Antonio Nicolucci

CMNS Consorzio Mario Negri Sud, Santa Maria Imbaro, Abruzzo, Italy

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Publications (225)1191.02 Total impact

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    ABSTRACT: We evaluated empowerment in T2DM and identified its correlates. A sample of individuals self-administered the Diabetes Empowerment Scale-Short Form (DES-SF) and other 9 validated instruments (person-centered outcomes). Correlates of DES-SF were identified through univariate and multivariate analyses. For person-centered outcomes, ORs express the likelihood of being in upper quartile of DES-SF (Q4) by 5 units of the scale. Overall, 2390 individuals were involved. Individuals in Q4 were younger, more often males, had higher levels of school education, lower HbA1c levels and prevalence of complications as compared to individuals in the other quartiles. The likelihood of being in Q4 was directly associated with higher selfreported self-monitoring of blood glucose (SDSCA6-SMBG) (OR=1.09; 95% CI: 1.03-1.15), higher satisfaction with diabetes treatment (GSDT) (OR=1.15; 95% CI: 1.07-1.25), perceived quality of chronic illness care and patient support (PACIC-SF) (OR=1.23; 95% CI: 1.16-1.31), and better person-centered communication (HCC-SF) (OR=1.10; 95% CI: 1.01-1.19) and inversely associated with diabetes-related distress (PAID-5) (OR=0.95; 95% CI: 0.92-0.98). Adjusted DES-SF mean scores ranged between centers from 69.8 to 93.6 (intra-class correlation=0.10; p<0.0001). Empowerment was associated with better glycemic control, psychosocial functioning and perceived access to person-centered chronic illness care. Practice of diabetes center plays a specific role. DES-SF represents a process and outcome indicator in the practice of diabetes centers. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Patient Education and Counseling 05/2015; DOI:10.1016/j.pec.2015.05.012 · 2.60 Impact Factor
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    ABSTRACT: This study evaluated the effect of supervised exercise training on liver enzymes and two surrogate measures of non-alcoholic fatty liver disease (NAFLD) in subjects with type 2 diabetes. Sedentary patients from 22 outpatient diabetes clinics were randomized by center, age and treatment to twice-a-week supervised aerobic and resistance training plus structured exercise counseling (exercise group, EXE; n=303) versus counseling alone (control group, CON; n=303) for 12 months. EXE participants were further randomized to low-to-moderate (n=142) or moderate-to-high (n=161) intensity training of equal energy cost. Baseline and end-of-study levels of liver enzymes, fatty liver index (FLI) and visceral adiposity index (VAI) were obtained. Enzyme levels did not change, whereas FLI and VAI decreased significantly in EXE, but not CON participants. Physical activity (PA) volume was an independent predictor of both FLI and VAI reductions, the extent of which increased from the 1st to the 4th quintile of PA volume and baseline to end-of-study changes in fitness parameters. Differences in the effect of LI versus HI training were negligible. Data from this large cohort of subjects with type 2 diabetes indicate that FLI and VAI decrease with supervised training in a volume-dependent manner. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Diabetes research and clinical practice 05/2015; DOI:10.1016/j.diabres.2015.05.033 · 2.54 Impact Factor
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    ABSTRACT: Chronic kidney disease (CKD) entails a worse cardiovascular outcome. The aim of our work was to study the relationship between CKD and the achievement of recommended targets for glycated haemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-c) and blood pressure (BP) in a real-life sample of patients with type 2 diabetes mellitus (T2DM). We analysed a sample of 116 777 outpatients from the Network of the Italian Association of Clinical Diabetologists; all patients had T2DM and at least one measurement of HbA1c, LDL-c, BP, serum creatinine and albuminuria in the year 2010. The outcome was the achievement of HbA1c, LDL-c and BP values as recommended by International Guidelines. In the entire sample, the mean value of HbA1c was 7.2 ± 1.2%, of LDL-c was 102 ± 33 mg/dL and of BP was 138/78 ± 19/9 mmHg. CKD and its components were associated with poor glycaemic and BP control, notwithstanding greater use of glucose and BP-lowering drugs, while no association was found with LDL-c values. Factors independently related to unsatisfactory glycaemic control included female gender, body mass index, duration of disease and high albuminuria. Men, older people and those taking statins were more likely to reach LDL-c target levels. Male gender, age and high albuminuria strongly affected the achievement of BP targets. CKD or its components, mainly high albuminuria, are associated with failure to reach therapeutic targets, especially for HbA1c and BP, despite a greater use of drugs in patients with T2DM. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
    Nephrology Dialysis Transplantation 04/2015; DOI:10.1093/ndt/gfv101 · 3.49 Impact Factor
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    ABSTRACT: Objective: The goal of this study was to design, develop, and evaluate a game for health, ''Gustavo in Gnam's Planet'' (''Gustavo''), aimed to improve knowledge on healthy foods and to increase consumption of healthy foods. Subjects and Methods: Eighty-three high school students were enrolled in the study. The game was designed and developed by a multidisciplinary team. Behavioral change theories were adopted to guide the design of the health messages. Participants were assessed about food frequency, healthy food knowledge, and the game's interest. Results: Forty-seven subjects (mean age, 14.9 – 1.0 years; 72.3 percent males) completed the study. At posttest, participants showed significant higher scores (i.e., increased knowledge) in the questionnaire on knowledge of healthy foods (70.0 – 9.2 versus 71.3 – 10.0 for pretest and posttest, respectively; P < 0.05). Improvements in healthy eating habits were also detected: higher frequency of consumption during a week of white meat (1 [1–2] versus 2 [1–2]; P = 0.01), eggs (1 [1–1] versus 1 [1–2]; P = 0.01], and legumes (1 [0–1] versus 1 [1–2]; P = 0.03) and lower frequency of consumption of sugar-containing packaged snacks (1 [0–1] versus 0 [0–1]; P = 0.009). Most of the participants found the game easy to use and clear in its content. Half of the participants found the game interesting. Conclusions: Our study shows that ''Gustavo'' is a promising tool for health education, in schools or in other environments. Limitations of the study and future directions are discussed.
    03/2015; 4(4):Not available-ahead of print. DOI:10.1089/g4h.2014.0107
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    ABSTRACT: Detection of asymptomatic thyroid nodules has increased. Consensus is lacking regarding the optimal follow-up of cytologically proven benign lesions and sonographically nonsuspicious nodules. Current guidelines recommend serial ultrasound examinations and reassessment of cytology if significant growth is observed. To determine the frequency, magnitude, and factors associated with changes in thyroid nodule size. Prospective, multicenter, observational study involving 992 consecutive patients with 1 to 4 asymptomatic, sonographically or cytologically benign thyroid nodules. Patients were recruited from 8 hospital-based thyroid-disease referral centers in Italy between 2006 and 2008. Data collected during the first 5 years of follow-up, through January 2013, were analyzed. Baseline nodule growth (primary end point) was assessed with yearly thyroid ultrasound examinations. Size changes were considered significant for growth if an increase of 20% or more was recorded in at least 2 nodule diameters, with a minimum increase of 2 mm. Baseline factors associated with growth were identified. Secondary end points were the sonographic detection of new nodules and the diagnosis of thyroid cancer during follow-up. Nodule growth occurred in 153 patients (15.4% [95% CI, 14.3%-16.5%]). One hundred seventy-four of the 1567 original nodules (11.1% [95% CI, 10.3%-11.9%]) increased in size, with a mean 5-year largest diameter increase of 4.9 mm (95% CI, 4.2-5.5 mm), from 13.2 mm (95% CI, 12.1-14.2 mm) to 18.1 mm (95% CI, 16.7-19.4 mm). Nodule growth was associated with presence of multiple nodules (OR, 2.2 [95% CI 1.4-3.4] for 2 nodules; OR, 3.2 [95% CI, 1.8-5.6 for 3 nodules; and OR, 8.9 [95% CI, 4.4-18.0] for 4 nodules), main nodule volumes larger than 0.2 mL (OR, 2.9 [95% CI, 1.7-4.9] for volumes >0.2 to <1 mL and OR, 3.0 [95% CI, 1.8-5.1] for volumes ≥1 mL), and male sex (OR, 1.7 [95% CI, 1.1-2.6]), whereas an age of 60 years or older was associated with a lower risk of growth than age younger than 45 years (OR, 0.5 [95% CI 0.3-0.9]). In 184 individuals (18.5% [95% CI, 16.4%-20.9%]), nodules shrank spontaneously. Thyroid cancer was diagnosed in 5 original nodules (0.3% [95% CI, 0.0%-0.6%]). Only 2 had grown. An incidental cancer was found at thyroidectomy in a nonvisualized nodule. New nodules developed in 93 patients (9.3% [95% CI, 7.5%-11.1%]), with detection of one cancer. Among patients with asymptomatic, sonographically or cytologically benign thyroid nodules, the majority of nodules exhibited no significant size increase during 5 years of follow-up and thyroid cancer was rare. These findings support consideration of revision of current guideline recommendations for follow-up of asymptomatic thyroid nodules.
    JAMA The Journal of the American Medical Association 03/2015; 313(9). DOI:10.1001/jama.2015.0956 · 30.39 Impact Factor
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    ABSTRACT: Hypoglycemia is common in type 1 diabetes mellitus (T1DM). We aimed to update the incidence of severe and symptomatic hypoglycemia and investigate several correlated factors. In this multicenter, observational retrospective study, the data of 206 T1DM patients from a sample of 2,229 consecutive patients seen at 18 diabetes clinics were analyzed. Sociodemographic and clinical characteristics, severe hypoglycemia in the past 12 months, and symptomatic hypoglycemia in the past 4 weeks were recorded with a self-report questionnaire and a clinical form during a routine visit. Poisson multivariate models were applied. A minority of patients accounted for the majority of both severe and symptomatic episodes. The incidence rate (IR) of severe hypoglycemia was 0.49 (0.40-0.60) events/person-years. The incidence rate ratio (IRR) was higher in patients with previous severe hypoglycemia (3.71; 2.28-6.04), neuropathy (4.16; 2.14-8.05), long duration (>20 years, 2.96; 1.60-5.45), and on polypharmacy (1.24; 1.13-1.36), but it was lower when a complication was present. The IR of symptomatic hypoglycemia was 53.3 events/person-years, with an IRR significantly higher among women or patients with better education, or shorter duration or on pumps. The IRR was lower in patients with higher BMI or neuropathy or aged more than 50 years. Fewer than 20 % of T1DM patients are free from hypoglycemia, with one in six having experienced at least one severe episode in the last year. The distribution is uneven, with a tendency of episodes to cluster in some patients. Severe and symptomatic episodes have different correlates and reflect different conditions.
    Acta Diabetologica 02/2015; DOI:10.1007/s00592-015-0713-4 · 3.68 Impact Factor
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    ABSTRACT: The study aimed to evaluate the frequency of episodes of symptomatic hypoglycemia (SH) in elderly patients with type 2 diabetes and their impact on quality of life. The study was conducted in 12 Italian regions. Participants filled in a questionnaire collecting data on socio-demographic and clinical characteristics and episodes of SH occurred in the last 4 weeks. The questionnaire included validated scales measuring fear of hypoglycemia (FHQ), psychological well-being (WHO-5), and diabetes-related distress (PAID-5). Overall, 1,323 participants were involved (mean age 70.0 ± 8.7, 47.6 % male, disease duration 15.6 ± 11.7, 63.2 % treated with oral agents, 16.9 % with insulin alone, 14.4 % with insulin plus oral agents), of whom 44.6 % reported 1-3 episodes of SH and 23.8 % reported more than 3 episodes. Patients who reported SH had significantly higher levels of fear of hypoglycemia, lower psychological well-being, and higher diabetes-related distress (p < 0.0001 for all the scales). At multivariate analysis, the experience of more than 3 episodes of hypoglycemia was associated with a 13-fold higher risk of high fear of hypoglycemia (aOR = 13.3; CI 95 % 8.4-21.0), an almost 60-fold higher risk of high diabetes-related distress (PAID-5 score ≥40) (aOR = 59.1; CI 95 % 29.2-119.8), and a higher risk of low psychological well-being (WHO-5 <50) (aOR = 1.5; CI 95 % 0.9-2.4). The occurrence of symptoms of hypoglycemia is very common among older adults with diabetes and their presence is associated with an extremely negative impact on quality of life. Minimizing the risk of hypoglycemia represents a high priority in the diabetes treatment of elderly people.
    Acta Diabetologica 02/2015; DOI:10.1007/s00592-015-0717-0 · 3.68 Impact Factor
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    ABSTRACT: Background. Dyslipidemia contribute to the excess of coronary heart disease (CHD) risk observed in women with type 2 diabetes (T2DM). Low density lipoprotein-cholesterol (LDL-C) is the major target for CHD prevention, and T2DM women seem to reach LDL-C targets less frequently than men. Aim. To explore age- and gender-related differences in LDL-C management in a large sample of outpatients with T2DM. Results. Overall, 415.294 patients (45.3% women) from 236 diabetes centers in Italy were included. Women were older and more obese, with longer diabetes duration, higher total-cholesterol, LDL-C, and HDL-C serum levels compared to men (P < 0.0001). Lipid profile was monitored in ~75% of subjects, women being monitored less frequently than men, irrespective of age. More women did not reach the LDL-C target as compared to men, particularly in the subgroup treated with lipid-lowering medications. The between-genders gap in reaching LDL-C targets increased with age and diabetes duration, favouring men in all groups. Conclusions. LDL-C management is worst in women with T2DM, who are monitored and reach targets less frequently than T2DM men. Similarly to men, they do not receive medications despite high LDL-C. These gender discrepancies increase with age and diabetes duration, exposing older women to higher CHD risk.
    International Journal of Endocrinology 01/2015; 2015:957105. DOI:10.1155/2015/957105 · 1.52 Impact Factor
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    ABSTRACT: Objective Quality of care monitoring is a key strategy for health policy. In Italy, the AMD Annals continuous monitoring and quality improvement initiative has been in place since 2006. Results after 8 years are now available. Research design and methods Quality of diabetes care indicators during the years 2004–2011 were extracted from electronic medical records of 300 diabetes clinics. From 200,000 to 500,000 patients with type 2 diabetes were analyzed per year. Six process indicators, eight intermediate outcome indicators, seven indicators of treatment intensity/appropriateness, and a quality of care summary score (Q score) were evaluated. Previous studies documented that the risk of developing a new cardiovascular event was 80 % higher in patients with a Q score 25. Results The proportion of patients with HbA1c ≤7 %, LDL cholesterol Q score Q score >25 increased from 22.9 to 38.5 %. Conclusions AMD Annals document the progress in quality of diabetes care. Longitudinal improvements in Q score can translate into less cardiovascular events, with evident clinical and economic implications. AMD Annals represent a physician-led effort not requiring allocation of extra-economic resources, which is easy to implement and deeply rooted in routine clinical practice. They are a potential case model for other healthcare systems.
    Acta Diabetologica 12/2014; 52(3). DOI:10.1007/s00592-014-0688-6 · 3.68 Impact Factor
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    ABSTRACT: Abstract Objectives. Adherence to insulin therapy can be threatened by pain and needle fear. This cross-over randomised non inferiority trial evaluated a new Pic Insupen 33Gx4mm needle vs. a 32Gx4mm needle in terms of metabolic control, safety and acceptability in patients with diabetes treated with insulin. Research design and methods. We used a centralised, permuted block randomisation, stratified by centre and maximum insulin dose per single injection. Subjects used the two needles in two 3-week treatment periods. The primary endpoint was the absolute percentage variation of the blood fructosamine between the two treatments (% |ΔFru|). Additional endpoints were: glycemic variability, total insulin doses, body weight, severe hypoglycaemic episodes, leakage at injection sites and pain measured by visual analogue scale. Equivalent glycemic control was defined a priori as % |ΔFru| (including 95% CI) within 20%. Results. Of 87 subjects randomized, 77 completed the study (median age 53.1 (IR 42.3-61.2), median BMI 24.3 Kg/m(2) (IR 21.3-28.5), median duration of insulin therapy (in months) 141.4 (IR 56.3-256.9), median baseline HbA1c 7.9% (IR 7.2-8.8)). % |ΔFru| was 7.93% (95% CI 6.23-9.63), meeting the non inferiority criterion. The fasting blood glucose standard deviation was 46.2 (mean 154.6) with the 33G needle and 42.8 (mean 157.3) with the 32G needle (p=0.42). Insulin daily dose and patients' weight did not show any statistically significant variation. We observed 95 episodes of symptomatic hypoglycaemia with the 33G needle and 96 with the 32G needle. One episode of severe hypoglycaemia was documented in the latter group. As for insulin leakage we observed 37.55 episodes per 100 patient-days with the 33G needle and 32.21 episodes per 100 patient-days with the 32G needle (p=0.31). Patients reported less pain with the 33Gx4mm needle (p=0.05). Study limitations. Study sample was mainly composed of adults with type 1 diabetes and study was not blinded. Conclusions. The 33G needle is not inferior to the 32G needle in terms of efficacy and safety, with reduced pain and no difference in insulin leakage. Clinical trial registration: NCT01745549.
    Current Medical Research and Opinion 12/2014; 31(3):1-18. DOI:10.1185/03007995.2014.993025 · 2.37 Impact Factor
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    ABSTRACT: Beta-cell dysfunction is an early event in the natural history of type 2 diabetes. However, its progression is variable and potentially influenced by several clinical factors. We report the baseline data of the BetaDecline study, an Italian prospective multicenter study on clinical predictors of beta-cell dysfunction in type 2 diabetes.
    PLoS ONE 10/2014; 9(10):e109702. DOI:10.1371/journal.pone.0109702 · 3.53 Impact Factor
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    ABSTRACT: The aim of this study was to estimate the incidence of type 2 diabetes (primary objective) and hospitalisation for cardiovascular events (secondary objective) in women with previous gestational diabetes mellitus (GDM) and in those with normal glucose tolerance (NGT) in pregnancy, and to evaluate the role of stillbirth in differentiating the risks.
    Diabetologia 10/2014; DOI:10.1007/s00125-014-3403-9 · 6.88 Impact Factor
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    ABSTRACT: Background and aims: The prevalence of diabetes in people over 75 years approaches 30%, while at least 25% of all patients attending Italian outpati ents diabetes clinics are older than 75 years. Clinicians who manage older people with diabetes re quire special skills to provide high-quality care. In the context of a continuous quality improvement initiative promoted in Italy by Associazione Medici Diabetologi (AMD Annals initiative), we eval uated the trends over 8 years in the quality of care provided by diabetes clinics to elderly patien ts (i.e. > 75 years). Materials and methods: Overall, 300 diabetes clinics (about half of all c linics in Italy), all using electronic medical record systems, extracted data r elative to the years 2004-2011 . The proportion of patients with at least one value registered during each year (process measures), the percentage of patients reaching specific favorable or unfavorable targets (intermediate outcome measures), and rates of use of drugs were evaluated. In addition, a qual ity of care summary score (Q score) was calculated. The Q score, ranging between 0 and 40, is based on process and outcome indicators (HbA1c, blood pressure, LDL-cholesterol, microalbuminuria) and is closely related to long-term outcomes in diabetic patients. Results: Over the years, there was an increase in the perce ntage of patients aged > 75 years (19.9% in 2004 vs. 27.2% in 2011) and in the prevalence of ma le patients (42% in 2004 vs. 46% in 2011). As compared to 2004 we observed after 8 years a slight increase in the mean age (79.9±3.8 vs. 80.5±4.1) and in the duration of diabetes (13.8±10.5 vs. 14.2 ±10.9). Table 1 shows quality of care indicators. Conclusion: Care provided by diabetes clinics to elderly patie nts shows a significant improvement over the years. Elderly patients are more frequentl y monitored for blood pressure, lipid profile and microalbuminuria, show better intermediate outcomes and are less often treated with sulphonylureas. In addition we observe a better global quality of c are with a significant increase in the Q score thro ugh the years.
    50th Scientific Session, European Association for the Study of Diabetes, Vienna; 09/2014
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    ABSTRACT: Background and aims: In the framework of an EU funded study, the “Safet y Evaluation of Adverse Reactions in Diabetes (SAFEGUARD) project”, a meta- analysis of randomized clinical trials (RCTs) to assess the cardiovascular (CV) safety of dipepti dyl peptidase-4 inhibitors (DPP-4i) was performed. Materials and methods: Trials were identified through searches of MEDLINE , EMBASE and Cochrane databases (January 1966-September 2013) us ing standard search strategies. Reference lists of selected articles were also checked. Eligible st udies included published RCTs that compared DPP- 4i against placebo/no treatment, or another non-ins ulin blood glucose lowering agent in individuals with type 2 diabetes and reported major CV events ( CV mortality, sudden death, myocardial infarction, stroke, or heart failure). Two reviewer s independently assessed trials for inclusion and extracted data. Effect estimates were pooled using fixed or random effects meta-analysis based on exact bivariate non-linear mixed models. Results ar e reported as relative risks (RR) with 95% confidence intervals (CI). Results: The electronic search identified 8,168 citations o n all non-insulin blood glucose lowering agents, of which 334 were selected. Out of 140 RCTs on DPP-4i, 70 reported at least one CV event. When DPP-4i were compared with placebo/no treatment , no association was suggested with CV mortality (27 studies, 43,381 participants; RR=0.85 ; 0.71-1.02), sudden death (15 studies, 23,494 participants; RR=1.17; 0.90-1.51), myocardial infar ction (20 studies, 27,553 participants; RR=0.95; 0.84-1.09), and ischemic stroke (15 studies, 27,224 participants; RR=1.04; 0.84-1.29). There was an increase in the risk of heart failure in patients t reated with DPP-4i compared to placebo (9 studies, 20,349 participants; RR=1.24, 1.03-1.49). For activ e comparator studies no association was found for CV mortality (24 studies, 22,064 participants; RR=0 .92; 0.50-1.70), sudden death (8 studies, 7,130 participants; RR=0.83; 0.23-3.00), myocardial infar ction (12 studies, 5,453 participants; RR=0.70; 0.34-1.43), or heart failure (6 studies, 6180 parti cipants; RR=1.31; 0.50-3.43). DPP-4i reduced the ri sk of ischemic stroke when compared to active comparat or (8 studies, 7,777 participants; RR=0.33; 0.14- 0.79). Conclusion: These results, based on publicly available data, s uggest that DPP-4i did not influence the risk of CV mortality or other CV events in comparis on with placebo/no treatment, except for an increased risk of heart failure. However, the resul ts are driven by the findings from the “Saxagliptin Assessment of Vascular Outcomes Recorded in Patient s with Diabetes Mellitus (SAVOR)- Thrombolysis in Myocardial Infarction (TIMI) 53” st udy and the finding needs to be confirmed by pooling these data with those of other ongoing stud ies specifically designed to assess the effect on C V end-points. Furthermore, DPP-4i showed a lower risk of ischemic stroke than active comparators. Additional trial data are required before definitiv ely draw conclusions on CV safety of DPP-4i. Supported by: EC 7th Framework Programme (FP7/2007- 2013 grant agreement 282521– SAFEGUARD
    50th Scientific Session, European Association for the Study of Diabetes, Vienna; 09/2014
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    ABSTRACT: Background and aims: Women with gestational diabetes mellitus (GDM) are at increased risk for the onset of type 2 diabetes (T2DM) and cardiovascular disease in the years following pregnancy. Aim of the study was to estimate the incidence of T2DM and cardiovascular events in women with previous GDM and in those with normal glucose tolerance in pregnancy and to evaluate the rol e of stillbirth in differentiating the risks. Materials and methods: A population - based cohort study using administrative data of 12 local health authorities in Puglia, Italy, during the index period from January 1, 2002, to December 31, 2010 was conducted . From a population - based sample of 2.1 million women we identified those with a diagnosis of GDM during the index period and they were propensity - matched on a 1 - to - 3 basis with women without GDM or diabetes mellitus. Characteristics that were matched were age, local health authority code, use of antihypertensive and antithrombotic agents. Main outcome measures were T2DM development and hospitalizations for cardiovascular events occurring after a pregnancy complicated by GDM and ended at term or in miscarri age. Results: There were 3851 women with GDM (mean age 37.1±5.9 years) and 11553 matched controls without GDM. During a median follow - up of 5.4 years, the incidence rate of T2DM was of 2.1 per 1000 person - years in women without GDM, of 54.0 per 1000 person - years among women with GDM and pregnancy at term, and 115.0 per 1000 person - years among women with GDM and a pregnancy ended in stillbirth. The cumulative IRs of T2DM development showed that GDM increased the risk of T2DM by 21.7 times, while GDM complica ted by stillbirth increased the risk of T2DM by 46.9 times as compared with women with a normal pregnancy. GDM and stillbirth during GDM were associated with a significantly higher risk of cardiovascular events compared with normal pregnancy (IRR, 2.4;95% CI, 1.5 to 3.8 and IRR, 16.7; 95% CI, 3.7 to 74.7, respectively). Conclusion: Pregnancy complicated by GDM and ended in stillbirth represents a decisive factor in determining the development of T2DM and future cardiovascular events. For this reason these w omen deserve a careful follow - up
    50th Scientific Session, European Association for the Study of Diabetes, Vienna; 09/2014
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    ABSTRACT: The Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicentre Study is an ongoing observational survey that examines the role of estimated glomerular filtration rate (eGFR) as an independent predictor of cardiovascular and renal outcomes in 15,773 Italian subjects with type 2 diabetes. The analysis of data collected at the enrollment visit has provided a picture of chronic kidney disease (CKD) and its association with other complications, risk factors for cardiovascular disease (CVD) and treatments in a large contemporary cohort. Main results of this analysis were that (a) non-albuminuric renal impairment is the predominant clinical phenotype in patients, particularly women, with reduced eGFR; (b) concordance rate between CKD and diabetic retinopathy is low, with only a minority of patients with renal dysfunction presenting with any or advanced retinal lesions; (c) the non-albuminuric form is associated with a significant prevalence of CVD, especially at the level of coronary vascular bed; (d) CKD is associated with hemoglobin (Hb) A1c variability more than with average HbA1c, whereas retinopathy and CVD are not; (e) in elderly individuals with moderate-to-severe eGFR reduction, use of agents which are not recommended, such as sulphonylureas and metformin, is still frequent ; and (f) though complications are generally more prevalent in men (except non-albuminuric renal impairment) women show a less favourable CVD risk profile and achieve therapeutic targets to a lesser extent than men, despite the fact that treatment intensity is nor lower. These data update existing information on the natural history of CKD in patients with type 2 diabetes. Trial registration number and date NCT00715481; 10.07.2008.
    Nutrition, metabolism, and cardiovascular diseases: NMCD 08/2014; 24(8). DOI:10.1016/j.numecd.2014.02.013 · 3.88 Impact Factor
  • 25° Congresso Nazionale - Società Italiana Diabetologia, Bologna; 05/2014
  • 25° Congresso Nazionale - Società Italiana Diabetologia, Bologna, Bologna; 05/2014
  • 25° Congresso Nazionale - Società Italiana Diabetologia, Bologna; 05/2014
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    ABSTRACT: Appropriate management of hyperglycemia is crucial for patients with type 2 diabetes. Aim of the FADOI-DIAMOND study was to evaluate real-world management of type 2 diabetic patients hospitalized in Internal Medicine wards (IMW) and the effects of a standardized educational intervention for IMW staff. DIAMOND has been carried out in 53 Italian IMW, with two cross-sectional surveys interspersed with an educational program (PRE phase and POST phase). In PRE phase, each center reviewed the charts of the last 30 hospitalized patients with known type 2 diabetes. An educational program was conducted in each center by means of the "outreach visit," a face-to-face meeting between IMW staff and a trained external expert. Six months after, each center repeated the data collection (POST phase), specular to the PRE. A total of 3,167 patients were enrolled (1,588 PRE and 1,579 POST). From PRE phase to POST, patients with registered anthropometric data (54.1 vs. 74.9 %, p < 0.001) and in-hospital/recent measurement of glycated hemoglobin (48.2 vs. 61.4 %, p < 0.005) increased significantly. After educational program, more patients received insulin during hospitalization (68.3 vs. 63.6 %, p = 0.005). A more relevant variation in glycemia during hospitalization was observed in POST phase than PRE (-22.2 vs. -15.5 mg/dL, p < 0.001), without differences as for occurrence of hypoglycemia (12.3 vs. 11.9 %). A one-shot educational intervention led to persistent improvement in the management of hospitalized patients with type 2 diabetes and to significant better glycemic control. Further studies might evaluate the effectiveness of a more aggressive educational program, on both management and outcomes.
    Acta Diabetologica 04/2014; 51(5). DOI:10.1007/s00592-014-0585-z · 3.68 Impact Factor

Publication Stats

5k Citations
1,191.02 Total Impact Points


  • 1989–2015
    • CMNS Consorzio Mario Negri Sud
      • Department of Clinical Pharmacology and Epidemiology
      Santa Maria Imbaro, Abruzzo, Italy
  • 2002–2013
    • Università di Pisa
      • Department of Clinical and Experimental Medicine
      Pisa, Tuscany, Italy
    • Novo Nordisk
      København, Capital Region, Denmark
  • 2011–2012
    • Sapienza University of Rome
      • Department of Clinical and Molecular Medicine
      Roma, Latium, Italy
  • 2009–2012
    • Università degli Studi di Bari Aldo Moro
      Bari, Apulia, Italy
  • 2010
    • University of Otago
      • Department of Medicine (Dunedin)
      Dunedin, Otago, New Zealand
    • Sant'Andrea Medical Hospital
      Spezia, Liguria, Italy
  • 2005–2007
    • University of California, Irvine
      Irvine, California, United States
  • 1988–2004
    • Mario Negri Institute for Pharmacological Research
      • • Unit of Pharmacoepidemiology Unit
      • • Laboratory of Clinical Epidemiology
      Milano, Lombardy, Italy
  • 2001–2003
    • Tufts University
      Бостон, Georgia, United States
  • 1997
    • McGill University
      Montréal, Quebec, Canada
  • 1996
    • Università degli Studi di Perugia
      Perugia, Umbria, Italy