The present data do not support widespread screening of patients with type 2 diabetes for Cushing's syndrome; however, the disorder is less rare than previously thought when considering epidemiology of type 2 diabetes. Our results support a case-finding approach in patients with uncontrolled diabetes and hypertension despite appropriate treatment.

We hypothesized that redox analysis could provide sensitive markers of the oxidative pathway associated to the presence of an increasing number of cardiovascular risk factors (RFs), independently of type. We classified 304 subjects without cardiovascular disease into 4 groups according to the total number of RFs (smoking, hypertension, hypercholesterolaemia, hyperhomocysteinaemia, diabetes, obesity, and their combination). Oxidative stress was evaluated by measuring plasma total and reduced homocysteine, cysteine (Cys), glutathione, cysteinylglycine, blood reduced glutathione, and malondialdehyde. Twenty-seven percent of subjects were in group 0 RF, 26% in 1 RF, 31% in 2 RF, and 16% in ≥3 RF. By multivariable ordinal regression analysis, plasma total Cys was associated to a higher number of RF (OR = 1.068; 95% CI = 1.027–1.110, P = 0.002). Total RF burden is associated with increased total Cys levels. These findings support a prooxidant effect of Cys in conjunction with RF burden, and shed light on the pathophysiologic role of redox state unbalance in preclinical atherosclerosis.

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In Italy, diabetes affects more than 3.5 million people, about 5.5% of the general population.1 In the last 20 years, the number of Italians with diabetes has increased by about 60%, from only 3.4% in 1993.1-3 As a result of these epidemic proportions, the Italian Health Service estimates spending about V10 billion ($US 11 billion) yearly for direct and indirect costs related to diabetes care. 4 This relative increase in expenditure is, at least in part, due to the increase of the mean lifetime expectancy observed in Italy over the last decades. Current epidemiological data show that 1 person out of 3 affected by diabetes is older than 65, and of these, 1 out of 4 is older than 75 years of age.

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