Basilio Pintaudi

Azienda Ospedaliera Niguarda Ca' Granda, Milano, Lombardy, Italy

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Publications (33)64.92 Total impact

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    ABSTRACT: To describe the degree of diffusion and acceptance of national guideline on screening and diagnosis of gestational diabetes (GDM) among Italian diabetes centers and to detect possible areas for benchmarking.
    No preview · Article · Jan 2016
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    ABSTRACT: Objective: To evaluate whether myo-inositol supplementation may reduce gestational diabetes mellitus (GDM) rate in overweight women.Methods: In an open-label, randomized trial, myo-inositol (2 g plus 200 μg folic acid twice a day) or placebo (200 μg folic acid twice a day) was administered from the first trimester to delivery in pregnant overweight non-obese women (pre-pregnancy body mass index ≥ 25 and < 30 kg/m2). The primary outcome was the incidence of GDM.Results: From January 2012 to December 2014, 220 pregnant women were randomized at two Italian University hospitals, 110 to myo-inositol and 110 to placebo. The incidence of GDM was significantly lower in the myo-inositol group compared to the placebo group (11.6% versus 27.4%, respectively, p = 0.004). Myo-inositol treatment was associated with a 67% risk reduction of developing GDM (OR 0.33; 95% CI 0.15–0.70).Conclusions: Myo-inositol supplementation, administered since early pregnancy, reduces GDM incidence in overweight non-obese women.
    No preview · Article · Dec 2015 · Journal of Maternal-Fetal and Neonatal Medicine
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    ABSTRACT: Aim: Our objective was to compare, in a Caucasian population, the perinatal outcomes of pregnancies complicated by pregestational diabetes diagnosed in the first-trimester of pregnancy with those of pregnancies complicated by gestational diabetes. Methods: A retrospective evaluation of maternal and neonatal outcomes was performed for all consecutive pregnancies complicated by gestational or pregestational diabetes that happened between 2005 and 2011. Pregestational diabetes was diagnosed for the first time in pregnancy if the first-trimester fasting glycaemia was≥126mg/dL. Gestational diabetes was diagnosed according to Carpenter-Coustan criteria until May 2010, and then according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) panel criteria modified by the American Diabetes Association. A specific diet, self-monitoring of blood glucose and, if required, insulin treatment were prescribed. Results: Overall, 411 pregnant women were considered eligible for the study (379 with gestational diabetes and 32 with pregestational diabetes). Women with pregestational vs. gestational diabetes were diagnosed earlier in pregnancy (11.6±1.0 weeks vs. 25.9±1.7 weeks; P=0.0001), had a higher mean first-trimester fasting glycaemic level (129.5±3.6mg/dL vs. 81.6±10.5mg/dL; P=0.0001), more often had a family history of diabetes (46.9% vs. 25.9%; P=0.02) and more often needed insulin treatment (78.1% vs. 14.0%; P=0.0001). Furthermore, a higher rate of fetal malformations in women with pregestational diabetes was detected (9.4% vs. 1.6%, P=0.02). No other differences in neonatal outcomes were identified. Conclusion: In a Caucasian population, the prevalence of fetal malformations and insulin requirements with pregestational diabetes first diagnosed in pregnancy were significantly higher compared with women with gestational diabetes. In any case, glucose impairment in pregnancy needs to be diagnosed in a timely fashion and appropriately treated to improve both maternal and fetal outcomes.
    No preview · Article · Dec 2015 · Diabetes & Metabolism
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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.
    Full-text · Article · Sep 2015
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    ABSTRACT: Objective: To evaluate correlates of high diabetes-related distress (HD) among individuals with type 2 diabetes mellitus (T2DM). Methods: The study involved a sample of patients with T2DM who filled in the Problem Areas in Diabetes questionnaire (PAID-5); a score >= 40 indicates HD. Additional instruments included: SF12 health survey (SF12), Well-Being Index (WHO-5), Diabetes Empowerment Scale-Short Form (DES-SF), Patient Assessment of Chronic Illness Care-Short Form (PACIC-SF), Health Care Climate-Short Form (HCC-SF), Global Satisfaction with Diabetes Treatment (GSDT), Summary of Diabetes Self-Care Activities (SDSCA-6); Barriers to Medications (BM), Perceived Social Support (PSS). Clinical data were extracted from computerized medical records. Multivariable logistic regression analyses were performed to identify correlates of HD. Results: Of 2374 patients (mean age 65.0 +/- 10.2 years, diabetes duration 14.0 +/- 15.3 years, 59.9% males), 1429 (60.2%) had HD. Compared to patients with a PAID-5 score < 40 those with HD were more often female, living alone, had a lower level of education, higher HbA1c levels, a greater perceived impact of hyperglycemic and hypoglycemic symptoms, a greater number of diabetes-related complications, lower scores of WHO-5, DES-SF, PSS, GSDT, SF-12 PCS, SDSCA-healthy diet and physical activity subscales, higher scores of BM and SDSCA-SMBG component. Multivariable analyses confirmed the relationship between HD and symptoms of hyperglycemia, levels of empowerment, global satisfaction with treatment, perception of barriers to medication, and psychological well-being. Conclusion HD is extremely common among people with T2DM, affecting almost two-thirds of patients. High levels of distress are associated with worse clinical and psychosocial outcomes and should be considered as a key patient-centered indicator.
    No preview · Article · Sep 2015 · Journal of Psychosomatic Research
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    ABSTRACT: To evaluate whether myo-inositol supplementation, an insulin sensitizer, reduces the rate of gestational diabetes mellitus (GDM) and lowers insulin resistance in obese pregnant women. In an open-label, randomized trial, myo-inositol (2 g plus 200 micrograms folic acid twice a day) or placebo (200 micrograms folic acid twice a day) was administered from the first trimester to delivery in pregnant obese women (prepregnancy body mass index 30 or greater. We calculated that 101 women in each arm would be required to demonstrate a 65% GDM reduction in the myo-inositol group with a statistical power of 80% (α=0.05). The primary outcomes were the incidence of GDM and the change in insulin resistance from enrollment until the diagnostic oral glucose tolerance test. From January 2011 to April 2014, 220 pregnant women at 12-13 weeks of gestation were randomized at two Italian university hospitals, 110 to myo-inositol and 110 to placebo. Most characteristics were similar between groups. The GDM rate was significantly reduced in the myo-inositol group compared with the control group, 14.0% compared with 33.6%, respectively (P=.001; odds ratio 0.34, 95% confidence interval 0.17-0.68). Furthermore, women treated with myo-inositol showed a significantly greater reduction in the homeostasis model assessment of insulin resistance compared with the control group, -1.0±3.1 compared with 0.1±1.8 (P=.048). Myo-inositol supplementation, started in the first trimester, in obese pregnant women seems to reduce the incidence in GDM through a reduction of insulin resistance. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01047982.
    No preview · Article · Aug 2015 · Obstetrics and Gynecology
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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.
    No preview · Article · May 2015 · Patient Education and Counseling
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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.
    Full-text · Article · Apr 2015 · International Journal of Endocrinology
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    ABSTRACT: Context: Autoimmune thyroid diseases (AITD) can be associated with type 1 diabetes (T1D). The prevalence of serum antibodies against thyroid hormones (THAb) in subjects with autoimmune diseases others than T1D is increasing. No data are available for T1D. Objective: To evaluate: the rate of associated AITD; the rate of positiveness for serum THAb; the panel of THAb based on thyroid hormone interaction and on immunoglobulin class; the association of AITD alone, THAb alone or AITD plus THAb with diabetes-related complications. Design: Observational, prospective, study with six years (2005-2011) follow-up. Setting: Outpatient diabetes clinic. Patients: 52 consecutive subjects (53.8% males, mean age 37.4±7.4 years, diabetes duration 19.9±8.2 years) with T1D. All participants completed the study. Main Outcome Measures: AITD rate; THAb positivity according to hormone interaction and to immunoglobulin class; association of AITD and THAb with diabetes-related complications. Results: AITD rate increased from baseline (34.6%) to follow-up (38.5%). Subjects with T1D had a high prevalence of THAb (92.3%). The presence of AITD at baseline was associated with subsequent development of macroangiopathy (0% vs. 33% at baseline and follow-up, respectively; p=0.029). Some THAb patterns, the majority having T3 binding in common, were associated with the progression and the development of diabetes-related complications. Conclusions: THAb synthesis in T1D might be driven by increased glycosylation of thyroglobulin. Anti T3-THAb may cause a relative "tissue hypothyroidism" by sequestering thyroid hormone, this at least partially contributing in worsening diabetes-related vascular complications. In a clinical setting THAb positivity could identify subjects more likely to develop diabetes complications.
    No preview · Article · Feb 2015 · Journal of Clinical Endocrinology & Metabolism
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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.
    Full-text · Article · Feb 2015 · Acta Diabetologica
  • Basilio Pintaudi · Antonio Nicolucci
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    ABSTRACT: Self-monitoring of blood glucose (SMBG) is an integral component of diabetes care for patients with type 1 diabetes mellitus (T1DM). It is an essential tool for the improvement of glycemic control and to increase patient empowerment and adherence to treatment. The standard recommended frequency of SMBG in T1DM is 3-4 times daily, even though many patients might require more frequent monitoring in special conditions. The frequency of testing should be agreed upon by the patients and their healthcare teams. As a general rule, more blood glucose tests are needed as the therapy becomes more intensive. People using insulin pump therapy should perform SMBG at least 4-6 times daily, and especially during establishment of pump therapy. To confirm hypoglycemia, patients must perform SMBG and repeat it every 15 min until euglycemia. Patients undergoing frequent asymptomatic hypoglycemia should perform SMBG more often. During intercurrent illness, patients need to monitor their blood glucose levels at least every 4 h, or every 2 h when blood glucose levels keep rising, to avoid diabetic ketoacidosis. With physical activity, patients should perform SMBG before, during, and after exercise. While driving, SMBG should be performed before leaving and at 2-hour intervals during long journeys. The issue of SMBG in women with T1DM deserves specific attention, especially during the menstrual period, preconception time, pregnancy (at least 7 tests/day), and breastfeeding.
    No preview · Article · Jan 2015 · Frontiers in Diabetes
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    ABSTRACT: Aims/hypothesis: 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. Methods: This was a population-based cohort study using administrative data and involving 12 local health authorities. Women with GDM (n = 3,851) during the index period from 2002 to 2010 were propensity matched with women with NGT (n = 11,553). Information was collected on type 2 diabetes development and hospitalisation for cardiovascular events. Results: During a median follow-up of 5.4 years, the incidence rate per 1,000 person-years of type 2 diabetes was 2.1 (95% CI 1.8, 2.5) in women without GDM and 54.0 (95% CI 50.2, 58.0) among women with GDM and pregnancy at term (incidence rate ratio [IRR] 26.9; 95% CI 22.1, 32.7 compared with NGT and pregnancy at term). A history of stillbirth increased the risk of type 2 diabetes development by about twofold, irrespective of GDM status. No significant interaction between stillbirth and GDM on type 2 diabetes risk was found. GDM was associated with a significantly higher risk of cardiovascular events compared with NGT (IRR 2.4; 95% CI 1.5, 3.8). Conclusions/interpretation: Pregnancy complicated by GDM and ending in stillbirth represents an important contributory factor in determining type 2 diabetes development. Women with GDM are at a high risk of future cardiovascular events. Women with pregnancy complicated by GDM and stillbirth deserve careful follow-up.
    Full-text · Article · Oct 2014 · Diabetologia
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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
    Full-text · Conference Paper · Sep 2014
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    ABSTRACT: 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.
    Full-text · Article · Sep 2014 · Giornale Italiano di Diabetologia e Metabolismo
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    ABSTRACT: Background: Sclerostin is an osteocyte derived inhibitor of the Wnt/β Catenin signaling pathway which acts as a negative regulator of bone formation. Published data on sclerostin levels in type 1 diabetes mellitus (T1DM) are few. Objective: To evaluate gender differences in sclerostin serum levels, and the association between sclerostin, bone mass, bone metabolism and the main clinical characteristics of subjects with T1DM. Design and methods: Sixty-nine patients with T1DM (mean age 33.7± 8.1; 49% males) were enrolled in this study cross-sectional study in a clinical research center. Bone mineral density was measured by phalangeal quantitative ultrasound (QUS); bone turnover markers (urinary PYR, D-PYR, OH-PRO to evaluate bone resorption; serum B-ALP and BGP to evaluate bone formation) and sclerostin were assessed. Results: D-PYR and sclerostin were significantly higher in women in comparison to men (P=0.04). A disease duration greater than 15 years was associated to higher sclerostin levels (P=0.03). Bone turnover markers and QUS parameters were not correlated to sclerostin. A significant negative correlation was observed between QUS parameters, BMI and OH-PRO. Sclerostin serum levels correlated with homocysteine (r=-0.34; P=0.005) and vitamin B12 (r=-0.31; P=0.02). Generalized linear model showed that macroangiopathy was the only predictor of sclerostin serum levels (beta=-11.8, 95%CI from -21.9 to -1.7; P=0.02). Conclusions: Our data demonstrate that women with T1DM exhibit higher sclerostin levels than men, and that circulating sclerostin is not associated with bone turnover markers and phalangeal QUS measurements. Macroangiopathy was associated with sclerostin levels.
    Full-text · Article · Jun 2014 · European Journal of Endocrinology

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  • No preview · Conference Paper · Mar 2014
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    ABSTRACT: In the context of the DAWN-2 initiatives, the BENCH-D Study aims to test a model of regional benchmarking to improve not only the quality of diabetes care, but also patient-centred outcomes. As part of the AMD-Annals quality improvement program, 32 diabetes clinics in 4 Italian regions extracted clinical data from electronic databases for measuring process and outcome quality indicators. A random sample of patients with type 2 diabetes filled in a questionnaire including validated instruments to assess patient-centred indicators: SF-12 Health Survey, WHO-5 Well-Being Index, Diabetes Empowerment Scale, Problem Areas in Diabetes, Health Care Climate Questionnaire, Patients Assessment of Chronic Illness Care, Barriers to Medications, Patient Support, Diabetes Self-care Activities, and Global Satisfaction for Diabetes Treatment. Data were discussed with participants in regional meetings. Main problems, obstacles and solutions were identified through a standardized process, and a regional mandate was produced to drive the priority actions. Overall, clinical indicators on 78,854 patients have been measured; additionally, 2,390 patients filled-in the questionnaire. The regional mandates were officially launched in March 2012. Clinical and patient-centred indicators will be evaluated again after 18 months. A final assessment of clinical indicators will take place after 30 months. In the context of the BENCH-D study, a set of instruments has been validated to measure patient well-being and satisfaction with the care. In the four regional meetings, different priorities were identified, reflecting different organizational resources of the different areas. In all the regions, a major challenge was represented by the need of skills and instruments to address psychosocial issues of people with diabetes. The BENCH-D study allows a field testing of benchmarking activities focused on clinical and patient-centred indicators.
    Full-text · Article · Feb 2014 · SpringerPlus

  • No preview · Conference Paper · Feb 2014
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    Full-text · Article · Jan 2014 · Giornale Italiano di Diabetologia e Metabolismo

Publication Stats

108 Citations
64.92 Total Impact Points

Institutions

  • 2015
    • Azienda Ospedaliera Niguarda Ca' Granda
      Milano, Lombardy, Italy
  • 2013-2015
    • CMNS Consorzio Mario Negri Sud
      Italy
  • 2011-2015
    • Università degli Studi di Messina
      • Dipartimento di Medicina Clinica e Sperimentale
      Messina, Sicily, Italy