Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Type 1 Diabetes Among Sardinian Children Is Increasing

OBJECTIVE—The Sardinian type 1 diabetes register represented the basis to determine the most recent trends and the age distribution of type 1 diabetes incidence among Sardinians <15 years of age during 1989–1999. Part of the data (1989–1998) has been already published by the EURODIAB Group with a lower completeness of ascertainment (87%). The geographical distribution of type 1 diabetes risk was also investigated. RESEARCH DESIGN AND METHODS—The new cases of type 1 diabetes in children aged 0–14 years in Sardinia were prospectively registered from 1989 to 1999 according to the EURODIAB ACE criteria. The completeness of ascertainment calculated applying the capture-recapture method was 91%. Standardized incidence rates and 95% CI were calculated assuming the Poisson distribution. Trend of type 1 diabetes incidence was analyzed using the Poisson regression model. Maps of the geographical distribution of type 1 diabetes risk for the whole time period and separately for 1989–1994 and 1995–1999 were produced applying a Bayesian method. RESULTS—A total of 1,214 type 1 diabetic patients were registered yielding to an overall age- and sex-standardized incidence rate of 38.8/100,000 (95% CI 36.7–41.1). There was a male excess with an overall male-to-female ratio of 1.4 (1.3–1.8). The increase of incidence during the 11 years analyzed was statistically significant (P = 0.002) with a yearly increasing rate of 2.8% (1.0–4.7). No evidence of an effect of age and sex on this trend has been found. The geographical distribution of type 1 diabetes relative risk (RR) showed that the highest risk areas are located in the southern and central-eastern part of the island and the lowest risk in the northeastern part, even if most of these differences were not statistically significant. This geographical distribution seemed to remain mainly the same between 1989–1994 and 1995–1999. CONCLUSIONS—The homogeneity of diabetes risk and the increase of incidence over the age-groups in the Sardinian population stress the role of an environmental factor uniformly distributed among the genetically high-risk Sardinians

Gravidanza e diabete. Studio delle rappresentazioni mentali in un gruppo di donne con diabete mellito gestazionale (GDM).

Introduzione e principali riferimenti in letteratura Il diabete mellito gestazionale (GDM) è tra le più frequenti complicanze della gravidanza e, se non riconosciuto e adeguatamente trattato, è ancora associato ad elevata morbilità materno-fetale (ADA, 2003). A fronte dei numerosi studi condotti in ambito medico-scientifico e dei consistenti progressi negli ambiti della diagnosi e del trattamento del GDM, ad oggi appare poco indagato il ruolo delle dinamiche psichiche che si attivano nelle gestanti con questa patologia e che possono avere un effetto sul benessere della madre e del nascituro (Tambelli, Errante, 2009; Singh, Lustman, Clouse, 2004; Badii, 2001; Langer, Langer, 2000). Obiettivo generale del nostro studio è stato quello di analizzare la qualità delle rappresentazioni materne in un gruppo di gestanti con diagnosi positiva per GDM, al fine di valutare se i vissuti legati alla diagnosi e alla gestione della gravidanza diabetica potessero rappresentare fattori in grado di influenzare le rappresentazioni di sé e del futuro bambino, nelle donne con questa problematica. Metodo Sono state reclutate 64 gestanti, 32 con diagnosi positiva per GDM e 32 con diagnosi negativa per GDM, di età compresa tra i 22 e i 42 anni (Media=33,8; DS=4,5). A tutte le donne è stata somministrata l’IRMAG-R, Intervista per le Rappresentazioni Materne in Gravidanza (Ammaniti et al., 1995), e il questionario Symptom Check List-Revised, (SCL-90-R, Derogatis, 1994) per la valutazione della sintomatologia psichica. Risultati Un primo livello di analisi, puramente descrittivo, ha evidenziato, in entrambi i gruppi, una prevalenza di gestanti con rappresentazioni del tipo integrate-equilibrate. La statistica del Chi quadro ha evidenziato una differenza non significativa ( =4.667; gdl=2; p=0.097) tra gestanti GDM e non GDM, rispetto alla distribuzione delle rappresentazioni materne. Le ANOVA condotte considerando i punteggi delle gestanti alle sette dimensioni relative alla rappresentazione di sé come madre e del bambino hanno confermato la mancanza di differenze statisticamente significative tra i due gruppi. Infine, non si sono evidenziati effetti significativi del gruppo d’appartenenza delle gestanti (GDM/nonGDM) sulle scale sintomatologiche dell’SCL-90. Discussioni e conclusioni I risultati ottenuti sul nostro campione indicano che il GDM non costituisce un fattore in grado di influenzare negativamente le rappresentazioni delle gestanti né il loro benessere psicologico. L’analisi dei contenuti delle narrative suggerisce che ciò potrebbe essere dovuto, da una parte, alla percezione di non cronicità della patologia e, dall’altra, alla funzione protettiva rappresentata dalle specifiche modalità di presa in carico multidisciplinare delle donne con GDM, attuate presso la struttura in cui le partecipanti sono state reclutate. Il confronto con gruppi reclutati presso altre strutture, che seguono differenti iter diagnostici e terapeutici, potrebbe chiarire questi aspetti. Inoltre, studi di follow up potranno evidenziare se la condizione di benessere delle donne con GDM persista anche nel puerperio

RILEVANZA ECONOMICA, ECONOMIA DELLE IMPRESE CONCESSIONARIE E SCENARI EVOLUTIVI DEL COMPARTO DELLA VENDITA E ASSISTENZA POST VENDITA AUTOMOTIVE IN ITALIA

La ricerca ha affrontato i seguenti argomenti tra di loro strettamente collegati: - La costruzione di scenari macroeconomici relativi all’andamento della domanda di auto in Italia; - L’analisi dell’economia dell’impresa concessionaria e la sostenibilità di tale business, all’interno de-gli scenari individuati. - Gli interventi legislativi a sostegno del mercato automobilistico

Recognition of ZnT8, Proinsulin, and Homologous MAP Peptides in Sardinian Children at Risk of T1D Precedes Detection of Classical Islet Antibodies

As numerous studies put in evidence the increasing incidence of type 1 diabetes (T1D) in children, an early diagnosis is of great importance to define correct treatment and diet. Currently, the identification of classical islet autoantibodies is the primary biomarker for diagnosis in subjects at risk, especially in pediatric patients. Recent studies suggest that detection of antibodies against ZnT8 protein in preclinical phase can predict the development of T1D. We previously demonstrated a significant association of Mycobacterium avium subspecies paratuberculosis (MAP) with T1D in adult Sardinian patients. To enforce this finding, we investigated the presence of antibodies against ZnT8 and proinsulin (PI) with respective homologous epitopes: MAP3865c133–141/ZnT8186–194, MAP3865c125–133/ZnT8178–186, MAP2404c70–85/PI46–61, and MAP1,4αgbp157–173/PI64–80, in 23 children at risk for T1D, formerly involved in the TRIGR study, and 22 healthy controls (HCs). Positivity to anti-MAP and homologous human peptides was detected in 48% of at-risk subjects compared to 5,85% HCs, preceding appearance of islet autoantibodies. Being MAP easily transmitted to humans with infected cow’s milk and detected in retail infant formulas, MAP epitopes could be present in extensively hydrolyzed formula and act as antigens stimulating β-cell autoimmunity