USC Diabetologia

Sotto il Monte Giovanni XXIII, Italy

USC Diabetologia

Sotto il Monte Giovanni XXIII, Italy
SEARCH FILTERS
Time filter
Source Type

Beltramello G.,Unita di Medicina Interna | Trevisan R.,USC Diabetologia
Acta Diabetologica | Year: 2013

Hyperglycaemic patients admitted to hospital have worse clinical outcomes with higher operational costs than normoglycaemic patients. Identifying, defining and treating hyperglycaemia promptly and appropriately is essential during hospitalisation; adequate 'continuity of care' must be assured after discharge. This requires a multidisciplinary clinical collaboration between the internist and the diabetes team, which plays a central role in the treatment course and should be involved soon after patient admission to the hospital. This document aims to establish guidelines and recommendations for good clinical practice in managing hyperglycaemic internal medicine patients, with or without previous diagnosis of diabetes. The Associazione Medici Diabetologi (AMD), Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI) and Società Italiana di Diabetologia (SID) have decided to publish a document useful for internists in the management of hospitalised patients with hyperglycaemia. The Trialogue project, coordinated by a Board of Scientific Experts from the three scientific societies, was initiated for this purpose. A questionnaire consisting of 16 multiple choice questions on the management of hyperglycaemia in hospital was answered by 660 physicians from over 250 Internal Medicine units distributed throughout Italy. Analysis of responses has yielded an overview of routine clinical practice and provided a wealth of ideas to better identify critical points in the treatment of hospitalised patients with hyperglycaemia. These recommendations were developed with the aim of providing mutually agreed practical guidance (instructions for use) that can be readily applied by healthcare professionals in routine clinical practice. © 2013 Associazione Medici Diabetologi (AMD), Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI), Società Italiana di Diabetologia (SID).


Hyperglycaemic patients admitted to hospital have worse clinical outcomes with higher operational costs than normoglycaemic patients. Identifying, defining and treating hyperglycaemia promptly and appropriately is essential during hospitalization; adequate "continuity of care" must be assured after discharge. This requires a multidisciplinary clinical collaboration between the internist and the diabetes team, which plays a central role in the treatment course and should be involved soon after patient admission to the hospital. This document aims to establish guidelines and recommendations for good clinical practice in managing hyperglycaemic Internal Medicine patients, with or without previous diagnosis of diabetes. The Associazione Medici Diabetologi (AMD), Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI) and Società Italiana di Diabetologia (SID) have decided to publish a document useful for internists in the management of hospitalised patients with hyperglycaemia. The Trialogue project, coordinated by the Board of Scientific experts from the three Scientific Societies, was initiated for this purpose. A questionnaire consisting of 16 multiple choice questions on the management of hyperglycaemia in hospital was answered by 660 physicians from over 250 internal medicine units distributed throughout Italy. Analysis of responses has yielded an overview of routine clinical practice and provided a wealth of ideas to better identify critical points in the treatment of hospitalized patients with hyperglycaemia. These recommendations were developed with the aim of providing mutually agreed practical guidance (instructions for use) that can be readily applied by healthcare professionals in routine clinical practice. © 2012 Associazione Medici Diabetologi (AMD), Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI), Società Italiana di Diabetologia (SID). Published by Elsevier Srl. All rights reserved.


Type 2 diabetes is a chronic progressive disease often requiring the combination of multiple drugs, including insulin. Few studies have examined the effectiveness on blood glucose control of adding a glitazone as the third oral agent. Aim of this study was to evaluate the short-term effect on HbA 1c of adding a glitazone to maximal tolerated doses of metformin and sulfonylurea. To this aim, 70 type 2 diabetic patients (42 males and 28 females, age 61 ± 10 years, diabetes duration 10 ± 6 years, BMI 30 ± 5 kg/m2) with HbA1c > 7% were evaluated before and after 4 months of triple oral therapy. The addition of glitazone (pioglitazone 30 mg/day or rosiglitazone 8 mg/day) improved metabolic control (HbA1c 7.4 ± 2.2 vs 9 ± 1.5%, p < 0.001): after 4 months, 27 patients (39%) showed HbA1c ≤ 7.5% and 13 patients reached an HbA1c ≤ 7%. Thirty-seven patients (53%) had HbA 1c > 9% at baseline. They showed a greater decrease in HbA 1c (-1.6%) than those with HbA1c < 9% (-0.9%, p < 0.01). Body weight increased significantly at the end of the study (+2.2 kg, p < 0.001). The addition of glitazone improved triglycerides plasma levels (148 ± 58 vs 180 ± 63 mg/dl, p < 0.05), increased HDL-cholesterol (52 ± 12 vs 49 ± 11 mg/dl, p < 0.05) and decreased uric acid plasma levels (4.6 ± 2.3 vs 5.1 ± 1.8 mg/dl, p < 0.05). The addition of glitazone to maximal tolerated doses of metformin and sulfonylurea significantly improved HbA1c in type 2 diabetic patients in poor metabolic control. A significant proportion of patients (58%) reached in 4 months an HbA1c ≤ 7.5%.


Lepore G.,USC Diabetologia | Scaranna C.,USC Diabetologia | Corsi A.,USC Diabetologia | Dodesini A.R.,USC Diabetologia | Trevisan R.,USC Diabetologia
Giornale Italiano di Diabetologia e Metabolismo | Year: 2013

In recent years manufacturers have added automatic bolus calculators to their insulin pumps to help patients establish the correct dose of insulin when they need a bolus to deal with carbohydrate intake and out-of-range blood glucose. The insulin dose is calculated on the basis of the following parameters: current blood glucose, target blood glucose, carbohydrate intake, carbohydrate-to-insulin ratio, insulin sensitivity factor, duration of insulin action (insulin on board). Bolus calculators have now been integrated in glucose meters and are also available for multiple daily insulin injections. This review analyzed studies that examined the clinical effectiveness of bolus calculators on glucose variability, long-term blood glucose control and quality of life.


Trevisan R.,U.S.C. Diabetologia
Giornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia | Year: 2012

Microalbuminuria is not only a risk factor for diabetic nephropathy but also for cardiovascular morbidity and mortality. Microalbuminuria is a marker of endothelial dysfunction, which is a promoter of atherosclerosis. In type 1 diabetes, intensive glucose control decreases the microalbuminuria risk by 20-30%. In patients with this type of diabetes, microalbuminuria prevention is associated with a significant reduction of cardiovascular events. In type 2 diabetes, good metabolic control is similarly effective in microalbuminuria prevention, as shown by the ACCORD, ADVANCE and VADT studies. The role of renin-angiotensin system inhibition in the prevention of microalbuminuria is still unclear. In type 1 diabetes, there are no studies available showing that drugs inhibiting the renin-angiotensin system are able to prevent albuminuria. In patients with type 2 diabetes there are contrasting data: ACE-inhibitors prevent the appearance of microalbuminuria, while angiotensin receptor blockers do not prevent albuminuria or are associated with adverse effects. Therefore in type 2 diabetes patients with normoalbuminuria there is evidence that ACE inhibitors are effective in preventing microalbuminuria only in those patients with hypertension. In these patients good metabolic control and ACE inhibitor therapy are clearly able to prevent microalbuminuria.

Loading USC Diabetologia collaborators
Loading USC Diabetologia collaborators