Endocrinology, Diabetology and Metabolic Diseases

The Complex Operating Unit (UOC) of Endocrinology, Diabetology and Metabolic Diseases of Gemelli Isola Tiberina Hospital deals with the diagnostic-therapeutic management of endocrine diseases. In particular, it carries out clinical-care activities for the treatment of thyroid and parathyroid, adrenal and pituitary pathologies, diabetes, obesity and its complications, endocrine diseases of the reproductive system and osteoporosis within dedicated multidisciplinary pathways, in collaboration with the other specialist units.   

The UOC is recognised as a centre of excellence for obesity care accredited by the Italian Society of Obesity (SIO) and the European Association Study of Obesity (EASO). The UOC offers multidisciplinary pathways (endocrinologist, nutritional biologist, psychologist and dedicated nurse) aimed at weight loss, the prevention and treatment of complications and the restoration of psychophysical well-being, through lifestyle intervention, cognitive behavioural therapy and any pharmacological and/or surgical therapy.

The UOC is accredited as a reference diabetological centre by the Italian Society of Diabetology (SID) for the care and treatment of diabetic pathology, with specific experience in the evaluation of peripheral and autonomic diabetic neuropathy. It employs specialized staff that includes the diabetologist endocrinologist, the nutritionist biologist and the diabetes expert nurse as well as multidisciplinary paths in collaboration with the different professional figures involved in the management of chronic complications of diabetic pathology. The UOC also offers a path dedicated to women with diabetes in pregnancy, both gestational and pre-pregnancy, which includes a specialized outpatient activity. It is also a diabetic facility authorized by the Lazio Region for the prescription and management of advanced technologies applied to diabetes or insulin pumps and glycemic monitoring systems with sensor, for which a dedicated outpatient course has been defined. 

In addition, it is a reference centre for the management and prescription of 2nd level drugs for osteoporosis, actively collaborating with the Breast Unit, Oncology and Radiotherapy for the management of Osteoporosis secondary to neoplastic diseases

Description of the structure

The UOC structure consists of 3 rooms for outpatient visits, equipped with ultrasound for echocolordoppler of the neck and eco-guided needle aspiration, instrumentation dedicated to the evaluation of diabetic neuropathy; bioimpedance; scale dedicated to the obese patient; polysomnography; Holter blood pressure, instrumentation for capillary, continuous and flash glycemic monitoring. It also has a dedicated testing environment for clinical research equipped with a centrifuge for the processing of biological samples and refrigeration systems for the storage of experimental drugs.

Main conditions treated

Thyroid, parathyroid, adrenal, pituitary, type 1 diabetes, type 2 diabetes, adult autoimmune diabetes (ADAD), diabetes in pregnancy, obesity, osteoporosis, endocrine diseases of reproduction.

Services provided

Each Macroarea deals with the diagnosis and treatment of the endocrine diseases of competence with particular attention to the prevention of the pathology and its complications.

Thyroid macroarea/general endocrinology

•  General endocrinology visits
• Joint endocrine-surgical visits
• Reproductive endocrinology visits
• Andrological visits
• Thyroid Ultrasound and Doppler Thyroid Ultrasound
• Thyroid needle aspirate    
• Day Hospital Endocrinology

Diabetes macroarea

• General diabetology visits
• Type 1 diabetes visits
• Visits for diabetes in pregnancy
• Management of the insulin pump and continuous glycemic monitoring systems 
• Dietary visits to develop a personalised nutritional plan
• Bioimpedance for the evaluation of body composition
• Tests for the evaluation of peripheral diabetic neuropathy and cardiovascular tests for the evaluation of autonomic diabetic neuropathy
• Diabetes Complex Outpatient Package (PAC) (P2500)
• Day Hospital Diabetologia

Macroarea obesity and diseases of metabolism

• Endocrinological visits for obesity and metabolic disorders
• Bioimpedance for the evaluation of body composition
• Dietary visits to develop a personalised nutritional plan

Osteoporosis macroarea

• Visits for osteoporosis
• PAC Osteoporosis (P7330)

Outpatient activity

The UOC has clinics dedicated to the management, diagnostic and therapeutic framework of the main endocrinological pathologies. 

In particular, specialist outpatient visits are carried out dedicated to the first visit and follow-up of pregnant women diagnosed with gestational diabetes or with pre-pregnancy diabetes. The outpatient course provides a program of personalized nutritional medical therapy, educational therapy for home glycemic self-control, diabetological evaluations for the management of glycemic compensation, pharmacological treatment, and postpartum follow-up. 

The UOC also provides specialized outpatient visits for the application of advanced technologies in diabetes, through continuous glycemic monitoring systems and insulin therapy by continuous subcutaneous infusion with micro-infusers and management of insulin infusion control algorithms. In this area, it provides complex outpatient services through the diabetes PAC for the management of patients with decompensated diabetes, in terms of evaluation of chronic complications and comorbidities, with specific expertise in the study of metabolic syndrome and diabetic autonomic and peripheral neuropathy. 

The UOC is recognised as a Centre of Excellence accredited by the Italian Society of Obesity (SIO) and the European Association for the Study of Obesity (EASO) for the prevention and treatment of obesity. The path for the patient suffering from obesity involves the endocrinological examination during which the clinical and metabolic classification of the patient is carried out and the evaluation of complications. Subsequently, the path continues with the nutritional visit with the evaluation of body composition and the elaboration of the personalised nutritional plan. There are six-monthly endocrinological check-ups and monthly nutritional check-ups. For the treatment of complications, the patient is sent to the reference specialists and for psychological support to the Psychology unit. The centre collaborates with the Internal Medicine and Digestive System Diseases unit for the management of liver diseases associated with obesity and for bariatric endoscopy interventions.

In the clinic dedicated to endocrinological examinations for osteoporosis, the patient is subjected to the evaluation of the main risk factors in order to identify the individuals at greatest fracture risk and direct them towards the most effective and innovative anti-osteoporotic therapies thanks to the help of specific decision-making algorithms. To complete the endocrinological examination for osteoporosis, the patient can be started on the osteoporosis PAC which includes specific laboratory tests, MOC-DEXA examination with trabecular bone score (TBS) study, and vertebral morphometric examination.

The UOC also provides outpatient services aimed at the integrated medical approach for the diagnosis and treatment of pathologies of the female and male reproductive system, ovarian polycytosis, hyperandrogenism with specialist endocrinological evaluation and screening of female and male infertility issues.

It is also possible to carry out a specific outpatient diagnostic procedure for nodular thyroid and parathyroid pathology that includes an ultrasound examination of the neck, eco-guided aspiration, a joint endocrinology and surgery visit for the diagnostic and therapeutic framework of endocrine diseases candidates for surgical treatment in collaboration with the UOC of Endocrine Surgery and post-surgical follow-up. 

These services are provided in agreement with the National Health Service or in private, either intramoenia, or in an outpatient social private rate.

RENEWAL SERVICE OF THE THERAPEUTIC PLANS
The renewal of the license certificate is a private social service and it is necessary to carry out the following examinations: electrocardiogram, fundus oculi, evaluation of diabetic neuropathy (prior to a maximum period of 6 months) and hematochemical and urinary examinations for dosage of glycated hemoglobin, creatinine and microalbuminuria/creatininuria (prior to a maximum period of 3 months).

The renewal of the therapeutic plan for osteoporosis is carried out on Thursday morning from 10.00 to 11.00, by reservation only, bringing in lumbar and femoral MOC-DEXA vision (prior to a maximum period of 12 months) and blood chemistry tests for calcemia and 25-OH vitamin D (prior to a maximum period of 3 months).

Scientific research activities

The current scientific research activity of the UOC is dedicated to the following macro-areas:

New markers of chronic complications in diabetes mellitus: retinal neurodegeneration as an early marker for the assessment of diabetic neuropathy in different diabetic populations. Assessment of the connection between diabetes and cognitive decline by identifying predictors in elderly patients; identification of possible associations between cognitive decline and diabetic neuropathy in the elderly diabetic patient.In vitro studies on the activation and reprogramming of MIO-M1 human Mϋller cells exposed to high glucose, glucose variability, and high glucose co-treatment or glucose variability and high palmitic acid concentration.

Pharmacological therapy in type 2 diabetes: Cardiovascular outcome trials(CVOT) of innovative therapies for diabetes in patients at high cardiovascular risk; weekly basal insulin efficacy and safety study in patients with type 2 diabetes on multi-injector insulin therapy.

Managing the obese patient: a study evaluating the utility and effectiveness of remote body composition monitoring in overweight or obese adults during lifestyle intervention

Teaching activity

Prof. Simona Frontoni and Prof. Patrizia Borboni are professors at the University of Rome “Tor Vergata” in the Master’s Degree Course in Medicine and Surgery and in the Specialization, Master and Doctorate courses. Dr. Picconi is a professor of Endocrinology of the Degree Course in Obstetrics at the Fatebenefratelli Isola Tiberina Hospital. Dr. Benedetta Russo is a professor of the Degree Course in Dietetics at the University of Rome “Tor Vergata”.