Long-term body weight trajectories and metabolic control in type 1 diabetes patients on insulin pump or multiple daily injections: A 10-year retrospective controlled study.

BACKGROUND AND AIMS: Overweight/obesity is a clinical concern also in patients with Type 1 diabetes (T1DM). These patients' body weight may vary depending on whether treatment consists in continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI), as these treatments lead to different blood glucose control, insulin doses, and eating behaviors. We compared long-term body weight trajectories in persons with diabetes on CSII or MDI regimens. METHODS AND RESULTS: Annual changes in body weight, HbA1c, and daily insulin doses over 6-10 years were retrospectively analyzed in T1DM adult patients on CSII (n = 90) or MDI (n = 90), strictly matched for sex, age, BMI, and diabetes duration. Mean follow-up was 9.1 ± 1.4 years. Body weight increased linearly (∼0.5 kg per year) throughout the observation period (p = 0.001, repeated measures ANOVA) with no significant difference between the CSII and MDI cohorts (p = 0.74), in either normal-weight or overweight/obese patients. HbA1c over follow-up was lower with CSII than with MDI (p = 0.037), maintaining the initial reduction after starting pump therapy. Insulin doses over follow-up were stably lower than baseline (∼20%) with CSII, while linearly increasing (∼20% from baseline to the end of observation) with MDI (p = 0.002). Mean annual weight changes correlated directly with total insulin dose changes (r = 0.191; p = 0.011) and baseline HbA1c level (r = 0.267; p = 0.001), and inversely with HbA1c changes (-0.173; p = 0.021) and baseline age (r = -0.254; p = 0.001). CONCLUSION: T1DM patients on CSII or MDI showed comparable body weight gain over a 10-year follow-up, despite improved glycemic control and decreased insulin doses with CSII.

Gastrointestinal effects of extra-virgin olive oil associated with lower postprandial glycemia in type 1 diabetes.

OBJECTIVE: To explore the possible mechanisms behind the lower glycemic response observed when extra-virgin olive oil (EVOO) is added to a high-glycemic index meal in patients with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: According to a randomized cross-over design, eleven T1D patients (6 women, 5 men) on insulin pump consumed in the metabolic ward, one week apart, three high-glycemic index meals differing only for amount and quality of fat: high-monounsaturated fat (EVOO), high-saturated fat (Butter), and low-fat (LF). Before and after the meals, blood glucose (continuous glucose monitoring), gastric emptying rate (ultrasound technique), and plasma concentrations of glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide GIP (ELISA), glucagon (RIA), and lipids (colorimetric assays) were evaluated. RESULTS: Blood glucose iAUC (mmol/lx360 min) was lower after the EVOO (690 ± 431) than after the Butter (1320 ± 600) and LF meals (1007 ± 990) (M ± SD, p = 0.041 by repeated measures ANOVA). Gastric antrum volume was significantly larger in the early (60-90 min) postprandial phase (106 ± 21 vs. 90 ± 16 ml, p = 0.048) and significantly smaller in the late phase (330-360 min) (46 ± 10 vs. 57 ± 22 ml, p = 0.045) after the EVOO than after Butter meal. EVOO significantly increased postprandial GLP-1 iAUC (261 ± 311) compared to Butter (189 ± 349) (pmol/Lx180 min, p = 0.009). Postprandial GIP and glucagon responses were not significantly different between EVOO and Butter. Postprandial triglyceride iAUC was significantly higher after EVOO (100 ± 53) than after Butter (65 ± 60) (mmol/l × 360 min, p = 0.048). CONCLUSIONS: Changes in gastric emptying and GLP-1 secretion and reduced glucose absorption through glucose-lipid competition may contribute to lower glycemia after a high-glycemic index meal with EVOO in T1D patients. CLINICAL TRIALS NUMBER: NCT02330939.

Primary acquired Grynfeltt Hernia: two new cases and literature review.

AIM: We report two cases of the very rare Primary Acquired Grynfeltt Hernia. The related abdominal wall defects were repaired, by open surgery, placing a partially absorbable plug and mesh. The observation and management of these two new cases prompted us to review the literature with the purpose of suggesting the most appropriate surgical approach and technique. MATHERIAL OF STUDY: A 60 years old female patient showing a swelling at the left lumbar region, and a 76 years old male patient showing evidence of a tumefaction located at the right lumbar region, were diagnosed at our department with Primary Acquired Grynfeltt Hernia. RESULTS: Postoperative courses were uneventful and the patients were discharged from hospital respectively on the third and second postoperative day. Follow-up at thirty days, six months, two and three years showed no signs of recurrence. DISCUSSION: Primary Acquired Grynfeltt Hernia is one of the rarest abdominal hernias. In literature there are no comparative studies showing which type of surgical approach should be preferred for this specific abdominal wall defect. In our department, open surgery was successfully performed for the treatment of two new cases of Primary Acquired Grynfeltt Hernias and, second time in literature, partially absorbable plug and mesh were placed in order to repair the causative abdominal wall defect. CONCLUSION: Based on our experience and literature review, we consider open hernia repair with partially absorbable plug and mesh as an appropriate and advisable surgical approach for not complicated cases of Primary Acquired Grynfeltt Hernia. Surgery is performed rapidly, effortlessly and securely if the patient is under general anesthesia, in lateral decubitus position with the operating table flexed at the level of the iliac crest. KEY WORDS: Primary Acquired Grynfeltt Hernia, Lumbar Hernia.

Extra-Virgin Olive Oil Reduces Glycemic Response to a High-Glycemic Index Meal in Patients With Type 1 Diabetes: A Randomized Controlled Trial.

OBJECTIVE: To evaluate whether fat quality, in the context of meals with high- (HGI) or low-glycemic index (LGI), influences postprandial blood glucose (PPG) response in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS: According to a randomized crossover design, 13 patients with type 1 diabetes on insulin pump consumed two series (HGI or LGI) of meals with the same carbohydrate quantity while differing for amount and quality of fat: 1) low in fat ("low fat"), 2) high in saturated fat (butter), or 3) high in monounsaturated fat (extra-virgin olive oil) (EVOO). Premeal insulin doses were based on insulin-to-glycemic load ratios. Continuous glucose monitoring was performed and 6-h PPG evaluated. RESULTS: PPG was significantly different between HGI and LGI meals (P = 0.005 for time × glycemic index interaction by repeated-measures analysis [RMA]), being significantly higher during the first 3 h after the HGI meals with a later tendency to an opposite pattern. In the context of HGI meals, PPG was significantly lower after EVOO than after low fat or butter (P < 0.0001 for time × meal interaction by RMA), with a marked difference in the 0- to 3-h glucose incremental area under the curve between EVOO (mean ± SD 198 ± 274 mmol/L × 180 min) and either low fat (416 ± 329) or butter (398 ± 355) (P < 0.05). No significant differences were observed in PPG between the three LGI meals. CONCLUSIONS: Carbohydrate quality of a mixed meal influences shape and extent of PPG. Besides, using EVOO in a HGI meal attenuates the early postprandial glucose response observed when this meal is consumed with either low fat or butter. Therefore, an optimal prandial insulin administration would require considering, in addition to the quantity of carbohydrates, the quality of both carbohydrate and fat.