Associazione Medici Diabetologi

IntroductionEarly treatment of obesity is essential and requires proactive engagement from healthcare providers. A 2022 survey among the members of the Italian Association of Clinical Endocrinologists (AME) revealed that they often did not address or manage the condition. This study aims to examine if attitudes and practices of Italian endocrinologists in managing obesity have changed in recent years, following several educational initiatives promoted by AME and the upcoming availability of specific treatments.MethodsThis research utilized a web-based survey distributed to members of AME. The survey explored endocrinologists’ approaches to obesity management, covering treatment methods, referral practices, and perceived challenges in providing effective care. At the time of the survey semaglutide and tirzepatide were not commercially available in Italy for the treatment of obesity/overweight.ResultsThe survey received responses from 16.6% of AME members (424 out of 2560). Among respondents, 32.5% 37 identified obesity and nutrition as key areas of focus. Among participants, 43.4% reported that over 35% of the patients they see each month have obesity, compared to 37.8% in the previous survey. The proportion of endocrinologists who reported managing obesity themselves, either independently or as part of a dedicated team, slightly increased from 42.6% 40 to 45.5%. In terms of pharmacological treatment, Liraglutide was prescribed to 25% of suitable patients (IQR 5-50), as compared to 10% (IQR 0-30) in the previous survey. Participants reported with less worries about side effects of treatment and patient resistance. Poor effectiveness almost disappeared among the reported obstacles to prescribing anti-obesity drugs. High treatment costs were cited as a primary barrier to prescribing anti-obesity medications, significantly affecting long-term adherence.DiscussionAddressing the unmet educational needs of endocrinologists is essential to enhance their awareness of obesity and increase their confidence in managing this widespread condition, which has a profound impact on individuals and society.

While osteoporosis in primary hyperparathyroidism (PHPT) is widely studied, PHPT patients with osteopenia remain less characterized. This study aimed to evaluate the prevalence, biochemical features, and estimated fracture risk of osteopenic PHPT patients in a real-life cohort. We retrospectively analyzed a consecutive series of PHPT patients with available densitometric data at three sites. Postmenopausal women and men over 50 years old with PHPT and osteopenia were selected. FRAX scores were used to estimate fracture risk, and subgroup analyses were conducted based on sex, age, and PHPT clinical presentation. One hundred out of 439 PHPT patients (22.8%) were osteopenic. As compared to osteopenic women, osteopenic men were older (p = 0.03), had higher BMD at the spine and femoral neck (p = 0.007 and p = 0.006, respectively), and more frequent occurrence of nephrolithiasis (p = 0.046). Osteopenic patients older than 65 years had worst FRAX scores and higher prevalence of comorbidities, as type 2 diabetes and hypertension, than their younger counterparts (both p < 0.001). FRAX scores of osteopenic PHPT patients were not different according to their clinical classification of PHPT. Patients with osteopenia account for about one fifth of our whole series and two thirds of them met surgical indication according to latest international guidelines. Neither densitometric data nor estimated fracture risk differed between osteopenic PHPT patients meeting or not surgical criteria.

Cognitive stimulation has been widely recognized in recent years for its ability to enhance overall cognitive functioning in older adults, including those with mild cognitive impairment and dementia. Among various non-pharmacological approaches, music-based interventions have demonstrated significant effects on both general and specific cognitive functions, engaging brain areas associated with memory, motivation, emotion, cognition, and motor function. This article reports a pilot study evaluating the feasibility of a novel cognitive-stimulation protocol using digital tools and musical instruments that was developed by an experienced music therapist. The primary objective of the protocol was memory enhancement, alongside broader cognitive activation including perception, focused attention, auditory-motor synchronization, and executive function. Designed for implementation in an Italian daycare center for older adults, the protocol comprises musical activities of varying types and progressive levels of complexity, tailored to each participant’s cognitive abilities. These activities require either verbal responses or the use of musical instruments. The effects of the intervention on memory, general cognitive function, and quality of life were assessed through neuropsychological evaluations. Preliminary findings and future research directions are discussed.

ABSTRACTObjectiveThe practice of treating hypothyroid and euthyroid patients with thyroid hormones varies between countries, as observed in the recent surveys of European thyroid experts, THESIS. As part of the THESIS initiative, we investigated Canadian endocrinologists′ perspectives on this topic, focusing on combination therapy with either liothyronine (LT3) plus levothyroxine (LT4) or desiccated thyroid extract (DTE).DesignMembers of the Canadian Society of Endocrinology and Metabolism (CSEM) were invited to participate in an anonymous online survey.ResultsOut of 348 eligible CSEM members, 68 (19.5%) respondents were included in the analysis. All respondents used LT4 as the first‐line treatment for hypothyroid patients. Many respondents (64.7%) would consider LT4 + LT3 for patients on LT4 with persistent symptoms, whereas fewer would consider DTE (16.2%). Most respondents attributed persistent symptoms in LT4‐treated patients to psychosocial factors, comorbidities, or unrealistic expectations. Approximately half of the respondents stated that thyroid hormone therapy is never indicated for euthyroid patients. The remaining respondents considered thyroid hormones for euthyroid women with infertility and high thyroid antibody levels (36.8%), depression (13.2%), and growing goiter (7.4%).ConclusionsFollowing current guidelines, LT4 tablet is the preferred treatment for hypothyroidism. Most respondents would consider triiodothyronine‐containing therapy for patients with persistent symptoms, preferring LT4 + LT3 over DTE. The number of endocrinologists considering combination therapy for hypothyroid patients in Canada was higher than in Europe. Finally, at variance with current guidelines, a fraction of the respondents would consider thyroid hormones in patients with non‐thyroidal conditions.

The experimentation with innovative ways to enhance the accessibility, resonance, and meaningfulness of our cultural heritage is a cornerstone to contemporary museums’ development. The article explores this topic through an insight into the first experience carried out within the Open Atelier project, designed to test cutting-edge formats promoting new interactions among the audience, the museum, and its professionals. This experiment was realized through the cooperation among Art Museums of Skagen and Associazione Marchigiana Attività Teatrali. It engaged a group of Italian artists in the development of a cross-disciplinary and co-creative process intended to turn a collection of historical photos into a new experiential heritage, capable of fostering innovative interplays among different places, people, and cultures. The paper offers a thorough illustration of this case-based experience, by systematically describing its objectives and operational framework, the processes that enabled it, and the results that were achieved, and by providing contextual insights aligned with current debates in the field. This initiative has the potential to become a lens through which to explore broader implications for innovative interpretations and uses of heritage, enhancing its accessibility and resonance for contemporary societies. Its critical observation aims to foster the debate, and thus to inform and stimulate broader practice and policy around the topic.

PurposeThe use of thyroid hormones (TH) to treat obesity is unsupported by evidence as reflected in international guidelines. We explored views about this practice, and associations with respondent characteristics among European thyroid specialists.MethodsSpecialists from 28 countries were invited to a survey via professional organisations. The relevant question was whether “Thyroid hormones may be indicated in biochemically euthyroid patients with obesity resistant to lifestyle interventions”.ResultsOf 17,232 invitations 5695 responses were received (33% valid response rate; 65% women; 90% endocrinologists). Of these, 290 (5.1%) stated that TH may be indicated as treatment for obesity in euthyroid patients. This view was commoner among non-endocrinologists (8.7% vs. 4.7%, p < 0.01), private practice (6.5% vs. 4.5%, p < 0.01), and varied geographically (Eastern Europe, 7.3%; Southern Europe, 4.8%; Western Europe, 2.7%; and Northern Europe, 2.5%). Respondents from Northern and Western Europe were less likely to use TH than those from Eastern Europe (p < 0.01). Gross national income (GNI) correlated inversely with this view (OR 0.97, CI: 0.96–0.97; p < 0.001). Having national guidelines on hypothyroidism correlated negatively with treating obesity with TH (OR 0.71, CI: 0.55–0.91).ConclusionsDespite the lack of evidence, and contrary to guidelines’ recommendations, about 5% of respondents stated that TH may be indicated as a treatment for obesity in euthyroid patients resistant to life-style interventions. This opinion was associated with (i) respondent characteristics: being non-endocrinologist, working in private practice, treating a small number of hypothyroid patients annually and (ii) national characteristics: prevalence of obesity, Eastern Europe, low GNI and lack of national hypothyroidism guidelines.

The importance of Organizations and Private Volunteer Projects for International Development Cooperation is widely recognized. However, although there are some websites that collect and describe information on welfare societies, very few are aimed at a detailed description of the projects. In particular, at the Italian level, the associations working for development cooperation in Africa are poorly described on the Internet, and this makes responses to humanitarian needs less efficient than they could be. Indeed, for very fruitful operations, collaborations between associations as well as funding for projects are very productive. Therefore, the dissemination of information and data in a scientific way is crucial in the framework of development cooperation. With this in mind, a web portal was created for the promotion and dissemination of humanitarian projects. It is the result of the joint work of a multidisciplinary team that includes university researchers, technology specialists and volunteers from non-profit associations. It currently places particular emphasis on small Italian associations operating in Africa, aimed at making their voices heard and promoting their activities. This contribution introduces this portal, showing how to insert it in the scenario of humanitarian projects, favoring the use of technologies for development cooperation.

invecchiamento e a identificare alcune vie metaboliche su cui potenzialmente possibile intervenire per rallentare l'et biologica.

Le principali linee di sviluppo del PNRR Missione 6 si basano su potenziamento e riorganizzazione dei servizi sanitari territoriali attraverso reti di prossimità e sviluppo della telemedicina. L’obiettivo del lavoro proposto è quello di supportare un possibile modello organizzativo del polo diabetologico nelle Case di Comunità (CdC), adattabile alle varie realtà italiane, attraverso un nuovo percorso clinico-assistenziale territoriale multi-professionale, che preveda anche strumenti digitali. Il modello è stato elaborato su un contesto demografico di circa 500.000 abitanti, di cui 30.000 pazienti diabetici noti e 7.500 diabetici non diagnosticati. Sono stati definiti i criteri di stratificazione della popolazione diabetica, identificate le attività del team diabetologico da svolgere in presenza e da remoto, nonché il personale da dedicare al progetto. Il Business Process Reengineering ha permesso di rimodellare i processi esistenti, ridefinire i flussi e costruire la nuova organizzazione. I pazienti, suddivisi in cluster omogenei, sono stati indirizzati a differenti percorsi assistenziali. Per comprendere la sostenibilità del modello proposto è stata effettuata una valutazione di carattere economico sulla base dei costi fissi e variabili ipotizzati sul volume di attività e sul personale del team coinvolto, arrivando a calcolare il Break Even Point (BEP). Il modello del Polo Diabetologico nelle Case di Comunità prevede il mantenimento delle attività proprie del team diabetologico, per assicurare percorsi di educazione terapeutica e assistenza diabetologica, anche in contesti territoriali. Multidisciplinarietà e tecnologie digitali integrate nel progetto garantiscono al paziente, anche in contesti periferici (compreso il domicilio), la possibilità di accedere a screening e monitoraggio della patologia e delle complicanze. PAROLE CHIAVE Case di Comunità (CdC); Piano Nazionale di Ripresa e Resilienza (PNRR); telemedicina; team diabetologico; Percorso Diagnostico Terapeutico Assistenziale (PDTA).