OBJECTIVETo evaluate whether postprandial blood glucose predicts cardiovascular events and all-cause mortality in type 2 diabetes in a long-term follow-up taking into account A1C and the main cardiovascular risk factors.RESEARCH DESIGN AND METHODSConsecutive type 2 diabetic patients (n = 505) followed up at our diabetes clinic were evaluated at baseline (1995) for the main cardiovascular risk factors and for five glycemic control parameters (fasting blood glucose, blood glucose 2 h after breakfast, blood glucose 2 h after lunch, blood glucose before dinner, and A1C); all-cause mortality and the first cardiovascular events occurring during the 14-year follow-up were measured.RESULTSWe observed 172 cardiovascular events (34.1% of the population) and 147 deaths (29.1% of the population). Using the Cox analysis with the backward method, we categorized the variables according to the therapeutic targets of the American Diabetes Association. Our observations were as follows. When the five glycemic control parameters were considered together, the predictors were 1) for cardiovascular events, blood glucose 2 h after lunch (hazard ratio 1.507, P = 0.010) and A1C (1.792, P = 0.002); and 2) for mortality, blood glucose 2 h after lunch (1.885, P < 0.0001) and A1C (1.907, P = 0.002). When blood glucose 2 h after lunch and A1C were considered together with the main cardiovascular risk factors, the following glycemic control parameters were predictors: 1) for cardiovascular events, blood glucose 2 h after lunch (1.452, P = 0.021) and A1C (1.732, P = 0.004); and 2) for mortality, blood glucose 2 h after lunch (1.846, P = 0.001) and A1C (1.896, P = 0.004).CONCLUSIONSIn type 2 diabetes, both postprandial blood glucose and A1C predict cardiovascular events and all-cause mortality in a long-term follow-up.

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Background An “obesity paradox” for mortality has been shown in chronic disorders such as diabetes, and attributed to methodological bias, including the use of body mass index (BMI) for obesity definition. This analysis investigated the independent association of BMI versus surrogate measures of central adiposity with all-cause mortality in individuals with type 2 diabetes. Methods The Renal Insufficiency And Cardiovascular Events Italian Multicentre Study is a prospective cohort study that enrolled 15,773 patients in 19 Italian centres in 2006–2008. Exposures were BMI and the surrogate measures of central adiposity waist circumference (WC), waist-to-height ratio (WHtR), and A Body Shape Index (ABSI). Vital status was retrieved on 31 October 2015 for 15,656 patients (99.3%), Results Age- and sex-adjusted hazard ratios and 95% confidence intervals were significantly higher in BMI-based underweight (1.729 [1.193–2.505), P = 0.004), moderately obese (1.214 [1.058–1.392), P = 0.006) and severely obese (1.703 [1.402–2.068), P < 0.0001), lower in overweight (0.842 [0.775–0.915), P < 0.0001) and similar in mildly obese (0.950 [0.864–1.045), P = 0.292), compared to normal-weight individuals. When further adjusting for smoking, physical activity (PA), and comorbidities, risk was lower also in mildly obese versus normal-weight patients. The BMI-mortality relationship did not change after sequentially excluding ever smokers, individuals with comorbidities, and those died within two years from enrollment and when analyzing separately participants below and above the median age. Conversely, a paradox relationship was observed among inactive/moderately inactive, but not moderately/highly active patients. Mortality risk adjusted for age, gender, smoking, PA and comorbidities was significantly higher in the highest tertile of WC (1.279 [1.089–1.501], P = 0.003), WHtR (1.372 [1.165–1.615], P < 0.0001), and ABSI (1.263 [1.067–1.495], P = 0.007) versus the lowest tertile. However, risk was lower in the intermediate versus lowest tertile for WC (0.823 [0.693–0.979], P = 0.028), similar for WHtR, and higher, though not significantly, for ABSI. Conclusions An “overweight paradox” remained after controlling for age, smoking, and comorbidities, arguing against a collider bias or reverse causation. However, it could be partly explained by confounding from PA level, possibly through its impact on lean mass and cardiorespiratory fitness. No obesity paradox was observed with WHtR and especially ABSI, which predicted mortality risk associated with central adiposity better than WC. Trial registration ClinicalTrials.gov, NCT00715481, 15 July, 2008

Small intestine tumors are rare, with an incidence of less than 1 case per 100,000/year and accounting for less than 0.5% of all cancers.1 However, in almost 80% of the cases small bowel tumors are malignant.2,3 Adenocarcinomas comprise 35-50% of all tumors, carcinoid tumors 20-40%, lymphomas 15% and the remaining is characterized by sarcomas. 4 Generally, adenocarcinomas are located in the duodenum, while lymphomas and carcinoid tumors are frequently in the ileum. Benign tumors are generally stromal tumor and adenomas. Finally, cancers from other organs may infiltrate peritoneum and small bowel in metastatic diseases. Small bowel tumors did not have a recurrent clinical presentation and could be associated with abdominal pain, unspecific gastrointestinal symptoms or can exhibit symptoms/signs due to the secretion of different hormones. 3 The diagnosis of small bowel tumor is really challenging even in the modern medicine when novel approaches such as video capsule endoscopy and nuclear magnetic resonance (NMR) are available.5-12 Here, we report the diagnosis of small bowel cancer with NMR in a patient presenting with intestine sub-occlusion. Case ReportA male patient was admitted to our division of Internal Medicine because of abdominal pain, weight loss and intestinal sub-occlusion. Both abdomen echography and computed tomography-scan (data not shown) did not reveal any significant pathological signs. Due to the persistence of the symptoms, an abdomen NMR was performed. As shown in Figure 1A and B, NMR revealed that a portion of the small bowel was characterized by the swelling of the bowel wall. A laparoscopic surgical evaluation was performed confirming the presence of small bowel stenosis. This small intestine segment was therefore surgical removed. At the pathological examination, this portion of the bowel revealed an infiltration of the wall by an adenocarcinoma ( Figure 1C). Moreover, infiltration of the peritoneum was also observed ( Figure 1D). Small bowel cancer diagnosis: role of nuclear magnetic resonance ABSTRACTThe diagnosis of small intestine tumors is challenging. Even in the era of modern medicine, standard approaches including echography, computed tomography-scan and conventional endoscopy are unable to reveal small bowel lesions. Video-capsule has substantially improved the evaluation of small bowel; however this procedure cannot be proposed to all patients and in particular to those experiencing intestine sub-occlusion. Nuclear magnetic resonance (NMR) of the abdomen is an additional diagnostic approach that offers high sensitivity in the identification of small bowel lesions. Here, we describe a case of small bowel neoplasia identified with NMR of the abdomen.