The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Kinetics of CO2methanation on a Ru-based catalyst at process conditions relevant for Power-to-Gas applications

In this paper we show that a 0.5 wt.% Ru/γ-Al2O3catalyst is appropriate to carry out the Sabatier reaction (CO2methanation) under process conditions relevant for the Power-to-Gas application and we provide a kinetic model able to describe the CO2conversion over a wide range of process conditions, previously unexplored. To achieve these goals, the effects of feed gas composition (H2/CO2ratio and presence of diluents), space velocity, temperature and pressure on catalyst activity and selectivity are investigated. The catalyst is found stable when operating over a wide range of CO2conversion values, with CH4selectivity always over 99% and no deactivation, even when working with carbon-rich gas streams. The effect of water on the catalyst performance is also investigated and an inhibiting kinetic effect is pointed out. Eventually, the capacity of kinetic models taken from the literature to account for CO2conversion under the explored experimental conditions is assessed. It is found that the kinetic model proposed by Lunde and Kester in 1973 (J. Catal. 30 (1973) 423) is able to describe satisfactorily the catalyst behavior in a wide range of CO2conversion spanning from differential conditions to thermodynamic equilibrium, provided that a new set of kinetic parameters is used. It is shown however that a better fitting can be achieved by using a modified kinetic model, accounting for the inhibiting effect of H2O on CO2conversion rate

CO2 hydrogenation to hydrocarbons over Co and Fe-based Fischer-Tropsch catalysts

The performances of representative Co-based and Fe-based Fischer-Tropsch catalysts have been comparatively investigated in the hydrogenation of CO and CO2. Over an un-promoted Co/γ-Al2O3 catalyst, CO2 is easily hydrogenated and its conversion rate is even faster than that of CO; however, the selectivities of the two processes are extremely different, with methane largely dominating the product distribution in the case of CO2 hydrogenation and long-chain hydrocarbons dominating the products pool during CO hydrogenation. As opposite to cobalt, CO2 hydrogenation rate over K-promoted 100Fe/10Zn/1Cu (at/at) catalysts is slower than that of CO, but the products are dominated by middle distillates when CO2 replaces CO in the feed. Such behaviors depend on the different adsorption strengths of CO and CO2, which affect the H/C atomic ratio on the catalyst surface. In the case of Fe-based catalyst, we have also found that the catalytic sites active in the chain growth process (iron carbides) are transformed into sites active in the hydrogenation reactions (iron oxides/reduced iron centers) at low CO partial pressures. Potassium has a key role in promoting the stability of chain growth sites, thus decreasing the secondary reactions of olefins

Effects of Zn and Mn Promotion in Fe-Based Catalysts Used for COxHydrogenation to Long-Chain Hydrocarbons

The promoting effect of Mn and Zn on the performance of Fe-based catalysts has been comparatively investigated in the COxhydrogenation to heavy hydrocarbons in the presence of H2-deficient streams. To this scope, two catalysts have been prepared by coprecipitation, followed by impregnation with Cu and K, and tested at 220 °C and 30 bargafter an activation treatment with syngas. Both catalysts have been found to be active and selective to long-chain hydrocarbons in the presence of either H2/CO or H2/CO2mixtures. Despite lower catalyst reducibility, the presence of Zn has resulted in higher COxconversion rates. Furthermore, the Zn-promoted catalyst converted COxinto heavier and less-saturated hydrocarbons. These results are consistent with a role of Zn in promoting the catalyst basicity, which is a key property to keep low the superficial H/C ratio and to slow chain termination reactions as well as secondary olefin hydrogenations