Cardiometabolic indices predict hypogonadism in male patients with type 2 diabetes.

PURPOSE: To evaluate in men with type 2 diabetes the association of cardiometabolic indices [Visceral Adiposity Index (VAI), Triglyceride Glucose Index (TyG), and lipid accumulation product (LAP)] with total testosterone (TT) levels, and their predictive cut-off values in identifying hypogonadism. METHODS: 265 consecutive men aged 40-70 years with type 2 diabetes performed an andrological evaluation; metabolic parameters and TT were determined. Receiver operating characteristic (ROC) curves were used to identify cut-off values of cardiometabolic indices in predicting low testosterone (TT < 12 nmol/l). RESULTS: VAI, TyG, and LAP were negatively associated with TT levels. The prevalence of hypogonadism in men in the fourth quartiles of VAI, TyG, and LAP was ~ 70.0-75.0% compared to ~ 10.0-17.0% in men in the first quartiles (p < 0.001). The sensitivity and specificity of the three cardiometabolic indices in predicting TT < 12 nmol/l were significantly higher concerning BMI, waist circumference, lipid profile and HbA1c. Cut off values of VAI ≥ 3.985, TyG ≥ 4.925, and LAP ≥ 51.645 predict hypogonadism with good sensitivity and specificity. CONCLUSION: This is the first study evaluating the association of VAI, TyG, and LAP with hypogonadism in men with type 2 diabetes. Alterations in these indices should direct the patients to andrological evaluation.

Assessment of simple strategies for identifying undiagnosed diabetes and prediabetes in the general population.

BACKGROUND AND AIMS: The rising tide of diabetes mellitus (DM) and prediabetes (PDM) is urgently calling for strategies easily applicable to anticipate diagnosis. We assessed the effectiveness of random capillary blood glucose (RCBG), administration of a validated DM risk questionnaire, or the combination of both. MATERIALS AND METHODS: RCBG measurement and/or questionnaire administration were offered to all individuals presenting at gazebos organized during the World Diabetes Day or similar public initiatives on diabetes awareness. Subjects with suspicious DM or PDM were invited to the Diabetes Center (DC) for laboratory confirmation (fasting plasma glucose and HbA1c). RESULTS: Among 8563 individuals without known diabetes undergoing RCBG measurement, 341 (4%) had suspicious values. Diagnosis of DM was confirmed in 36 (41.9%) of the 86 subjects who came to the DC and PDM was found in 40 (46.5%). Among 3351 subjects to whom the questionnaire was administered, 480 (14.3%) had suspicious scores. Diagnosis of DM was confirmed in 40 (10.1%) of the 397 who came to the DC and PDM was found in 214 (53.9%). These 3351 subjects also had RCBG measurement and 30 out of them had both tests positive. Among them, 27 subjects came to DC and DM was diagnosed in 17 (63.0%) and PDM was found in 9 (33.3%). CONCLUSIONS: These data suggest that RCBG definitely outperforms the questionnaire to identify unknown DM and PDM. RCBG measurement, with questionnaire as an adjunctive tool, appears to be a simple, fast, and feasible opportunistic strategy in detecting undiagnosed DM and PDM.

Dietary intake and major food sources of polyphenols in people with type 2 diabetes: The TOSCA.IT Study.

PURPOSE: Proper evaluation of polyphenols intake at the population level is a necessary step in order to establish possible associations with health outcomes. Available data are limited, and so far no study has been performed in people with diabetes. The aim of this work was to document the intake of polyphenols and their major food sources in a cohort of people with type 2 diabetes and in socio-demographic subgroups. METHODS: We studied 2573 men and women aged 50-75 years. Among others, anthropometry was measured by standard protocol and dietary habits were investigated by food frequency questionnaire (EPIC). The intake of polyphenols was evaluated using US Department of Agriculture and Phenol-Explorer databases. RESULTS: The mean total polyphenol intake was 683.3 ± 5.8 mg/day. Non-alcoholic beverages represented the main food source of dietary polyphenols and provided 35.5% of total polyphenol intake, followed by fruits (23.0%), alcoholic beverages (14.0%), vegetables (12.4%), cereal products and tubers (4.6%), legumes (3.7%) and oils (2.1%); chocolate, cakes and nuts are negligible sources of polyphenols in this cohort. The two most important polyphenol classes contributing to the total intake were flavonoids (47.5%) and phenolic acids (47.4%). Polyphenol intake increased with age and education level and decreased with BMI; furthermore, in the northern regions of Italy, the polyphenol intake was slightly, but significantly higher than in the central or southern regions. CONCLUSIONS: The study documents for the first time the intake of polyphenols and their main food sources in people with diabetes using validated and complete databases of the polyphenol content of food. Compared with published data, collected in people without diabetes, these results suggest a lower intake and a different pattern of intake in people with diabetes.

Independent association of estimated pulse-wave velocity with all-cause mortality in individuals with type 2 diabetes.

BACKGROUND: Estimated pulse-wave velocity (ePWV), a surrogate measure of arterial stiffness, was shown to independently predict morbidity and mortality from cardiovascular disease and other causes in both the general population and high-risk individuals. However, in people with type 2 diabetes, it is unknown whether ePWV adds prognostic information beyond the parameters used for calculating it. AIMS: To assess the independent association of ePWV with all-cause mortality in individuals with type 2 diabetes. DESIGN: Prospective cohort study that enrolled 15 773 patients in 19 Italian centres in 2006-08. METHODS: ePWV was calculated from a regression equation using age and mean blood pressure (BP). All-cause mortality was retrieved for 15 656 patients in 2015. RESULTS: Percentage and rate of deaths, Kaplan-Meier estimates and unadjusted hazard ratios increased from Quartile I to Quartile IV of ePWV. After adjustment for age, sex, BP levels and anti-hypertensive treatment, the strength of association decreased but mortality risk remained significantly higher for Quartiles II (+34%), III (+82%) and IV (+181%) vs. Quartile I and was virtually unchanged when further adjusting for other cardiovascular risk factors and complications/comorbidities. Each m·s- 1 increase in ePWV was associated with an increased adjusted risk of death in the whole cohort (+53%) and in participants with (+52%) and without (+65%) cardiorenal complications. Moreover, ePWV significantly improved prediction of mortality risk over cardiovascular risk factors and complications/comorbidities, though the net increase was modest. CONCLUSIONS: These findings suggest that ePWV may represent a simple and inexpensive tool for providing prognostic information beyond traditional cardiovascular risk factors. TRIAL REGISTRATION: ClinicalTrials.gov, NCT00715481, https://clinicaltrials.gov/ct2/show/NCT00715481.

Gender differences in cardiovascular disease risk factors, treatments and complications in patients with type 2 diabetes: the RIACE Italian multicentre study.

OBJECTIVES: Poorer control of risk factors for cardiovascular disease (CVD) has been reported in diabetic women, as compared with diabetic men. It has been proposed that this finding is due to gender disparities in treatment intensity. We investigated this hypothesis in a large contemporary cohort of subjects with type 2 diabetes. DESIGN: Observational, cross-sectional study. SUBJECTS AND SETTING: Consecutive patients with type 2 diabetes from the Renal Insufficiency And Cardiovascular Events (RIACE) Italian multicentre study (n = 15 773), attending 19 hospital-based diabetes clinics in 2007-2008. MAIN OUTCOME MEASURES: Traditional CVD risk factors, macro- and microvascular complications and current glucose-, lipid- and blood pressure (BP)-lowering treatments were assessed. RESULTS: Although CVD was more prevalent in men, women showed a less favourable CVD risk profile and worse performance in achieving treatment targets for haemoglobin A1c , LDL, HDL and non-HDL cholesterol, systolic blood pressure (BP) and in particular obesity [body mass index (BMI) and waist circumference], but not for triglycerides and diastolic BP. However, women were more frequently receiving pharmacological treatment for hypertension and to a lesser extent hyperglycaemia and dyslipidaemia than men, and female gender remained an independent predictor of unmet therapeutic targets after adjustment for confounders such as treatments, BMI, duration of diabetes and, except for the systolic BP goal, age. CONCLUSIONS: In women with type 2 diabetes from the RIACE cohort, a more adverse CVD risk profile and a higher likelihood of failing treatment targets, compared with men, were not associated with treatment differences. This suggests that factors other than gender disparities in treatment intensity are responsible.

Enhanced responsiveness of blood pressure to sodium intake and to angiotensin II is associated with insulin resistance in IDDM patients with microalbuminuria.

We assessed blood pressure (BP), body weight, renal hemodynamics, and insulin sensitivity (by euglycemic-hyperinsulinemic clamp) in nine normoalbuminuric and seven microalbuminuric IDDM patients after 6 days on a low-sodium diet (20 mEq) and after 6 days on a high-sodium diet (250 mEq). In microalbuminuric but not in normoalbuminuric IDDM patients, switching from a low to a high-sodium diet was associated with a significant increase in mean BP (from 92 +/- 3 to 101 +/- 4 mmHg; P < 0.001) and in body weight (2.91 +/- 0.63 vs. 1.47 +/- 0.26 kg; P < 0.05). Moreover, under high-sodium conditions, angiotensin II infusion (3 ng x kg(-1) x min(-1)) caused a greater increase in mean BP (14 +/- 2 vs. 7.4 +/- 1 mmHg; P < 0.05) and a smaller reduction in renal plasma flow (-122 +/- 29 vs. -274 +/- 41 ml x min(-1) x 1.73 m2; P < 0.05) in microalbuminuric than in normoalbuminuric IDDM patients. Under low sodium conditions, aldosterone increments after angiotensin II infusion were lower (P < 0.05) in microalbuminuric than in normoalbuminuric IDDM patients. Insulin-mediated glucose disposal was not affected by sodium dietary content, but it was lower in microalbuminuric (P < 0.05) than in normoalbuminuric IDDM patients. The salt-induced changes in mean BP were related to insulin sensitivity (r = -0.78; P < 0.001). In conclusion, in IDDM patients, microalbuminuria is associated with 1) an increased responsiveness of BP to salt intake and angiotensin II, 2) impaired modulation of renal blood flow, and 3) insulin resistance. Therefore, salt sensitivity in IDDM patients clusters with other factors that are likely to play an important role in the pathogenesis of diabetic nephropathy and its cardiovascular complications.

Effects of metformin treatment on whole-body and splanchnic amino acid turnover in mild type 2 diabetes.

The effects of metformin therapy on whole body and splanchnic amino acid turnover are not known. Therefore, we have studied fasting and postprandial phenylalanine kinetics in type 2 diabetic subjects (non-insulin-dependent diabetes mellitus), previously treated with diet only, both before and after 4 weeks of either metformin (850 mg twice a day) (n = 11) or placebo administration (n = 6). Phenylalanine kinetic was evaluated by means of a multiple isotope technique: tritiated phenylalanine was infused i.v., whereas carbon-labeled phenylalanine was incorporated into a chemically-defined meal. Compared with placebo, metformin administration decreased both fasting (from 162 +/- 17 to 141 +/- 20 mg/dl) and postprandial (from 217 +/- 20 to 164 +/- 20 mg/dl) glucose concentrations (P < 0.05-P < 0.01). Fasting insulin concentrations were unaffected, but postmeal insulin tended to be lower (P < 0.06) after metformin. Compared with the pretreatment period, metformin administration did not change total phenylalanine rate of appearance (fasted state, 0.74 +/- 0.10 vs. 0.71 +/- 0.08 mumol/kg.min; fed state, 0.77 +/- 0.10 vs. 0.75 +/- 0.08 mumol/kg.min, respectively), dietary and endogenous phenylalanine rate of appearance, dietary phenylalanine oxidation, and splanchnic uptake, similar to what was observed in the placebo group. Our data indicate that, at least after a 4-week treatment, metformin does not affect fasting and postprandial protein turnover, as indicated by phenylalanine data, in subjects with mild non-insulin-dependent diabetes mellitus.

A simple method for electrical field stimulation of cultured granule cells.

A method suitable for electrical field stimulation of superfused primary cultures of cerebellar granule cells is described. A microchamber of about 0.5 ml was obtained by closing the culture dishes with a perspex plug equipped with stimulating electrodes and inlet-outlet tubing. Two-minute trains of electrical pulses (alternate polarity, 2-ms duration; 100 mA intensity; 10 V drop between electrodes; frequency 5, 10 and 20 Hz) applied to cultures kept at 27 degrees C, elicited a D-[3H]aspartate outflow which was frequency related, [Ca2+]0 dependent, tetrodotoxin sensitive. Moreover 2 trains of 10 Hz pulses (S1 and S2) at 30-min intervals caused an S2/S1 ratio equal or near to one, thus demonstrating that a steady-state condition had been achieved. The NMDA antagonist DL-2-amino-5-phosphonopentanoic acid (AP5) but not the non-NMDA antagonist, 6-cyano-7-nitroquinozaline-2,3-dione (CNQX), added before S2, significantly increased the electrically evoked tritium efflux, suggesting that the endogenous transmitter released during electrical stimulation activated an NMDA-mediated negative feed-back. This technique of electrical field stimulation seems particularly feasible to study the extent and time course of drug effects on spontaneous and evoked D-[3H]aspartate outflow.

Identification of afferent connections to cortical area 6abeta of the cat by means of retrograde horseradish peroxidase transport.

Ten cats were injected in cortical area 6abeta with HRP. The distribution of the cortico-cortical and thalamo-cortical afferent neurones were analysed. In the ipsilateral cortex, labelled cells were found in the following gyri: sigmoid, coronal, anterior ectosylvian, anterior suprasylvian, and orbital. In the contralateral cortex, HRP-positive neurones were found only in zones homotopic to the injection site. In the thalamus, the most heavily labelled nuclei were ventralis lateralis and ventralis medialis, while ventralis anterior, medialis dorsalis, and the intralaminar nuclei were labelled to a lesser extent. No labelled cells were found in contralateral thalamic nuclei.

Effects of the recombinant human erythropoietin (rHuEPO) administration on hematologic parameters, red cell creatine and 2,3-diphosphoglycerate contents, in patients affected by end-stage renal disease.

Twenty patients with renal failure and severe anemia (hemoglobin range 6.6-8.7 g/dl) on thrice-weekly maintenance hemodialysis were treated with recombinant human erythropoietin (rHuEPO). After three months of intravenous (iv) therapy the hemoglobin increase averaged 2 g/dl, and was steadily maintained even after two months of subcutaneous (sc) therapy. The significant increase of macrocyte counts, determined by an automated red blood cell counter after both steps of therapy, suggested the release of young red cells (large cells) into blood circulation. This assumption may be supported by the significant increase of the red cell creatine contents. 2,3-diphosphoglycerate (2,3-DPG) levels of the erythrocytes did not significantly change after rHuEPO administration.

[Effect on erythropoiesis of conditioned media of mammal erythrocytes]. / Azione sull'eritropoiesi di mezzi condizionati di eritrociti di mammiferi.

It is known that a medium conditioned by erythrocytes (ECM) reduces 59Fe uptake into haem in hemopoietic cell cultures. In order to evaluate if the release of this factor in conditioned media is correlated with the whole erythrocyte surface, the same volume of packed erythrocytes of Mammals characterized by different MCV were incubated according to the method of Cole and Regan (1977). The influence of these conditioned media upon 59Fe uptake into haem in cultures of Guinea pig bone marrow cells was studied. Our results demonstrate that ECM of lamb erythrocytes (MCV = 28) caused a more marked depression of haem synthesis in vitro than ECM of calf (MCV = 34) and Guinea pig (MCV = 69) erythrocytes, and that this inhibitory effect is correlated to the MCV of considered erythrocytes.

Inhibition by beta-thalassemic erythrocytes of erythropoiesis in vitro.

It is known that a medium conditioned by erythrocytes (ECM) reduces 59Fe uptake into haem in haemopoietic cell cultures. In order to evaluate whether the release of this factor in conditioned media is correlated with the whole erythrocyte surface, the same volume of packed erythrocytes of beta-thalassemic and normal subjects were incubated according to the method of Cole and Regan (1977). The influence of these conditioned media upon 59Fe uptake into haem in cultures of guinea pig bone marrow cells was studied. The results demonstrate that ECM of beta-thalassemic erythrocytes caused a more marked depression than ECM of normal erythrocytes, and that this inhibitory effect was correlated with the mean corpuscular volume (MCV) of the erythrocytes investigated.

The epidemiology of diabetes mellitus.

Insulin-dependent diabetes mellitus (IDDM) develops predominantly in children and young adults, but may appear in all age groups. The incidence of IDDM differs greatly among populations, with Finland and Sardinia showing the greatest incidence rates (approximately 30-35% of cases annually per 100000 children up to age 14 years) and oriental populations showing the lowest rates. IDDM is diagnosed more frequently in the winter months. The major genetic susceptibility to IDDM is linked to the HLA complex on chromosome 6. These genetic backgrounds interact with environmental factors (possibly certain viruses, foods and climate) to initiate the immune-mediated process that leads to beta-cell destruction. Non-insulin dependent diabetes (NIDDM) is the most common form of diabetes. The prevalence of NIDDM varies enormously from population to population. The greatest rates have been found in Pima Indians. The major environmental factors identified as contributing to this form of diabetes are obesity and reduced physical activity. NIDDM shows strong familial aggregation in all populations and is clearly the result of an interaction between genetic susceptibility and environmental factors. Before NIDDM develops, insulin concentrations are high for the degree of glycaemia and of obesity, reflecting the presence of insulin resistance. As insulin resistance worsens, glucose levels increase, with the appearance of glucose intolerance and, finally, of NIDDM, when insulin response cannot compensate for insulin resistance.

Epo serum levels in heterozygous beta-thalassemia.

An immunoenzymatic assay (Epo-Eia) has been used in order to evaluate the seric Epo level in beta-thalassemic heterozygous subjects. The present results lead one to conclude that serum Epo levels in thalassemic subjects are higher than in normal subjects and that the differences between thalassemic and normal females are highly significant statistically (p < 0.01). The Epo levels in thalassemic females are also higher than those in thalassemic males (0.01 < p < 0.05). Differences in Epo levels may be observed between thalassemic and normal males although they are not highly significant statistically. No correlations seem to exist between Epo and Hb values.

[The effects of vitamin A on carcinoma of portio cervicis in organ culture]. / Azione della vitamina A su colture organotipiche di carcinoma della portio.

Vitamin A can transform, in vitro, keratinized, multilayered, non secretory epithelium of carcinoma of portio cervicis into a simple mucous-secreting epithelium in the 40% of explants. The different response of Vit. A action on carcinoma may be associated with a different sensibility to this substance.

Erythropoietin levels in heterozygous alpha-thalassemia.

In guinea pig bone marrow cultures with heterozygous alpha-thalassemic serum, 59Fe uptake values are elevated above iron values of cultures with serum of normal subjects. These results show that erythropoietin (EP) activity values in heterozygous alpha-thalassemia are comparable to those previously observed by ourselves in heterozygous beta-thalassemia despite of the different Hb concentration in these thalassemic syndromes. This points to the existence of signals which regulate Ep synthesis independently of Hb levels.

Changes in human epithelial kidney cells induced by nordihydroguaiaretic acid in vitro.

Some chemical agents induce kidney cystic changes in vivo comparable to human multicystic kidney disease. The biochemical aspects of human tubular cells were analysed by in vitro culture in the presence of nordihydroguaiaretic acid (NDGA). The uptake of 3H-thymidine in cultured cells in the presence of NDGA was comparable with control cultures, while 3H-hydroxyproline incorporation produced elevated values. The results suggest that NDGA in vitro induces modifications which may be related only to the synthesis of basement membrane components.

Effects of exercise on haematologic parameters, serum iron, serum ferritin, red cell 2,3-diphosphoglycerate and creatine contents, and serum erythropoietin in long-distance runners during basal training.

We studied 18 well-trained male long-distance runners during the basal training. Haematologic parameters, serum iron and ferritin, red cell 2,3-diphosphoglycerate (2,3-DPG) and creatine contents, serum erythropoietin were investigated before and after the daily training and were compared with a group of healthy untrained controls. Red blood cell parameters did not change with the training, even though they were significantly lower than in controls. However, a true anaemic state cannot be suggested because the haemoglobin values fell into the lower limit of the normal range, even before the exercise. A slight but significant increase of neutrophils was found after the exercise, while no alteration of platelet count was observed. Serum iron and ferritin ranged normally. No increase of red cell 2,3-DPG was observed after the exercise, but it was significantly higher than in controls. After the exercise red creatinine was slightly increased. The athletes' erythropoietin was higher than that of controls, and showed a further increase after the training.