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Background: Greater efforts are needed to overcome the worldwide reported low achievement of LDL-c targets. This survey aimed to dissect whether and how the physician-based evaluation of patients with diabetes is associated with the achievement of LDL-c targets. Methods: This cross-sectional self-reported survey interviewed physicians working in 67 outpatient services in Italy, collecting records on 2844 patients with diabetes. Each physician reported a median of 47 records (IQR 42–49) and, for each of them, the physician specified its perceived cardiovascular risk, LDL-c targets, and the suggested refinement in lipid-lowering-treatment (LLT). These physician-based evaluations were then compared to recommendations from EAS/EASD guidelines. Results: Collected records were mostly from patients with type 2 diabetes (94%), at very-high (72%) or high-cardiovascular risk (27%). Physician-based assessments of cardiovascular risk and of LDL-c targets, as compared to guidelines recommendation, were misclassified in 34.7% of the records. The misperceived assessment was significantly higher among females and those on primary prevention and was associated with 67% lower odds of achieving guidelines-recommended LDL-c targets (OR 0.33, p < 0.0001). Peripheral artery disease, target organ damage and LLT-initiated by primary-care-physicians were all factors associated with therapeutic-inertia (i.e., lower than expected probability of receiving high-intensity LLT). Physician-suggested LLT refinement was inadequate in 24% of overall records and increased to 38% among subjects on primary prevention and with misclassified cardiovascular risk. Conclusions: This survey highlights the need to improve the physicians' misperceived cardiovascular risk and therapeutic inertia in patients with diabetes to successfully implement guidelines recommendations into everyday clinical practice. [ABSTRACT FROM AUTHOR]

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Background. Taurine transporter gene expression (RNA-TauT) has a role in retinal cell function and is modulated in vitro and in vivo by hyperglycemia and/or oxidative stress. This study was aimed at testing whether RNA-TauT gene expression is modified in blood mononuclear peripheral cells (MPCs) of type 1 diabetic patients, is related to plasma markers of oxidative stress or endothelial dysfunction, or, finally, is related to presence of retinopathy. Methods. RNA-TauT was measured in MPCs by real-time PCR-analysis in 35 type 1 diabetic patients and in 33 age- and sex-matched controls, additionally measuring plasma and cell taurine and markers of oxidative stress and endothelial dysfunction. Results. RNA-TauT, expressed as 2-ΔΔCt, was significantly higher in MPCs of type 1 diabetic patients than in controls [median (interquartile range): 1.32(0.31) versus 1.00(0.15); P=0.01]. In diabetic patients RNA-TauT was related to HbA1c (r=0.42; P=0.01) and inversely to plasma homocysteine (r=-0.39; P=0.02) being additionally significantly higher in MPCs of patients without retinopathy [(n=22); 1.36(0.34)] compared to those with retinopathy [(n=13); 1.16(0.20)], independently from HbA1c or diabetes duration. Conclusions. RNA-TauT gene expression is significantly upregulated in MPCs of type 1 diabetes patients and is related to HbA1c levels and inversely to plasma homocysteine. Finally, in diabetes patients, RNA-TauT upregulation seems to be blunted in patients with retinopathy independently of their metabolic control or longer diabetes duration. [ABSTRACT FROM AUTHOR]

Correction to: Cardiovascular Diabetology (2022) 21:57https://doi.org/10.1186/s12933-022-0149... Following publication of the original article [[1]], the authors identified an error in the author name of Angelo Avogaro. Physicians' misperceived cardiovascular risk and therapeutic inertia as determinants of low LDL-cholesterol targets achievement in diabetes. [Extracted from the article]

Purpose: To investigate whether gender affects therapeutic response by exenatide twice a day (BID) in type 2 diabetes by using a database concerning patients monitored by five outpatient clinics in Tuscany, Italy. Patients and methods: We considered a cohort of 315 (154 male/161 female) patients experiencing therapeutic failure while on oral therapy (metformin, or combination therapy metformin + sulphonylureas), who were given exenatide (10 μg/BID) and who fully completed 4 months, 8 months, and 12 months of follow-ups. Results: Among patients stratified by gender and well matched for age, body mass index, and hemoglobin A1c (HbA1c), it was found that the length of disease was longer in females than in males (12 ± 8 years versus 10 ± 7 years; P = 0.037), and the ratio of patients on metformin to those on combination therapy was higher in men (P = 0.018). Target glycemic response (1-year HbA1c ⩽ 7%) was achieved in a significantly higher proportion of males than females (38% versus 27%; χ² = 4.66; P = 0.03). Target weight loss expressed as 1-year weight percent fall from baseline ⩾ 75th percentile (8.5%) was significantly higher in females at 8 and 12 months (P < 0.05; for both). One-year glycemic target response was inversely related to baseline HbA1c levels and diabetes duration among males, while metformin therapy (compared to oral combination therapy) was a significant predictor of better glycemic targets among females. Homeostasis model assessment-B, measured in 117 patients, predicted hypoglycemic response only in women (P = 0.009). Target 1-year weight loss was predicted by longer diabetes duration among males and by lower baseline HbA1c among females. Finally, no significant difference between genders was noted as to gastrointestinal side effects after exenatide therapy. Conclusion: According to this "real world" experience, predictors of glycemic control and body weight loss after 12 months of exenatide BID therapy are different between genders in type 2 diabetes. [ABSTRACT FROM AUTHOR]

Gestational diabetes (GDM) carries a high risk of incident diabetes. We asked the question, whether prior GDM has any impact on B-cell function and insulin action in women who have normal glucose tolerance (NGT). Ninety-one NGT women (age 41±8 years, mean±SD) were studied (by mathematical modelling of a frequently-sampled OGTT) 7 [6] years (median [interquartile range]) after the index pregnancy, during which 52 of them were GDM. Fasting (4.64±0.56 vs 4.97±0.46 mM) and 2-h plasma glucose (5.91±1.14 vs 5.914-1.21 mM) were similar in prior-GDM (age 41 ± 5 y, BMI 25.4±3.9 kg/m²) and non-prior-GDM women (age 41 ± 5 y, BMI 26.8±6.4 kg/m²). However, β-cell glucose sensitivity (slope of the insulin-secretion/plasma glucose dose-response function) (95 [71] vs 115 [79] pmol⋅min[sup -1] ⋅m[sup -2]⋅mM[sup -1], p=0.025 [Mann Whitney]) and insulin sensitivity (398 [77] vs 424 [98] ml⋅min[sup -1]⋅m[sup -2], p=0.025) were both reduced in prior-GDM women. At the time of the index pregnancy, GDM and non-GDM had similar age and BMI; however, insulin sensitivity was significantly lower (359 [93] vs 417 [92] ml⋅min[sup -1]⋅ m[sup -2], p=0.001) and the ratio of incremental insulin area/incremental glucose area (as an empirical index of β-cell function) was reduced (18 [13] vs 27 [26] µU/mmol, p=0.02) in GDM vs non-GDM women. Both at the index pregnancy and follow up, β-cell function and insulin sensitivity were idependent determinants of mean OGTT glucose levels (r²'s of 0.40 and 0.22, p<0.0001 for both) independently of age and BMI. We conclude that the impairment in B-cell function and insulin sensitivity that characterise GDM are carried over into the NGT status even years after a GDM pregnancy. [ABSTRACT FROM AUTHOR]

Objective: It is well known that limited joint mobility of the ankle and foot level, impaired muscular performance and reduced gait speed are risk factors for ulceration in diabetic foot. The aim of this study was to evaluate the effect of an experimental protocol of exercise therapy on joint mobility, muscular strength and gait speed in a group of long-term diabetic subjects., Methods: The protocol consisted of a 12-week supervised training program; both joint mobility and muscular strength at the ankle were measured before and after exercise therapy respectively by an inclinometer and isometric dynamometers in 26 diabetic subjects and compared to 17 healthy controls., Results: Ankle joint mobility of plantar flexion was reduced about 36% and dorsal flexion by about 23% in diabetic subjects compared to controls (p < 0.001), but significantly increased after exercise therapy (p < 0.001 for both). Ankle muscular strength in plantar flexion was reduced by about 51% and in dorsal flexion by 30% in diabetic patients compared to controls, but these also significantly increased after exercise therapy (p < 0.001). Consequently, patients' walking speed increased after exercise therapy by 0.28 m/s (p < 0.001)., Conclusion: A 12-week supervised program of exercise therapy significantly improves joint mobility, muscular performance and walking speed in diabetic patients--thus limiting one of the pathogenic factors of diabetic foot and potentially preventing disability.