The authors have examined the currently accepted methods to face a chronic disease like diabetes.... more The authors have examined the currently accepted methods to face a chronic disease like diabetes. The person affected by this illness should learn to accept his/her limits and find a new identity. The aim of technical and scientific medicine is to teach the patient how to cope with the disease. However, in spite of the progress of the scientific research in this field, diabetes remains a poorly treated disease. A review of the literature shows that there is a deep interaction between diabetes and psychological states. Psychological disorders like depression and anxiety might be associated with the origin of diabetes and can affect its course. It seems that emotional factors have a more important role than education in diabetes care. The psychological aspect becomes even more important during adolescence, as the chronic illness can affect the normal development of the teen-ager who will deny it to protect himself. If the patient does not collaborate, his behaviour may be unconsciousl...
The presence of about 90.000 patients in Italy brings about the need for an in-depth analysis of ... more The presence of about 90.000 patients in Italy brings about the need for an in-depth analysis of the psycho-social implications of such a prevalence of diabetes. It appears in the early period of life and then becomes chronic, forcing young people to deal with specific therapies, all life long. Diabetics have to manage the difficult task of adapting their normal life perspectives with a self image that is severely disturbed by the disease. Therefore the relationship with one's self, the doctor, the family and the social environment becomes extremely important. The disease and other related factors can strongly alter both the psychological and physical development in the adolescent; a bio-psycho-social approach is therefore needed. Daily management is very complex, involving changes in food intake habits and in physical activities, and requiring insulinic therapy and the monitoring of glycemic levels. Taking care of the diabetics should be associated with an educational process f...
Research in the last 25 years has shown that diabetic patients' adhesion to medical advice is... more Research in the last 25 years has shown that diabetic patients' adhesion to medical advice is a multi-factor phenomenon. Most recent research has focused on a patient-centred approach, on the representations that the patient has with respect to medicine, health and disease (with particular regard to the perceived self-efficiency in managing the disease, trust in conventional medicine, treatment, drugs, etc) and on the level of agreement between the patient's representations and those of the health care provider. These representations can potentially act as barriers/facilitators on patients' adhesion to treatment; the best adherence can only be obtained if the real needs of the patient are met, matching therapy with his/her representations and expectations, and acknowledging the constraints that everyday life puts on the individual. The indication is therefore to avoid exclusively considering the physical burdens of the disease, while ignoring the personal and social sign...
The aim of this chronobiological study was to investigate temporal correlations in the circadian ... more The aim of this chronobiological study was to investigate temporal correlations in the circadian patterns of 6 hormones, namely somatotrophic hormone (SIX), prolactin (PRL), cortisol (F), aldosterone (ALD), insulin (IRI) and C-peptide (CP), assayed in systemic blood serum drawn at 07:00, lO:OO, 13:00, 16:00, 19:OO and 22:00 h from an antecubital vein in 19 young subjects (aged 20-29 yr, comprising 10 males and 9 females; and 20 elderly subjects (aged 70-81 yr, comprising 10 males and 10 females). All subjects were sampled on a normal dietary sodium intake (120-140 mEq/24h) while following a social routine of diurnal activity (07:00-23:00) and nocturnal rest (23:00-07:OO). Time-qualified data were analyzed by lead-lag correlation and by cosinor analysis. According to the lead-lag correlation findings, it would appear that the correlation which exists between several time-qualified series in young subjects is no longer present in elderly subjects. The circadian rhythms which were found to have lost their temporal correlations with advancing age were those between STH and IRI, STH and ALD, PRL and IRI, PRL and CP, and ALD and CP. It should be noted that the correlation between hormonal rhythms breaks down mainly on account of a peculiar age-related change in the magnitude of the circadian fluctuation. This chronological decline in amplitude led to the conclusion that the senescence of endocrine rhythmic functions is a biological phenomenon characterized by altered circadian variability.
The progressive B-cell destruction at the onset of type 1 diabetes and the relevance of residual ... more The progressive B-cell destruction at the onset of type 1 diabetes and the relevance of residual B-cell function to metabolic control prompted us to try to prevent further B-cell destruction in new-onset type 1 diabetic patients. Having already shown positive effects of sulfonylreas in long-standing IDDM patients, we decided to try the association of gliclazide with insulin in newly diagnosed IDDM patients. Therefore, 22 patients were randomly assigned to either gliclazide, 160 mg/24 h, or placebo (in association with standard insulin treatment) from the third week since the onset of the disease. Patients were studied every 6 months for 18 months. The insulin need was similar in the two groups at time 0, but thereafter it steadily decreased in the GCZ group becoming at 6, 12 and 18 months, respectively 65%, 42% and 39% of that of the PL group. The metabolic control was very similar in the two groups throughout the study. The residual B-cell function (fasting and post-breakfast C peptide), which was similar in the two groups at time 0, remained unchanged or improved in the GCZ group, whereas it decreased in the PL group. In conclusion, the combined insulin-gliclazide treatment appeared to improve B-cell function during the first 18 months of type 1 diabetes, inducing a major reduction of the insulin need with respect to patients treated with insulin alone.
Education (TPE) Conference. The first session on changing the course of diabetes globally was cha... more Education (TPE) Conference. The first session on changing the course of diabetes globally was chaired by
Forty-five diabetic patients were studied to evaluate adaptation and coping strategies. The autho... more Forty-five diabetic patients were studied to evaluate adaptation and coping strategies. The authors have also analysed personality traits mainly to study different behaviour in compliance conduct. The results revealed an important psychological dimension made up of difficulties in accepting insulin immediately, in fear of addiction and doubts about the therapy. On the basis of these results the sample was then divided into two subgroups, which were then tested and compared with the Adjective Check List. The subgroup that showed more fear, insecurity and initial resistance towards insulin therapy appeared to be more rigid and seemingly conforming. These people also revealed personality aspects compatible with the presence of passive-aggressive and avoidant traits.
The effects of glucose on cAMP accumulation, insulin (IRI) release, and proinsulin synthesis were... more The effects of glucose on cAMP accumulation, insulin (IRI) release, and proinsulin synthesis were simultaneously measured in isolated rat islets. Proinsulin synthesis was assayed by measuring the incorporation of [3H] leudne into islet proteins reacting with Sepharose-bound anti-insulin gamma globulin. The accumulation of cAMP in islets and incubation medium was measured by the incorporation of [3H]-adenine into [3H] CAMP and purified by ion-exchange chromatography and barium sulfate precipitation. Glucose dose-response studies were performed in the absence and presence of 0.1 and 1.0 mM isobutylmethylxanthine (IBMX). The IRI and cAMP responses to glucose demonstrated similar stimulation thresholds and Km values at all IBMX concentrations. With increasing amounts of IBMX, the Vmax was increased and the Km decreased for both responses. There was parallelism between IRI secretion and accumulation of [3H] CAMP in the medium, except at nonstimulatory glucose concentrations, where, espec...
A quasi un secolo dalla scoperta dell’insulina, la terapia del diabete tipo 1 ha fatto e continua... more A quasi un secolo dalla scoperta dell’insulina, la terapia del diabete tipo 1 ha fatto e continua a fare enormi progressi, tanto che un diabetologo degli anni Settanta (per esempio chi scrive) piovuto improvvisamente oggi fra noi farebbe fatica a raccapezzarsi fra insuline “ingegnerizzate”, penne monouso, microinfusori, misuratori della glicemia in continuo e algoritmi di correzione. Da una parte ciò non soddisfa appieno né i pazienti né gli operatori sanitari, i quali – tutti – auspicano che si arrivi alla scomparsa della malattia (guarigione anziché cura, ovvero cure vs care), tuttavia non si può negare che i progressi della cura hanno liberato i pazienti da tante schiavitù che li affliggevano ancora trent’anni fa, e ciò ha consentito ai giovani con diabete di cimentarsi con successo in tutte le discipline sportive (1-2), incluse quelle considerate “estreme” e una volta “proibite” ai diabetici. Fra queste, l’alpinismo – in tutte le sue declinazioni – presenta caratteristiche parti...
Life support systems : the journal of the European Society for Artificial Organs, 1985
In order to avoid the host foreign-body reaction which is probably responsible for the long-term ... more In order to avoid the host foreign-body reaction which is probably responsible for the long-term failure of the artificial membrane diffusion chambers currently used for protecting the implanted islet tissue from rejection, we tested the human amniotic membrane as a possible new tool for enclosing transplanted islets of Langerhans. Bag-shaped chambers were made with human amniotic membranes and the diffusion of 125 I-Insulin out and of D-glucose into the chambers was measured. The diffusion patterns of insulin and glucose were shown to be better than those described for the best artificial membranes, the 50% diffusion being reached at min 42 for 125 I-Insulin and at min 11 for D-glucose. Moreover, it was shown that no lymphocytes diffused into the amniotic membrane chambers. These results, together with the already known characteristics of the human amniotic membrane, induce us to propose it as a suitable material for further experimental work in islet tissue transplantation.
The authors have examined the currently accepted methods to face a chronic disease like diabetes.... more The authors have examined the currently accepted methods to face a chronic disease like diabetes. The person affected by this illness should learn to accept his/her limits and find a new identity. The aim of technical and scientific medicine is to teach the patient how to cope with the disease. However, in spite of the progress of the scientific research in this field, diabetes remains a poorly treated disease. A review of the literature shows that there is a deep interaction between diabetes and psychological states. Psychological disorders like depression and anxiety might be associated with the origin of diabetes and can affect its course. It seems that emotional factors have a more important role than education in diabetes care. The psychological aspect becomes even more important during adolescence, as the chronic illness can affect the normal development of the teen-ager who will deny it to protect himself. If the patient does not collaborate, his behaviour may be unconsciousl...
The presence of about 90.000 patients in Italy brings about the need for an in-depth analysis of ... more The presence of about 90.000 patients in Italy brings about the need for an in-depth analysis of the psycho-social implications of such a prevalence of diabetes. It appears in the early period of life and then becomes chronic, forcing young people to deal with specific therapies, all life long. Diabetics have to manage the difficult task of adapting their normal life perspectives with a self image that is severely disturbed by the disease. Therefore the relationship with one's self, the doctor, the family and the social environment becomes extremely important. The disease and other related factors can strongly alter both the psychological and physical development in the adolescent; a bio-psycho-social approach is therefore needed. Daily management is very complex, involving changes in food intake habits and in physical activities, and requiring insulinic therapy and the monitoring of glycemic levels. Taking care of the diabetics should be associated with an educational process f...
Research in the last 25 years has shown that diabetic patients' adhesion to medical advice is... more Research in the last 25 years has shown that diabetic patients' adhesion to medical advice is a multi-factor phenomenon. Most recent research has focused on a patient-centred approach, on the representations that the patient has with respect to medicine, health and disease (with particular regard to the perceived self-efficiency in managing the disease, trust in conventional medicine, treatment, drugs, etc) and on the level of agreement between the patient's representations and those of the health care provider. These representations can potentially act as barriers/facilitators on patients' adhesion to treatment; the best adherence can only be obtained if the real needs of the patient are met, matching therapy with his/her representations and expectations, and acknowledging the constraints that everyday life puts on the individual. The indication is therefore to avoid exclusively considering the physical burdens of the disease, while ignoring the personal and social sign...
The aim of this chronobiological study was to investigate temporal correlations in the circadian ... more The aim of this chronobiological study was to investigate temporal correlations in the circadian patterns of 6 hormones, namely somatotrophic hormone (SIX), prolactin (PRL), cortisol (F), aldosterone (ALD), insulin (IRI) and C-peptide (CP), assayed in systemic blood serum drawn at 07:00, lO:OO, 13:00, 16:00, 19:OO and 22:00 h from an antecubital vein in 19 young subjects (aged 20-29 yr, comprising 10 males and 9 females; and 20 elderly subjects (aged 70-81 yr, comprising 10 males and 10 females). All subjects were sampled on a normal dietary sodium intake (120-140 mEq/24h) while following a social routine of diurnal activity (07:00-23:00) and nocturnal rest (23:00-07:OO). Time-qualified data were analyzed by lead-lag correlation and by cosinor analysis. According to the lead-lag correlation findings, it would appear that the correlation which exists between several time-qualified series in young subjects is no longer present in elderly subjects. The circadian rhythms which were found to have lost their temporal correlations with advancing age were those between STH and IRI, STH and ALD, PRL and IRI, PRL and CP, and ALD and CP. It should be noted that the correlation between hormonal rhythms breaks down mainly on account of a peculiar age-related change in the magnitude of the circadian fluctuation. This chronological decline in amplitude led to the conclusion that the senescence of endocrine rhythmic functions is a biological phenomenon characterized by altered circadian variability.
The progressive B-cell destruction at the onset of type 1 diabetes and the relevance of residual ... more The progressive B-cell destruction at the onset of type 1 diabetes and the relevance of residual B-cell function to metabolic control prompted us to try to prevent further B-cell destruction in new-onset type 1 diabetic patients. Having already shown positive effects of sulfonylreas in long-standing IDDM patients, we decided to try the association of gliclazide with insulin in newly diagnosed IDDM patients. Therefore, 22 patients were randomly assigned to either gliclazide, 160 mg/24 h, or placebo (in association with standard insulin treatment) from the third week since the onset of the disease. Patients were studied every 6 months for 18 months. The insulin need was similar in the two groups at time 0, but thereafter it steadily decreased in the GCZ group becoming at 6, 12 and 18 months, respectively 65%, 42% and 39% of that of the PL group. The metabolic control was very similar in the two groups throughout the study. The residual B-cell function (fasting and post-breakfast C peptide), which was similar in the two groups at time 0, remained unchanged or improved in the GCZ group, whereas it decreased in the PL group. In conclusion, the combined insulin-gliclazide treatment appeared to improve B-cell function during the first 18 months of type 1 diabetes, inducing a major reduction of the insulin need with respect to patients treated with insulin alone.
Education (TPE) Conference. The first session on changing the course of diabetes globally was cha... more Education (TPE) Conference. The first session on changing the course of diabetes globally was chaired by
Forty-five diabetic patients were studied to evaluate adaptation and coping strategies. The autho... more Forty-five diabetic patients were studied to evaluate adaptation and coping strategies. The authors have also analysed personality traits mainly to study different behaviour in compliance conduct. The results revealed an important psychological dimension made up of difficulties in accepting insulin immediately, in fear of addiction and doubts about the therapy. On the basis of these results the sample was then divided into two subgroups, which were then tested and compared with the Adjective Check List. The subgroup that showed more fear, insecurity and initial resistance towards insulin therapy appeared to be more rigid and seemingly conforming. These people also revealed personality aspects compatible with the presence of passive-aggressive and avoidant traits.
The effects of glucose on cAMP accumulation, insulin (IRI) release, and proinsulin synthesis were... more The effects of glucose on cAMP accumulation, insulin (IRI) release, and proinsulin synthesis were simultaneously measured in isolated rat islets. Proinsulin synthesis was assayed by measuring the incorporation of [3H] leudne into islet proteins reacting with Sepharose-bound anti-insulin gamma globulin. The accumulation of cAMP in islets and incubation medium was measured by the incorporation of [3H]-adenine into [3H] CAMP and purified by ion-exchange chromatography and barium sulfate precipitation. Glucose dose-response studies were performed in the absence and presence of 0.1 and 1.0 mM isobutylmethylxanthine (IBMX). The IRI and cAMP responses to glucose demonstrated similar stimulation thresholds and Km values at all IBMX concentrations. With increasing amounts of IBMX, the Vmax was increased and the Km decreased for both responses. There was parallelism between IRI secretion and accumulation of [3H] CAMP in the medium, except at nonstimulatory glucose concentrations, where, espec...
A quasi un secolo dalla scoperta dell’insulina, la terapia del diabete tipo 1 ha fatto e continua... more A quasi un secolo dalla scoperta dell’insulina, la terapia del diabete tipo 1 ha fatto e continua a fare enormi progressi, tanto che un diabetologo degli anni Settanta (per esempio chi scrive) piovuto improvvisamente oggi fra noi farebbe fatica a raccapezzarsi fra insuline “ingegnerizzate”, penne monouso, microinfusori, misuratori della glicemia in continuo e algoritmi di correzione. Da una parte ciò non soddisfa appieno né i pazienti né gli operatori sanitari, i quali – tutti – auspicano che si arrivi alla scomparsa della malattia (guarigione anziché cura, ovvero cure vs care), tuttavia non si può negare che i progressi della cura hanno liberato i pazienti da tante schiavitù che li affliggevano ancora trent’anni fa, e ciò ha consentito ai giovani con diabete di cimentarsi con successo in tutte le discipline sportive (1-2), incluse quelle considerate “estreme” e una volta “proibite” ai diabetici. Fra queste, l’alpinismo – in tutte le sue declinazioni – presenta caratteristiche parti...
Life support systems : the journal of the European Society for Artificial Organs, 1985
In order to avoid the host foreign-body reaction which is probably responsible for the long-term ... more In order to avoid the host foreign-body reaction which is probably responsible for the long-term failure of the artificial membrane diffusion chambers currently used for protecting the implanted islet tissue from rejection, we tested the human amniotic membrane as a possible new tool for enclosing transplanted islets of Langerhans. Bag-shaped chambers were made with human amniotic membranes and the diffusion of 125 I-Insulin out and of D-glucose into the chambers was measured. The diffusion patterns of insulin and glucose were shown to be better than those described for the best artificial membranes, the 50% diffusion being reached at min 42 for 125 I-Insulin and at min 11 for D-glucose. Moreover, it was shown that no lymphocytes diffused into the amniotic membrane chambers. These results, together with the already known characteristics of the human amniotic membrane, induce us to propose it as a suitable material for further experimental work in islet tissue transplantation.
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Papers by Aldo Maldonato