63 results on '"Esposito K."'
Search Results
2. Semen quality and metabolic profile in people with type 1 diabetes with and without erectile dysfunction: a cross-sectional study.
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Longo, M., Caruso, P., Varro, C., Tomasuolo, M., Cirillo, P., Scappaticcio, L., Romano, L., Arcaniolo, D., Maiorino, M. I., Bellastella, G., De Sio, M., and Esposito, K.
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- 2024
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Catalog
3. Case Report: Post-gastrectomy reactive hyperinsulinemic hypoglicaemia: glucose trends before and after canagliflozin treatment.
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Bellastella, G., Caruso, P., Carbone, C., di Nuzzo, M., Scappaticcio, L., Amoresano Paglionico, V., Maiorino, M. I., and Esposito, K.
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INSULIN aspart ,GLUCOSE ,CANAGLIFLOZIN ,HYPOGLYCEMIA ,EXTRACELLULAR fluid ,FOOD habits ,HYPERGLYCEMIA - Abstract
The pathogenesis of post-gastrectomy reactive hyperinsulinaemic hypoglycaemia is not yet fully clarified. Recent studies suggest an up-regulation of the intestinal glucose transporter SGLT-1 aimed to prevent carbohydrate malabsorption. The overexpression of SGLT-1 could therefore represents one of the mechanisms underlying the wide glycemic excursions found in patients after gastrectomy, but studies investigating the use of SGLT-1/SGLT-2 inhibitors in patients with post-gastrectomy reactive hyperinsulinemic hypoglycaemia are very scant in the literature. We report the case of a 37-year-old non diabetic man who frequently presented symptoms of hypoglycaemia in the postprandial period. In 2012, he underwent Roux en-Y gastric bypass (RYGB) and after two years, he started to experience typical symptoms of reactive hyperinsulinaemic hypoglycaemia. We suggested healthy modifications of dietary habits and periodic follow-up visits with a dietitian. After three months, the patient still presented symptoms of reactive hypoglycaemia; we provided him with Flash Glucose Monitoring (FGM) to assess trend of glucose levels in interstitial fluid during the day and we decided to introduce canagliflozin 300 mg/day before the main meal. Hypoglycaemic events previously referred by the patient and clearly recorded by FGM completely disappeared taking canagliflozin. We found a reduction of time spent in hypoglycaemia, an improvement of glycemic variability and an increase of time in target range. It was also noted a reduction of time spent in hyperglicemia with consequent improvement of average glucose values and of glucose main indicator. This is the first report with FGM supporting a role of canagliflozin in th emanagement of post-gastrectomy reactive hyperinsulinaemic hypoglycaemia. Our preliminary results are very limited but in line with those of the literature and showed for the first time a reduction of hypoglycaemic events and an improvement of glycemic variability through a flash glucose monitoring system. Further studies are mandatory to confirm this therapeutic opportunity. [ABSTRACT FROM AUTHOR] more...
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- 2023
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4. Glucose control in home-isolated adults with type 1 diabetes affected by COVID-19 using continuous glucose monitoring.
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Longo, M., Scappaticcio, L., Petrizzo, M., Castaldo, F., Sarnataro, A., Forestiere, D., Caiazzo, F., Bellastella, G., Maiorino, M. I., Capuano, A., and Esposito, K.
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- 2022
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5. Thyroid surgery during the COVID-19 pandemic: results from a systematic review.
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Scappaticcio, L., Maiorino, M. I., Iorio, S., Camponovo, C., Piccardo, A., Bellastella, G., Docimo, G., Esposito, K., and Trimboli, P.
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- 2022
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6. New insights into vitamin D regulation: is there a role for alkaline phosphatase?
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Bellastella, G., Scappaticcio, L., Longo, M., Carotenuto, R., Carbone, C., Caruso, P., Maio, A., Paglionico, V. A., Vietri, M. T., Maiorino, M. I., and Esposito, K.
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- 2021
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7. Cardiovascular outcome trials and major cardiovascular events: does glucose matter? A systematic review with meta-analysis.
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Giugliano, D., Chiodini, P., Maiorino, M. I., Bellastella, G., and Esposito, K.
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- 2019
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8. Endocrine rhythms and sport: it is time to take time into account.
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Bellastella, G., De Bellis, A., Maiorino, M. I., Paglionico, V. A., Esposito, K., and Bellastella, A.
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- 2019
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9. Clinical inertia, reverse clinical inertia, and medication non-adherence in type 2 diabetes.
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Giugliano, D., Maiorino, M. I., Bellastella, G., and Esposito, K.
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- 2019
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10. Sexual dysfunctions in young women with type 1 diabetes and high glucose variability: findings from the METRO study.
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Longo, M., Scappaticcio, L., Castaldo, F., Sarnataro, A., Carbone, C., Caruso, P., Maiorino, M. I., Bellastella, G., Esposito, K., on behalf of METRO study group, Petrizzo, Michela, Gicchino, Maurizio, Caputo, Mariangela, Cirillo, Paolo, Maio, Antonietta, Pernice, Vlenia, Tomasuolo, Maria, and Di Fraia, Rosa more...
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- 2020
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11. Dissonance among treatment algorithms for hyperglycemia in type 2 diabetes: an egalitarian dialog.
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Giugliano, D., Maiorino, M. I., Bellastella, G., and Esposito, K.
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- 2019
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12. From inflammation to sexual dysfunctions: a journey through diabetes, obesity, and metabolic syndrome.
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Maiorino, M. I., Bellastella, G., Giugliano, D., and Esposito, K.
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- 2018
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13. TSH oscillations in young patients with type 1 diabetes may be due to glycemic variability.
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Bellastella, G., Maiorino, M. I., Scappaticcio, L., Casciano, O., Petrizzo, M., Caputo, M., Paglionico, V. A., Giugliano, D., and Esposito, K.
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- 2018
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14. The great opportunity of the andrological patient: cardiovascular and metabolic risk assessment and prevention.
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Foresta, C., Ferlin, A., Lenzi, A., Montorsi, P., Corona, G., Esposito, K., Fadini, G.P., Isidori, A.M., La Vignera, S., Mannucci, E., Tona, F., and Zaninelli, A.
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CARDIOVASCULAR diseases risk factors ,METABOLIC syndrome risk factors ,IMPOTENCE ,BIOMARKERS ,ENDOTHELIUM diseases - Abstract
Andrologists, cardiologists and diabetologists (and general practitioners) have the great opportunity to collaborate and find shared clinical workup for the benefit of a large number of men. Several evidence established a link between erectile dysfunction ( ED), cardiovascular disease ( CVD), diabetes, and metabolic syndrome. Not only these conditions share many risk factors and pathophysiological mechanisms but also an emerging paradigm indicates that ED is, in fact, an independent marker of cardiovascular disease risk, CV events and CV mortality. However, there is no consensus on the best cardiologic investigation in men with ED with no known CVD and, on the contrary, on what is the clinical and prognostic role of detecting ED during cardiovascular investigation and CVD risk assessment. Only vasculogenic ED, which represents the most common type of organic ED, indeed represents a harbinger of CVD, especially for younger patients, and might be diagnosed by dynamic penile color doppler ultrasonography, which represents a real cardiovascular imaging technique that give evidence on the presence of systemic endothelial dysfunction and atherosclerosis. Furthermore, assessment of glucose and lipid metabolism is warranted as first step workup in all ED patients, and diabetologists should ask their patients for erectile function, address ED patients to andrologists, and consider vasculogenic ED in the context of the cardiovascular and metabolic workup and in the context of diabetic complications. Sexual symptoms (and testosterone levels) should sound as harbinger for cardiovascular and metabolic investigation and cardiologists and diabetologists have the opportunity to have a symptom (erectile dysfunction) and a vascular test (penile color doppler) that help them in better management of patients, their comorbidities and complications. [ABSTRACT FROM AUTHOR] more...
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- 2017
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15. Sexual function in young women with type 1 diabetes: the METRO study.
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Maiorino, M., Bellastella, G., Castaldo, F., Petrizzo, M., Giugliano, D., and Esposito, K.
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- 2017
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16. Vitamin D and autoimmunity: what happens in autoimmune polyendocrine syndromes?
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Bellastella, G., Maiorino, M., Petrizzo, M., Bellis, A., Capuano, A., Esposito, K., and Giugliano, D.
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- 2015
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17. A MULTI-DISCIPLINARY APPROACH TO THE REMOVAL OF EMERGING CONTAMINANTS IN MUNICIPAL WASTEWATER TREATMENT PLANTS IN NEW YORK STATE, 2003-2004.
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Phillips, P. J., Stinson, B., Zaugg, S. D., Furlong, E. T., Kolpin, D. W., Esposito, K. M., Bodniewicz, B., Pape, R., and Anderson, J.
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- 2007
18. Basal supplementation of insulin lispro protamine suspension versus insulin glargine and detemir for type 2 diabetes: meta-analysis of randomized controlled trials.
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Esposito K, Chiodini P, Capuano A, Petrizzo M, Improta MR, Giugliano D, Esposito, Katherine, Chiodini, Paolo, Capuano, Annalisa, Petrizzo, Michela, Improta, Maria Rosaria, and Giugliano, Dario
- Abstract
Objective: We compared the effect of insulin lispro protamine suspension (ILPS) with that of insulin glargine and insulin detemir, all given as basal supplementation, in the treatment of patients with type 2 diabetes.Research Design and Methods: We conducted an electronic search until February 2012, including online registries of ongoing trials and abstract books. All randomized controlled trials comparing ILPS with insulin glargine or detemir with a duration of ≥12 weeks were included.Results: We found four trials lasting 24-36 weeks involving 1,336 persons: three studies compared ILPS with glargine, and one trial compared ILPS with detemir. There was no significant difference in change in HbA(1c) level between ILPS and comparators, in the proportion of patients achieving the HbA(1c) goals of ≤6.5 or <7%, in weight change, or in daily insulin doses. There was no difference in overall hypoglycemia, but nocturnal hypoglycemia occurred significantly more with ILPS than with comparator insulins (mean difference 0.099 events/patient/30 days [95% CI 0.03-0.17]). In a prespecified sensitivity analysis comparing data obtained in patients who remained on their once-daily insulin regimen, not significantly different event rates for nocturnal hypoglycemia were observed between ILPS and comparator insulins (0.063 [-0.007 to 0.13]), and ILPS was associated with lower insulin dose (0.07 units/kg/day [0.05-0.09]).Conclusions: There is no difference between ILPS and insulin glargine or detemir for targeting hyperglycemia, but nocturnal hypoglycemia occurred more frequently with ILPS than with comparator insulins. Nocturnal hypoglycemia was not significantly different in people who injected insulin once daily. [ABSTRACT FROM AUTHOR] more...- Published
- 2012
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19. Metabolic syndrome and risk of cancer: a systematic review and meta-analysis.
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Esposito K, Chiodini P, Colao A, Lenzi A, Giugliano D, Esposito, Katherine, Chiodini, Paolo, Colao, Annamaria, Lenzi, Andrea, and Giugliano, Dario
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Objective: Available evidence supports the emerging hypothesis that metabolic syndrome may be associated with the risk of some common cancers. We did a systematic review and meta-analysis to assess the association between metabolic syndrome and risk of cancer at different sites.Research Design and Methods: We conducted an electronic search for articles published through October 2011 without restrictions and by reviewing reference lists from retrieved articles. Every included study was to report risk estimates with 95% CIs for the association between metabolic syndrome and cancer.Results: We analyzed 116 datasets from 43 articles, including 38,940 cases of cancer. In cohort studies in men, the presence of metabolic syndrome was associated with liver (relative risk 1.43, P < 0.0001), colorectal (1.25, P < 0.001), and bladder cancer (1.10, P = 0.013). In cohort studies in women, the presence of metabolic syndrome was associated with endometrial (1.61, P = 0.001), pancreatic (1.58, P < 0.0001), breast postmenopausal (1.56, P = 0.017), rectal (1.52, P = 0.005), and colorectal (1.34, P = 0.006) cancers. Associations with metabolic syndrome were stronger in women than in men for pancreatic (P = 0.01) and rectal (P = 0.01) cancers. Associations were different between ethnic groups: we recorded stronger associations in Asia populations for liver cancer (P = 0.002), in European populations for colorectal cancer in women (P = 0.004), and in U.S. populations (whites) for prostate cancer (P = 0.001).Conclusions: Metabolic syndrome is associated with increased risk of common cancers; for some cancers, the risk differs betweens sexes, populations, and definitions of metabolic syndrome. [ABSTRACT FROM AUTHOR] more...- Published
- 2012
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20. Associate residency training directors in psychiatry: demographics, professional activities, and job satisfaction.
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Arbuckle MR, Degolia SG, Esposito K, Miller DA, Weinberg M, and Brenner AM
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- 2012
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21. Proportion of patients at HbA1c target <7% with eight classes of antidiabetic drugs in type 2 diabetes: systematic review of 218 randomized controlled trials with 78 945 patients.
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Esposito, K., Chiodini, P., Bellastella, G., Maiorino, M. I., and Giugliano, D.
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ENDOCRINE diseases ,TYPE 2 diabetes ,PANCREATIC secretions ,INSULIN ,HYPOGLYCEMIC agents - Abstract
Aim: We assessed the efficacy of eight classes of diabetes medications used in current clinical practice [metformin, sulphonylureas, α-glucosidase inhibitors, thiazolidinediones, glinides, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 (GLP-1) analogues and insulin analogues] to reach the HbA1c target <7% in type 2 diabetes. Methods: MEDLINE, EMBASE and the Cochrane CENTRAL were searched from inception through April 2011 for randomized controlled trials (RCTs) involving antidiabetic drugs. RCTs had to report the effect of any diabetes medication on the HbA1c levels, to include at least 30 subjects in every arm of the study, and to report the effect of therapy after a minimum of 12 weeks. Data were summarized across studies using random-effects meta-regression. Results: A total of 218 RCTs (339 arms and 77 950 patients) met the inclusion criteria. The proportion of patients who achieved the HbA1c goal ranged from 25.9% (95% CI 18.5-34.9) with α-glucosidase inhibitors to 63.2% (54.1-71.5) with the long-acting GLP-1 analogue. There was a progressive decrease of the proportion of patients at target for each 0.5% increase in baseline HbA1c, ranging from 57.8% for HbA1c ≤7.5% to 20.8% for HbA1c ≥10% (p for trend <0.0001), with some difference between insulin and non-insulin drugs: for insulin, the proportion of patients at goal reached a plateau for basal HbA1c value >9.0% with no further decrease, whereas for non-insulin drugs the relationship was continuous without any evidence of plateau. Conclusions: There is a considerable variability with regard to attainment of HbA1c goal of <7% among the different classes of diabetes medications; baseline HbA1c is an important determinant of observed efficacy. [ABSTRACT FROM AUTHOR] more...
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- 2012
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22. Lifestyle and metabolic approaches to maximizing erectile and vascular health.
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Meldrum, D R, Gambone, J C, Morris, M A, Esposito, K, Giugliano, D, and Ignarro, L J
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OXIDATIVE stress ,INFLAMMATION ,NITRIC oxide ,INSULIN resistance ,VASCULAR diseases - Abstract
Oxidative stress and inflammation, which disrupt nitric oxide (NO) production directly or by causing resistance to insulin, are central determinants of vascular diseases including ED. Decreased vascular NO has been linked to abdominal obesity, smoking and high intakes of fat and sugar, which all cause oxidative stress. Men with ED have decreased vascular NO and circulating and cellular antioxidants. Oxidative stress and inflammatory markers are increased in men with ED, and all increase with age. Exercise increases vascular NO, and more frequent erections are correlated with decreased ED, both in part due to stimulation of endothelial NO production by shear stress. Exercise and weight loss increase insulin sensitivity and endothelial NO production. Potent antioxidants or high doses of weaker antioxidants increase vascular NO and improve vascular and erectile function. Antioxidants may be particularly important in men with ED who smoke, are obese or have diabetes. Omega-3 fatty acids reduce inflammatory markers, decrease cardiac death and increase endothelial NO production, and are therefore critical for men with ED who are under age 60 years, and/or have diabetes, hypertension or coronary artery disease, who are at increased risk of serious or even fatal cardiac events. Phosphodiesterase inhibitors have recently been shown to improve antioxidant status and NO production and allow more frequent and sustained penile exercise. Some angiotensin II receptor blockers decrease oxidative stress and improve vascular and erectile function and are therefore preferred choices for lowering blood pressure in men with ED. Lifestyle modifications, including physical and penile-specific exercise, weight loss, omega-3 and folic acid supplements, reduced intakes of fat and sugar, and improved antioxidant status through diet and/or supplements should be integrated into any comprehensive approach to maximizing erectile function, resulting in greater overall success and patient satisfaction, as well as improved vascular health and longevity. [ABSTRACT FROM AUTHOR] more...
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- 2012
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23. Dipeptidyl peptidase-4 inhibitors and HbA1c target of <7% in type 2 diabetes: meta-analysis of randomized controlled trials.
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Esposito, K., Cozzolino, D., Bellastella, G., Maiorino, M. I., Chiodini, P., Ceriello, A., and Giugliano, D.
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CD26 antigen ,TYPE 2 diabetes ,PEOPLE with diabetes ,PLACEBOS ,RANDOMIZED controlled trials ,META-analysis - Abstract
We assessed the efficacy of dipeptidyl peptidase-4 (DPP-4) inhibitors vildagliptin, sitagliptin, saxagliptin and alogliptin to reach the haemoglobin HbA1c target of <7% in people with type 2 diabetes. We conducted an electronic search for randomized controlled trials (RCTs) involving DPP-4 inhibitors through September 2010. RCTs were included if they lasted at least 12 weeks, included 30 patients or more and reported the proportion of patients reaching the HbA1c target of <7%. A total of 43 RCTs reporting 52 comparisons met the selection criteria, which included 19 101 study participants evaluated for the primary endpoint, 10 467 treated with a DPP-4 inhibitor and 8634 treated with placebo or a comparator drug. DPP-4 inhibitors showed a statistically significant reduction in HbA1c compared to placebo and approximately 40% of participants achieved the HbA1c goal of <7%: this was associated with weight neutrality and no greater hypoglycaemia. The reduction of the HbA1c level and the rate of HbA1c goal attainment was not different from comparator drugs, with similar hypoglycaemia, and different effect on weight owing to the nature of comparator (metformin, sulfonylurea or glitazones). Baseline HbA1c was the best predictor for achievement of A1C target (overall weighted r value = 0.410, p < 0.001). A greater proportion of type 2 diabetic patients can achieve the HbA1c goal <7% with DPP-4 inhibitors compared to placebo, with no weight gain, and no hypoglycaemic risk when used alone; DPP-4 inhibitors were not different from comparator drugs. [ABSTRACT FROM AUTHOR] more...
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- 2011
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24. Obesity, the Metabolic Syndrome, and Sexual Dysfunction in Men.
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Esposito, K. and Giugliano, D.
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OBESITY ,IMPOTENCE ,SEXUAL dysfunction ,NITRIC oxide ,METABOLIC syndrome ,TESTOSTERONE - Abstract
The article discusses the relationship between obesity, sexual dysfunction and metabolic syndrome in men. It states that increased prevalence of visceral adiposity and related risk factors are linked with a proinflammatory state which causes decline in nitric oxide (NO) availability. Reduced NO availability results in endothelial injury and erectile dysfunction (ED). It further states that reduction in testosterone levels due to obesity and metabolic syndrome also contribute to ED. more...
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- 2011
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25. Relationship of baseline HbA1c, HbA1c change and HbA1c target of < 7% with insulin analogues in type 2 diabetes: a meta-analysis of randomised controlled trials.
- Author
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Giugliano, D., Maiorino, M., Bellastella, G., Chiodini, P., and Esposito, K.
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We performed a meta-analysis of randomised controlled trials (RCTs) with insulin analogues in type 2 diabetes utilising a least-squared regression model in order to assess the relationship between baseline HbA1c, the magnitude of HbA1c decrease and attainment of HbA1c target of < 7%. Randomised controlled trials involving insulin regimens (basal, prandial, biphasic and basal-bolus) were identified through electronic searches (MEDLINE, EMBASE, CINAHL and The Cochrane Library) through September 2010. We included any study arm of RCTs if they were at least 12 weeks in duration; the number of patients in any arm was more than 30 and reported the baseline HbA1c and change from baseline HbA1c. We found 87 studies, with a total of 135 arms, and 38,803 patients. The weighted R values for the overall analysis assessing the association between baseline HbA1c and absolute change in HbA1c or the proportion of patients at target were 0.485 (p < 0.001) and 0.146 (p < 0.001), respectively. Subanalyses of insulin regimens for the association between basal HbA1c and absolute decrease of HbA1c produced weighted R, which were significant for all insulin regimens with the highest association for basal-bolus (R=0.719, p < 0.001). The strong positive relationship between baseline HbA1c and the magnitude of HbA1c change we found in RCTs using insulin analogues in type 2 diabetes should be considered when assessing the clinical efficacy of insulin therapies. [ABSTRACT FROM AUTHOR] more...
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- 2011
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26. Effects of pioglitazone versus metformin on circulating endothelial microparticles and progenitor cells in patients with newly diagnosed type 2 diabetes-a randomized controlled trial.
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Esposito, K., Maiorino, M. I., Di Palo, C., Gicchino, M., Petrizzo, M., Bellastella, G., Saccomanno, F., and Giugliano, D.
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ENDOTHELINS ,DIABETES ,LOW-cholesterol diet ,ISOPENTENOIDS ,C-reactive protein - Abstract
Endothelial microparticles (EMPs) and endothelial progenitor cells (EPCs) are markers of endothelial injury and repair. We compared the effects of pioglitazone versus metformin on the circulating numbers of EMPs and EPCs in patients with newly diagnosed type 2 diabetes. This was a randomized, double-blind, comparator-controlled, 24-week single-centre trial conducted in a Teaching Hospital in Naples, Italy. One hundred and ten people with newly diagnosed type 2 diabetes who were never treated with antihyperglycaemic drugs and had haemoglobin A1c (HbA1c) levels between 7 and 10% were given pioglitazone hydrochloride (15-45 mg/day) (n = 55) or metformin (1000-2000 mg/day) (n = 55) as an active comparator. Absolute change from baseline to final visit in circulating EMPs and EPCs and their ratio were the main outcomes. Baseline characteristics did not differ between the study groups. The decrease in circulating EMPs CD31+ [intergroup difference, −32 counts/µl (95% CI −51 to −9)] and the increase in EPCs CD34+/KDR+ [intergroup difference, 33 cells/10 events (95% CI 13 to 55)] were greater with pioglitazone versus metformin. EMPs/EPCs ratio was reduced with pioglitazone and unchanged with metformin [difference, −1.5 (95% CI −2.6 to −0.5), p < 0.001]. Participants assigned to pioglitazone gained more weight and experienced greater improvements in some coronary risk measures [high-density lipoprotein (HDL)-cholesterol, triglycerides, adiponectin and C-reactive protein (CRP)] than did those assigned to metformin. Compared with metformin, pioglitazone treatment improved the imbalance between endothelial damage and repair capacity and led to more favourable changes in coronary risk factors in patients with newly diagnosed type 2 diabetes. [ABSTRACT FROM AUTHOR] more...
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- 2011
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27. The possible protective role of glucagon-like peptide 1 on endothelium during the meal and evidence for an "endothelial resistance" to glucagon-like peptide 1 in diabetes.
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Ceriello A, Esposito K, Testa R, Bonfigli AR, Marra M, Giugliano D, Ceriello, Antonio, Esposito, Katherine, Testa, Roberto, Bonfigli, Anna Rita, Marra, Maurizio, and Giugliano, Dario
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Objective: Glucagon-like peptide 1 (GLP-1) stimulates insulin secretion. However, GLP-1 also improves endothelial function in diabetes.Research Design and Methods: Sixteen type 2 diabetic patients and 12 control subjects received a meal, an oral glucose tolerance test (OGTT), and two hyperglycemic clamps, with or without GLP-1. The clamps were repeated in diabetic patients after 2 months of strict glycemic control.Results: During the meal, glycemia, nitrotyrosine, and plasma 8-iso prostaglandin F2α (8-iso-PGF2a) remained unchanged in the control subjects, whereas they increased in diabetic patients. Flow-mediated vasodilation (FMD) decreased in diabetes, whereas GLP-1 increased in both groups. During the OGTT, an increase in glycemia, nitrotyrosine, and 8-iso-PGF2a and a decrease in FMD were observed at 1 h in the control subjects and at 1 and 2 h in the diabetic patients. In the same way, GLP-1 increased in both groups at the same levels of the meal. During the clamps, in both the control subjects and the diabetic patients, a significant increase in nitrotyrosine and 8-iso-PGF2a and a decrease in FMD were observed, effects that were significantly reduced by GLP-1. After improved glycemic control, hyperglycemia during the clamps was less effective in producing oxidative stress and endothelial dysfunction and the GLP-1 administration was most effective in reducing these effects.Conclusions: Our data suggest that during the meal GLP-1 can simultaneously exert an incretin effect on insulin secretion and a protective effect on endothelial function, reasonably controlling oxidative stress generation. The ability of GLP-1 in protecting endothelial function seems to depend on the level of glycemia, a phenomenon already described for insulin secretion. [ABSTRACT FROM AUTHOR] more...- Published
- 2011
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28. Efficacy of insulin analogs in achieving the hemoglobin A1c target of <7% in type 2 diabetes: meta-analysis of randomized controlled trials.
- Author
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Giugliano D, Maiorino MI, Bellastella G, Chiodini P, Ceriello A, Esposito K, Giugliano, Dario, Maiorino, Maria Ida, Bellastella, Giuseppe, Chiodini, Paolo, Ceriello, Antonio, and Esposito, Katherine
- Abstract
Objective: Insulin analogs are increasingly used in patients with type 2 diabetes. We compared the effect of basal, biphasic, prandial, and basal-bolus insulin regimens with insulin analogs to reach the hemoglobin A(1c) (HbA(1c)) target of <7% in people with type 2 diabetes.Research Design and Methods: We conducted an electronic search for randomized controlled trials (RCTs) involving insulin analogs. RCTs were included if they lasted at least 12 weeks, reported the proportion of diabetic patients reaching the HbA(1c) target of <7% (primary outcome), and the number of patients in any arm was >30.Results: We found 16 RCTs, with 20 comparisons and 7,759 patients. A greater proportion of patients achieved the HbA(1c) goal of <7% with both biphasic (odds ratio 1.88 [95% CI 1.38-2.55]) and prandial (2.07 [1.16-3.69]) insulin compared with basal insulin; this was associated for biphasic insulin with greater hypoglycemia (event/patient/30 days, mean difference, 0.34 [range 0-0.69]) and weight gain in kg (1.0 kg [0.28-1.73]). Compared with biphasic insulin, the basal-bolus regimen was associated with a greater chance to reach the HbA(1c) goal (odds ratio 1.75 [95% CI 1.11-2.77]), with no greater hypoglycemia or weight gain. The effect of insulin analogs on long-term diabetes complications is still lacking.Conclusions: A greater proportion of type 2 diabetic patients can achieve the HbA(1c) goal <7% with biphasic or prandial insulin compared with basal insulin; in absolute terms, the basal-bolus regimen was best for the attainment of the HbA(1c) goal. [ABSTRACT FROM AUTHOR] more...- Published
- 2011
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29. Effect of acute hyperglycaemia, long-term glycaemic control and insulin on endothelial dysfunction and inflammation in Type 1 diabetic patients with different characteristics.
- Author
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Ceriello, A., Esposito, K., Ihnat, M., Thorpe, J., and Giugliano, D.
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HYPERGLYCEMIA ,ANTIMETABOLITES ,OXIDATIVE stress -- Risk factors ,TREATMENT of diabetes ,BLOOD sugar ,DISEASE risk factors - Abstract
Diabet. Med. 27, 911–917 (2010) Objective To investigate the possibility of reversing endothelial dysfunction and inflammation by glucose normalization, antioxidants and insulin per se, in different subgroups of Type 1 diabetic patients. Methods Three subgroups of Type 1 diabetic patients were studied: patients within 1 month of diagnosis (subgroup 1); patients with approximately 5 years’ disease duration and with glycated haemoglobin (HbA
1c ) ≤ 7.0% (subgroup 2) or > 7.0% since diagnosis (subgroup 3). Participants underwent four procedures: 2-h hyperglycaemic clamp followed by: (A) 12 h near-normalization of blood glucose, with the addition of vitamin C during the last 6 h; (B) 12-h vitamin C and near-normalization of blood glucose for the last 6 h; (C) both vitamin C and near-normalization of blood glucose for 12 h; (D) hyperglycaemic–hyperinsulinaemic clamp for 12 h, with the addition of vitamin C during the last 6 h. Results After 2 h of hyperglycaemia, markers of endothelial dysfunction, nitrotyrosine, 8-iso prostaglandin F2α, soluble intercellular adhesion molecule-1, soluble vascular adhesion molecule-1, interleukin (IL)-6 and IL-18 were increased in all the subgroups. Levels were normalized, at all time points, by treatments A, B and C in the subgroups 1 and 2. In the third subgroup, levels were normalized only by the simultaneous normalization of blood glucose and vitamin C treatment. During treatment D, the levels were improved at 6 h in all the subgroups, but normalized at 12 h only after vitamin C in subgroups 1 and 2, but not in subgroup 3. Conclusions This study suggests that different subgroups of Type 1 diabetic patients react identically to acute hyperglycaemia and insulin, but differently to glucose normalization. [ABSTRACT FROM AUTHOR] more...- Published
- 2010
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30. Determinants of erectile dysfunction in type 2 diabetes.
- Author
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Giugliano, F., Maiorino, M., Bellastella, G., Gicchino, M., Giugliano, D., and Esposito, K.
- Subjects
IMPOTENCE ,PEOPLE with diabetes ,TYPE 2 diabetes diagnosis ,BODY mass index ,HYPERTENSION - Abstract
This study was designed to evaluate the prevalence and correlates of ED in a population of diabetic men. Consecutive patients with type 2 diabetes were recruited among outpatients regularly attending Diabetes Clinics. Inclusion criteria for the initial selection of patients were a diagnosis of type 2 diabetes for at least 6 months but less than 10 years, age 35–70 years, body mass index (BMI) of 24 or higher, HbA1c of 6.5% or higher: a total of 555 (90.8%) of the 611 men were analyzed in this study. ED was assessed by the IIEF-5 instrument. Approximately, 6 in 10 men in our sample of diabetic men had varying degrees of erectile dysfunction: mild 9%, mild to moderate 11.2%, moderate 16.9% and severe 22.9%. The prevalence of severe ED increased with age. Higher hemoglobin A1c (HbA1c) levels were associated with ED; similarly, the presence of metabolic syndrome, hypertension, atherogenic dyslipidemia (low levels of HDL-cholesterol and high levels of triglycerides) and depression was associated with ED. Physical activity was protective of ED; men with higher levels of physical activity were 10% less likely to have ED as compared with those with the lowest level. In conclusion, among subjects with type 2 diabetes glycemic control and other metabolic covariates were associated with ED risk, whereas higher level of physical activity was protective. These results encourage the implementation of current medical guidelines that place intensive lifestyle changes as the first step of the management of type 2 diabetes. [ABSTRACT FROM AUTHOR] more...
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- 2010
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31. Determinants of female sexual dysfunction in type 2 diabetes.
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Esposito, K., Maiorino, M. I., Bellastella, G., Giugliano, F., Romano, M., and Giugliano, D.
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TYPE 2 diabetes ,MENOPAUSE ,WOMEN'S sexual behavior ,SMOKING ,METABOLIC syndrome - Abstract
Studies assessing sexual dysfunction in type 2 diabetic women are scanty. This study was designed to evaluate the prevalence and correlates of female sexual function in a quite large population of diabetic women. A total of 595 women with type 2 diabetes completed a questionnaire of self-report measures of sexual dysfunction and were analyzed in this study. Their age was 57.9±6.9 (mean and s.d.), duration of diabetes was 5.2±1.5 years and mean hemoglobin A1c (HbA1c) level was 8.3±1.3%. Female sexual dysfunction (FSD) was assessed by the Female Sexual Function Index instrument with a cut-off score of 23. The overall prevalence of FSD among the diabetic women was 53.4%, significantly higher in menopausal women (63.9%), as compared with nonmenopausal women (41.0%, P<0.001). There was no association between HbA1c, duration of diabetes, hypertension, or cigarette smoking status and FSD; on the contrary, age, metabolic syndrome and atherogenic dyslipidemia were significantly associated with FSD. Both depression and marital status were independent predictors of FSD, while physical activity was protective. Further studies are needed to elucidate in full the mechanisms underlying the evident differences between male and female sexual function. In the meantime, evaluation of female sexuality should become a routine evaluation in women with type 2 diabetes, such as other diabetic complications. [ABSTRACT FROM AUTHOR] more...
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- 2010
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32. Adherence to a Mediterranean diet and glycaemic control in Type 2 diabetes mellitus.
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Esposito, K., Maiorino, M. I., Di Palo, C., and Giugliano, D.
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GLYCEMIC index ,BODY mass index ,METABOLIC syndrome ,MULTIVARIATE analysis ,GLUCOSE ,DIET ,PHYSIOLOGY ,DIABETES prevention - Abstract
Aims Mediterranean-type diets reduce the risk of Type 2 diabetes. Whether a Mediterranean-type diet improves glycaemic control in diabetes remains unknown. Methods We conducted a cross-sectional analysis in 901 outpatients with Type 2 diabetes attending diabetes clinics located in Campania County, South Italy. We explored the relation between glycated haemoglobin (HbA
1c ), measured centrally, self-measured pre- and postprandial glucose levels and consumption of a Mediterranean-type diet. Adherence to a Mediterranean-type diet was assessed by a 9-point scale that incorporated the salient characteristics of this diet (range of scores, 0–9, with higher scores indicating greater adherence). The study was conducted from 2001 to 2007. Results Diabetic patients with the highest scores (6–9) had lower body mass index and waist circumferences, a lower prevalence of the metabolic syndrome and lower HbA1c and post-meal glucose levels than diabetic patients with the lowest scores (0–3). In multivariate analysis, mean HbA1c and 2-h post-meal glucose concentrations were significantly lower in diabetic patients with high adherence to a Mediterranean-type diet than those with low adherence [difference: HbA1c 0.9%, 95% confidence intervals (CI) 0.5–1.2%, P < 0.001; 2-h glucose 2.2 mmol/l, 95% CI 0.8–2.9 mmol/l, P < 0.001]. Conclusions In Type 2 diabetes, greater adherence to a Mediterranean-type diet is associated with lower HbA1c and postprandial glucose levels. [ABSTRACT FROM AUTHOR] more...- Published
- 2009
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33. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial.
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Esposito K, Maiorino MI, Ciotola M, Di Palo C, Scognamiglio P, Gicchino M, Petrizzo M, Saccomanno F, Beneduce F, Ceriello A, Giugliano D, Esposito, Katherine, Maiorino, Maria Ida, Ciotola, Miryam, Di Palo, Carmen, Scognamiglio, Paola, Gicchino, Maurizio, Petrizzo, Michela, Saccomanno, Franco, and Beneduce, Flora more...
- Abstract
Background: Low-carbohydrate and low-fat calorie-restricted diets are recommended for weight loss in overweight and obese people with type 2 diabetes.Objective: To compare the effects of a low-carbohydrate Mediterranean-style or a low-fat diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes.Design: Single-center, randomized trial. Randomization was computer-generated and unstratified. Allocation was concealed in sealed study folders held in a central, secure location until participants gave informed consent. Participants and investigators were aware of treatment assignment, and assessors of the primary outcome were blinded.Setting: Teaching hospital in Naples, Italy.Patients: 215 overweight people with newly diagnosed type 2 diabetes who were never treated with antihyperglycemic drugs and had hemoglobin A(1c) (HbA(1c)) levels less than 11%.Intervention: Mediterranean-style diet (<50% of daily calories from carbohydrates) (n = 108) or a low-fat diet (<30% of daily calories from fat) (n = 107).Measurements: Start of antihyperglycemic drug therapy, defined by protocol as indicated for follow-up HbA(1c) level greater than 7% (primary outcome), and changes in weight, glycemic control, and coronary risk factors (secondary outcomes).Results: After 4 years, 44% of patients in the Mediterranean-style diet group and 70% in the low-fat diet group required treatment (absolute difference, -26.0 percentage points [95% CI, -31.1 to -20.1 percentage points]; hazard ratio, 0.63 [CI, 0.51 to 0.86]; hazard ratio adjusted for weight change, 0.70 [CI, 0.59 to 0.90]; P < 0.001). Participants assigned to the Mediterranean-style diet lost more weight and experienced greater improvements in some glycemic control and coronary risk measures than did those assigned to the low-fat diet.Limitations: Investigators responsible for initiating drug therapy were not blinded to treatment assignment. Dietary intake was self-reported.Conclusion: Compared with a low-fat diet, a low-carbohydrate, Mediterranean-style diet led to more favorable changes in glycemic control and coronary risk factors and delayed the need for antihyperglycemic drug therapy in overweight patients with newly diagnosed type 2 diabetes.Primary Funding Source: Second University of Naples. [ABSTRACT FROM AUTHOR] more...- Published
- 2009
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34. Reply to the letter to the editor by Mungmunpuntipantip et al.
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Longo, M., Maiorino, M. I., and Esposito, K.
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- 2022
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35. Addition of neutral protamine lispro insulin or insulin glargine to oral type 2 diabetes regimens for patients with suboptimal glycemic control: a randomized trial.
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Esposito K, Ciotola M, Maiorino MI, Gualdiero R, Schisano B, Ceriello A, Beneduce F, Feola G, Giugliano D, Esposito, Katherine, Ciotola, Miryam, Maiorino, Maria Ida, Gualdiero, Roberto, Schisano, Bruno, Ceriello, Antonio, Beneduce, Flora, Feola, Giovanni, and Giugliano, Dario more...
- Abstract
Background: Injection of long-acting insulin at bedtime is a common therapeutic approach for patients with type 2 diabetes that is poorly controlled with oral regimens. Neutral protamine lispro (NPL) insulin has demonstrated better glycemic control and similar incidence of hypoglycemic events than that of neutral protamine Hagedorn insulin.Objective: To compare the clinical efficacy and safety of bedtime NPL insulin or insulin glargine in patients with type 2 diabetes who had suboptimal glycemic control while receiving stable doses of metformin and sulfonylurea.Design: Open-label, randomized trial.Setting: Teaching hospital (Azienda Ospedaliera Universitaria, Second University of Naples), Naples, Italy.Patients: 116 adults receiving stable doses of metformin plus sulfonylurea for longer than 90 days with hemoglobin A(1c) (HbA(1c)) levels of 7.5% to 10% and fasting plasma glucose levels of 6.7 mmol/L or greater (> or =120 mg/dL).Intervention: 10 IU of NPL insulin or insulin glargine injected subcutaneously at bedtime with weekly dose titrations to target fasting glucose levels less than 5.6 mmol/L (<100 mg/dL) in addition to stable oral regimens. Patients receiving nighttime sulfonylurea before the study were switched to metformin.Measurements: The primary outcome was change in HbA(1c) levels from baseline to week 36. Secondary outcomes were HbA(1c) levels less than 7%, self-reported hypoglycemic episodes, insulin dose, self-monitored glucose level, and body weight. Twenty patients in each group had continuous glucose monitoring for 3 consecutive days before adding insulin and at week 36.Results: Improvement in HbA(1c) levels was similar in both groups (1.83% and 1.89% for NPL and glargine, respectively). The difference between the groups was 0.06 percentage point (95% CI, -0.1 to 0.15 percentage points). Secondary outcomes did not differ between groups. Hemoglobin A(1c) levels less than 7% occurred in 62% of patients receiving NPL and 64% of patients receiving glargine (difference, 2.0 percentage points [CI, -1.1 to 5.0 percentage points]). Fasting plasma glucose levels less than 5.6 mmol/L (<100 mg/dL) occurred in 40% of patients receiving NPL and 41% of patients receiving glargine (difference, 1.0 percentage point [CI, -0.9 to 3.0 percentage points]). Any hypoglycemic event occurred in 74% of patients receiving NPL and 67% of patients receiving glargine (difference, 7 percentage points [CI, -5 to 13 percentage points]). Continuous glucose level monitoring in the patients who had this measurement did not differ statistically.Limitation: The study was not blinded, had limited power to detect differences in hypoglycemic events, and did not obtain continuous glucose level monitoring for all patients.Conclusion: Similar glycemic control occurred with the addition of NPL or glargine insulin to oral regimens in patients with poorly controlled type 2 diabetes. Hypoglycemia was similar in the 2 groups, but sample size limited the ability to make a definite safety assessment. [ABSTRACT FROM AUTHOR] more...- Published
- 2008
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36. Obesity and sexual dysfunction, male and female.
- Author
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Esposito, K., Giugliano, F., Ciotola, M., De Sio, M., D'Armiento, M., and Giugliano, D.
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OBESITY ,IMPOTENCE ,METABOLIC syndrome ,INSULIN resistance ,WOMEN'S sexual behavior - Abstract
Obesity has become a worldwide public health problem of epidemic proportions, as it may decrease life expectancy by 7 years at the age of 40 years: excess bodyweight is now the sixth most important risk factor contributing to the overall burden of disease worldwide. Overweight and obesity may increase the risk of erectile dysfunction (ED) by 30–90% as compared with normal weight subjects. On the other hand, subjects with ED tend to be heavier and with a greater waist than subjects without ED, and also are more likely to be hypertensive and hypercholesterolemic. The metabolic syndrome, characterized by a clustering of risk factors associated with insulin resistance and abdominal obesity, associates with ED. Moreover, women with the metabolic syndrome have an increased prevalence of sexual dysfunctions as compared with matched control women. Lifestyle changes aimed at reducing body weight and increasing physical activity induce amelioration of both erectile and endothelial functions in obese men. Moreover, preliminary evidence suggests that a Mediterranean-style diet might be effective in ameliorating sexual function in women with the metabolic syndrome. Lifestyle changes, mainly focussing on regular physical activity and a healthy diet, are effective and safe ways to reduce cardiovascular diseases and premature mortality in all population groups; they may also prevent and treat sexual dysfunctions in both sexes.International Journal of Impotence Research (2008) 20, 358–365; doi:10.1038/ijir.2008.9; published online 10 April 2008 [ABSTRACT FROM AUTHOR] more...
- Published
- 2008
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37. Defining the Role of Insulin Lispro in the Management of Postprandial Hyperglycaemia in Patients with Type 2 Diabetes Mellitus.
- Author
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Giugliano, D., Ceriello, A., Razzoli, E., and Esposito, K.
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TYPE 2 diabetes ,INSULIN ,PEOPLE with diabetes ,DIABETES ,MICROCIRCULATION disorders ,THERAPEUTICS ,DIAGNOSIS - Abstract
The role of postprandial hyperglycaemia in contributing to the risk of both micro- and macrovascular complications in patients with diabetes mellitus is being increasingly recognized. In type 2 diabetes, there is a progressive shift in the relative contributions of postprandial and fasting hyperglycaemia to the overall glycaemic control as the disease progresses. For patients with fairly good glycaemic control (glycosylated hemoglobin [HA
1c ] <8.5%). postprandial hyperglycaemia makes a relatively greater contribution to the overall glycaemic load than fasting hyperglycaemia, but in patients with poorer control, the relative contribution of the two states to the overall glycaemic load is reversed. This finding, coupled with epidemiological evidence that elevated postprandial glucose concentration is an independent risk factor for cardiovascular disease (CVD), and is associated with a greater CVD risk than elevated fasting glucose, points to the need to monitor and target postprandial glucose, as well as fasting glucose and HbA1c levels, when optimizing insulin therapy for patients with type 2 diabetes. When insulin therapy becomes necessary in patients with type 2 diabetes who can no longer be controlled with oral antihyperglycaemic therapy, use of short-acting insulin analogues with a rapid onset of action and capable of controlling postprandial glycaemic excursions when injected immediately before a meal, has advantages over regular human insulin in that they provide a more favourable time-action profile that mimics normal physiological insulin secretion. Among the available rapid-acting insulin analogues, insulin lispro has been shown to reduce postprandial glucose concentrations to a significantly greater degree than regular human insulin in patients with type 2 diabetes. Moreover, premixed combinations of insulin lispro with the longer acting analogue neutral insulin lispro protamine suspension in 25% : 75% or 50% : 50% combinations are significantly more effective in towering postprandial blood glucose concentrations than premixed regular human insulin plus neutral protamine Hagedorn (NPH) 30%) : 70%. The premixed insulin lispro combinations offer the advantage of fewer daily injections than intensive insulin therapy, and the convenience of not having to mix insulin preparations manually. Although it has yet to be conclusively established that targeting postprandial hyperglycaemia reduces CVD risk, the potential benefits of improved postprandial and interprandial hyperglycaemia favour the use of newer insulin analogues, such as insulin lispro and insulin lispro mixes, over conventional insulin therapy, whenever insulin therapy becomes necessary in patients with type 2 diabetes. [ABSTRACT FROM AUTHOR] more...- Published
- 2008
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38. Mediterranean diet improves sexual function in women with the metabolic syndrome.
- Author
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Esposito, K., Ciotola, M., Giugliano, F., Schisano, B., Autorino, R., Iuliano, S., Vietri, M. T., Cioffi, M., De Sio, M., and Giugliano, D.
- Subjects
WOMEN'S sexual behavior ,METABOLIC syndrome ,DIAGNOSIS ,SEXUAL dysfunction ,SYNDROMES ,AROUSAL (Physiology) - Abstract
In the present study, we tested the effect of a Mediterranean-style diet on sexual function in women with the metabolic syndrome. Women were identified in our database of subjects participating in controlled trials evaluating the effect of lifestyle changes and were included if they had a diagnosis of female sexual dysfunction (FSD) associated with a diagnosis of metabolic syndrome, a complete follow-up in the study trial and an intervention focused mainly on dietary changes. Fifty-nine women met the inclusion/exclusion criteria; 31 out of them were assigned to the Mediterranean-style diet and 28 to the control diet. After 2 years, women on the Mediterranean diet consumed more fruits, vegetables, nuts, whole grain and olive oil as compared with the women on the control diet. Female sexual function index (FSFI) improved in the intervention group, from a mean basal value of 19.7±3.1 to a mean post-treatment value of 26.1±4.1 (P=0.01), and remained stable in the control group. C-reactive protein (CRP) levels were significantly reduced in the intervention group (P<0.02). No single sexual domain (desire, arousal, lubrication, orgasm, satisfaction, pain) was significantly ameliorated by the dietary treatment, suggesting that the whole female sexuality may find benefit from lifestyle changes. A Mediterranean-style diet might be effective in ameliorating sexual function in women with metabolic syndrome.International Journal of Impotence Research (2007) 19, 486–491; doi:10.1038/sj.ijir.3901555; published online 2 August 2007 [ABSTRACT FROM AUTHOR] more...
- Published
- 2007
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39. Association of body weight with sexual function in women.
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Esposito, K., Ciotola, M., Giugliano, F., Bisogni, C., Schisano, B., Autorino, R., Cobellis, L., De Sio, M., Colacurci, N., and Giugliano, D.
- Subjects
DISEASES in women ,WOMEN'S health ,WOMEN'S sexual behavior ,SEXUAL dysfunction ,SEXUAL excitement ,SEXUAL intercourse - Abstract
Sexual difficulties in women appear to be widespread in society; the relationship between female sexual function and obesity is unclear. This study aimed to investigate the relationship between body weight, the distribution of body fat and sexual function in women. Fifty-two, otherwise healthy women with abnormal values of female sexual function index (FSFI) score (23) were compared with 66 control women (FSFI >23), matched for age and menopausal status. All women were free from diseases known to affect sexual function. FSFI strongly correlated with body mass index (BMI) (r=–0.72, P=0.0001), but not with waist-to-hip ratio (r=–0.09, P=0.48), in women with sexual dysfunction. Of the six sexual function parameters, desire and pain did not correlate with BMI, while arousal (r=–0.75), lubrication (r=–0.66), orgasm (r=–0.56) and satisfaction (r=–0.56, all P<0.001) did. FSFI score was significantly lower in overweight women as compared with normal weight women, while cholesterol and triglyceride levels were higher. On multivariate analysis, both age and BMI explained about 68% of FSFI variance, with a primacy of BMI over age (ratio 4:1). In conclusion, obesity affects several aspects of sexuality in otherwise healthy women with sexual dysfunction.International Journal of Impotence Research (2007) 19, 353–357; doi:10.1038/sj.ijir.3901548; published online 8 February 2007 [ABSTRACT FROM AUTHOR] more...
- Published
- 2007
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40. Endothelial microparticles correlate with erectile dysfunction in diabetic men.
- Author
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Esposito, K., Ciotola, M., Giugliano, F., Schisano, B., Improta, L., Improta, M. R., Beneduce, F., Rispoli, M., De Sio, M., and Giugliano, D.
- Subjects
IMPOTENCE ,PEOPLE with diabetes ,DIABETES ,BLOOD vessels - Abstract
Cell-derived microparticles are supposed to be involved in endothelial dysfunction and atherogenesis. This study aimed to evaluate circulating microparticles in diabetic subjects with erectile dysfunction (ED) and their relation with endothelial dysfunction. Thirty diabetic men with ED and 20 age-matched control subjects without ED were assessed for circulating microparticles and endothelial dysfunction. Flow cytometry was used to assess microparticles by quantification of circulating endothelial (EMP, CD31
+ /CD42b− ) and platelet (PMP, CD31+ /CD42b+ ) microparticles in peripheral blood. Endothelium-dependent flow-mediated dilation (FMD) was evaluated in the right brachial artery after reactive hyperemia. Compared with non-diabetic subjects, diabetic men presented significantly higher numbers of EMP (P=0.001), and reduced FMD (P=0.01), with a significant inverse correlation between the number of circulating EMP and the International Index of Erectile Function (IIEF) score (r=−0.457, P=0.01). Multivariate analysis correcting for age, anthropometric indices, glucose and lipid parameters, FMD and PMP identified EMP as the only independent predictor for IIEF score (P=0.03). EMP are elevated in impotent diabetic subjects and independently involved in the pathogenesis of ED.International Journal of Impotence Research (2007) 19, 161–166. doi:10.1038/sj.ijir.3901500; published online 10 August 2006 [ABSTRACT FROM AUTHOR] more...- Published
- 2007
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41. Endocrine complications of COVID-19: what happens to the thyroid and adrenal glands?
- Author
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Bellastella, G., Maiorino, M. I., and Esposito, K.
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- 2020
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42. Mediterranean diet, endothelial function and vascular inflammatory markers.
- Author
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Esposito K, Ciotola M, Giugliano D, Esposito, Katherine, Ciotola, Miryam, and Giugliano, Dario
- Abstract
Objectives: To discuss present knowledge about the relation between adipose tissue, inflammation and the Mediterranean-style diet.Design: Review of the literature and personal perspectives.Setting and Results: Recent studies indicate that adipose tissue is an endocrine organ producing numerous proteins, collectively referred to as adipokines, with broad biological activity, which play an important autocrine role in obesity-associated complications. Adipose tissue in general and visceral fat in particular are thought to be key regulators of inflammation which is heavily involved in the onset and development of atherothrombotic disease. Moreover, chronic inflammation may also represent a triggering factor in the origin of the metabolic syndrome and type 2 diabetes mellitus. An increased release of proinflammatory adipokines from the visceral adipose tissue, associated with a reduced secretion of anti-inflammatory adipokines and cytokines, could determine a low-grade chronic inflammatory state which might play a role in the future development of the metabolic syndrome, diabetes and atherosclerosis through both insulin resistance and endothelial dysfunction. Interventions aimed at decreasing weight loss and improving adherence to a Mediterranean-style diet in people with obesity or metabolic syndrome decrease the inflammatory milieu and ameliorate both insulin resistance and endothelial dysfunction.Conclusions: Appropriate dietary patterns, as those associated with the eating model of Mediterranean-type diets, represent therapeutic strategies to reduce inflammation and the associated metabolic and cardiovascular risk. [ABSTRACT FROM AUTHOR] more...- Published
- 2006
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43. Dietary factors in erectile dysfunction.
- Author
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Esposito, K., Giugliano, F., De Sio, M., Carleo, D., Di Palo, C., D'armiento, M., and Giugliano, D.
- Subjects
MEN'S health ,IMPOTENCE ,DIET in disease ,HYPERTENSION ,HYPERCHOLESTEREMIA ,BODY mass index ,LIPIDS in human nutrition ,PREVENTIVE health services - Abstract
The role of dietary factors in erectile dysfunction (ED) has never been addressed. In the present case–control study, we investigated the relation of the Mediterranean diet with ED. A total of 100 men with ED were compared with 100 age-matched men without ED. A scale indicating the degree of adherence to the Mediterranean diet was constructed: the total Mediterranean diet score ranged from 0 (minimal adherence to the Mediterranean diet) to 9 (maximal adherence). The percentage of physical inactivity was greater in the ED group (35 vs 19%, P=0.04), whereas the diet score was lower (4.7±0.5 vs 5.4±0.5, P<0.01), indicating a reduced adherence to the Mediterranean diet. In analyses adjusted for the prevalence of associated risk factors (hypertension, hypercholesterolemia), body mass index, waist, physical inactivity and total energy intake, the intake of fruits and nuts, and the ratio of monounsaturated lipids to saturated lipids remained the only individual measures associated with ED. In conclusion, the results of the present study show that dietary factors may be important in the development of ED: adoption of healthy diets would hopefully help preventing ED.International Journal of Impotence Research (2006) 18, 370–374. doi:10.1038/sj.ijir.3901438; published online 5 January 2006 [ABSTRACT FROM AUTHOR] more...
- Published
- 2006
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44. Mediterranean diet improves erectile function in subjects with the metabolic syndrome.
- Author
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Esposito, K., Ciotola, M., Giugliano, F., De Sio, M., Giugliano, G., D'armiento, M., and Giugliano, D.
- Subjects
MEN'S health ,IMPOTENCE ,METABOLIC syndrome ,INSULIN resistance ,DIET in disease ,C-reactive protein ,INFLAMMATORY mediators - Abstract
Men with the metabolic syndrome demonstrate an increased prevalence of erectile dysfunction (ED). In the present study, we tested the effect of a Mediterranean-style diet on ED in men with the metabolic syndrome. Men were identified in our database of subjects participating in controlled trials evaluating the effect of lifestyle changes and were included if they had a diagnosis of ED associated with a diagnosis of metabolic syndrome, complete follow-up in the study trial, and intervention focused mainly on dietary changes. Sixty-five men with the metabolic syndrome met the inclusion/exclusion criteria; 35 out of them were assigned to the Mediterranean-style diet and 30 to the control diet. After 2 years, men on the Mediterranean diet consumed more fruits, vegetables, nuts, whole grain, and olive oil as compared with men on the control diet. Endothelial function score and inflammatory markers (C-reactive protein) improved in the intervention group, but remained stable in the control group. There were 13 men in the intervention group and two in the control group (P=0.015) that reported an IIEF score of 22 or higher. Mediterranean-style diet rich in whole grain, fruits, vegetables, legumes, walnut, and olive oil might be effective per se in reducing the prevalence of ED in men with the metabolic syndrome.International Journal of Impotence Research (2006) 18, 405–410. doi:10.1038/sj.ijir.3901447; published online 5 January 2006 [ABSTRACT FROM AUTHOR] more...
- Published
- 2006
- Full Text
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45. The ubiquitin-proteasome system and inflammatory activity in diabetic atherosclerotic plaques: effects of rosiglitazone treatment.
- Author
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Marfella R, D'Amico M, Esposito K, Baldi A, Di Filippo C, Siniscalchi M, Sasso FC, Portoghese M, Cirillo F, Cacciapuoti F, Carbonara O, Crescenzi B, Baldi F, Ceriello A, Nicoletti GF, D'Andrea F, Verza M, Coppola L, Rossi F, and Giugliano G more...
- Abstract
The role of ubiquitin-proteasome system in the accelerated atherosclerotic progression of diabetic patients is unclear. We evaluated ubiquitin-proteasome activity in carotid plaques of asymptomatic diabetic and nondiabetic patients, as well as the effect of rosiglitazone, a peroxisome proliferator-activated receptor (PPAR)-gamma activator, in diabetic plaques. Plaques were obtained from 46 type 2 diabetic and 30 nondiabetic patients undergoing carotid endarterectomy. Diabetic patients received 8 mg rosiglitazone (n = 23) or placebo (n = 23) for 4 months before scheduled endarterectomy. Plaques were analyzed for macrophages (CD68), T-cells (CD3), inflammatory cells (HLA-DR), ubiquitin, proteasome 20S activity, nuclear factor (NF)-kappaB, inhibitor of kappaB (IkappaB)-beta, tumor necrosis factor (TNF)-alpha, nitrotyrosine, matrix metalloproteinase (MMP)-9, and collagen content (immunohistochemistry and enzyme-linked immunosorbent assay). Compared with nondiabetic plaques, diabetic plaques had more macrophages, T-cells, and HLA-DR+ cells (P < 0.001); more ubiquitin, proteasome 20S activity (TNF-alpha), and NF-kappaB (P < 0.001); and more markers of oxidative stress (nitrotyrosine and O2(-) production) and MMP-9 (P < 0.01), along with a lesser collagen content and IkappaB-beta levels (P < 0.001). Compared with placebo-treated plaques, rosiglitazone-treated diabetic plaques presented less inflammatory cells (P < 0.01); less ubiquitin, proteasome 20S, TNF-alpha, and NF-kappaB (P < 0.01); less nitrotyrosine and superoxide anion production (P < 0.01); and greater collagen content (P < 0.01), indicating a more stable plaque phenotype. Similar findings were obtained in circulating monocytes obtained from the two groups of diabetic patients and cultured in the presence or absence of rosiglitazone (7.0 micromol/l). Ubiquitin-proteasome over-activity is associated with enhanced inflammatory reaction and NF-kappaB expression in diabetic plaques. The inhibition of ubiquitin-proteasome activity in atherosclerotic lesions of diabetic patients by rosiglitazone is associated with morphological and compositional characteristics of a potential stable plaque phenotype, possibly by downregulating NF-kappaB-mediated inflammatory pathways. [ABSTRACT FROM AUTHOR] more...
- Published
- 2006
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46. The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes: response to Kahn et al.
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Giugliano D, Esposito K, Citrome L, Holt RIG, Dinan TG, Cheta DM, Psaty BM, Lumley T, Furberg CD, Kahn R, Buse J, Ferrannini E, Stern M, Giugliano, Dario, and Esposito, Katherine
- Published
- 2006
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47. Obesity, the metabolic syndrome, and sexual dysfunction.
- Author
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Esposito, K. and Giugliano, D.
- Subjects
BODY weight ,SEXUAL dysfunction ,OBESITY ,IMPOTENCE ,ETIOLOGY of diseases ,QUALITY of life ,DISEASE risk factors - Abstract
Sexual problems in both sexes appear to be widespread in society, influenced by both health-related and psychosocial factors, and are associated with impaired quality of life. Epidemiological studies suggest that modifiable health behaviors, including physical activity and leanness, are associated with a reduced risk for erectile dysfunction (ED) among men. Data from other surveys also indicate a higher prevalence of impotence in obese men. Obesity may be a risk factor for sexual dysfunction in both sexes; the data for the metabolic syndrome are very preliminary and need to be confirmed in larger epidemiologic studies. The high prevalence of ED in patients with cardiovascular risk factors suggests that abnormalities of the vasodilator system of penile arteries play an important role in the pathophysiology of ED. We have shown that one-third of obese men with ED can regain their sexual activity after 2 y of adopting health behaviors, mainly regular exercise and reducing weight. Western societies actually spend a huge part of their health care costs on chronic disease treatment and interventions for risk factors. The adoption of healthy lifestyles can reduce the prevalence of obesity and the metabolic syndrome, and hopefully the burden of sexual dysfunction.International Journal of Impotence Research (2005) 17, 391–398. doi:10.1038/sj.ijir.3901333; published online 19 May 2005 [ABSTRACT FROM AUTHOR] more...
- Published
- 2005
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48. Effect of atorvastatin and irbesartan, alone and in combination, on postprandial endothelial dysfunction, oxidative stress, and inflammation in type 2 diabetic patients.
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Ceriello A, Assaloni R, Da Ros R, Maier A, Piconi L, Quagliaro L, Esposito K, Giugliano D, Ceriello, Antonio, Assaloni, Roberta, Da Ros, Roberto, Maier, Amabile, Piconi, Ludovica, Quagliaro, Lisa, Esposito, Katherine, and Giugliano, Dario more...
- Published
- 2005
49. Impairment of coronary circulation by acute hyperhomocysteinaemia and reversal by antioxidant vitamins.
- Author
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Coppola, A., Astarita, C., Liguori, E., Fontana, D., Oliviero, M., Esposito, K., Coppola, L., and Giugliano, D.
- Subjects
CORONARY circulation ,ANTIOXIDANTS ,VITAMINS ,CHEMOKINES ,HOMOCYSTEINE ,CARDIOVASCULAR diseases ,DISEASE risk factors ,CARDIOLOGY - Abstract
Coppola A, Astarita C, Liguori E, Fontana D, Oliviero M, Esposito K, Coppola L, Giugliano D (Second University of Naples, Naples; and S. Maria della Misericordia Hospital, Sorrento, Italy) Impairment of coronary circulation by acute hyperhomocysteinaemia and reversal by antioxidant vitamins.J Intern Med2004;256:398–405.To evaluate the effect of acute hyperhomocysteinaemia with and without antioxidant vitamins pretreatment on coronary circulation and circulating chemokine levels.Observer-blinded, randomized crossover study.This study was conducted at a university hospital and at a general hospital in Italy.Sixteen healthy hospital staff volunteers (nine men, seven women), aged 26–40 years.Subjects were given each three loads in random order at 1-week intervals: oral methionine, 100 mg kg
−1 in fruit juice; the same methionine load immediately following ingestion of antioxidant vitamin E, 800 IU, and ascorbic acid, 1000 mg; and methionine-free fruit juice (placebo).Coronary flow velocity reserve (CFVR), assessed by noninvasive transthoracic Doppler echocardiography, blood pressure, heart rate, lipid and glucose, monocyte chemoattractant protein-1 (MCP-1) and interleukin-8 (IL-8) parameters evaluated at baseline and 4 h following ingestion of the loads.The oral methionine load increased plasma homocysteine from 12.8 ± 1.8 to 33.3 ± 3.4 μmol L−1 at 4 h (P < 0.001). A similar increase was observed with same load plus vitamins (P < 0.001) but not with placebo (P = 0.14). Circulating MCP-1 and IL-8 levels rose after the methionine load (P < 0.001), but not after placebo or methionine plus vitamins. The methionine load significantly reduced CFVR (decrease, 26 ± 8.2%;P < 0.001). The methionine load with ingestion of vitamins partially prevented the impairment of CFVR (decrease, 11 ± 4%;P < 0.001).Our data suggest that acute hyperhomocysteinaemia reduces CFVR and increases plasma MCP-1 and IL-8 levels in healthy subjects. Pretreatment with antioxidant vitamin E and ascorbic acid prevents the effects of hyperhomocysteinaemia, suggesting an oxidative mechanism. [ABSTRACT FROM AUTHOR] more...- Published
- 2004
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- View/download PDF
50. Effect of irbesartan on nitrotyrosine generation in non-hypertensive diabetic patients.
- Author
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Ceriello, A., Assaloni, R., Da Ros, R., Maier, A., Quagliaro, L., Piconi, L., Esposito, K., and Giugliano, D.
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DIABETES ,CARBOHYDRATE intolerance ,CARDIOVASCULAR diseases ,PATIENTS ,BLOOD plasma ,GLUCOSE ,OXIDATIVE stress - Abstract
Aims/hypothesis. Oxidative stress is involved in the pathogenesis of microangiopathic and macroangiopathic diabetic complications. The results of recent trials suggest that type 1 angiotensin II (AT-1) receptor blockers may prevent or delay nephropathy and cardiovascular disease in diabetic patients, independently of their anti-hypertensive action. There is evidence that AT-1 receptor blockers can work as intracellular antioxidants. This study investigated whether the AT-1 receptor blocker irbesartan is able to reduce nitrotyrosine formation in non-hypertensive diabetic patients under fasting conditions and during acute hyperglycaemia. Methods. A total of 40 non-hypertensive, non-microalbuminuric Type 2 diabetic patients and 20 healthy, normotensive subjects were recruited for this study. Diabetic patients followed a randomised, doubleblind, placebo-controlled, crossover protocol, taking either irbesartan (150 mg orally, twice daily) or placebo for 60 days. Fasting glucose and nitrotyrosine were measured at baseline and at the end of each treatment period. An OGTT was also performed at the same time intervals, during which plasma glucose and nitrotyrosine levels were monitored. Results. Compared with baseline measurements, treatment with irbesartan (0.57±0.4 vs 0.35±0.3 µmol/l, p<0.01) but not placebo (0.58±0.3 vs 0.59±0.2 µmol/l) significantly reduced fasting nitrotyrosine levels. Irbesartan also significantly reduced nitrotyrosine formation during the OGTT. Conclusions/interpretation. This study demonstrates that irbesartan reduces plasma levels of nitrotyrosine in diabetic patients and is effective in counterbalancing nitrotyrosine formation during acute hyperglycaemia. Our results may help to elucidate how AT-1 receptor blockers exert their beneficial effect independently of their BP-lowering activity. [ABSTRACT FROM AUTHOR] more...
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- 2004
- Full Text
- View/download PDF
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