The Diabetes, Endocrinology and Metabolic Diseases Unit, active in the Cardiology Centre since November 2017, deals with a series of important diseases that are frequent in the cardiologic patient or that increase the risk of developing cardiovascular diseases, and is therefore involved in all the Institute’s activities, providing support for both clinical work and research.
The Unit partipates in both "acute" management (patients in the Accident and Emergency Unit and inpatients) and "chronic" care (outpatients and prevention programmes) and has a multidisciplinary team: the specialist endocrinologist is assisted by a specific, skilled nurse and has the external support of Psychology and Nutrition Services.
Why care for diabetes in a Cardiology Centre?
Diabetes mellitus is an extremely common disease. According to data from the cardiovascular epidemiological observatory in Italy, 10% of men and 7% of women in the 35-74 age group are diabetic, and 8% of men and 4% of women in this age range have glucose intolerance (a condition also called prediabetes because of the high risk of it evolving into diabetes). Among the elderly, 20% of men and 15% of women over 65 years old (and 12% of menopausal women) are diabetic.
Diabetes mellitus is closely associated with cardiovascular diseases. The risk of diabetic subjects having a heart attack or stroke is two to four times higher than that in the rest of the population and in Italy 30% of deaths in diabetics are caused by cardiovascular disease. This is why the cardiovascular risk of a diabetic patient is similar to that of a patient who has already had a cardiovascular event.
For these reasons, from a multidisciplinary point of view, the expertise of a diabetologist is a key part of prevention programmes, completes the diagnostic classification of the cardiologic patient and integrates the therapeutic possibilities, as the new generation of drugs for diabetes have a positive effect, reducing mortality.
Particular attention is given to people with type 1 diabetes mellitus and to the management of "gold standard" technology for the treatment of these patients (insulin pumps, integrated systems with continuous glucose monitoring).
Areas of clinical focus in the field of diabetes
- diagnosis and treatment of type 1 diabetes mellitus, with particular experience in the use of "gold standard" technology for its treatment (insulin pumps, integrated systems with continuous glucose monitoring);
- diagnosis and treatment of type 2 diabetes mellitus, with particular experience in the use of innovative drugs (including those in clinical trials);
- diagnosis and treatment of obesity and metabolic syndrome, with particular attention to secondary forms and second-level therapies, in a multidisciplinary perspective.
Why have an Endocrinology service in an Cardiology Centre?
Changes in the main hormonal systems frequently affect patients with cardiovascular disease. For example, thyroid dysfunction can underlie arrhythmias, pituitary and adrenal diseases are involved in the more resistant forms of arterial hypertension and electrolyte alterations, in particular hyponatraemia, are very common in patients in hospital and following surgery. In addition, the endocrinologist's expertise fits perfectly into the project “Monzino Women”, both because of the interest in Gender Medicine and because of menopausal-related hormonal alterations, with particular attention to metabolic bone diseases and the opening of a clinic dedicated to osteoporosis.
Areas of clinical focus in the field of endocrinology
- diagnosis and treatment of osteoporosis and metabolic bone diseases, with particular attention to secondary forms and second-level therapies;
- screening, diagnosis and treatment of secondary arterial hypertension (diseases of the pituitary and adrenal glands);
- diagnosis and treatment of thyroid diseases, with particular attention to thyroid abnormalities associated with cardiac arrhythmias;
- diagnosis and treatment of electrolyte disorders, in particular hyponatraemia.
The Unit performs both spontaneous and sponsored clinical trials, in collaboration with the Trial Office and the main five clinical areas of the Institute. The Unit has also activated collaborations with the Research Units of CCM to carry on studies managed by nurses and psychologists on the psycho-social aspects of diabetes.
An important collaboration has been started with the Department of Cardiovascular, Dysmetabolic and Aging Diseases of the Istituto Superiore di Sanità (ISS) focused on the study of diabetes, cardiovascular diseases and related risk factors. ISS and CCM will share the data collected by the Institutes on these topics, in particular the data from the CUORE Project, and carry out detailed statistical analyses for:
- evaluation of lifestyles aspects in diabetic patients, and association with other clinical and socio-economic risk conditions;
- assessment of the role of fasting glucose for the prediction of cardiovascular risk in the general population;
- implementation of nested case-control studies, using biological data and samples available from both parties for project proposals in public health setting;
- realization of common projects for the implementation of strategies to prevent diabetes and its complications, and more generally chronic diseases at the population level;
- activation of initiative services of primary prevention aiming to slow, and/or avoid, and/or postpone the disease in people with dysglycemia and pre-hypertension, improving lifestyles and in particular physical activity;
- dissemination of information on dysglycemia and diabetes and on the promotion of prevention through healthy lifestyles, indicated in the mission of the Department of Cardiovascular, Dysmetabolic and Aging Diseases of ISS.