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Possiamo ottenere un cambiamento dello stile di vita significativo e stabile nel tempo? 随着时间的推移,我们能实现有意义和稳定的生活方式改变吗?
Pub Date : 2023-05-18 DOI: 10.30682/ildia2301a
P. Moghetti
Lifestyle is universally considered a fundamental issue in the preven¬tion and therapy of both type 2 diabetes and metabolic syndrome. However, implementation at a general population level of recom¬mendations resulting from available evidence is largely insufficient. In particular, only a limited fraction of the general population meets the recommended levels of aerobic physical activity, and individuals meeting the recommended levels of resistance physical activity are even less. Interestingly, there is further reduction in these proportions in subjects with prediabetes and especially in those with type 2 diabe¬tes. It is noteworthy that people with or at risk for diabetes represent a significant proportion of the general population, show objective evi¬dence of impaired exercise capacity, for different mechanisms, and fre¬quently have long-standing sedentary habits, difficult to be changed. All these aspects should be taken into account, when designing in-tervention programs aimed at improving the current situation. As re¬gards the possibility of a stable increase in physical exercise levels and reduction in sedentary habits of individuals with diabetes, available data are limited. However, they indicate that it is possible to improve these aspects in a significant proportion of subjects. Behavioral chan¬ges reported in studies are generally smaller than the prefixed impro¬vements, but sufficient to obtain favorable and clinically significant effects. Interventions applied in these programs show several shortco¬mings, indicating the need for a continuous revision of strategies.
生活方式被普遍认为是预防和治疗2型糖尿病和代谢综合征的一个基本问题。然而,根据现有证据得出的建议在一般人群层面上的实施在很大程度上是不足的。特别是,只有一小部分普通人群达到推荐的有氧运动水平,而达到推荐的抵抗运动水平的人就更少了。有趣的是,在糖尿病前期,尤其是2型糖尿病患者中,这一比例进一步降低。值得注意的是,糖尿病患者或有糖尿病风险的人在普通人群中占很大比例,客观证据表明,由于不同的机制,运动能力受损,并且经常有长期久坐的习惯,难以改变。在设计旨在改善现状的干预方案时,应考虑到所有这些方面。至于糖尿病患者稳定增加体育锻炼水平和减少久坐习惯的可能性,现有数据有限。然而,他们表明,在很大比例的科目中,这些方面是有可能改善的。研究中报告的行为改变通常小于先前的改善,但足以获得有利的临床显著效果。在这些项目中应用的干预措施显示出若干不足,表明需要不断修订战略。
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引用次数: 0
Lo screening nella retinopatia diabetica 糖尿病视网膜病筛查
Pub Date : 2023-05-18 DOI: 10.30682/ildia2301f
Emanuele Fusi, Maria Vittoria Cicinelli, R. Lattanzio, F. Bandello
Diabetic retinopathy (DR) is the main ocular complication of diabetes. Among all the causes of blindness, it is the only one whose global pre-valence has increased over the past 30 years. DR prevalence is expected to increase in the upcoming years. Therefore, it is essential to establish cost-effective screening programs for early diagnosis of DR, which using new imaging systems, telemedicine and artificial intelligence prevent its evolution to advanced sight-threatening stages.
糖尿病视网膜病变(DR)是糖尿病的主要眼部并发症。在所有致盲原因中,它是唯一在过去30年中全球前价有所上升的原因。预计未来几年DR患病率将会增加。因此,必须建立具有成本效益的筛查方案,以早期诊断DR,使用新的成像系统,远程医疗和人工智能,防止其发展到严重的视力威胁阶段。
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引用次数: 0
L’esercizio fisico nel diabete di tipo 2: come possiamo migliorare l’aderenza? 糖尿病2型的运动:我们如何提高抓地力?
Pub Date : 2023-05-18 DOI: 10.30682/ildia2301c
A. Corrado, G. Annuzzi
Regular exercise is associated to several health benefits. However, only 39% of adults with type 2 diabetes reach the recommended goals for physical activity. Adherence to exercise needs removing barriers to behavioural changes by setting realistic goals. To make the chan¬ge lasting, group is fundamental and automatic behaviours must be created. However, the extent of the problem clearly indicates that a patient-centred approach is not enough. National policies including programs to encourage regular exercise are needed, with intensive in-terventions and investments.
经常锻炼对健康有很多好处。然而,只有39%的成人2型糖尿病患者达到了建议的身体活动目标。坚持锻炼需要通过设定现实的目标来消除行为改变的障碍。为了使变革持久,群体是根本,必须创造自动行为。然而,问题的严重程度清楚地表明,以病人为中心的方法是不够的。有必要制定国家政策,包括鼓励定期锻炼的项目,并进行密集的干预和投资。
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引用次数: 0
Sindrome progeroide atipica con lipodistrofia parziale familiare, dovuta alla mutazione missenso c.1045 C > T (p.Arg349Trp) in eterozigosi del gene LMNA, e diabete mellito di tipo 2 由于c.1045突变引起的家族部分脂质营养不良的非典型原类综合症LMNA基因杂合子C > T (p.Arg349Trp)和2型糖尿病
Pub Date : 2023-05-18 DOI: 10.30682/ildia2301g
Benedetta Russo, I. Malandrucco, Marika Menduni, Andrea Mari, Caterina Pelosini, Francesco Brancati, Maria Rosaria D’Apice, Fabiana Picconi, S. Frontoni
Familial partial lipodystrophy (FPLD) associated with LMNA gene mutations is a rare form of lipodystrophy disorder characterized by partial absence of subcutaneous adipose tissue and predisposition to develop metabolic complications related to insulin-resistance inclu-ding type 2 diabetes mellitus (T2D). Recently, this peculiar phenotype has been associated to atypical progeroid syndrome (APS). We present a case of 31-year-old woman with progeria features, partial lipodystro¬phy, type 2 diabetes mellitus (T2D), hypertriglyceridemia and hepatic steatosis. The baseline insulin sensitivity and secretion assessment showed strong insulin-resistance with hyperglycemia and elevated insulin secretion. Genetic analysis revealed a missense heterozygous LMNA mutation c.1045 C > T (p. Arg349Trp) that established APS diagnosis with FPLD, so far studied and described in only 10 patients worldwide. The patient was initially treated with metformin, fenofi¬brate, omega-3 and low carb and low fat diet with optimal results on metabolic control related to glycemic and lipid profile; later, liragluti¬de (Glucagon-Like Peptide-1 analog, GLP-1) therapy was added. Du¬ring the 6 month follow-up the anthropometric parameters improved, in particular a significant improvement in body composition with redi¬stribution of fat mass and a reduction of visceral fat and liver volume were observed. The improvements obtained were consolidated and maintained in the following years. However, with disease progression, focal segmental glomerulosclerosis (FSGS) and peripheral neuropathy developed. This case highlights the clinical and metabolic characteristics of this rare form of lipodystrophy and proposes an innovative therapeutic approach to manage the disease.
与LMNA基因突变相关的家族性部分脂肪营养不良(FPLD)是一种罕见的脂肪营养不良疾病,其特征是皮下脂肪组织部分缺失,易发生与胰岛素抵抗相关的代谢并发症,包括2型糖尿病(T2D)。最近,这种特殊的表型与非典型类早衰综合征(APS)有关。我们报告一例31岁女性,具有早衰特征,部分脂肪代谢不良,2型糖尿病(T2D),高甘油三酯血症和肝脂肪变性。基线胰岛素敏感性和分泌评估显示强烈的胰岛素抵抗,伴有高血糖和胰岛素分泌升高。遗传分析显示一个错义杂合LMNA突变c.1045C > T (p. Arg349Trp)确定APS诊断为FPLD,迄今为止全球仅在10例患者中进行了研究和描述。患者最初接受二甲双胍、非诺菲酯、欧米伽-3和低碳水化合物低脂肪饮食治疗,在与血糖和血脂相关的代谢控制方面效果最佳;随后,利拉格鲁肽(胰高血糖素样肽-1类似物,GLP-1)治疗加入。在6个月的随访中,人体测量参数得到改善,特别是身体成分的显著改善,脂肪量的重新分布,内脏脂肪和肝脏体积的减少。取得的改进在随后几年得到巩固和维持。然而,随着疾病进展,局灶节段性肾小球硬化(FSGS)和周围神经病变发展。本病例强调了这种罕见形式的脂肪营养不良的临床和代谢特征,并提出了一种创新的治疗方法来控制这种疾病。
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引用次数: 0
Il cambiamento che possiamo ottenere produce effetti clinicamente rilevanti? 我们所能得到的改变会产生重要的临床上的影响吗?
Pub Date : 2023-05-18 DOI: 10.30682/ildia2301b
G. Pugliese
Adopting and maintaining a physically active lifestyle provides si¬gnificant health benefits to people with diabetes and prediabetes by increasing energy expenditure, insulin sensitivity, and physical fitness and decreasing chronic low-grade inflammation. Physical activity (PA)/exercise favors control of hyperglycemia and other risk factors for cardiovascular disease (CVD) and, therefore, it is recommended for diabetes prevention and treatment and for improving overall health. According to current guidelines, people with type 2 diabetes are re-commended to perform at least 150 min/week of moderate-to-vigorous intensity aerobic exercise plus 2-3 sessions/week of resistance exercise on non-consecutive days. Unfortunately, these individuals are usually well below the recommended level of PA and, hence, it is difficult for them to put into action guideline recommendations for a number of external and internal barriers, thus suggesting the need for effective strategies to promote a sustained behavior change. Several randomi¬zed clinical trials have shown that supervised exercise programs are effective in improving surrogate endpoints such as blood glucose and other CVD risk factors, physical fitness, and well-being. However, such programs are not suitable for long-term implementation in rou¬tine clinical practice and adherence to PA/exercise is usually strictly dependent on participation to supervised sessions and falls once the intervention ends. In this regard, counseling interventions appear to be more feasible and adequate to promote a true, long-lasting beha¬vior change. A limited number of studies have tested the efficacy of counseling interventions designed to promote walking through the provision of pedometers. These interventions resulted in modest and transient increases in moderate-to-vigorous PA (MVPA) and, accor¬dingly, failed to significantly improve CVD risk factors and other sur¬rogate outcomes or to produce sustained increases in cardiorespiratory fitness. These results are in contrast with those of several epidemio¬logical surveys, showing that, in physically inactive and sedentary or unfit individuals, even modest amounts of (MV)PA, corresponding to one-third to one-half of those recommended by guidelines, exert a beneficial impact on morbidity and mortality. This discrepancy might be explained by the fact that walking-based interventions are focused only on leisure-time MPVA. Conversely, current guidelines consider also other domains, such as sedentary behavior and light-intensity PA (LPA), and other settings, such as home, work and commuting, as they recommend also to decrease the amount of sedentary (SED)-time and to interrupt prolonged sitting with bouts of LPA every 30 min. In fact, in the Italian Diabetes and Exercise Study 2 (IDES_2), a counse¬ling intervention targeting both MVPA and sedentary behavior was effective in promoting increases in MVPA, which were modest but sustained over a three-year follow-up and associated wit
采用并保持积极的生活方式,通过增加能量消耗、胰岛素敏感性和身体健康以及减少慢性低度炎症,为糖尿病和前驱糖尿病患者提供了显著的健康益处。体育活动(PA)/运动有助于控制高血糖和心血管疾病(CVD)的其他危险因素,因此,它被推荐用于糖尿病的预防和治疗,并改善整体健康。根据目前的指导方针,建议2型糖尿病患者每周至少进行150分钟的中等至高强度有氧运动,加上每周2-3次非连续天的阻力运动。不幸的是,这些人通常远低于推荐的PA水平,因此,他们很难将针对许多外部和内部障碍的指南建议付诸行动,因此表明需要有效的策略来促进持续的行为改变。一些随机临床试验表明,有监督的锻炼计划在改善替代终点(如血糖和其他心血管疾病风险因素)、身体健康和幸福感方面是有效的。然而,这样的计划并不适合在日常临床实践中长期实施,并且坚持PA/锻炼通常严格依赖于参与监督会议,一旦干预结束就会下降。在这方面,咨询干预似乎更可行,更足以促进真正的,持久的行为改变。有限数量的研究已经测试了通过提供计步器来促进步行的咨询干预的功效。这些干预措施导致中度至剧烈PA (MVPA)的适度和短暂增加,因此,未能显着改善CVD危险因素和其他替代结果,或产生持续的心肺健康增加。这些结果与几项流行病学调查的结果相反,这些调查表明,在不运动和久坐或不健康的个人中,即使是适量的(MV)PA,相当于指南推荐量的三分之一到一半,也会对发病率和死亡率产生有益的影响。这种差异可能是由于以步行为基础的干预措施只关注休闲时间的MPVA。相反,目前的指南还考虑了其他领域,如久坐行为和低强度PA (LPA),以及其他环境,如家庭、工作和通勤,因为他们还建议减少久坐(SED)时间,并以每30分钟一次的LPA来中断长时间的坐着。事实上,在意大利糖尿病和运动研究2 (IDES_2)中,针对MVPA和久坐行为的咨询干预对促进MVPA的增加是有效的。这是适度的,但在三年的随访中持续存在,并且与sed时间的大幅减少和LPA的相应增加有关。在三年的随访中,这导致了有临床意义的身体健康改善,并在较小程度上改善了心血管疾病的危险因素和评分。相反,仅针对sed时间的咨询干预没有观察到有临床意义的效果。总之,咨询干预在产生有临床意义的效果方面是有效的,即使只导致休闲时间MVPA的适度增加,前提是它们也针对PA/久坐行为的其他领域和设置。
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引用次数: 0
Meccanismi comuni tra diabete e declino cognitivo 糖尿病和认知衰退之间的常见机制
Pub Date : 2022-12-22 DOI: 10.30682/ildia2204a
Vittoria Cataldo, Lucia Scisciola, Martina Franzese, Armando Puocci, Michelangela Barbieri
The increased prevalence of diabetes (DM) constitutes a major public health problem, primarily due to its numerous comorbidity and complications. It is widely demonstrated that DM is a significant risk factor for the development of cognitive impairment. Metabolic diseases can influence cognitive functions through multiple interconnected mechanisms. Cerebral insulin resistance, oxidative stress, neuroinflammation, and neuroendocrine dysfunctions can further the development of neurodegeneration diseases. The identification of the molecular mechanisms involved represents the target for the founding of early potential markers and new therapeutic targets of neurodegenerative diseases.
糖尿病(DM)患病率的增加构成了一个主要的公共卫生问题,主要是由于其许多合并症和并发症。糖尿病是认知功能障碍发生的重要危险因素。代谢性疾病可以通过多种相互关联的机制影响认知功能。脑胰岛素抵抗、氧化应激、神经炎症和神经内分泌功能障碍可进一步发展为神经退行性疾病。分子机制的确定为神经退行性疾病早期潜在标志物的建立和新的治疗靶点的建立提供了目标。
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引用次数: 0
La terapia cellulare autologa è efficace nel trattamento delle ulcere del piede diabetico 自体细胞疗法在治疗糖尿病足溃疡方面非常有效
Pub Date : 2022-12-22 DOI: 10.30682/ildia2204e
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引用次数: 0
L’elefante nella stanza 房间里的大象
Pub Date : 2022-12-22 DOI: 10.30682/ildia2204d
A. Piaggesi, Roberto Ferraresi, Mauro Gargiulo
Despite its increasing prevalence, severity and mortality, the Diabetic Foot Syndrome (DFS) still remains an unaddressed critical issue in Diabetology.The management of DFS is adequately performed only in few Centres, and clinical outcomes vary, depending on the possibility of patients to access optimal standards of care.To rivitalize the debate upond DFS and to make concrete proposals to improve the quality of therapy and the accessibility to optimal care, we wrote this editorial.
尽管糖尿病足综合征(DFS)的患病率、严重程度和死亡率不断上升,但它仍然是糖尿病学中一个未解决的关键问题。只有少数中心对DFS进行了充分的管理,临床结果因患者获得最佳护理标准的可能性而异。为了重振关于DFS的辩论,并提出具体建议,以提高治疗质量和获得最佳护理,我们写了这篇社论。
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引用次数: 0
Il ripristino della funzione beta cellulare nel diabete mellito di tipo 2: aspetti traslazionali 2型糖尿病的细胞功能恢复:通病方面
Pub Date : 2022-12-22 DOI: 10.30682/ildia2204f
Mara Suleiman, Carmela De Luca, Silvia Del Guerra, Marta Tesi, L. Marselli
Type 2 diabetes (T2D) has been considered a relentlessly worsening disease, due to the progressive deterioration of the pancreatic beta cell functional mass. Evidence indicates that remission of T2D may occur in variable proportions of patients after specific treatments that are associated with recovery of beta cell function. The recovery of beta cells has been shown in human islets obtained from non-diabetic organ donors that recover from “lipo-glucotoxic” conditions, and human islets isolated from T2D organ donors exposed to specific treatments or by a period of exposure to a “non-diabetic” milieu. The improvement of insulin secretion and the associated molecular traits unveil the possibility to promote T2D remission by directly targeting pancreatic beta cells.
2型糖尿病(T2D)一直被认为是一种不断恶化的疾病,由于胰腺β细胞功能团的进行性恶化。有证据表明,经过与β细胞功能恢复相关的特定治疗后,不同比例的患者可能出现T2D缓解。从非糖尿病器官供体获得的从“脂糖中毒”状态恢复的人类胰岛,以及从暴露于特定治疗或暴露于“非糖尿病”环境一段时间的T2D器官供体分离的人类胰岛,均显示出β细胞的恢复。胰岛素分泌的改善和相关的分子特征揭示了通过直接靶向胰腺细胞来促进T2D缓解的可能性。
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引用次数: 0
Crononutrizione: una tematica emergente nella gestione del diabete di tipo 2 营养:2型糖尿病管理的一个新主题
Pub Date : 2022-12-22 DOI: 10.30682/ildia2204c
Cristiana Randazzo, Carola Buscemi, Anna Maria Barile e Silvio Buscemi
Evidence has been accumulated that a different timing in the consumption of meals, namely the chrononutrition, is able to influence the daily metabolic biorhythms, influencing the onset and possibly the treatment of clinical conditions as obesity and diabetes, including the possibility of independently influencing the cardiovascular risk. Behaviors originating from new social customs are able to interfere with these physiological mechanisms activating of genes and proteins that make individuals more or less flexible, capable of adaptation. So, the inability to adapt could favor a higher risk to health. Therefore, chrononutrition is a characteristic of the diet that is important to address further to the amount of energy and macronutrient intake. Once again, even in this area, the Mediterranean dietary style proves to be a healthy reference approach.
已经积累的证据表明,进餐的不同时间,即时间营养,能够影响日常代谢生物节律,影响肥胖症和糖尿病等临床病症的发病,并可能影响其治疗,包括可能独立影响心血管风险。源于新的社会习俗的行为能够干扰这些生理机制,激活基因和蛋白质,使个体或多或少具有灵活性和适应能力。因此,无法适应可能会增加健康风险。因此,时间营养是饮食的一个特征,对于进一步解决能量和大量营养素摄入量的问题很重要。再一次,即使在这个地区,地中海饮食方式也被证明是一种健康的参考方法。
{"title":"Crononutrizione: una tematica emergente nella gestione del diabete di tipo 2","authors":"Cristiana Randazzo, Carola Buscemi, Anna Maria Barile e Silvio Buscemi","doi":"10.30682/ildia2204c","DOIUrl":"https://doi.org/10.30682/ildia2204c","url":null,"abstract":"Evidence has been accumulated that a different timing in the consumption of meals, namely the chrononutrition, is able to influence the daily metabolic biorhythms, influencing the onset and possibly the treatment of clinical conditions as obesity and diabetes, including the possibility of independently influencing the cardiovascular risk. Behaviors originating from new social customs are able to interfere with these physiological mechanisms activating of genes and proteins that make individuals more or less flexible, capable of adaptation. So, the inability to adapt could favor a higher risk to health. Therefore, chrononutrition is a characteristic of the diet that is important to address further to the amount of energy and macronutrient intake. Once again, even in this area, the Mediterranean dietary style proves to be a healthy reference approach.","PeriodicalId":119243,"journal":{"name":"Il Diabete","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130494368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Il Diabete
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