OBJECTIVEFew studies have assessed the efficacy of carbohydrate counting in type 1 diabetes, and none have validated its efficacy in patients who are treated with continuous subcutaneous insulin infusion (CSII). The aim of our study was to test the effect of carbohydrate counting on glycemic control and quality of life in adult patients with type 1 diabetes who are receiving CSII.RESEARCH DESIGN AND METHODSSixty-one adult patients with type 1 diabetes treated with CSII were randomly assigned to either learning carbohydrate counting (intervention) or estimating pre-meal insulin dose in the usual empirical way (control). At baseline and 12 and 24 weeks, we measured HbA1c, fasting plasma glucose, BMI, waist circumference, recorded daily insulin dose, and capillary glucose data, and administered the Diabetes-Specific Quality-of-Life Scale (DSQOLS) questionnaire.RESULTSIntention-to-treat analysis showed improvement of the DSQOLS score related to diet restrictions (week 24 – baseline difference, P = 0.008) and reduction of BMI (P = 0.003) and waist circumference (P = 0.002) in the intervention group compared with control subjects. No changes in HbA1c, fasting plasma glucose, daily insulin dose, and hypoglycemic episodes (<2.8 mmol/L) were observed. Per-protocol analysis, including only patients who continuously used carbohydrate counting and CSII during the study, confirmed improvement of the DSQOLS score and reduction of BMI and waist circumference, and showed a significant reduction of HbA1c (−0.35% vs. control subjects, P = 0.05).CONCLUSIONSAmong adult patients with type 1 diabetes treated with CSII, carbohydrate counting is safe and improves quality of life, reduces BMI and waist circumference, and, in per-protocol analysis, reduces HbA1c.

Aims/hypothesis: The largely unsatisfactory results reported for the pharmacological treatment of diabetic neuropathy has spurred the search for alternative therapies. The aim of this study was to evaluate the efficacy of frequency-modulated electromagnetic neural stimulation (FREMS) as a novel treatment for painful diabetic neuropathy. Methods: Patients (n=31) with painful neuropathy associated with decreased nerve conduction velocity (<40 m/s) and increased vibration perception threshold (>25 V) were enrolled in a randomised, double-blind, crossover study designed to compare the effects of FREMS with those of placebo. Each patient received two series of ten treatments of either FREMS or placebo in random sequence, with each series lasting no more than 3 weeks. The primary efficacy end point was the change in pain measured by a visual analogue scale (VAS). Results: FREMS induced a significant reduction in daytime and night-time VAS pain score (all p<0.02). Furthermore, FREMS induced a significant increase in sensory tactile perception, as assessed by monofilament; a decrease in foot vibration perception threshold, as measured by a biothesiometer; and an increase in motor nerve conduction velocity (all p<0.01). No significant changes were observed after placebo. Comparison of measurements at the 4-month follow-up with those at baseline revealed that a significant benefit persisted for all measures that showed an improvement at the end of treatment, with an additional improvement in quality of life evaluated by the Short Form-36 questionnaire (all p< 0.05). No significant side effects were recorded during the study. Conclusions/interpretation: FREMS is a safe and effective therapy for neuropathic pain in patients with diabetes and is able to modify some parameters of peripheral nerve function.

A 68-year-old man presented with a 4-month history of progressive memory loss and mood disorders. Neurologic examination revealed severe impairment of attention and verbal skills, without motor and sensory deficits. His medical history included mild arterial hypertension, idiopathic partial epilepsy, and obsessive compulsive disorder.Brain MRI showed the presence of bilateral, asymmetric, swollen white matter lesions in the cerebral hemispheres, hyperintense in T2-weighted images, that partially involved the left frontal cortex (figure). On diffusion-weighted sequences, the white matter abnormalities were consistent with vasogenic edema. No pathologic contrast enhancement was present.Routine blood tests, inflammatory markers, autoantibodies, neoplastic markers, and paraneoplastic antibodies were within normal limits. CSF examination revealed increased level of proteins (152 mg/dL) and cell count (14 leukocyte/L), without intrathecal synthesis of oligoclonal bands. Bacterioscopic and virologic tests (including HIV and JCV) were negative, both on CSF and serum. Search for tumor or infection by total body CT scan was negative.Stereotactic biopsy of the left frontal white matter lesion showed gliosis without signs of infections or neoplasm.After the biopsy, the patient was treated with dexamethasone 24 mg/day IV for 20 days with marked clinical improvement. A control CSF analysis performed 3 months later was within normal limits (Ͻ1 leukocyte/ L, protein 27 mg/dL). Brain MRI demonstrated a reduction in number and extension of the white matter T2-hyperintense lesions (figure). T2*-weighted gradient echo images showed the presence of multiple microhemorrhages scattered over the entire cerebral cortex. No microbleeds were present in basal ganglia, thalami, and posterior fossa (figure).Diagnosis of probable cerebral amyloid angiopathy-related inflammation (CAA-ri) was made upon clinical and MRI findings, supported by the demonstration of APOE ⑀4 homozygosity.A search for A␤ deposits in brain tissue and vessel walls on the biopsy sample was negative; a possible explanation is the deep white matter target, with absence of cortex and leptomeninges in the specimen. The A␤ 1-42 protein in the CSF was reduced both in the first (129 pg/mL) and second (125 pg/mL) lumbar puncture compared to normal values (682-1,063 pg/mL). The A␤ 1-40 protein was also investigated (457 pg/mL in the first CSF; 238 pg/mL in the second); however, due to the large variability of this assay as reported in literature, the meaning of these values is unclear.We hypothesized a spontaneous autoimmune process against CNS A␤ proteins, and assessed the levels of anti-A␤ 1-40 and 1-42 autoantibodies in our patient's CSF, both before and after steroid treatment, compared to 6 age-matched controls (mean age: 63 Ϯ 19 years) and 4 patients with MS (mean age: 45 Ϯ 17 years). We used our ELISA, as described, 1 and detected a marked increase of anti-A␤ 1-40 and 1-42 autoantibodies in the CSF of our CAA-ri patient obtained prior to treatment compared to controls and ...

The increased activity of hepatic lipase after intraperitoneal insulin administration in IDDM patients appears to be one of the main determinants of lipoprotein changes observed, resulting in the normalization of lipoprotein composition during this mode of therapy. The normal inverse relationship between VLDL triglycerides and HDL cholesterol, which was not present in IDDM patients with subcutaneous therapy, was restored with intraperitoneal insulin regimen.