Organization and regional distribution of centers for the management of children and adolescents with diabetes in Italy

The incidence of type 1 diabetes in childhood is increasing by 3 % per year, placing growing demands on healthcare professionals and medical expenditures. Aim of this study wars to assess the organization of care to children with diabetes in Italy

Abdominal adiposity and cardiovascular risk factors in adolescents with type 1 diabetes.

AIM: To analyze the prevalence of abdominal adiposity and other traditional risk factors for cardiovascular disease in a large sample of Italian adolescents with type 1 diabetes mellitus (T1DM). METHODS: T1DM adolescents (n=412 age: 17.3 \ub1 0.9 years) were enrolled from 18 clinical centres. Anthropometric and laboratory parameters, blood pressure and data on insulin treatment were registered. Metabolic syndrome (MetSy) was defined according to the International Diabetes Federation criteria. RESULTS: Abdominal obesity was the most common risk factor (20.1%) in females, while hypertension in males (25.1%). MetSy was found in 9.5% patients, predominantly in females. Patients with MetSy exhibited higher insulin requirement per body surface area and higher glycated hemoglobin than patients without MetSy. Overweight/obese patients had a much higher prevalence of MetSy than normal weight patients. The logistic regression analysis showed that just waist-to-height ratio and insulin dose per body surface area contributed to discriminate subjects with the MetSy from those without. CONCLUSION: Adolescence is a critical period in determining risk of future vascular complications in T1DM. Pediatric diabetologists need to be aware of the considerable occurrence of abdominal adiposity and MetSy in T1DM patients, particularly in females, and should make every effort to achieve normal weight and better health outcome

Effects of different feeding time and frequency on metabolic conditions and milk production in heat-stressed dairy cows

The aim of this paper was to evaluate the effects of three different feeding management (FM) schedules on physiological markers of heat stress (HS), metabolic conditions, milk yield and quality during hot season in dairy cows. The study involved 27 mid-lactating cows, subdivided in 3 homogeneous groups differing for feeding time and frequency: total mixed ration (TMR) delivered once daily in the morning (M); twice daily, half in the morning and half in the evening (ME); once daily in the evening (E). During the trial blood samples were collected in the morning (a.m.) and in the evening (p.m.), breathing rate (BR), rectal temperature (RT), and milk yield were recorded and individual milk samples were collected. Microclimate data indicated that cows were subjected to mild-moderate HS. During the hotter days, cows in M treatment showed higher values of RT (38.97 \ub0C vs. 38.68 \ub0C and 38.62 \ub0C, in ME and E) and BR (71.44 vs. 66.52 and 65.26 breaths min-1, in ME and E), a.m. plasma glucose was lower in M (3.69 vs. 3.83 and 3.83 mmol L-1, in ME and E) and a.m. plasma urea was lower in E (4.82 vs. 5.48 and 5.35 mmol L-1, in M and ME). Milk yield was unaffected by FM, as well as milk composition and cheese-making properties. Only milk protein content and yield were higher in M (3.42 vs. 3.36 and 3.27%; and 1.11 vs 1.08 and 1.02 kg d-1, for ME and E). Our results on cow physiology indicate how M seems the less suitable FM to match cow welfare during the summer season

Insulin pump failures in Italian children with Type 1 diabetes: retrospective 1-year cohort study.

AIMS: Insulin pump failure and/or malfunction requiring replacement have not been thoroughly investigated. This study evaluated pump replacement in children and adolescents with Type 1 diabetes using insulin pump therapy. METHODS:Data were collected for all participants younger than 19 years, starting insulin pump therapy before 31 December 2013. For each child, age, disease duration, date of insulin pump therapy initiation, insulin pump model, failure/malfunction/replacement yes/no and reason were considered for the year 2013. RESULTS:Data were returned by 40 of 43 paediatric centres belonging to the Diabetes Study Group of the Italian Society of Paediatric Endocrinology and Diabetology. In total, 1574 of 11 311 (13.9%) children and adolescents with Type 1 diabetes were using an insulin pump: 29.2% Animas VIBE\u2122 , 9.4% Medtronic MiniMed 715/515\u2122 , 34.3% Medtronic MiniMed VEO\u2122 , 24.3% Accu-Check Spirit Combo\u2122 and 2.8% other models. In 2013, 0.165 insulin pump replacements per patient-year (11.8% due to pump failure/malfunction and 4.7% due to accidental damage) were recorded. Animas VIBE\u2122 (22.1%) and Medtronic MiniMed VEO\u2122 (17.7%) were the most replaced. CONCLUSIONS:In a large cohort of Italian children and adolescents with Type 1 diabetes, insulin pump failure/malfunction and consequent replacement are aligned with rates previously reported and higher in more sophisticated pump models

Erratum: Organization and regional distribution of centers for the management of children and adolescents with diabetes in Italy

Unfortunately, the original version of this article [1] contained an error. The name of one of the authors from the Study Group for Diabetes of ISPED was included incorrectly and it read “A. Galero” instead of “A. Gaiero” in the Acknowledgements section

Epidemiology of diabetic ketoacidosis in Italy,Epidemiologia della chetoacidosi diabetica in Italia

Ketoacidosis is a potentially life-threatening complication in patients with type 1 diabetes mellitus (T1DM), particularly children.If diabetic ketoacidosis (DKA) is diagnosed late, the child riskscerebral edema, permanent neurological damage or even death.There have been only few studies of DKA in Italy.From January-May 2014 a nation-wide observational, retro-spective study of DKA at diabetes onset was done by the Pe-diatric Diabetology Study Group (PDSG) of the Italian Society ofPediatric Endocrinology and Diabetes (ISPED), involving 76 Italiancenters. DKA was defined using ISPAD criteria; 7457 new casesof T1DM were recruited from mainland Italy and the island of Si-cily and 770 from Sardinia, in the period 2004-2013. On the main-land and in Sicily, DKA at diabetes onset was about 32.9% (95%CI 31.8-34.0%), and there was 6.6% (95% CI 6.02-7.20%) of thesevere form. Mild and severe DKA risk was significantly higher inchildren aged 0-4 years; no significant temporal trend was foundin the study period. Patients living in Sardinia or having a first-degree relative with T1DM were at significantly lower risk of DKAat diabetes onset. In the ten-year study period three children diedof DKA at onset and four suffered permanent neurological lesions.From November 2011-April 2012 the PDSG conducted a retro-spective study based on a sample of 2025 patients with T1DM,aged 0-18 years, involving 29 national centers for pediatric dia-betes. The incidence of DKA was 2.4% (IC 95% 1.8-3.1), withchildren older than ten years at significantly higher risk, probablydue to shortages of insulin. Multiple analysis showed a higher riskof DKA in those using a rapid-acting insulin analog and in those with high HbA1c. Young mothers and low levels of education werealso associated with DKA.In conclusion, although a wide network of specialized home pedia-tricians and pediatric diabetes centers is spread across the coun-try, the incidence of DKA at diabetes onset is still high. Further socialand health-system efforts are needed to boost awareness of thisrisk and to reduce damages and costs related to the complication

Metabolic control and complications in Italian people with diabetes treated with continuous subcutaneous insulin infusion

The objective of this cross-sectional study was to evaluate the degree of glycaemic control and the frequency of diabetic complications in Italian people with diabetes who were treated with continuous subcutaneous insulin infusion (CSII)