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Novità delle linee guida Ada. Confronto con la versione precedente e gli Standard italiani
#1 Inviato : mercoledì 21 marzo 2018 8.09.10(UTC)
Rank: Administration
Messaggi: 7.172


Puntuali, come ogni anno, sono state pubblicate in gennaio su "Diabetes Care" le Linee Guida (LG) aggiornate dell'American Diabetes Association (ADA) sulla gestione del diabete mellito, che - come afferma Basilio Pintaudi , della SSD Diabetologia Grande Ospedale Metropolitano Niguarda di Milano e coordinatore nazionale degli Standard Italiani per la cura del diabete per AMD (Associazione medici diabetologi) - si caratterizzano, rispetto all'analogo testo italiano, per un coinvolgimento più...

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Sergio Stagnaro
#2 Inviato : mercoledì 21 marzo 2018 8.09.25(UTC)
Rank: Member
Messaggi: 16
E' giunta l'ora per i Diabetologi del mondo di parlare di meno e studiare di pù, aggiornandosi sui progressi che permettono la prevenzione pre-primaria e Primaria de T2DM. Se ve lo permettono pubblicate quanto segue: Gene Mutations parallel Biological Alterations: The New War against Five Stages of type 2 Diabetes Mellitus. — Dear Friends, first of all, I emphasise here once again that gene mutations bring about necessarily modifications of biological functions, bedside assessed in a reliable manner, as I have demonstrated earlier (Stagnaro Sergio. Biological System Functional Modification parallels Gene Mutation. http://www.Nature.com, March 13, 2008,http://blogs.nature.com/nm/spoonful/2008/03/gout_gene.html). Secondly, according to WHO competent Authorities, there were in 2010 250 milion of diabetics, and they will be 366 milion in 2030, indicating that type 2 DM is today’s growing epidemics (1-15). In my opinion, as far as diabetes is concerned, pre-primary (analogously to the Manuel’s Story, http://www.sisbq.org/qbs-magazine.html), as well as primary prevention, especially when initiated in the first two stages among the five of the natural history of the disease, is far better than therapy, as usually. Unfortunately, Diabetic “and” Dislipidemic Constitutions, conditio sine qua non of type 2 DM, are nowadays unfortunately overlooked by the majority of physicians all around the world (12-14). A long well established clinical experience allows me to state that with the aid of Quantum Biophysical Semeiotics, physicians can quickly and easili bedside recognize the “microcirculatory remodelling”, based on newborn-pathological, subtype a) oncological , and b), aspecific, type I, Endoarteriolar Blocking Devices in tissue, wherein does really exist the inherited real risk of human common and severe diseases, as diabetes (12-15). Obviously that happens in individuals with defined Biophysical Semeiotics Constitutions, in our case, Diabetic “and” Dislipidemic, according to Joslin(1-6, 12-15). To realize on vast scale Diabetes both Pre-Primary, and Primary Prevention (PP),enrolling exclusively individuals at type 2 DM Inherited Real Risk, we need new clinical tools, aiming to lower the increasing number of patients, because the present, expensive screening has failed (14). For instance, in the normal Langheran’s islets microcirculatory bed, there are exclusively “normal” type II (= in arterioles, according to Hammersen), but not type I (= in small arterioles) endoarteriolar blocking devices, i.e. EBD, of first and second classes, according to S.B.Curri (See http://www.semeioticabiofisica.it/microangiologia). In health, i.e., not involved by Diabetic Constitution, we cannot observe type I, newborn- pathological, EBD in above-mentioned biological system. On the contrary, in individuals involved by diabetic constitution as well as diabetic “Inherited Real Risk” and overt diabetes, of course, we observe with the aid of Quantum Biophysical Semeiotics also type I, newborn-pathological, subtype b) a-specific , EBD, facilitating the diagnosis and consequently diabetes primary prevention. In addition, the evaluation of Insulin Secretion Acute Pick Renal Test is significantly impaired, corroborating the clinical diagnosis (1-3) (See above cited- website, Practical Applications, and Glossary). Finally, an interesting clinical tool in recognizing diabetic constitution -dependent inherited real risk, as well as in diagnosing diabetes since early stages and diabetic monitoring proved to be bedside Biophysical-Semeiotic Osteocalcin Test and Siniscalchi’s Sign (10, 15) As a matter of fact, Pre-hypertension during Young Adulthood may be involved by Coronary Calcium Later in Life exclusively in presence of Inherited Real Risk of CAD, typical for individuals with lithyasic Constitution, present in about 50% OF ALL CASES OF Pre-Metabolic and Metabolic Syndrome (www.semeioticabiofisica.it; Constitutions and Bibliography). Considering the frequent association between hypertension and diabetes, more important, in my opinion based on 53-year-long clinical experience, is bedside recognizing diabetic predisposition, now-a-days possible since birth, utilising a lot of methods, different in difficulty, but all reliable. For the first time, from the clinical view-point, I have recently illustrated an original manoeuvre, based on a singular activity of osteocalcin, and reliable in bedside detecting diabetes in one minute, with the aid of a stethoscope (10). In fact, osteocalcin, a product of osteoblasts, among other action mechanisms, stimulates both insulin secretion and insulin receptor sensitivity. As a consequence, osteocalcin, secreted by above-mentioned bone cells during mean-intense lasting digital pressure – for instance – applied upon lumbar vertebrae, brings about increasing pancreatic diameters, i.e., technically speaking, type I, associated, Langherans’s islet microcirculatory activation, so that doctors assess pancreas size augmentation, which in health, lasts 10 seconds exactly (1-11). After that, pancreas diameters return to basal value for 3 sec. The second pancreas size increasing lasts 20 sec., and finally the third show the highest value: 30 sec. I terme such as clinical investigation. On the contrary, in case of diabetic constitution (3, 4, 11, 13) the…
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