Prevalence and risk of new-onset diabetes mellitus after COVID-19: a systematic review and meta-analysis.

Aims: After the acute phase of SARS-CoV-2 infection, the onset of glycemic impairment and diabetes have been reported. Nevertheless, the exact burden of glycemic impairment and diabetes after COVID-19 has not been clearly described. Materials and methods: Electronic search was run in Pubmed (MEDLINE), Web of Science, Scopus, and ClinicalTrial.org for reports published from database inception to September 2022. We included observational studies reporting quantitative data on diabetes prevalence or its onset in subjects with a history of SARS-CoV-2 infection from at least 60 days. Risk of bias was assessed by the JBI's critical appraisal checklist. Random effect model was used to calculate pooled data. The review protocol was registered on PROSPERO (CRD42022310722). Results: Among 1,630 records screened, 20 studies were included in the analysis. The mean or median age of participants ranged from ~ 35 to 64 years, with a percentage of males ranging from 28% to 80%. Only two studies were considered at low risk of bias. The estimate of diabetes prevalence, calculated on a total of 320,948 participants pooled with 38,731 cases, was 16% (95%CI: 11-22%). The estimate of proportion of incident cases of diabetes was 1.6% (95%CI: 0.8-2.7%). Subgroup analysis showed that previous hospitalization increased the prevalence of diabetes and the proportion of incident cases. Conclusion: Diabetes is common in individuals who have experienced SARS-CoV-2 infection, especially if they required hospitalization. This data may be helpful to screen for diabetes and manage its complications in individuals who experienced COVID-19. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022310722, identifier CRD42022310722.

Diabetes and cognitive decline.

Epidemiologic studies have documented an association between diabetes and increased risk of cognitive decline in the elderly. Based on animal model studies, several mechanisms have been proposed to explain such an association, including central insulin signaling, neurodegeneration, brain amyloidosis, and neuroinflammation. Nevertheless, the exact mechanisms in humans remain poorly defined. It is reasonable, however, that many pathways may be involved in these patients leading to cognitive impairment. A major aim of clinicians is identifying early onset of neurologic signs and symptoms in elderly diabetics to improve quality of life of those with cognitive impairment and reduce costs associated with long-term complications. Several biomarkers have been proposed to identify diabetics at higher risk of developing dementia and diagnose early stage dementia. Although biomarkers of brain amyloidosis, neurodegeneration and synaptic plasticity are commonly used to diagnose dementia, especially Alzheimer disease, their role in diabetes remains unclear. The aim of this review is to explore the molecular mechanisms linking diabetes with cognitive decline and present the most important findings on the clinical use of biomarkers for diagnosing and predicting early cognitive decline in diabetics.

Influence of Nutritional Status and Physical Exercise on Immune Response in Metabolic Syndrome.

Metabolic Syndrome (MetS) is a cluster of metabolic alterations mostly related to visceral adiposity, which in turn promotes glucose intolerance and a chronic systemic inflammatory state, characterized by immune cell infiltration. Such immune system activation increases the risk of severe disease subsequent to viral infections. Strong correlations between elevated body mass index (BMI), type-2-diabetes and increased risk of hospitalization after pandemic influenza H1N1 infection have been described. Similarly, a correlation between elevated blood glucose level and SARS-CoV-2 infection severity and mortality has been described, indicating MetS as an important predictor of clinical outcomes in patients with COVID-19. Adipose secretome, including two of the most abundant and well-studied adipokines, leptin and interleukin-6, is involved in the regulation of energy metabolism and obesity-related low-grade inflammation. Similarly, skeletal muscle hormones-called myokines-released in response to physical exercise affect both metabolic homeostasis and immune system function. Of note, several circulating hormones originate from both adipose tissue and skeletal muscle and display different functions, depending on the metabolic context. This review aims to summarize recent data in the field of exercise immunology, investigating the acute and chronic effects of exercise on myokines release and immune system function.

Tropomyosin: A panallergen that causes a worldwide allergic problem.

Background: Panallergens are proteins that take part in key processes of organisms and, therefore, are ubiquitously distributed with highly conserved sequences and structures. One class of these panallergens is composed of the tropomyosins. The highly heat-stable tropomyosins comprise the major allergens in crustaceans and mollusks, which make them important food allergens in exposed populations. Tropomyosins are responsible for a widespread immunoglobulin E cross-reactivity among allergens from different sources. Allergic tropomyosins are expressed in many species, including parasites and insects. Methods: This panallergen class is divided, according to it capacity of induced allergic symptoms, into allergenic or nonallergenic tropomyosin. Although vertebrate tropomyosins share ∼55% of sequence homology with invertebrate tropomyosins, it has been thought that the invertebrate tropomyosins would not have allergic properties. Nevertheless, in recent years, this opinion has been changed. In particular, tropomyosin has been recognized as a major allergen in many insects. Results: A high grade of homology has been shown among tropomyosins from different species, such as crustaceans and insects, which supports the hypothesis of cross-reactivity among tropomyosins from divergent species. Moreover, the emerging habit of consuming edible insects has drawn the attention of allergists to invertebrate tropomyosin protein due to its potential allergenic risk. Nevertheless, evidence about tropomyosin involvement in clinical allergic response is still scarce and deserves more investigation. Conclusion: This review intended to report allergic reactions associated with different tropomyosins when considering house dust mites, parasites, seafood, and insects, and to summarize our current knowledge about its cross-reactivity because this could help physicians to accurately diagnose patients with food allergy.

Glycated Albumin for Glycemic Control in T2DM Population: A Multi-Dimensional Evaluation.

PURPOSE: To investigate the glycated albumin (GA) introduction implications, as an add-on strategy to traditional glycemic control (Hb1Ac and fasting plasma glucose - FPG) instruments, considering insulin-naïve individuals with type 2 diabetes mellitus (T2DM), treated with oral therapies. METHODS: A Health Technology Assessment was conducted in Italy, as a multi-dimensional approach useful to validate any innovative technology. The HTA dimensions, derived from the EUnetHTA Core Model, were deployed by means of literature evidence, health economics tools and qualitative questionnaires, filled-in by 15 professionals. RESULTS: Literature stated that the GA introduction could lead to a higher number of individuals achieving therapeutic success after 3 months of therapy (97.0% vs 71.6% without GA). From an economic point of view, considering a projection of 1,955,447 T2DM insulin-naïve individuals, potentially treated with oral therapy, GA introduction would imply fewer individuals requiring a therapy switch (-89.44%), with a 1.06% in costs reduction, on annual basis, thus being also the preferable solution from a cost-effectiveness perspective (cost-effectiveness value: 237.74 vs 325.53). According to experts opinions, lower perceptions on GA emerged with regard to equity aspects (0.13 vs 0.72, p-value>0.05), whereas it would improve both individuals (2.17 vs 1.33, p-value=0.000) and caregivers quality of life (1.50 vs 0.83, p-value=0.000). Even if in the short term, GA required additional investments in training courses (-0.80 vs 0.10, p-value = 0.036), in the long run, GA could become the preferable technology (0.30 vs 0.01, p-value=0.018) from an organisational perspective. CONCLUSION: Adding GA to traditional glycaemic control instruments could improve the clinical pathway of individuals with T2DM, leading to economic and organisational advantages for both hospitals and National Healthcare Systems.

The different daily distribution of proteins does not influence the variations in body composition in a sample of subjects undergoing a low-calorie Mediterranean-type diet.

BACKGROUND: Controversy exists regarding whether the different daily balances of proteins between meals and snacks in a low-calorie diet may influence the effects on body composition (BC) results. Aim of this study is to evaluate BC changes made by a lifestyle intervention in a randomized homogeneous sample of two groups with equal daily caloric reduction but different protein distributions between meals. METHODS: Forty-seven men and women (mean age: 32±10 years; Body Mass Index: 28.4±2.4 kg/m2) consumed an energy-restricted diet (788 kcal/d below the requirement) for eight weeks in a free-living contest. Subjects consumed 90.1 g protein/d (1.10±0.16 g/kg/day) and were randomized in an EVEN (16.7% at breakfast, 32.8% at lunch, 31.3% at dinner, 19.2% at snacks; N.=23) or UNEVEN (15.4% at breakfast, 36.6% at lunch, 34.9% at dinner, 12.4% at snacks; N.=24) distribution pattern. The nutritional characteristics and caloric deficit of the two diets were similar. RESULTS: The total sample had an overall improvement in both BMI (-0.9±0.6) and fat mass (FM: -2.3±1.5), while lean body mass was preserved (LBM: 0.0±0.7). There were no significant differences between the two groups in variations in BC. CONCLUSIONS: In overweight and obese subjects undergoing a Mediterranean-type low-calorie diet, a different distribution of daily protein intake between meals and snacks does not result in significant differences in terms of FM loss and LBM maintenance. This is one of the first studies showing that nutritional dietary plans with different daily protein distribution show no particular differences in fat loss and lean mass maintenance.

Losing Weight after Menopause with Minimal Aerobic Training and Mediterranean Diet.

OBJECTIVE: It is a common belief that menopausal women have greater difficulty losing weight. The aim of this study was to assess the efficacy of a Mediterranean diet (MD) to promote weight loss in postmenopausal women. All participants were prescribed a hypocaloric traditional MD, tailored to the individual. Subjects were asked not to begin any kind of physical activity. Body composition was measured at the beginning and after 8 weeks of treatment. In total, 89 women (age 52.8 ± 4.5 years, BMI 30.0 ± 5.2 kg/m2, fat mass 31.6 ± 10.5 kg) were divided into two groups: the first group consisted of fertile women over 45 years of age, the second group consisted of those diagnosed as menopausal. All women had an improvement in body composition (fat mass -2.3 ± 2.1 kg, p < 0.001; protein -0.1 ± 0.7 kg, p = 0.190) and blood pressure values. No differences were found between the two groups except for a higher reduction of low-density lipoprotein in the menopausal group (p = 0.035). A positive significant correlation between plant to animal protein ratio and fat-free mass variation was found in the menopausal group. These data suggest that a high adherence to a traditional MD would enable menopausal women to lose fat mass and maintain muscle mass with no significant difference to younger women. Fat mass reduction provides menopausal women with improved cardiovascular and metabolic risk factors.

Effects of Quality and Quantity of Protein Intake for Type 2 Diabetes Mellitus Prevention and Metabolic Control.

PURPOSE OF REVIEW: The aim of this review is to evaluate the ideal protein quality and quantity and the dietary composition for the prevention and metabolic control of type 2 diabetes mellitus (T2DM). INTRODUCTION: Although some reviews demonstrate the advantages of a diet with a higher protein intake, other reviews have observed that a diet high in carbohydrates, with low-glycaemic index carbohydrates and good fibre intake, is equally effective in improving insulin sensitivity. METHODS: Over 2831 articles were screened, and 24 from the last 5 years were analysed and summarised for this review, using the protein, diabetes and insulin glucose metabolic keywords in Pubmed in June 2019. RESULTS: Eleven studies demonstrate that a higher consumption of proteins has a positive effect on insulin sensitivity. A higher intake of animal protein seems to be related to an increased risk of T2DM. Four studies show that consumption of meat has a deleterious effect. Higher intake of plant protein and dairy products is associated with a modestly reduced risk. DISCUSSION: Based on the results obtained, for the prevention of T2DM and all disorders related to metabolic syndrome, no ideal dietary composition has yet been found. The advantage of plant protein sources may be related to the foods' low-glycaemic index due to the high fibre content. However, the right protein quality (animal and plant) and the quantity for T2DM prevention and metabolic control are unclear and need to be investigated with further long-term studies.

Klotho and vitamin D in multiple sclerosis: an Italian study.

INTRODUCTION: Low vitamin D levels have been recognised as an important risk factor for autoimmune diseases, including multiple sclerosis (MS). MS is a multifactorial disease, the pathogenesis of which contributes both to genetic and environmental factors. Polymorphisms in genes codifying molecules involved in vitamin D homeostasis have been associated with hypovitaminosis D. However, the influence of polymorphisms of Klotho, which codify a protein with a pivotal role in vitamin D metabolism, have never been investigated. The aim of this study was to evaluate the association among genetic variants of Klotho, namely rs1207568 and rs9536314, serum 25(OH)D3 levels, and multiple sclerosis (both risk and disease progression). MATERIAL AND METHODS: 107 patients with MS and 133 healthy controls were enrolled in this study. Serum 25(OH)D3 levels and genotyping of Klotho SNPs were evaluated in all participants by high-performance liquid chromatography and real-time polymerase chain reaction, respectively. RESULTS: Allelic and genotypic frequencies did not differ between patients and controls. Concerning rs1207568, we found a trend toward lower serum 25(OH)D3 levels in MS patients with A allele (mutant), both in heterozygosis (AG) and in homozygosis (AA), in comparison to MS patients with G allele in homozygosis (GG) (AG + AA 20.5 ±6.3 µg/l; GG 22.5 ±7.5 µg/l, p = 0.07). CONCLUSIONS: Our findings did not identify a role of Klotho in the genetic susceptibility to MS.

Use of Troponin as a predictor for cardiovascular diseases in patients with type 2 Diabetes Mellitus.

People with type 2 diabetes mellitus (T2DM) have two- to four-fold increased cardiovascular mortality in comparison to the general population. With the identification of new therapeutic targets and hypoglycemic drugs for T2DM, the need for a better stratification of CVD risk has emerged to select patients who may need intensive or specific treatment. At present, risk stratification is based on clinical, demographic, and biochemical factors. High sensitivity cardiac troponin (hs-cTn) increases after several ischemic and non-ischemic insults and it is considered a marker of myocardial injury. This review summarizes the main findings about hs-cTn utilization for risk stratification in people with T2DM and no clinical CVD. Several large observational studies have documented the association between hs-cTn and adverse cardiovascular outcomes in both the general population and in patients with T2DM. Lifestyle interventions, and particularly promotion of physical activity and adoption of healthy nutritional habits, have been associated to a significant benefit on hs-cTn release in the general population. Randomized controlled trials suggested that hypoglycemic, anti-hypertensive and lipid-lowering therapy may influence the degree of T2DM-induced cardiac injury. Besides these promising findings, the efficacy of an hs-cTn-based approach for CVD prevention in T2DM patients still requires more investigations.

Diet high in protein-rich foods with structured sport activity may be useless to lose fat mass and maintain fat-free mass.

BACKGROUND: The aim of this study was to demonstrate that a normal protein diet along with minimal sports activity can be enough to lose fat mass and maintain muscle mass. METHODS: All participants were prescribed a hypocaloric nutritionally balanced Mediterranean-style diet tailored to the individual for 8 weeks. Body composition and energy expenditure were measured. Sedentary patients (G1) were only recommended to perform minimal aerobic training, while sport subjects (G2) were prescribed structured physical activity and higher calorie and protein contents in the diet. RESULTS: There were no significant differences between the two groups for any of the measured parameters. CONCLUSIONS: The models of lifestyle changes that are currently circulating were for the most part ineffective. It does not appear to be necessary to increase the protein content of the diet above that recommended by guidelines in order to lose weight. Even prescribing specific physical activity is not necessary to maintain muscle mass.

Non-Skeletal Activities of Vitamin D: From Physiology to Brain Pathology.

Vitamin D is a secosteroid hormone regulating the expression of almost 900 genes, and it is involved in the regulation of calcium and phosphate metabolism, immune response, and brain development. Low blood vitamin D levels have been reported in patients affected by various diseases. Despite a large amount of literature data, there is uncertainty surrounding the role of vitamin D as a serum biomarker in Alzheimer's disease (AD) and Parkinson's disease (PD). Indeed, the lack of internationally recognized 25(OH)D3 reference measurement procedures and standard materials in the past led to unstandardized serum total 25(OH)D3 results among research and clinical care laboratories. Thus, most of the literature studies reported unstandardized data, which are of little use and make it difficult to draw conclusions of the role of vitamin D in AD and PD. This review summarizes the extra-skeletal actions of vitamin D, focusing its role in immunomodulation and brain function, and reports the issue of lacking standardized literature data concerning the usefulness of vitamin D as a biomarker in AD and PD.

Establishing the 99th percentile for high sensitivity cardiac troponin I in healthy blood donors from Southern Italy.

INTRODUCTION: The knowledge of high sensitivity cardiac troponin I (hsTnI) distribution in a reference population is mandatory for its introduction in clinical practice. The aim of this study was to define the Upper Reference Limit (URL) of hsTnI measured by Single Molecule Counting technology (SMC) in an accurately selected reference population. MATERIALS AND METHODS: In the study 1140 blood donors were included and selected on the basis of medical history and biomarkers. High sensitivity cardiac troponin I was measured by SMC technology (Clarity, Singulex, Alamed, USA). The 99th percentile was calculated by the non-parametric method according to the Clinical and Laboratory Standard Institute - CLSI C28-A3. RESULTS: The median age was 41 years (IQR: 28 - 50) and 69% were males. The overall 99th percentile was 5 ng/L (90% CI: 4.2 - 5.6). When considering sex-related differences, we found slight differences between the 99th percentile in males and females. Moreover, the 99th percentile trended with age, especially in females. CONCLUSIONS: We defined the 99th percentile of hs-cTnI measured by SMC technology in a highly selected healthy population, with only minor differences between males and females. Our findings provide the basic criteria for the reliable interpretation of hsTnI concentrations measured by the SMC technology in clinical settings.

Cerebrospinal Fluid Analysis in Multiple Sclerosis Diagnosis: An Update.

Multiple sclerosis (MS) is an immune-mediated demyelinating disease of the central nervous system (CNS) with brain neurodegeneration. MS patients present heterogeneous clinical manifestations in which both genetic and environmental factors are involved. The diagnosis is very complex due to the high heterogeneity of the pathophysiology of the disease. The diagnostic criteria have been modified several times over the years. Basically, they include clinical symptoms, presence of typical lesions detected by magnetic resonance imaging (MRI), and laboratory findings. The analysis of cerebrospinal fluid (CSF) allows an evaluation of inflammatory processes circumscribed to the CNS and reflects changes in the immunological pattern due to the progression of the pathology, being fundamental in the diagnosis and monitoring of MS. The detection of the oligoclonal bands (OCBs) in both CSF and serum is recognized as the "gold standard" for laboratory diagnosis of MS, though presents analytical limitations. Indeed, current protocols for OCBs assay are time-consuming and require an operator-dependent interpretation. In recent years, the quantification of free light chain (FLC) in CSF has emerged to assist clinicians in the diagnosis of MS. This article reviews the current knowledge on CSF biomarkers used in the diagnosis of MS, in particular on the validated assays and on the alternative biomarkers of intrathecal synthesis.

Glycated albumin as a glycaemic marker in patients with advanced chronic kidney disease and anaemia: a preliminary report.

Background: The association between glycated albumin (GA) and glycaemic status has not been fully described in patients with advanced chronic kidney disease (CKD) in relation to anaemia. The aim of this study was to evaluate the relationship between GA and fasting plasma glucose (FPG) and HbA1c in patients with advanced CKD and to evaluate the influence of anaemia in such relationship. Materials and methods: Patients with CKD stage 4 or 5 were included in the study. eGFR was calculated by the CKD-EPI creatinine equation. Plasma GA was measured by an enzymatic method. Results: Eighty-one patients were included in the study, 46 (57%) were males; the mean age was 67 ± 14 years. HbA1c was correlated with Hb (r = 0.39; p = .0003), and no significant correlation was detected between plasma GA and serum albumin (p = .82). A significant association between FPG and GA (r2 = 0.41; p < .0001), and between FPG and HbA1c (r2 = 0.42; p < .0001) was detected in the whole study population. Patients with moderate/severe anaemia had lower HbA1c than patients with no anaemia, while both FPG and GA were comparable between the two groups. Multivariate regression analysis showed that GA was a significant predictor of FPG in patients with moderate/severe anaemia while HbA1c did not (r2 = 0.55; p < .0001 for the model). Conclusions: GA, alone or in combination with other biomarkers, can be considered for the evaluation of glycaemic status in patients with advanced CKD and severe anaemia.

Endothelial Function, Adipokine Serum Levels, and White Matter Hyperintesities in Subjects With Diabetic Foot Syndrome.

CONTEXT: No study has analyzed the prevalence of white matter hyperintensities (WMHs) in subjects with diabetic foot syndrome (DFS) and their relationship to adipokine serum levels and indexes of endothelial and cognitive performance. OBJECTIVE: To evaluate omentin and vaspin serum levels and the prevalence of WMHs in subjects with DFS and to analyze their relationship with other endothelial, arterial stiffness, and cognitive functions. DESIGN: Case-control study enrolling 40 subjects with DFS, 40 diabetic subjects without foot complications, 40 controls with foot lesions without diabetes, and 40 patients without diabetes mellitus. MAIN OUTCOME MEASURES: Pulse wave velocity (PWV), augmentation index, reactive hyperemia index (RHI), serum vaspin and omentin levels, Fazekas score, and Mini-Mental State Examination (MMSE). RESULTS: Subjects with DFS showed higher mean PWV values when compared with diabetic controls and lower RHI values when compared with controls. They also showed a lower mean MMSE score, significantly lower omentin serum levels, and a higher prevalence of grade 2 severity of periventricular hyperintensities (PVHs). We observed a significant positive correlation between PWV and PVH and between Fazekas score and PWV among diabetic subjects, whereas among subjects with diabetic foot we observed a significant negative correlation between PVH and RHI. CONCLUSIONS: Diabetes seems to be more associated with endothelial function disturbance in comparison with patients with diabetic foot that exhibit a more strict association with microvascular brain damage as indicated by our significant finding of an association with PVHs.

Vitamin D in malaria: more hypotheses than clues.

Vitamin D is a secosteroid hormone regulating calcium and phosphate metabolism, immune response and brain development. Low blood 25(OH)D levels have been reported in patients affected by infectious diseases caused by parasites, including malaria. Despite the high effectiveness of antimalarials, malaria is burdened with high morbidity and mortality, and the search for additional therapies is rapidly growing. Furthermore, available preventive measures have proved to be barely effective so far. Finding new prevention and therapy tools is a matter of urgency. Studies on animal models and humans have hypothesized some mechanisms by which the hormone can influence malaria pathogenesis, and the role of Vitamin D supplementation in preventing and treating this disease has been suggested. Few studies on the association between Vitamin D and malaria are available and disagreeing results have been reported. Studies in humans reporting an association between low 25(OH)D circulating levels and Malaria have a small sample size and observational study-set. Randomized controlled trials are needed in order to understand if Vitamin D administration might play a role in preventing and treating malaria.

Mid-regional pro-adrenomedullin predicts poor outcome in non-selected patients admitted to an intensive care unit.

Background Mortality risk and outcome in critically ill patients can be predicted by scoring systems, such as APACHE and SAPS. The identification of prognostic biomarkers, simple to measure upon admission to an intensive care unit (ICU) is an open issue. The aim of this observational study was to assess the prognostic value of plasma mid-regional pro-adrenomedullin (MR-proADM) at ICU admission in non-selected patients in comparison to Acute Physiology and Chronic Health Evaluation II (APACHEII) and Simplified Acute Physiology Score II (SAPSII) scores. Methods APACHEII and SAPSII scores were calculated after 24 h from ICU admission. Plasma MR-proADM levels were measured by TRACE-Kryptor on admission (T0) and after 24 h (T24). The primary endpoint was intra-hospital mortality; secondary endpoint was length of stay (LOS). Results One hundred and twenty-six consecutive non-selected patients admitted to an ICU were enrolled. Plasma MR-proADM levels were correlated with LOS (r=0.28; p=0.0014 at T0; r=0.26; p=0.005 at T24). Multivariate analysis showed that T0 MR-proADM was a significant predictor of mortality (odds ratio [OR]: 1.27; 95% confidence interval [95%CI]: 1.03-1.55; p=0.022). Receiver operating characteristic curves analysis revealed that MR-proADM on ICU admission identified non-survivors with high accuracy, not inferior to the one of APACHEII and SAPSII scores (area under the curve [AUC]: 0.71; 95%CI: 0.62-0.78; p=0.0002 for MR-proADM; AUC: 0.71; 95%CI: 0.62-0.79; p<0.0001 for APACHEII; AUC: 0.8; 95%CI: 0.71-0.87; p<0.0001 for SAPSII). Conclusions Our findings point out a role of MR-proADM as a prognostic tool in non-selected patients in ICUs being a reliable predictor of mortality and LOS and support its use on admission to an ICU to help the management of critically ill patients.

Diagnostic and prognostic value of H-FABP in acute coronary syndrome: Still evidence to bring.

The assessment of chest pain patients presenting to the emergency area (EA) is still a clinical challenge, as the majority of patients are not diagnosed with acute coronary syndrome (ACS). New generation high sensitivity c-Tn (hs-cTn) assays have showed better performances compared to the standard c-Tn. However, hs-Tn still presents some limitations. Hence, novel, early biomarkers are needed in this setting. Among all, heart-type fatty acid binding protein (H-FABP) has been largely investigated. This article reviews the studies evaluating H-FABP performance in diagnosing acute myocardial infarction (AMI) and stratifying chest pain patients by risk. H-FABP optimal performances in ACS have been reported by studies that used low threshold for positivity, or compared the biomarker to cTn at 3-6 h, or by studies with small sample size. Literature review allows stating that H-FABP is clearly not a reliable marker in ACS, as it is unable to diagnose AMI, neither as a stand-alone test nor combined with hs-cTn. Few evidence supports its incremental value in ruling-out AMI and its risk stratification ability for chest pain patients presenting to EA. Thus, available data may not encourage going on investigating.

Clinical usefulness of Glycated Albumin in the diagnosis of diabetes: Results from an Italian study.

OBJECTIVES: Glycated Albumin (GA) has been proposed as a screening marker for diabetes in Asian countries in the last years. Nevertheless, few studies have been conducted in Caucasian population. The aim of this study is to evaluate the clinical usefulness of GA in diabetes diagnosis in Caucasian asymptomatic subjects considered at risk of diabetes based on medical history and Fasting Plasma Glucose (FPG). DESIGN AND METHODS: Three hundred and thirty-four Caucasian subjects having one or more risk factor for diabetes, and/or FPG ranging from 5.6 mmol/L to 6.9 mmol/L with no symptoms for diabetes were enrolled in this study. Plasma GA was measured by an enzymatic method (quantILab Glycated Albumin) on ILab Taurus instrument (Instrumentation Laboratory - A Werfen Company). RESULTS: GA median levels were 13.2% (IQR:12.2-14.4). Eighteen subjects (5.4%) were classified as diabetics based on their HbA1c. According to the ROC curve analysis, GA identified subjects with diabetes with a sensitivity of 72.2% (95% CI: 46.5-90.3) and a specificity of 71.8% (95% CI: 66.5-76.7) (AUC: 0.80; 95% CI: 0.75-0.84; P < 0.0001) at the cut-off of 14%. The cut-off of 13.5% was associated to a higher sensitivity 88.9% (95%CI: 65.3-98.6) and a specificity of 60.4% (95%CI, 54.8-65.9). CONCLUSIONS: This study confirms the clinical usefulness of GA for the diagnosis of diabetes in Caucasian subjects at risk for diabetes. More studies are required to clarify the role of GA in relation to the other diagnostic criteria for diabetes.