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Tornese G, Schiaffini R, Mozzillo E, Franceschi R, Frongia AP, Scaramuzza A. The effect of the COVID-19 pandemic on telemedicine in pediatric diabetes centers in Italy: Results from a longitudinal survey. Diabetes Res Clin Pract 2021; 179:109030. [PMID: 34461140 PMCID: PMC8438313 DOI: 10.1016/j.diabres.2021.109030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 12/05/2022]
Abstract
AIMS In March and April 2020, at the start of the COVID-19 pandemic, our previous survey of Italian pediatric diabetes centers showed that 75% of telemedicine use was voluntary. We hypothesized that the COVID-19 pandemic has acted as a picklock to overcome barriers to telemedicine regulation, use, and reimbursement. METHODS Between March 22nd and April 12th, 2021, the same survey administered in 2020 was sent to all 68 Italian pediatric diabetes centers belonging to the Italian Society for Pediatric Endocrinology and Diabetes (ISPED) to collect data on the demographic variables of respondents; information about the center; the use, codification, and reimbursement of telemedicine; and used tools. Descriptive data were evaluated to establish how the COVID-19 pandemic has changed telemedicine practice. RESULTS Eighty-two percent of responder centers reported an increase in the use of telemedicine, with televisits by video calling implemented in over half of centers. There was a significant increase in the number of centers formally tracking telemedicine use and obtaining reimbursement from the national health service (42% vs. 29% and 62% vs. 32%; p < 0.001, respectively). No reimbursement was provided to centers not using televisits. CONCLUSIONS From a voluntary procedure with a lack of traceability, telemedicine has become a new structured reality that may help our pediatric patients beyond this pandemic.
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Affiliation(s)
- Gianluca Tornese
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center for Pediatric Diabetes, University of Naples Federico II, Naples, Italy
| | | | | | - Andrea Scaramuzza
- Division of Pediatrics, ASST Cremona, "Ospedale Maggiore di Cremona", Viale Concordia 1, 26100 Cremona, Italy.
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2
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Mozzillo E, Franceschi R, Piona C, Passanisi S, Casertano A, Pjetraj D, Maltoni G, Calcaterra V, Cauvin V, Cherubini V, D’Annunzio G, Franzese A, Frongia AP, Lombardo F, Lo Presti D, Matteoli MC, Piccinno E, Predieri B, Rabbone I, Scaramuzza AE, Toni S, Zucchini S, Maffeis C, Schiaffini R. Diabetes and Prediabetes in Children With Cystic Fibrosis: A Systematic Review of the Literature and Recommendations of the Italian Society for Pediatric Endocrinology and Diabetes (ISPED). Front Endocrinol (Lausanne) 2021; 12:673539. [PMID: 34017312 PMCID: PMC8130616 DOI: 10.3389/fendo.2021.673539] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Cystic fibrosis related diabetes (CFRD) is a comorbidity of cystic fibrosis (CF) that negatively impacts on its clinical course. Prediabetes is an important predictor of either CFRD development and unfavorable prognosis of CF in both pediatric and adult patients. International guidelines recommend insulin only in case of CFRD diagnosis. Whether early detection and treatment of prediabetes may contribute to improve the clinical course of CF is still debated. A subgroup of pediatric diabetologists of the Italian Society for Pediatric Endocrinology and Diabetology (ISPED) performed a systematic review of the literature based on predefined outcomes: impact of pre-diabetes on clinical outcomes and on the risk of developing CFRD; diagnosis of diabetes and pre-diabetes under 10 years of age; effectiveness of therapy on glycemic control, impact of therapy on pulmonary function and nutritional status. Thirty-one papers were selected for the analysis data presented in these papers were reported in tables sorted by outcomes, including comprehensive evidence grading according to the GRADE approach. Following the grading of the quality of the evidence, the entire ISPED diabetes study group achieved consensus for the Italian recommendations based on both evidence and clinical experience. We concluded that in patients with CF, prediabetes should be carefully considered as it can evolve into CFRD. In patients with CF and prediabetic conditions, after complete evaluation of the OGTT trend, glucometrics, glycemic values measured during pulmonary exacerbations and/or steroid therapy, early initiation of insulin therapy could have beneficial effects on clinical outcomes of patients with CF and prediabetes.
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Affiliation(s)
- Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
- *Correspondence: Enza Mozzillo, ; Roberto Franceschi, ; Riccardo Schiaffini,
| | - Roberto Franceschi
- Pediatric Unit, S. Chiara Hospital, Trento, Italy
- *Correspondence: Enza Mozzillo, ; Roberto Franceschi, ; Riccardo Schiaffini,
| | - Claudia Piona
- Regional Center for Pediatric Diabetes, University of Verona, Verona, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Alberto Casertano
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Dorina Pjetraj
- SOD Pediatric Diabetology, Department of Women’s and Children’s, “G. Salesi” Children’s Hospital, AOU Ospedali Riuniti, Ancona, Italy
| | - Giulio Maltoni
- Department of Woman, Child and Urological Diseases, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Valeria Calcaterra
- University of Pavia, Pavia and Department of Pediatrics, "Vittore Buzzi" Children’s Hospital, Milano, Italy
| | | | - Valentino Cherubini
- SOD Pediatric Diabetology, Department of Women’s and Children’s, “G. Salesi” Children’s Hospital, AOU Ospedali Riuniti, Ancona, Italy
| | | | - Adriana Franzese
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | | | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Donatella Lo Presti
- Centro di Riferimento Regionale di Diabetologia Pediatrica A.O.U. Policlinico G. Rodolico, Catania, Italy
| | | | - Elvira Piccinno
- D.A.I. Pediatria, Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults - Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Science, University of Piemonte Orientale, Novara, Italy
| | | | - Sonia Toni
- Pediatric Diabetology Unit, Meyer Children Hospital, Florence, Italy
| | - Stefano Zucchini
- Department of Woman, Child and Urological Diseases, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Claudio Maffeis
- Regional Center for Pediatric Diabetes, University of Verona, Verona, Italy
| | - Riccardo Schiaffini
- Diabetes Unit, Bambino Gesù Children’s Hospital, Rome, Italy
- *Correspondence: Enza Mozzillo, ; Roberto Franceschi, ; Riccardo Schiaffini,
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Rabbone I, Minuto N, Bonfanti R, Marigliano M, Cerutti F, Cherubini V, d'Annunzio G, Frongia AP, Iafusco D, Ignaccolo G, Lombardo F, Schiaffini R, Toni S, Tumini S, Zucchini S, Pistorio A, Scaramuzza AE. Insulin pump failures in Italian children with Type 1 diabetes: retrospective 1-year cohort study. Diabet Med 2017; 34:621-624. [PMID: 27885706 DOI: 10.1111/dme.13294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 11/27/2022]
Abstract
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™ , 9.4% Medtronic MiniMed 715/515™ , 34.3% Medtronic MiniMed VEO™ , 24.3% Accu-Check Spirit Combo™ 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™ (22.1%) and Medtronic MiniMed VEO™ (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.
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Affiliation(s)
- I Rabbone
- Department of Paediatrics, University of Turin, Turin, Italy
| | - N Minuto
- Department of Paediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - R Bonfanti
- Department of Paediatrics, Scientific Institute Hospital San Raffaele, Vita-Salute University, Milan, Italy
| | - M Marigliano
- Regional Center for Paediatric Diabetes, University of Verona, Verona, Italy
| | - F Cerutti
- Department of Paediatrics, University of Turin, Turin, Italy
| | - V Cherubini
- Regional Center for Diabetes in Children and Adolescents, AOU Salesi Hospital, Ancona, Italy
| | - G d'Annunzio
- Department of Paediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - A P Frongia
- Unit of Paediatric Diabetes, Brotzu Hospital, Cagliari, Italy
| | - D Iafusco
- Regional Center for Paediatric Diabetes Second University of Naples, Naples, Italy
| | - G Ignaccolo
- Department of Paediatrics, University of Turin, Turin, Italy
| | - F Lombardo
- Department of Paediatric Sciences, University of Messina, Messina, Italy
| | - R Schiaffini
- Endocrinology and Diabetes Unit, University Department of Paediatric Medicine, Bambino Gesù Children's Hospital, Rome, Italy
| | - S Toni
- Juvenile Diabetes Center, Anna Meyer Children's Hospital, Florence, Italy
| | - S Tumini
- Center of Paediatric Diabetology, University of Chieti, Chieti, Italy
| | - S Zucchini
- Department of Paediatrics, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - A Pistorio
- Epidemiology and Biostatistics Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - A E Scaramuzza
- Department of Paediatrics, Azienda Ospedaliera, University of Milan, Milan, Italy
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Cherubini V, Skrami E, Ferrito L, Zucchini S, Scaramuzza A, Bonfanti R, Buono P, Cardella F, Cauvin V, Chiari G, D Annunzio G, Frongia AP, Iafusco D, Patera IP, Toni S, Tumini S, Rabbone I, Lombardo F, Carle F, Gesuita R. High frequency of diabetic ketoacidosis at diagnosis of type 1 diabetes in Italian children: a nationwide longitudinal study, 2004-2013. Sci Rep 2016; 6:38844. [PMID: 27991500 PMCID: PMC5171855 DOI: 10.1038/srep38844] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/15/2016] [Indexed: 12/15/2022] Open
Abstract
This longitudinal population-based study analyses the frequency of diabetic ketoacidosis (DKA) at type 1 diabetes diagnosis in Italian children under 15 years of age, during 2004-2013. DKA was defined as absent (pH ≥ 7.30), mild/moderate (7.1 ≤ pH < 7.30) and severe (pH < 7.1). Two multiple logistic regression models were used to evaluate the time trend of DKA frequency considered as present versus absent and severe versus absent, adjusted for gender, age group and geographical area of residence at diagnosis. Overall, 9,040 cases were ascertained. DKA frequency was 40.3% (95%CI: 39.3-41.4%), with 29.1% and 11.2% for mild/moderate and severe DKA, respectively. Severe DKA increased significantly during the period (OR = 1.03, 95%CI: 1.003-1.05). Younger-age children and children living in Southern Italy compared to Central Italy were at significantly higher risk of DKA and severe DKA. Family history of type 1 diabetes and residence in Sardinia compared to Central Italy were significantly associated with a lower probability of DKA and severe DKA. The high frequency of ketoacidosis in Italy over time and high variability among age groups and geographical area of residence, strongly suggests a continuing need for nationwide healthcare strategies to increase awareness of early detection of diabetes.
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Affiliation(s)
- Valentino Cherubini
- Division of Paediatric Diabetes, Women's and Children's Health, AOU Ancona, Salesi Hospital, Ancona, Italy
| | - Edlira Skrami
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Lucia Ferrito
- Division of Paediatric Diabetes, Women's and Children's Health, AOU Ancona, Salesi Hospital, Ancona, Italy
| | - Stefano Zucchini
- Department of Pediatrics, S. Orsola-Malpighi Hospital, Via Albertoni 15, 40138 Bologna, Italy
| | - Andrea Scaramuzza
- Department of Pediatrics, Azienda Ospedaliera, "Ospedale Luigi Sacco", University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Riccardo Bonfanti
- Department of Pediatrics, Endocrine Unit, Scientific Institute Hospital San Raffaele, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
| | - Pietro Buono
- UOSD Pediatric Diabetology, ASL NA2 Nord, Via Corrado Alvaro 8, Monteruscello, 80072 Pozzuoli, Italy
| | - Francesca Cardella
- Department of Pediatrics, U.O.S. Pediatric Diabetology, ARNAS Civico Di Cristina, Via Benedettini 1, 90134 Palermo, Italy
| | - Vittoria Cauvin
- Pediatric Unit, S. Chiara Hospital, Largo Medaglie d'Oro 9, 38122 Trento, Italy
| | - Giovanni Chiari
- Postgraduate School of Pediatrics, University of Parma, Viale Gramsci 14, 43100 Parma, Italy
| | | | - Anna Paola Frongia
- Unit of Pediatric Diabetes, Brotzu Hospital, Piazzale Ricchi 1, 09134 Cagliari, Italy
| | - Dario Iafusco
- Department of Pediatrics, Second University of Naples, Via S. Andrea delle Dame 4, 80138 Naples, Italy
| | - Ippolita Patrizia Patera
- Endocrinology and Diabetes Unit, University Department of Pediatric Medicine, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Sonia Toni
- Juvenile Diabetes Center, Anna Meyer Children's Hospital, Via Pieraccini 24, 50132 Florence, Italy
| | - Stefano Tumini
- Center of Pediatric Diabetology, University of Chieti, 66100 Chieti, Italy
| | - Ivana Rabbone
- Department of Pediatrics, University of Turin, Piazza Polonia 94, 10126 Turin, Italy
| | | | - Flavia Carle
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
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Cherubini V, Pintaudi B, Rossi MC, Lucisano G, Pellegrini F, Chiumello G, Frongia AP, Monciotti C, Patera IP, Toni S, Zucchini S, Nicolucci A. Severe hypoglycemia and ketoacidosis over one year in Italian pediatric population with type 1 diabetes mellitus: a multicenter retrospective observational study. Nutr Metab Cardiovasc Dis 2014; 24:538-546. [PMID: 24418381 DOI: 10.1016/j.numecd.2013.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 11/07/2013] [Accepted: 11/10/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS Evaluation of incidence and correlates of severe hypoglycemia (SH) and diabetes ketoacidosis (DKA) in children and adolescents with T1DM. METHODS AND RESULTS Retrospective study conducted in 29 diabetes centers from November 2011 to April 2012. The incidence of SH and DKA episodes and their correlates were assessed through a questionnaire administered to parents of patients aged 0-18 years. Incidence rates and incident rate ratios (IRRs) were estimated through multivariate Poisson regression analysis and multilevel analysis. Overall, 2025 patients were included (age 12.4 ± 3.8 years; 53% males; diabetes duration 5.6 ± 3.5 years; HbA1c 7.9 ± 1.1%). The incidence of SH and DKA were of 7.7 and 2.4 events/100 py, respectively. The risk of SH was higher in females (IRR = 1.44; 95%CI 1.04-1.99), in patients using rapid acting analogues as compared to regular insulin (IRR = 1.48; 95%CI 0.97-2.26) and lower for patients using long acting analogues as compared to NPH insulin (IRR = 0.40; 95%CI 0.19-0.85). No correlations were found between SH and HbA1c levels. The risk of DKA was higher in patients using rapid acting analogues (IRR = 4.25; 95%CI 1.01-17.86) and increased with insulin units needed (IRR = 7.66; 95%CI 2.83-20.74) and HbA1c levels (IRR = 1.63; 95%CI 1.36-1.95). Mother's age was inversely associated with the risk of both SH (IRR = 0.95; 95%CI 0.92-0.98) and DKA (IRR = 0.94; 95%CI 0.88-0.99). When accounting for center effect, the risk of SH associated with the use of rapid acting insulin analogues was attenuated (IRR = 1.48; 95%CI 0.97-2.26); 33% and 16% of the residual variance in SH and DKA risk was explained by center effect. CONCLUSION The risk of SH and DKA is mainly associated with treatment modalities and strongly depends on the practice of specialist centers.
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Affiliation(s)
- V Cherubini
- Division of Paediatric Diabetes in Children and Adolescents, Maternal-Infantile Department, Salesi Hospital, Ancona, Italy
| | - B Pintaudi
- Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Via Nazionale, S. Maria Imbaro 66030, CH, Italy
| | - M C Rossi
- Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Via Nazionale, S. Maria Imbaro 66030, CH, Italy
| | - G Lucisano
- Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Via Nazionale, S. Maria Imbaro 66030, CH, Italy
| | - F Pellegrini
- Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Via Nazionale, S. Maria Imbaro 66030, CH, Italy
| | - G Chiumello
- Endocrine Unit, Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy
| | - A P Frongia
- Pediatric Division, Brotzu Hospital, Cagliari, Italy
| | - C Monciotti
- Women & Children's Health Department, University of Padova, Padova, Italy
| | - I P Patera
- Department of Pediatrics, Bambino Gesù Hospital, Passoscuro (RM), Roma, Italy
| | - S Toni
- Diabetes Unit, Meyer Children Hospital, Firenze, Italy
| | - S Zucchini
- Department of Pediatrics, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - A Nicolucci
- Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Via Nazionale, S. Maria Imbaro 66030, CH, Italy.
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Scaramuzza A, Cherubini V, Tumini S, Bonfanti R, Buono P, Cardella F, d'Annunzio G, Frongia AP, Lombardo F, Monciotti ACM, Rabbone I, Schiaffini R, Toni S, Zucchini S, Frontino G, Iafusco D. Recommendations for self-monitoring in pediatric diabetes: a consensus statement by the ISPED. Acta Diabetol 2014; 51:173-84. [PMID: 24162715 DOI: 10.1007/s00592-013-0521-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 10/01/2013] [Indexed: 11/29/2022]
Abstract
A panel of experts of the Italian Society of Pediatric Endocrinology and Diabetology comprehensively discussed and approved the Italian recommendations regarding self-monitoring of blood glucose, continuous glucose monitoring and other measures of glycemic control in children and adolescents with type 1 diabetes. After an extensive review of the literature, we took these issues into account: self-monitoring blood glucose, continuous glucose monitoring, glycemic variability, glycosuria, ketonuria, ketonemia, glycated hemoglobin, fructosamine and glycated albumin, logbook, data downloading, lancing devices, carbohydrate counting, and glycemic measurements at school. We concluded that clinical guidelines on self-management should be developed in every country with faithful adaptation to local languages and taking into account specific contexts and local peculiarities, without any substantial modifications to the international recommendations. We believe that the National Health Service should provide all necessary resources to ensure self-monitoring of blood glucose and possibly continuous glucose monitoring of all children and adolescents with type 1 diabetes, according to the standards of care provided by these recommendations and internationally.
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Affiliation(s)
- Andrea Scaramuzza
- Department of Pediatrics, Azienda Ospedaliera, University of Milano, "Ospedale Luigi Sacco," via G.B. Grassi 74, 20157, Milan, Italy,
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7
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Cherubini V, Gesuita R, Bonfanti R, Franzese A, Frongia AP, Iafusco D, Iannilli A, Lombardo F, Rabbone I, Sabbion A, Salvatoni A, Scaramuzza A, Schiaffini R, Sulli N, Toni S, Tumini S, Mosca A, Carle F. Health-related quality of life and treatment preferences in adolescents with type 1 diabetes. The VIPKIDS study. Acta Diabetol 2014; 51:43-51. [PMID: 23508374 DOI: 10.1007/s00592-013-0466-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 03/04/2013] [Indexed: 10/27/2022]
Abstract
A multi-centre, observational, cross-sectional study was carried out to determine whether the health-related quality of life (HRQOL) of adolescents with type 1 diabetes is affected by different insulin treatment systems, and which features of HRQOL are impacted by the respective insulin treatment. The study regarded 577 adolescents, aged 10-17 years, with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) (n = 306) or multiple daily injections (MDI) (n = 271). The Insulin Delivery System Rating Questionnaire was validated in Italian and was self-completed by the subjects during a routine visit to the centres. Subjects were compared following the domains of the questionnaire. Good HRQOL was seen in subjects treated with either MDI or CSII. Significant differences were not found in the domains for general diabetes, including diabetes worries, social burden and psychological well-being. Multiple quantile regression analysis showed that CSII confers significant advantages in terms of HRQOL with improvements in treatment satisfaction, perceived clinical efficacy and reduction in treatment interference with daily activities. This favourable impact was more evident in subjects reporting lower HRQOL scores, suggesting that CSII may be especially useful for individuals perceiving a poor HRQOL. Analysis of the domains indicated that CSII was associated with a higher HRQOL than MDI. Life-course HRQOL evaluation using a standardised questionnaire can ensure better chronic disease management. This is particularly important when providing individualised care for adolescents, as they become increasingly responsible for managing their diabetes.
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Affiliation(s)
- V Cherubini
- Division of Pediatric Diabetes, Maternal-Infant Department, AOU OO RR Ancona, "G. Salesi" Hospital, Via Corridoni, 11, 60123, Ancona, Italy,
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8
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Lorini R, Klersy C, d'Annunzio G, Massa O, Minuto N, Iafusco D, Bellannè-Chantelot C, Frongia AP, Toni S, Meschi F, Cerutti F, Barbetti F. Maturity-onset diabetes of the young in children with incidental hyperglycemia: a multicenter Italian study of 172 families. Diabetes Care 2009; 32:1864-6. [PMID: 19564454 PMCID: PMC2752915 DOI: 10.2337/dc08-2018] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the prevalence of maturity-onset diabetes of the young (MODY) in Italian children with incidental hyperglycemia. RESEARCH DESIGN AND METHODS Among 748 subjects age 1-18 years with incidental hyperglycemia, minimal diagnostic criteria for MODY were met by 172 families. Mutational analyses of the glucokinase (GCK) and hepatocyte nuclear factor 1alpha (HNF1A) genes were performed. RESULTS We identified 85 GCK gene mutations in 109 probands and 10 HNF1A mutations in 12 probands. In GCK patients, the median neonatal weight and age at the first evaluation were lower than those found in patients with HNF1A mutations. Median fasting plasma glucose and impaired fasting glucose/impaired glucose tolerance frequency after oral glucose tolerance testing were higher in GCK patients, who also showed a lower frequency of diabetes than HNF1A patients. CONCLUSIONS GCK mutations are the prevailing cause of MODY (63.4%) when the index case is recruited in Italian children with incidental hyperglycemia.
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Affiliation(s)
- Renata Lorini
- Department of Pediatrics, IRCCS Gaslini Children's Hospital, University of Genoa, Genoa, Italy.
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9
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Pinelli L, Rabbone I, Salardi S, Toni S, Scaramuzza A, Bonfanti R, Cherubini V, Franzese A, Frongia AP, Iafusco D, Sulli N, Tumini S, Curto O, Miassimelli M. Insulin pump therapy in children and adolescents with type 1 diabetes: the Italian viewpoint. Acta Biomed 2008; 79:57-64. [PMID: 18551824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND AIM A panel of experts of the Italian Society of Paediatric Endocrinology and Diabetology translated into Italian the international insulin pump therapy recommendations in children and adolescents with type 1 diabetes. METHODS After an extensive review of the literature using evidence-based recommendations, several issues were taken into account, such as patient selection, advantages and disadvantages, instrument choice, insulin type, therapy planning and follow-up, emergencies, nutrition, particular occasions (like parties, holidays, sick days, travels), exercise, continuous glucose monitoring and integrated system, neonatal diabetes. The panel evaluated the cost-effectiveness of insulin pump therapy compared to multiple daily injection therapy, analysing the cost-benefit ratio. RESULTS Some tweak was needed due to the Italian dietetic singularity, meal schedule, climate and lifestyle. Insulin pump therapy in neonatal diabetes is a new issue and no guidelines have been published yet for this age-group. Moreover, legal issues according to the Italian law have been added and are peculiarity of our recommendations. An "informed therapeutic agreement" between the patient and his/her family and the diabetic team has to be signed before starting insulin pump therapy. CONCLUSIONS We think that nowadays the need for clinical guidelines is important and worth the effort that all countries develop faithful adaptation into their local languages taking into account specific contexts and local peculiarities, without making substantial modifications to the original text.
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