Città della Pieve, Italy
Città della Pieve, Italy

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Grassi G.,SCDU Endocrinologia | Bonomo M.,SSD di Diabetologia | Bruttomesso D.,UO Malattie del Metabolismo | Cherubini V.,SOD Diabetologia Pediatrica | And 4 more authors.
Giornale Italiano di Diabetologia e Metabolismo | Year: 2014

Clinical studies and real-life practice all indicate that the efficacy of real-time continuous glucose control (RT-CGM) closely depends on the selection of patients. Moreover, in these days of healthcare cost containment, the lack of clear identification of patients eligible for RT-CGM could limit its adoption and diffusion. Taking an evidence-based approach, with their daily practical experience, the authors have reviewed clinical studies, clinical guidelines and reimbursement indications in order to identify the categories of patients who are most likely to benefit from this recent technology. This consensus panel aims to identify criteria for patient selection in order to maximize the clinical benefit while, at the same time, ensuring the most appropriate use of healthcare resources.


Piccoli G.B.,University of Turin | Grassi G.,SCDU Endocrinologia | Cabiddu G.,Brotzu Hospital | Nazha M.,University of Turin | And 10 more authors.
Review of Diabetic Studies | Year: 2015

The term “diabetic kidney” has recently been proposed to encompass the various lesions, involving all kidney structures that characterize protean kidney damage in patients with diabetes. While glomerular diseases may follow the stepwise progression that was described several decades ago, the tenet that proteinuria identifies diabetic nephropathy is disputed today and should be limited to glomerular lesions. Improvements in glycemic control may have contributed to a decrease in the prevalence of glomerular lesions, initially described as hallmarks of diabetic nephropathy, and revealed other types of renal damage, mainly related to vasculature and interstitium, and these types usually present with little or no proteinuria. Whilst glomerular damage is the hallmark of microvascular lesions, ischemic nephropathies, renal infarction, and cholesterol emboli syndrome are the result of macrovascular involvement, and the presence of underlying renal damage sets the stage for acute infections and drug-induced kidney injuries. Impairment of the phagocytic response can cause severe and unusual forms of acute and chronic pyelonephritis. It is thus concluded that screening for albuminuria, which is useful for detecting “glomerular diabetic nephropathy”, does not identify all potential nephropathies in diabetes patients. As diabetes is a risk factor for all forms of kidney disease, diagnosis in diabetic patients should include the same combination of biochemical, clinical, and imaging tests as employed in nondiabetic subjects, but with the specific consideration that chronic kidney disease (CKD) may develop more rapidly and severely in diabetic patients. © by Lab & Life Press/SBDR.


Piccoli G.B.,University of Turin | Grassi G.,SCDU Endocrinologia | Cabiddu G.,Brotzu Hospital | Nazha M.,University of Turin | And 10 more authors.
Review of Diabetic Studies | Year: 2015

The term “diabetic kidney” has recently been proposed to encompass the various lesions, involving all kidney structures that characterize protean kidney damage in patients with diabetes. While glomerular diseases may follow the stepwise progression that was described several decades ago, the tenet that proteinuria identifies diabetic nephropathy is disputed today and should be limited to glomerular lesions. Improvements in glycemic control may have contributed to a decrease in the prevalence of glomerular lesions, initially described as hallmarks of diabetic nephropathy, and revealed other types of renal damage, mainly related to vasculature and interstitium, and these types usually present with little or no proteinuria. Whilst glomerular damage is the hallmark of microvascular lesions, ischemic nephropathies, renal infarction, and cholesterol emboli syndrome are the result of macrovascular involvement, and the presence of underlying renal damage sets the stage for acute infections and drug-induced kidney injuries. Impairment of the phagocytic response can cause severe and unusual forms of acute and chronic pyelonephritis. It is thus concluded that screening for albuminuria, which is useful for detecting “glomerular diabetic nephropathy”, does not identify all potential nephropathies in diabetes patients. As diabetes is a risk factor for all forms of kidney disease, diagnosis in diabetic patients should include the same combination of biochemical, clinical, and imaging tests as employed in non-diabetic subjects, but with the specific consideration that chronic kidney disease (CKD) may develop more rapidly and severely in diabetic patients. © 2015, Society for Biomedical Diabetes Research. All rights reserved.


Grassi G.,SCDU Endocrinologia | Ramella V.,SCDU Endocrinologia | Sicignano S.,University of Turin | Rabbone I.,University of Turin
Giornale Italiano di Diabetologia e Metabolismo | Year: 2013

Children with type 1 diabetes (T1DM) are often well into adolescence when they move from a pediatric to an adult care center (ACC), and problems can arise for the patient and the care team too. The differences between the insulin therapy regimens proposed by pediatricians and adult care providers are one source of problems in this transition. We describe the transition from the pediatric center to an ACC of a group of T1DM adolescents receiving continuous subcutaneous insulin infusion (CSII). We followed a homogeneous group of 49 young adults, mean age 18.5 ± 5.7 years at first observation, from 1 January 2002 to 31 December 2010. They were all using insulin pump therapy, and were transferred to the same ACC with a program identified as "outpatient transition-technology". They were reassessed again two years after the transition. Mean follow-up was 5.6 ± 2.7 years. HbA1c was stable throughout the CSII period (starting value 8.60 ± 1.5%, transition 8.23 ± 1.2%, re-assessment 8.35 ± 1.23%). The drop-out rate from CSII treatment was 10.2% but only one patient dropped out from the ACC (2%). The limited drop-out rates, overall adherence to the treatment, and metabolic stability show that the late teens may be a good period for transition. CSII is a well-standardized therapy and can improve the dynamics of the transfer, facilitating therapeutic continuity. The move to the ACC did not affect metabolic control, indicating that the patients had acquired adequate skills for managing their diabetes when they were transferred. This experience of moving from a pediatric center to the ACC illustrates the importance of a structured transition.


Piccoli G.B.,University of Turin | Piccoli G.B.,Center Hospitalier Le Mans | Ventrella F.,University of Turin | Capizzi I.,University of Turin | And 7 more authors.
Nutrients | Year: 2016

Low-protein diets (LPDs) are often considered as contraindicated in diabetic patients, and are seldom studied. The aim of this observational study was to provide new data on this issue. It involved 149 diabetic and 300 non-diabetic patients who followed a LPD, with a personalized approach aimed at moderate protein restriction (0.6 g/day). Survival analysis was performed according to Kaplan–Meier, and multivariate analysis with Cox model. Diabetic versus non-diabetic patients were of similar age (median 70 years) and creatinine levels at the start of the diet (2.78 mg/dL vs. 2.80 mg/dL). There was higher prevalence of nephrotic proteinuria in diabetic patients (27.52% vs. 13.67%, p = 0.002) as well as comorbidity (median Charlson index 8 vs. 6 p = 0.002). Patient survival was lower in diabetic patients, but differences levelled off considering only cases with Charlson index > 7, the only relevant covariate in Cox analysis. Dialysis-free survival was superimposable in the setting of good compliance (Mitch formula: 0.47 g/kg/day in both groups): about 50% of the cases remained dialysis-free 2 years after the first finding of e-GFR (estimated glomerular filtration rate) < 15 mL/min, and 1 year after reaching e-GFR < 10 mL/min. In patients with type 2 diabetes, higher proteinuria was associated with mortality and initiation of dialysis. In conclusion, moderately restricted LPDs allow similar results in diabetic and non non-diabetic patients with similar comorbidity. © 2016 by the authors; licensee MDPI, Basel, Switzerland.


PubMed | University of Turin, SCDU Endocrinologia and Brotzu Hospital
Type: Journal Article | Journal: Nutrients | Year: 2016

Low-protein diets (LPDs) are often considered as contraindicated in diabetic patients, and are seldom studied. The aim of this observational study was to provide new data on this issue. It involved 149 diabetic and 300 non-diabetic patients who followed a LPD, with a personalized approach aimed at moderate protein restriction (0.6 g/day). Survival analysis was performed according to Kaplan-Meier, and multivariate analysis with Cox model. Diabetic versus non-diabetic patients were of similar age (median 70 years) and creatinine levels at the start of the diet (2.78 mg/dL vs. 2.80 mg/dL). There was higher prevalence of nephrotic proteinuria in diabetic patients (27.52% vs. 13.67%,


Grassi G.,S.C.D.U. Endocrinologia | Scuntero P.,Cpsei Centro Unificato Diabetologia | Trepiccioni R.,Science Endocrinologia Diabetologia e Malattie Del Metabolismo | Marubbi F.,BD Medical | Strauss K.,BD
Journal of Clinical and Translational Endocrinology | Year: 2014

Purpose The purpose of the study is to assess whether proper Injection Technique (IT) is associated with improved glucose control over a three month period.Methods Patients (N = 346) with diabetes from 18 ambulatory centers throughout northern Italy who had been injecting insulin ≤ four years answered a questionnaire about their IT. The nurse then examined the patient's injection sites for the presence of lipohypertrophy (LH), followed by an individualized training session in which sub-optimal IT practices highlighted in the questionnaire were addressed. All patients were taught to rotate sites correctly to avoid LH and were begun on 4 mm pen needles to avoid intramuscular (IM) injections. They were instructed not to reuse needles.Results Nearly 49% of patients were found to have LH at study entry. After three months, patients had mean reductions in HbA1c of 0.58% (0.50%-0.66%, 95% CI), in fasting blood glucose of 14 mg/dL (10.2-17.8 mg/dL, 95% CI) and in total daily insulin dose of 2.0 IU (1.4-2.5 IU, 95% CI) all with p < 0.05. Follow-up questionnaires showed significant numbers of patients recognized the importance of IT and were performing their injections more correctly. The majority found the 4 mm needle convenient and comfortable.Conclusions Targeted individualized training in IT, including the switch to a 4 mm needle, is associated with improved glucose control, greater satisfaction with therapy, better and simpler injection practices and possibly lower consumption of insulin after only a three month period. © 2014 The Authors.

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