Centro Regionale Of Diabetologia Pediatrica

Verona, Italy

Centro Regionale Of Diabetologia Pediatrica

Verona, Italy
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Cherubini V.,Presidio | Gesuita R.,Marche Polytechnic University | Sternardi S.,Presidio | Ferrito L.,Presidio | And 107 more authors.
Giornale Italiano di Diabetologia e Metabolismo | Year: 2014

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 risks cerebral 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, retrospective study of DKA at diabetes onset was done by the Pediatric Diabetology Study Group (PDSG) of the Italian Society of Pediatric Endocrinology and Diabetes (ISPED), involving 76 Italian centers. DKA was defined using ISPAD criteria; 7457 new cases of T1DM were recruited from mainland Italy and the island of Sicily and 770 from Sardinia, in the period 2004-2013. On the mainland 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 the severe form. Mild and severe DKA risk was significantly higher in children aged 0-4 years; no significant temporal trend was found in the study period. Patients living in Sardinia or having a firstdegree relative with T1DM were at significantly lower risk of DKA at diabetes onset. In the ten-year study period three children died of DKA at onset and four suffered permanent neurological lesions. From November 2011-April 2012 the PDSG conducted a retrospective study based on a sample of 2025 patients with T1DM, aged 0-18 years, involving 29 national centers for pediatric diabetes. The incidence of DKA was 2.4% (IC 95% 1.8-3.1), with children older than ten years at significantly higher risk, probably due to shortages of insulin. Multiple analysis showed a higher risk of DKA in those using a rapid-acting insulin analog and in those with high HbA1c. Young mothers and low levels of education were also associated with DKA.In conclusion, although a wide network of specialized home pediatricians and pediatric diabetes centers is spread across the country, the incidence of DKA at diabetes onset is still high. Further social and health-system efforts are needed to boost awareness of this risk and to reduce damages and costs related to the complication. © (publication year), (publisher). All rights reserved.


Boscari F.,Dip. di Medicina | Del Favero S.,University of Padua | Messori M.,University of Pavia | Rabbone I.,University of Turin | And 23 more authors.
Giornale Italiano di Diabetologia e Metabolismo | Year: 2016

Background. The artificial pancreas (AP) system based on the Modular Model Predictive Control algorithm (MMPC) running on the wearable platform Diabetes Assistant (DiAs) has been used in adult outpatients with type 1 diabetes (T1D), reducing the time spent in hypoglycemia and increasing the time spent in the near-normal range of 70-180 mg/dl compared to Sensor Augmented Pump therapy (SAP). Objective. In the PEDiatric ARtificial PANcreas (PedArPan) project we tested a children-specific version of the MMPC on DiAs in 5-9 yearold children during a summer camp. This is the first outpatient AP trial in a population of this age. Study design and methods. Thirty 5-9 year-old children with T1D and their parents were recruited from five Italian pediatric centers and completed an open label, randomized, crossover trial in a summer camp (supervised outpatient setting). Glucose control in three days of AP use was compared with three days of parent-managed SAP. Results. Overnight (00:00-07:30). The AP significantly reduced time-in-hypo compared to SAP, 0% [0.00-2.22] vs. 2.19% [0.00- 12.30], p = 0.002, with no significant difference in time-in-target (70-180 mg/dl), 55.97% (22.53) vs. 59.69% (21.24), p = 0.430, or time-in-tight-target (80-140 mg/dl), 31.27% (20.23) vs. 33.02% (19.80), p = 0.694. Overall (00:00-24:00). There was a threefold reduction of time-in-hypo, 2.02% [1.17-4.54] vs. 6.67% [2.26-11.54], p < 0.001, with AP at the expense of some deterioration of time-in-target, 56.79% (13.47) vs. 63.09% (10.98), p = 0.022. Conclusions. This study showed the feasibility and safety of a wearable MMPC in young children. Next steps will include overnight testing at home and re-tuning the algorithm to boost efficacy during daytime. © 2016, UTET Periodici Scientifici srl. All rights reserved.


Iafusco D.,The Second University of Naples | Cardella F.,Centro Regionale Of Diabetologia Pediatrica | Prisco F.,The Second University of Naples
Giornale Italiano di Diabetologia e Metabolismo | Year: 2014

The prevalence and magnitude of childhood obesity are increasing dramatically around the world, including Europe and Mediterranean countries such as Italy which seemed somehow to be protected by their eating habits and cultural factors. Obesity plays an important pathogenic role in the metabolic syndrome and in type 2 diabetes in adolescents; this latter was virtually unknown in Italy until a few years ago. Here we briefly describe the pathogenesis and treatment of metabolic syndrome and type 2 diabetes mellitus in children and adolescents, and also present original data collected during a survey by the ISPED National Study Group on Diabetes on the phenotypic characteristics of the first cases of type 2 diabetes mellitus in adolescents in Italy. © 2014, UTET Periodici Scientifici srl. All rights reserved.

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