Intensive dietary intervention promoting the Mediterranean diet in people with high cardiometabolic risk: a non-randomized study.

AIMS: Mediterranean diet (MD) is acknowledged to exert a number of beneficial health effects. We assessed the efficacy and the durability of a 3-month intensive dietary intervention aimed at implementing the MD on body weight and cardiometabolic risk factors in subjects at high risk. METHODS: One hundred and sixteen subjects participated in the study (71 assigned to the intensive intervention and 45 to the conventional intervention). The intensive intervention consisted of 12 weekly group educational meetings and a free-of-charge supply of meals prepared according to the MD model. The conventional intervention consisted of an individual education session along with monthly reinforcements of nutritional messages by the general practitioner. All participants were followed up for 9 months. RESULTS: The two groups had similar pre-intervention characteristics. After the intervention, mean body weight decreased significantly in both groups (p < 0.001). However, the intervention group lost more weight (6.8 ± 4.0 vs. 0.7 ± 1.3, p < 0.0001) and showed a greater reduction in plasma glucose, triglycerides, blood pressure and an increase in HDL cholesterol than the control group (p < 0.01-p < 0.002). In the subgroup of participants with type 2 diabetes, there was a significant reduction in HbA1c level following the intensive (p < 0.0001) but not the conventional intervention. At follow-up, weight loss still persisted in the intervention group (p < 0.0001), while it was lost in the control group. Both interventions significantly reduced blood pressure in the long term (p < 0.001). A significant reduction in daily total energy intake was observed in both groups with a greater reduction in saturated fat and a higher increase in fibre intake in the intervention than in the control group (p < 0.009 and p < 0.001, respectively). CONCLUSIONS: A 3-month intensive dietary intervention inspired to the traditional MD produced greater and more durable weight loss and improvement in cardiometabolic risk profile than the conventional intervention.

Incidence of severe nocturnal hypoglycemia in patients with type 1 diabetes treated with insulin lispro or regular human insulin in addition to basal insulin glargine.

BACKGROUND AND AIMS: Once-daily (OD) basal insulin glargine (GLA) can be used as part of a multiple daily injection regimen in patients with type 1 diabetes mellitus. This randomized, multicenter study compared GLA+prandial regular human insulin (RHI) with GLA+prandial insulin lispro (LIS) in reducing the incidence of severe nocturnal hypoglycemia at endpoint. In addition, the effects on glycemic control of both treatments were investigated. METHODS AND RESULTS: Patients (489) previously on neutral protamine Hagedorn (NPH) insulin or GLAR plus RHI/LIS were switched to, or continued on GLA (target fasting blood glucose [FBG]=5.0-6.7 mmol/L [90-120 mg/dL]) for 8 weeks (qualification phase) prior to randomization; patients continued with their previous bolus insulin. Patients (n=395) were then randomized to LIS (n=193) or RHI (n=202) and treated for 16 weeks. The proportion of patients experiencing severe nocturnal hypoglycemia at the end of the study was 1.55% (n=3) in the RHI group and 1.11% (n=2) in the LIS group (p=0.938 between groups); the mean difference was 0.44% (95% CI: -1.77, 2.21), suggesting non-inferiority of RHI versus LIS. At the end of the study, both treatments did not differ with respect to glycemic control, as measured by hemoglobin A(1c) and FBG. CONCLUSION: These results suggest that GLA+LIS and GLA+RHI treatments were associated with a similar and low rate of severe nocturnal hypoglycemia. Further studies with greater patient sizes are necessary to verify the findings from the current study.

[Anti-platelet-aggregation drugs and atherosclerosis]. / Antiaggreganti piastrinici ed aterosclerosi.

The relationship between hyperlipidaemia and thrombophilic state in atherosclerosis was appraised by evaluation of platelet aggregation according to Breddin in 20 patients with clinically established atherosclerosis, 10 normal controls, and 22 subjects taken from the average population of a medical department aged 12-58 yr with no history of atherosclerosis. Normal screening for the disease was carried out in all patients. Drugs inhibiting platelet-aggregation were given to all subjects in Breddin's 3rd or 4th stage. A relationship was noted between Breddin stage and the seriousness of atherosclerosis, while the former was a pointer to thrombophilic states. The drugs administered were able to reverse the aggregation stage.

[Anticoagulants in therapy of patients with heart valve prostheses]. / Gli anticoagulanti nelle protesi valvolari

Thrombosis in subjects with valvular prostheses is primarily attributable to the tendency of platelets to adhere to non-natural surfaces. In addition, the release of ADP and serotonin leads to their clumping. Anticoagulant management is based on the employment of dicumarols, which inhibit the synthesis of factors VII, IX & X, and anti-clumping substances. When using the former, care must be taken to prevent unwanted side-effects and to watch for possible interactions with drugs that may enhance or diminish their effectiveness. Among the latter, a preference should be shown for those that act on the release of endogenous ADP; these are free from toxicity and significant side-effects. The main remedy, however, remains that elaborating prostheses coated with protein material to prevent adhesion by platelets and so obtain a non-thrombogenic surface.