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To the Editor: We read with great interest the article by Ferriera et al1 reporting a significant elevation of circulating endothelial microparticles (EMPs) strictly correlated with postmeal increase in serum triglycerides in healthy normolipidemic subjects after a single high-fat meal. The results of the study add to the long list of previous research demonstrating impairment of endothelial functions after a single high-fat meal in otherwise healthy subjects. Some aspects of this work deserve further comment. The authors’ statement about the calculated source of energy from fat (19%) in the high-fat meal is obviously wrong. Fifty grams of fat gives much more than 19% of energy if related to the total amount of the 900 energy units of the meal; a high-fat meal must contain at least 50% of energy from fat. The authors do not address in full the issue of whether the release of EMP represents a cause …

Patients with newly diagnosed type 2 diabetes are usually managed by pharmacotherapy as well as lifestyle changes. The latter are often ineffective and pharmacotherapy may fail over time or may increase cardiovascular and other risks. Specific diets recommended for weight loss in overweight and obese individuals with type 2 diabetes are low-carbohydrate and low-fat calorie-restricted diet. Mediterranean-style diets (MED) have been recommended because they increase insulin sensitivity and improve control of coronary risk factors and hyperglycemia. However, there have been few direct long-term comparisons with other diets in patients with diabetes. This single-center, randomized trial compared the long term effectiveness of a low-carbohydrate MED diet and a low-fat diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes. Effects on glycemic control and coronary risk factors were also compared. The study subjects were 215 overweight individuals, 30 to 70 years of age with newly diagnosed type 2 diabetes, who had a hemoglobin Alc (HbA 1c ) level

Some environmental factors may influence the pituitary-gonadal function. Among these, light plays an important role in animal and in humans. The effect of light on the endocrine system is mediated by the pineal gland, through the modulation of melatonin secretion. In fact, melatonin secretion is stimulated by darkness and suppressed by light, thus its circadian rhythm peaks at night. Light plays a favourable action on the hypothalamic-pituitary axis likely inhibiting melatonin secretion, even if the exogenous melatonin administration does not seem to impair the hormonal secretions of this axis. The basal and rhythmic pituitary-gonadal hormone secretions is regulated by a central clock gene and some independent clock genes present in the peripheral tissues. Light is able to induce the expression of some of these genes, thus playing an important role in regulating the hormonal secretions of pituitary -gonadal axis and the sexual and reproductive function in animals and humans. The lack of light stimulus in blind subjects induces increased plasma melatonin concentrations with a free-running rhythm of secretion, which impairs the hormonal secretions of pituitary-gonadal axis, causing disorders of reproductive processes in both sexes.

The release of recent guidelines for high cholesterol, hypertension and diabetes in the U.S. has been accompanied by great noise and concerns, both in the academic circuits and the lay press. For persons aged 40 to 75 years, with LDL cholesterol levels between 70-189 mg/dL and 7.5% or higher estimated 10-year risk, the peril of a global "statinization" has been advocated, predicting a 70% increase of statin use in this otherwise healthy people. A minority of the Eight Joint National Committee panel disagreed with the recommendation to increase the target systolic blood pressure from 140 to 150 mmHg in persons aged 60 years or older without diabetes mellitus or chronic kidney disease. The 2013-American Association of Clinical Endocrinologists algorithm and consensus statement on diabetes has been criticized with particular concerns about transparency, conflicts of interest, group composition, and the abundant use of personal judgment and experience instead of rigorous methodology. Separate careers for experts who collect evidence from persons who write the actual guidelines seems a good opportunity in order to attenuate the noise associated with release of new guidelines, especially those that counter prior practice.

The panoply of treatment algorithms, periodically released to improve guidance, is one mean to face therapeutic uncertainty in pharmacological management of hyperglycemia in type 2 diabetes, especially after metformin failure. Failure of recent guidelines to give advice on the use of specific antidiabetic drugs in patients with co-morbidity may generate further uncertainty, given the frequent association of type 2 diabetes with common comorbidity, including, although not limited to obesity, cardiovascular disease, impaired renal function, and frailty. The Italian Association of Diabetologists (Associazione Medici Diabetologi, AMD) recognized the need to develop personalized treatment plans for people with type 2 diabetes, taking into account the patients' individual profile (phenotype), with the objective of the safest possible glycemic control. As not every subject with type 2 diabetes benefits from intensive glycemic control, flexible regimens of treatment with diabetes drugs (including insulin) are needed for reaching individualized glycemic goals. Whether personalized diabetology will improve the quality healthcare practice of diabetes management is unknown, but specific research has been launched.