Long-Term Clinical Outcome in Familial and Sporadic Papillary Thyroid Carcinoma.

BACKGROUND: The definition and the behaviour of familial papillary thyroid cancer (FPTC) compared to the sporadic form (SPTC) are still debated. Some authors believe that only families with 3 or more affected members represent an actual example of familial diseases. OBJECTIVES: The objective of the study was to analyse the clinicopathological features and the outcome of sporadic and familial PTC patients also according to the number of affected members. METHODS: Among 731 patients, we identified 101 (13.8%) with familial diseases, 79 with 2 affected members (FPTC-2) and 22 with 3 or more affected members (FPTC-3) followed for a mean period of 10 years. RESULTS: FPTC patients had more frequently bilateral tumour (p = 0.007). No difference was found between the 2 groups for the other evaluated variables. At the time of the first follow-up (1-2 years after initial therapy), FPTC patients had a higher rate of persistent disease. However, at the last follow-up, the clinical outcome was not different between sporadic and familial patients. When the comparison between SPTC and FPTC was performed, according to the number of affected members, a significant trend between the 3 groups was observed for tumour diameter (p = 0.002) and bilaterality (p = 0.003), while we did not observe a significant trend for both response to initial therapy (p = 0.15) and last clinical outcome (p = 0.22). CONCLUSIONS: Our results suggest that, although the clinicopathological features of FPTC may be more aggressive, the long-term outcome is similar between FPTC and SPTC. A possible explanation is that PTC has a favourable prognosis, even when clinical presentation is more aggressive.

Conversation Maps™, an effective tool for the management of males and females with type 2 diabetes and mildly impaired glycemic control.

PURPOSE: The purpose of this study is to evaluate the effectiveness of the educational tool, Conversation Maps™ (CM), combined with a weight loss program, in improving metabolic control of as well as knowledge about diabetes, in a population with type 2 diabetes (T2DM) with mildly impaired glycemic control. METHODS: This is a longitudinal observational study in which 66 subjects, aged 67.8 ± 7.93, were included either in the educational program with CM, once weekly for 4 weeks (T4), combined with a weight loss regime (group A, n = 32), or in standard care with a weight loss regime (group B, n = 34), both followed for 3 months (T3M) after T4. RESULTS: At T4, both groups A and B had significantly lost weight and reduced waist circumference. However, group B did not lose weight or reduce waist circumference at T3M compared to T4. At T3M, only group A significantly lowered glycated hemoglobin (A1c) from baseline. At T3M, only group A had a significant increase in knowledge on diabetes therapy and foot care. CONCLUSIONS: CM may also play a significant role in T2DM characterized by mildly impaired glycemic control. Moreover, a systematic use of CM could be suggested for management of diabetes together with lifestyle changes and a weight loss diet.

Therapy with proton pump inhibitors in patients with type 2 diabetes is independently associated with improved glycometabolic control.

AIMS: Experimental data demonstrated that gastrin has incretin-like stimulating actions on ß-cells, resulting in a promotion of glucose-induced insulin secretion. As proton pump inhibitors (PPIs) consistently increase plasma gastrin levels, a possible effect of this treatment on glucose-insulin homeostasis may be hypothesized. Therefore, the aim of this study was to evaluate the effect of chronic PPIs treatment on glycemic control in patients affected by type 2 diabetes. METHODS: This is an observational, retrospective study. A total of 548 consecutive patients with type 2 diabetes (mean age ± SD: 67.1 ± 10.9 years, M/F: 309/239, diabetes duration: 12.4 ± 9.8 years) referring to our diabetes outpatient clinics were enrolled; among them, 45 %were treated with PPIs longer than 2 years for preventive/therapeutic purposes. Fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), serum lipids and transaminases were measured by standard laboratory methods. Major cardiovascular events and concomitant medications were recorded in all participants, and daily insulin requirement was calculated in insulin-treated subjects. RESULTS: PPIs-treated patients had significantly lower HbA1c (7.1 ± 1.07 %-54.1 ± 12 vs 7.4 ± 1.4 %-57.4 ± 8 mmol/mol, p = 0.011) and FPG (127 ± 36.9 vs 147.6 ± 49.4 mg/dl, p < 0.001) levels than those untreated. These differences increased in patients under insulin therapy and in those with concomitant PPIs + GLP-1-based therapy. The multivariate regression analysis demonstrated that the association between chronic PPIs treatment and HbA1c was independent from possible confounders (p = 0.01). CONCLUSIONS: PPIs treatment is associated with greater glycemic control in patients with type 2 diabetes, particularly in those on insulin- or GLP-1-based therapy. Our results suggest a role for PPIs in glucose-insulin homeostasis and may open a new scenario for diabetes therapy.