. Patients with high triglyceride levels were mostly male (80%), with a relatively young age (54 years), short duration of diabetes (6.3 years), and elevated hemoglobin A1c (HbA1c) levels (9.4%). By stratifying this group of patients according to the severity of hypertriglyceridemia, more severe hypertriglyceridemia (triglyceride levels ≥2000 mg/dL) was associated with an even younger age (52 vs. 54 years), even higher mean HbA1c values (10.0% vs. 9.4%), and significantly higher HDL-cholesterol levels (37.9 vs. 32.4 mg/dL; P < 0.0001). Patients with persistently elevated triglyceride levels (n = 34), on three measurements, had a younger age; lower body mass index, HbA1c, and HDL-cholesterol levels; more frequent use of fibrates and insulin; and a higher prevalence of major cardiovascular events. Conclusions: Severe hypertriglyceridemia is a frequent condition in outpatients with T2D participating in the AMD Annals Initiative, and it is associated with male sex, young age, short disease duration, and a worse glycemic profile. Among patients with persistent severe hypertriglyceridemia, hidden FCS may be present. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic drastically modified social life and lifestyle, in particular, among children and adolescents, promoting sedentary behaviors and unhealthy eating habits. The aims of this study were to assess the rate and the factors associated with outpatient drop-out in childhood obesity management, and to evaluate how the Covid-19 pandemic influenced weight status and lifestyle of children and adolescents with obesity. One hundred and forty-five children and adolescents with obesity were identified, including 80 subjects evaluated before the Covid-19 pandemic (group A) and 65 subjects in the period straddling the Covid-19 pandemic (group B). Anamnestic (family history of obesity, dietary habits, physical activity, screen time), socio-cultural (economic status, employment and schooling of parents, household composition, place of living) and clinical (weight, height, BMI, waist circumference) data were retrospectively analyzed for each subject in both groups at baseline (V0) and 12-months (V1) at in-person assessment. Glycemic and lipid profiles were assessed at V0. Drop-out rate did not differ significantly between the two groups. BMI SDS at V0 (OR=2.52; p=0.004), female sex (OR=0.41; p=0.035), and the presence of a single parent in the household (OR=5.74; p=0.033) significantly influenced drop-out in both groups. Weight loss between V0 and V1 was significantly greater among group A patients compared to group B (p=0.031). In group B, hours spent in physical activity significantly decreased from V0 to V1, being significantly lower than group A at V1; on the contrary, screen time significantly increased in the same period. The consumption of sugary drinks and snacks was significantly greater in group B than group A at V1. Our study documented that the Covid-19 pandemic, although not affecting the drop-out rate of obese children in a follow-up program, negatively influenced lifestyle and reduced the effectiveness of outpatient counseling in childhood obesity treatment.

Obesity, a major risk factor for acute coronary syndrome (ACS), is a multifaceted disease with different metabolic phenotypes and sex-specific features. Here, we evaluated the long-term cardiovascular risk by different obesity/metabolic phenotypes and by sex in ACS patients. The occurrence of the composite outcome of death, nonfatal reinfarction with or without PCI and/or stroke was evaluated in 674 patients (504 men; 170 women), consecutively hospitalized for ACS and followed-up for 7 years, who were stratified in metabolically healthy (MHNW) and unhealthy normal weight (MUNW), and in metabolically healthy (MHO) and unhealthy obese (MUO) groups. At baseline, 54.6% of patients were included in the MHNW group, 26.4% in the MUNW, 5.9% in the MHO and 13.1% in the MUO, with no sex-differences in the distribution of phenotypes. The overall rate of major outcome (100 person-years) in the reference group (MHNW) was higher in men than in women (RR: 1.19 vs. 0.6). The Kaplan–Meier curves for cumulative survival free from cardiovascular events according to obesity/metabolic status diverged significantly according to sex (log rank test, p = 0.006), this effect being more prominent in men (log 11.20; p = 0.011), than in women (log 7.98; p = 0.047). Compared to MHNW, the risk increased in obese men (RR: 2.2; 95% 1.11–1.54 in MUO group), whereas in women the risk was confined to metabolically unhealthy subjects (RR: 3.2; 95% CI 1.23–9.98, MUNW group). Our data show a sex-specific impact of obesity phenotypes on long-term cardiovascular risk in patients hospitalized for ACS.

An acute metabolic complication of diabetes mellitus, especially type 1, is diabetic ketoacidosis (DKA), which is due to an increase in blood ketone concentrations. Sodium/glucose co-transporter-2 inhibitor (SGLT2-i) drugs have been associated with the occurrence of a particular type of DKA defined as euglycemic (euDKA), characterized by glycemic levels below 300 mg/dL. A fair number of euDKA cases in SGLT2-i-treated patients have been described, especially in the last few years when there has been a significant increased use of these drugs. This form of euDKA is particularly insidious because of its latent onset, associated with unspecific symptomatology, until it evolves (progressing) to severe systemic forms. In addition, its atypical presentation can delay diagnosis and treatment. However, the risk of euDKA associated with SGLT2-i drugs remains relatively low, but it is essential to promptly diagnose and manage it to prevent its serious life-threatening complications. In this narrative review, we intended to gather current research evidence on SGLT2i-associated euDKA from randomized controlled trials and real-world evidence studies, its diagnostic criteria and precipitating factors. [ABSTRACT FROM AUTHOR]

Objective: The coronavirus disease 2019 (COVID-19) pandemic and its associated restrictions have adversely affected clinical and psychological well-being, especially in elderly subjects with type 2 diabetes (T2D). The aim of the stuy was to evaluate the impact of the restrictions imposed by the COVID-19 pandemic on metabolic parameters, diabetes quality of life (DQoL), and locus of control (LOC) in elderly outpatients with T2D, also taking into account potential gender differences. Methods: Major clinical parameters, DQoL, and LOC were evaluated in a group of consecutive elderly T2D patients on oral hypoglycemic drugs before and after 12 months of the lockdown period. Results: The glycemic control of the study subjects (n = 94; age 65-89 years) did not significantly change during the observation period. Overall, QoL slightly improved, mainly due to a reduction in the impact domain, which explores the consequences of diabetes on daily life. Regarding the LOC questionnaire, the internal score increased, and the scores of the external and chance domains decreased, indicating a lower attribution of disease control to chance or other people. These changes were more evident in men than in women. Conclusion: In this group of elderly T2D outpatients with good glycemic control, the restrictions imposed by the COVID-19 pandemic did not negatively impact health-related QoL and increased the awareness of patients’ role, especially in men. [ABSTRACT FROM AUTHOR]

Type 2 Diabetes (T2D) in elderly patients is challenging and it may have a strong impact on patients’ quality of life. In this study we evaluated whether personal, clinical, or gender-related variables may influenceDiabetes Specific Quality of Life(DSQoL) and locus of control (LOC) scores in a group of 100 elderly T2D outpatients (60% men, 40% women; mean age 72 years) on oral hypoglycaemic drugs and in good metabolic control (mean HbA1c 6.7%). Overall, women showed a greater cognitive impairment and a lower autonomy in daily lifeas compared to men. Mean DSQoL scores indicated a good quality of life, with a lower level of satisfaction in women (P=0.009).As for LOC, there was a high prevalence of the internal domain, indicating that these subjects had a good awareness of their own role in diabetes’s management. Women reached lower scores in the LOC external domain, suggesting that external factors were perceived as less important determinants of diabetes’ control in elderly women as compared to men (P=0.048). After stratifying all study variables according to QoL and LOC domains, only diabetes duration and hypoglycemic episodes were significantly associated with QoL, whereas only gender and the number of outpatient visits during the previous two years were associated with LOC domains. In conclusion, in elderly T2D patients QoL and LOC scores are clearly influenced by a number of clinical factors, including gender.

Diabetic kidney disease affects up to forty percent of patients with diabetes during their lifespan. Prevention and treatment of diabetic kidney disease is currently based on optimal glucose and blood pressure control. Renin−angiotensin aldosterone inhibitors are considered the mainstay treatment for hypertension in diabetic patients, especially in the presence of albuminuria. Whether strict blood pressure reduction entails a favorable renal outcome also in non-albuminuric patients is at present unclear. Results of several clinical trials suggest that an overly aggressive blood pressure reduction, especially in the context of profound pharmacologic inhibition of the renin−angiotensin−aldosterone system may result in a paradoxical worsening of renal function. On the basis of this evidence, it is proposed that blood pressure reduction should be tailored in each individual patient according to renal phenotype.

Type 2 diabetes mellitus (T2DM) is the leading cause of chronic kidney disease (CKD). Diabetic nephropathy (DN) is determined by specific pathological structural and functional alterations of the kidneys in patients with diabetes, and its clinical manifestations are albuminuria and decline of glomerular filtration rate (GFR). Apart from renin−angiotensin−aldosterone system (RAAS) inhibitors, no other drugs are currently available as therapy for diabetic kidney disease (DKD). Glucagon-like peptide-1 receptor (GLP-1R) agonists are a new class of anti-hyperglycemic drugs which have been demonstrated to prevent the onset of macroalbuminuria and reduce the decline of GFR in diabetic patients. These drugs may exert their beneficial actions on the kidneys through blood glucose- and blood pressure (BP)-lowering effects, reduction of insulin levels and weight loss. Clinical benefits of GLP-1R agonists were acknowledged due to data from large randomized phase III clinical trials conducted to assess their cardiovascular(CV) safety. These drugs improved renal biomarkers in placebo-controlled clinical studies, with effects supposed to be independent of the actions on glycemic control. In this review, we will focus on the actions of GLP-1R agonists on glucose metabolism and kidney physiology, and evaluate direct and indirect mechanisms through which these drugs may confer renal protection.