Improving Type 2 Diabetes Care with Extended-Release Metformin: Real-Life Insights from a Physician Educational Program.

BACKGROUND: Compared to Immediate-Release (IR) metformin, Extended-Release (ER) metformin reduces side effects and pill burden while improving adherence; however, there is little real-life data on patient satisfaction with this innovative formulation to guide physicians toward a more holistic approach. OBJECTIVE: Our goal is to train general practitioners on holistic patient management, with the aim of increasing patient satisfaction and treatment adherence, reducing side effects, and improving quality of life in patients with poor tolerance to metformin-IR. DESIGN AND METHODS: We designed an educational program for physicians called SlowDiab, aimed at establishing a holistic patient approach. In this context, adult patients with T2DM who experienced gastrointestinal discomfort with metformin-IR were enrolled and switched to metformin- ER. Data on glycemic control were collected at baseline and 2 months after switching. A survey was carried out on patients to assess their level of satisfaction. RESULTS: In 69 enrolled patients (mean [min-max] age, 68.2 [41-90]), side effects decreased after switching from 61.8% to 16.2% (p < 0.01), and the mean perceived burden of adverse events on a scale of 1 to 10 also decreased (6.17 vs. 3.82; p < 0.05). Among patients previously intolerant to metformin-IR, 74.3% reported no longer experiencing any side effects after the switch. The mean number of tablets taken daily (2.28 vs. 1.66; p < 0.01) and mean plasma glycated hemoglobin (HbA1c) values (7.0% vs. 6.7%; p < 0.05) decreased, while 93.8% of patients were satisfied with the treatment change. Moreover, 84.2% reported an improvement in glycemic control after the switch. CONCLUSION: In a real-life setting, an educational program for general practitioners confirmed that metformin ER reduces side effects and improves pill burden, therapeutic adherence, and patient satisfaction compared to metformin IR.

[Asbestos exposure in the non-asbestos textile industry: the experience of the Lombardy Mesothelioma Registry]. / Esposizioni professionali nel settore tessile non-amianto in Lombardia: i dati del Registro Regionale.

The Lombardy Mesothelioma Registry, activated in 2000, receives more than 300 cases per year of suspected malignant mesothelioma; the standardized (age and gender) incidence rate of pleural mesothelioma is 2.4/100,000 inhabitants (CI 95% 2.0-2.7). The finding of an increasing number of cases among workers of the non-asbestos-textile industry, classified as "unknown exposure to asbestos", upheld the suspect of presence of asbestos in this compartment. Specific information about a possible asbestos exposure were collected by technicians, maintenance personnel and other experts; industrial machinery utilized in the past was thoroughly examined; direct inspections were carried out in several workplaces that had not yet undergone significant changes with respect to the past. A large amount of asbestos had been regularly used on the ceilings and also to the walls of factories in order to avoid both condensation of steam and reflection of noise. In addition, asbestos had also been widely used to insulate water and steam pipes. The braking systems of most of machines also had asbestos gaskets, and on several looms some brakes operated continuously. The population in study was composed of 119 subjects, 27 males and 92 females, median age of 72 years. Asbestos exposure was ascribed to work in 106 cases (89%). The system devised by the Lombardy Registry had brought to light an occupational hazard in a professional area previously never believed as a source of asbestos exposure. In consideration of the described experience, both environmental and clinical, it seems reasonable to consider the non-asbestos-textile as a new department at risk for asbestos exposure.

[The Lombardy Mesothelioma Register, Regional Operating Centre (ROC) of National Mesothelioma Register: organizational aspects]. / Il Registro mesoteliomi Lombardia, Centro Operativo Regionale (COR) del Registro nazionale mesoteliomi: aspetti organizzativi .

The Lombardy Mesothelioma Register (LMR) collects all incident cases of Malignant Mesothelioma (MM) occurring since January 1, 2000 in residents of the Lombardy Region. For each "possible case" reported to the Registry by Lombardy hospitals, diagnosis is ascertained through examination of clinical records (including histology reports) according to ISPESL Guidelines. For confirmed cases, a standardized questionnaire is administered to the subject or next-of-kin in order to verify the possible sources of asbestos exposure in his/her lifetime. A panel composed of industrial hygienists, occupational health physicians and occupational epidemiologists evaluate asbestos exposure in the workplace and environmental settings. Case ascertainment completeness is routinely verified using other sources such as hospital discharge records and death certificates coded as 163 (ICD IX). In the period 2000-2004, 1563 cases were collected, of whom 887 have been evaluated: the diagnosis was confirmed for 626 (70.6%) 9 out of 887 evaluated cases. The age and gender standardized incidence rate for pleural mesothelioma in the Lombardy Region, in the year 2000 (the only one with completed data), was 2.4 (males 3.7; females 1.4) per 100,000 residents/year The 70.5% of certain and probable MM has an asbestos exposure, in particular the 64.5% of cases has an occupational exposure. The experience gathered over the years by the LMR has allowed to implement an efficient information network among different institutions and health services. In addition practical skills have been gained in processing epidemiological data, a useful tool to address new scientific hypothesis and to plan ad-hoc researches. In our experience the LMR represents a potential resource transferable to the epidemiological surveillance of different occupational tumours (i.e. sino-nasal cancers).