Giacomo Gastaldi

Hôpitaux Universitaires de Genève | HUG · Service d'endocrinologie, diabétologie et nutrition

Introduction The overall aim of this study was to evaluate the implementation of sodium-glucose cotransporter 2 inhibitors (SGLT2i) among patients in tertiary care with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Research design and methods The cross-sectional analysis was based on outpatients in tertiary diabetes care enroll...

Background: Chronic venous insufficiency (CVI) and diabetes mellitus (DM) pose significant burdens to patients and healthcare systems. While the two diseases share a number of commonalities in risk factors and pathophysiology, they are often assessed and managed separately. This can lead to a worsening of comorbidities and limitations in a patient’...

Background The objective of the present survey is to assess the knowledge about the relationship between oral health and diabetes and to identify the practice behaviors of Swiss endocrinologists and general practitioners regarding oral health in diabetic patients. Methods A thirty- item questionnaire was mailed to 428 internists and 99 endocrinolo...

Atherosclerotic cardiovascular disease (ASCVD) is defined as coronary heart disease (CHD), cerebrovascular disease, or lower extremity arterial disease (LEAD) also named peripheral arterial disease (PAD). ASCVD is considered to be of atherosclerotic origin and is the leading cause of morbidity and mortality mainly for individuals with diabetes mell...

As a first step, the authors emphasise lifestyle changes (increased physical activity, stopping smoking), blood pressure control, and lowering cholesterol). The initial medical treatment should always be a combination treatment with metformin and a sodium-glucose transporter 2 (SGLT-2) inhibitor or a glucagon-like 1 peptide (GLP-1) receptor agonist...

Background The objective of the present survey is to assess the knowledge about the relationship between oral health and diabetes and to identify the practice behaviors of Swiss endocrinologists and general practitioners regarding oral health in diabetic patients. Methods A thirty- item questionnaire was mailed to 428 internists and 99 endocrinolo...

Type 1 diabetes management is a highly demanding task that largely falls on people with diabetes, their family, and their peers. Diabetes self-management education and support aim at increasing knowledge, skills, and confidence to take appropriate diabetes management decisions. The current evidence shows that efficient diabetes self-management reli...

Glucocorticoids are the mainstay treatment of a variety of inflammatory and autoimmune disorders. Unfortunately, metabolic side effects, drug interactions and adverse reactions commonly lead to glucocorticoid-related side effects, thereby compromising their intended anti-inflammatory and immunosuppressive effects. The goal of this review is to help...

Les nouvelles technologies font partie intégrante de notre vie, de la médecine actuelle et de la prise en charge du diabète. Les technologies dédiées au diabète (TdD) désignent l’ensemble du matériel, les dispositifs et les logiciels utilisé par les personnes ayant un diabète. Ces technologies sont en phase de croissance exponentielle et ont déjà p...

Objective: The enormous burden of chronic venous disease among the general population is often overlooked, especially in the context of multi-morbidity. The aim of this study was to assess comorbidity of the pathologically-related conditions chronic venous disease and diabetes mellitus (DM). Methods: Data were derived from a quantitative market-res...

Chronic venous disease and diabetes mellitus are highly prevalent and debilitating conditions affecting millions of individuals globally. Although these conditions are typically considered as separate entities, they often co-exist which may be important in both understanding their pathophysiology and determining the best treatment strategy. Diabete...

Total pancreatectomy is a procedure primarily performed for chronic pancreatitis refractory to conservative therapy. It may nevertheless be indicated in the event of a malignant tumor, either as a treatment for a surgical complication or as a prevention of anastomotic leakage. If possible, islet auto-transplantation should be combined with total pa...

The transition from hospital to ambulatory care is a high-risk period for patients with diabetes mellitus and is a challenge for health care professionals. Various interprofessional collaborative interventions have shown a positive impact on continuity of care at discharge. Communication and transmission of information between the hospital and ambu...

L’auto-gestion du diabète de type 1 (AGDT1) est un processus complexe qui exige l’acquisition et le développement de compétences basées sur des savoirs et la répétition d’expériences. Le cours d’Insulino- Thérapie Fonctionnelle (ITF) est un dispositif éducatif validé, qui permet d’améliorer l’AGDT1, grâce à une approche expérientielle. Pour que l’e...

An amendment to this paper has been published and can be accessed via the original article.

Objective The aim of the study is to compare the levels of Gingival Crevicular Fluid (GCF) interleukin 8 (IL‐8), matrix metalloproteinase 8 (MMP‐8) and advanced glycated‐end products (AGEs) in a cohort of type 1 diabetic (T1D) subjects and healthy controls. Material and methods GCF samples and periodontal examination were assessed in 50 subjects w...

Background In patients with diabetic foot osteomyelitis (DFO) who underwent surgical debridement, we investigated whether a short (3 weeks), compared with a long (6 weeks) duration of systemic antibiotic treatment is associated with non-inferior results for clinical remission and adverse events (AE). Methods In this prospective, randomized, non-in...

Diabetes mellitus : impact of affects on self- management skills Diabetes self-management (DSM) is a process based on a series of complex learnings. The conceptualization of the role of the emotional dimensions that underlie and structure this process is critical to better understand why living with diabetes can become a burden. A clinical case ill...

Diabetes self-management (DSM) is a process based on a series of complex learnings. The conceptualization of the role of the emotional dimensions that underlie and structure this process is critical to better understand why living with diabetes can become a burden. A clinical case illustrates the intertwining of the affective and cognitive dimensio...

Diabetes self-management education (DSME) favors health outcomes and health-related quality of life. Nevertheless, achievement of glycemic control often remains low despite DSME interventions. Current validated DSME group activities provide educational, psychosocial and behavioural support with or without experience-based delivery methods (EBDM). T...

New technologic devices are presented: insulin pumps and continuous glucose monitoring (CGM) devices as well as morphine pumps to help general practitioners to deal different intensive situations. Insulin pumps and CGM devices are revolutionary for the management of diabetes. However, their use requires strong patient involvement, the opposite of a...

The current COVID-19 pandemic is a major concern for the diabetes community. A meta-analysis in China found that the proportions of people with COVID-19 and diabetes was 9.7% and that having diabetes resulted in a two-fold increased risk of having a severe case. Global guidance on confinement measures for the prevention of COVID-19 have a particula...

Background: Gain-of-function mutations in the GLUD1 gene, encoding for glutamate dehydrogenase (GDH), result in the hyperinsulinism/hyperammonemia HI/HA syndrome. HI/HA patients present with harmful hypoglycemia secondary to protein-induced HI and elevated plasma ammonia levels. These symptoms may be accompanied by seizures and mental retardation....

Background and aims: Hepatitis C virus (HCV) infection is associated with insulin resistance, which may lead to type 2 diabetes and its complications. Although HCV infects mainly hepatocytes, it may impair insulin sensitivity at the level of uninfected extrahepatic tissues (muscles and adipose tissue). The aim of this study was to assess whether a...

Diabetes mellitus (DM) affects an increasing proportion of workers, a trend that will compound with the ageing of the workforce. It is therefore important to consider DM in the workplace context. There is an interrelationship between DM and work. Indeed dysglycemia is associated with a greater risk of work accidents and long-term DM complications....

In patients with diabetes, pregnancy is associated with high maternal and fetal risks, especially in unplanned pregnancies. Current evidence confirms that timely family planning and interdisciplinary care and management starting at the preconceptional period can optimize metabolic control and significantly reduce these risks. The purpose of this ar...

To evaluate periodontal health and oral health behaviors in a cohort of subjects with type 1 diabetes (T1D), 50 persons with T1D (30 males and 20 females; mean age: 35.2 years) were recruited from the Diabetology Unit of the Geneva University Hospitals; 50 nondiabetic persons matched for gender, age, and smoking status comprised the control group....

Personalized approach to diabetes care and educations are worldwide recognized to favor health outcomes and health-related quality of life. Continuous glucose monitoring (CGM) can be a powerful tool to help diabetes education. Language and the way clinicians use it has an interactive impact on education. The aim of the study is to explore the langu...

Systems for continuous glucose monitoring (CGM) are changing the management of insulin treated patient providing dynamic glucose information. In Switzerland, CGMS are covered by the health insurance plan in case of intensive insulin therapy (> 3 injections/day) and chronic hyperglycemia, severe hypoglycemia or hypoglycaemia unawarness. The prescrip...

Cardiovascular diseases are the main cause of mortality in patients with type 1 diabetes (T1DM) despite modern technology and careful metabolic control. The occurrence of dyslipidemia is frequent with T1DM and affects the risk for cardiovascular disease as occur with the occurrence of micro vascular complications. Lifestyle modifications and statin...

Physical activity is recommended for all patients with diabetes, but it is important to be particularly attentive in patients with type 1 diabetes. Because of their treatment, these patients have a higher risk of hypoglycemia. The challenge for both caregivers and the patient is to find the best possible strategy to practice the desired physical ac...

The aim of the study was to evaluate small fiber neuropathy and periodontal health conditions on a cohort of patients with type 1 diabetes. The study participants were 18 females and 23 males with a mean age of 37.9 years (age range: 18-83 years). First, a routine medical examination was conducted at the Diabetology Clinics of the Geneva Universtit...

Factors strongly related to the risk of developing diabetic foot infections include vascular, neuropathic and hyperglycemic complications of long-standing diabetes mellitus. These infections are common and serious, posing a worldwide burden on administrative providers of healthcare, patients and physicians. The most appropriate approach to these in...

Metabolic surgery is a serious option to treat type 2 diabetes. The latest guidelines consider surgery as one of the first option, especially in patients suffering from severe obesity or those who have uncontrolled diabetes. However, the radicality of metabolic surgery limits its prescription and is difficult to handle. Indeed, criteria of success...

The association between hepatitis C virus (HCV) infection and type 2 diabetes (T2D) has been known for over 20 years. Cross-sectional and longitudinal studies have shown a higher prevalence and incidence, respectively, of T2D in patients with chronic HCV infection. HCV induces glucose metabolism alterations mostly interfering with the insulin signa...

Type 2 diabetes mellitus is a complex and progressive metabolic disease involving more than 400 millions of people worldwide. The treatments need to be constantly managed to maintain appropriate glycemic control and avoiding complications. There is a wide variety of therapeutic option including oral antidiabetes drugs or new insulin on the market....

Statins have now been used in clinical practice for more than 20 years, and are the cornerstone of primary and secondary prevention of cardiovascular disease. The increased risk of new-onset type 2 diabetes in patients treated with statins has been well established by large meta-analyses of randomized controlled trials and observational studies.1,2

Critically ill patients are hypercatabolic due to stress and inflammation. This condition induces hyperglycemia. Muscle wasting is intense during critical illness. Its prevention is essential. This is possible by early and appropriate nutritional support. Preserving the function of the gastrointestinal tract with enteral nutrition is the gold stand...

For patients with type I diabetes, transition from pediatric to adult care is a challenge due to complex treatment requirements and the physical, psychological and social changes of adolescence. Members of the care team must recognize that while these emerging adults need to develop self-management skills, this may conflict at times with the develo...

News on the front of diabetes have revealed the remarkable results of multifactorial treatment of type 2 diabetes on morbidity and mortality. Micro and macro-angiopathic complications have markedly decreased during the last 20 years. However, intervention trials on glycemic control alone show a slight or no benefit on cardiovascular complications o...

Charcot neuropathic osteoarthropathy (CNO) is a destructive process affecting the bone and joint structure of diabetic patients and resulting from peripheral neuropathy. It is a limb threatening condition resulting in dramatic deformities associated with severe morbi-mortality. The diagnosis is mostly made by the observation of inflammatory signs a...

Introduction We report for the first time the case of a patient with Albright hereditary osteodystrophy and pseudopseudohypoparathyroidism who underwent a Roux-en-Y gastric bypass. Case presentation A 26-year-old obese Caucasian woman with Albright hereditary osteodystrophy with pseudopseudohypoparathyroidism (heterozygous mutation (L272F) in GNAS...

In Switzerland over 200'000 people with diagnosed diabetes drive a car. Their physicians endorse many roles: usual medical care as well as informing properly about driving recommandations and handling the legal issues behing the licensing procedure. Ability to drive can be impaired in three ways: hypogylcemia, diabetes complications and hyperglycem...

The prevalence of eating disorders (ED) in individuals with type 1 diabetes (T1D) appears higher than in control populations, in particular the occurence of eating disorder not otherwise specified (EDNOS). EDNOS coexisting with T1D are mostly found in teenage girls and young women. These patients suffer of restless weight and shape concerns and typ...

The prevalence of eating disorders (ED) in individuals with type 1 diabetes (T1D) appears higher than in control populations, in particular the occurence of eating disorder not otherwise specified (EDNOS). EDNOS coexisting with T1D are mostly found in teenage girls and young women. These patients suffer of restless weight and shape concerns and typ...

Introduction Le traitement des patients diabetique de type 2 (DT2) par metformine augmente le risque de carence en vitamine B12 (Vit B12), deficit susceptible d’entrainer des taux plus eleves d’homocysteine plasmatique. Les consequences cliniques n’ont jamais ete evaluees. Patients et methodes Dans cette etude transversale, nous avons regarde si la...

Anorexia nervosa is a condition caracterized by a relentless preoccupation with dieting and weight loss that results in severe emaciation and can lead to death. Although the origin of anorexia nervosa remains obscure, symptoms are related to the convergence of environmental and psychosocial influences on genetically sensitive individuals. Recent br...

Chronic stress in Western society can activate the autonomus, neuroendocrine and inflammatory/immunlogic systems. Chronic exposure to stressors can indeed stimulate the hypothalamic-pituitary-adrenal axis and induce a disbalance between anabolic and catabolic hormones, responsible of an increased in visceral fat and of insulin resistance. These met...

The coexistence of diabetes and eating disorder (ED) is more prevalent than we think; indeed it seems to occur in 10 to 20% of cases. Therefore ED deserve attention to be detected and treated in order to permit a decreased in morbidity and better outcomes in body weight loss. The association of type 2 diabetes and ED is frequently seen in younger,...

In order to investigate the improvement of insulin resistance and cardiac autonomic function along massive weight loss, 12 obese women were evaluated before, and 3 and 12 months after Roux-en-Y gastric bypass. The 12-month values were compared to those of BMI-matched controls. Insulin sensitivity was assessed by euglycemic clamp and the cardiac aut...

The metabolic syndrome is a cluster of metabolic risk factors including: atherogenic dyslipidemia, elevated blood pressure, high plasma glucose and a prothrombotic and proinflammatory state, frequently associated to overweight. Impaired cell metabolism has been suggested as a relevant pathophysiological process. Indeed, the accumulation of intracel...

We investigated whether skeletal muscle peroxisome proliferator-activated receptor gamma coactivator-1 (PGC1A; also known as PPARGC1A) and its target mitofusin-2 (MFN2), as well as carnitine palmitoyltransferase-1 (CPT1; also known as carnitine palmitoyltransferase 1A [liver] [CPT1A]) and uncoupling protein (UCP)3, are involved in the improvement o...

PURPOSE: Findings recently have shown coupling protein-3 (UCP3) content to be decreased in the skeletal muscle of patients with chronic obstructive pulmonary disease (COPD). Uncoupling protein-3 mRNA exists as two isoforms: long (UCP3L) and short (UCP3S). The UCP3 protein is expressed the least in oxidative and the most in glycolytic muscle fibers....

Findings recently have shown coupling protein-3 (UCP3) content to be decreased in the skeletal muscle of patients with chronic obstructive pulmonary disease (COPD). Uncoupling protein-3 mRNA exists as two isoforms: long (UCP3L) and short (UCP3S). The UCP3 protein is expressed the least in oxidative and the most in glycolytic muscle fibers. Levels o...

Riboflavin-responsive, multiple acylcoenzyme A dehydrogenase deficiency (RR-MAD), a lipid storage myopathy, is characterized by, among others, a decrease in fatty acid (FA) beta-oxidation capacity. Muscle uncoupling protein 3 (UCP3) is up-regulated under conditions that either increase the levels of circulating free FA and/or decrease FA beta-oxida...

Intra-myocellular triglycerides (IMTG) accumulate in the muscle of obese and endurance-trained (ET) humans and are considered a pathogenic factor in the development of insulin resistance, in the former. We postulate that this paradox may be associated with the peroxidation status of the IMTG. IMTG content was the same in the obese and ET subjects....

Obesity concerns one out to five people in Switzerland today. WHO has even qualified the disease as a non infectious epidemic. Indeed the evolution is growing so fast that it is a matter of serious concern and interrogations. In the following pages we have been through the actual publications and we will try to briefly introduce physiopathology, en...