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Introduction: Recent guidelines for the treatment of type 2 diabetes mellitus (T2DM) provide evidence supporting limited use of sulphonylureas (SUs), especially in specific risk patient categories, yet data from national registries still suggest their widespread use. The aim of this study was to investigate characteristics of patients with diabetes treated with SUs and quantify the proportion of patients that met the recommendations for use of SUs by recent guidelines and of those presenting characteristics representing an inappropriate prescription risk (IPR). Methods: A multicenter, retrospective, cross-sectional, observational study in patients with T2DM receiving treatment with SUs (as monotherapy or in combination with another diabetes therapy) was conducted between 2017 and 2018 in 22 outpatient diabetes clinics across Italy. Exclusion criteria were type 1 diabetes, diabetes mellitus secondary to other conditions, and presence of severe/life-threatening diseases. Results: A total of 510 patients with T2DM (306 men, 204 women; mean age ± standard deviation 69.8 ± 9.3 years) who were receiving treatment with a SU (as monotherapy or in combination therapy) were assessed in the study. Overall, 70.6% [n = 360; 95% confidence interval (CI) 66.4%, 74.5%] were assessed to have an IPR. Of these, approximately half presented one factor for risk of inappropriate prescription, and 27 and 10.6% presented two and three factors, respectively. In terms of factors contributing to the total burden of risk of inappropriate treatment with SUs, 37.5% (95% CI 33.2%, 41.8%) of all patients were obese; 33.3% (95% CI 29.3%, 37.6%)] were aged ≥ 75 years; 18.6% (95% CI 15.3%, 22.3%) had a history of cardiovascular disease; 14.1% (95% CI 11.2%, 17.4%) had chronic renal insufficiency; 1.8% (95% CI 0.8%, 3.3%) had a history of severe hypoglycemia; 1.8% (95% CI 0.8%; 3.3%) had cognitive impairment; and 2.4% (95% CI 1.2%, 4.1%) had a risky occupation. Conclusions: The results of this study provide evidence of a high rate of inappropriate SU prescription risk among patients with T2DM, especially among those with overweight/obesity, older age, history of cardiovascular disease, and hypoglycemia. [ABSTRACT FROM AUTHOR]

Aims: The aim of our study was to estimate the overall rate of first hospitalizations for diabetic foot (DF) regardless of the outcome in amputations, as well as the mortality rate with their determinants in the period 2012–2016 in Piedmont Region in Italy. Methods: The study included all the subjects registered in the Regional Diabetes Registry and alive as at January 1, 2012. DF cases were identified by record linkage with the regional hospital discharge database. Incident cases of diabetic foot were followed up for mortality. Results: The 5-year rates were 1762, 324, and 343 × 100,000 patients for first hospitalization without amputations, with major amputations, and with minor amputations, respectively. Patients not undergoing amputations were more than 70% of the cohort. Patients with the more severe stages of diabetes and those with low education were at higher risk of each type of hospitalization. The risk of death during a mean follow-up of 2.5 years was about 16, 18, and 30% among patients without amputations, with major amputations, and with minor amputations, respectively. Males, insulin-treated patients, those affected with severe diabetes complications, particularly on dialysis, and those with lower levels of education were at higher risk. Conclusions: The heavier burden of DF on hospitalizations is due to cases without amputation, a condition that is seldom considered in the diabetes literature. The severity of diabetes, preexisting complications, and low educational levels are associated with both first hospitalization and subsequent survival at any level of severity of DF. [ABSTRACT FROM AUTHOR]

Introduction: The EFFECTUS (Evaluation of Final Feasible Effect of Control Training and Ultra Sensitisation) study is an educational programme, aimed at implementing global cardiovascular risk management in daily clinical practice in Italy. Objective: To evaluate global cardiovascular risk management among physicians stratified according to the use of conventional (CS) or electronic (ES) support for clinical data collection and registration. Methods: Involved physicians were asked to submit data into a study-designed, case-report form, covering the first ten adult outpatients consecutively seen in May 2006. A case-report form was made available on CS or ES, depending on physicians' preferences and attitudes. All available data were centrally analysed for global cardiovascular risk assessment and cardiovascular risk profile characterization. Results: Overall, 1078 physicians (27% females, aged 50 - 7 years) collected data from 9904 outpatients (46.5% females, aged 67 - 9 years). 299 physicians used CS for 2672 (27.0%) patients, whereas the remaining 779 physicians used ES for 7232 patients (73.0%). A higher prevalence of obesity, diabetes mellitus, ischaemic heart disease (mostly previous myocardial infarction) and stroke, was recorded by physicians using CS compared with those using ES. Blood pressure and fasting glucose levels were significantly higher in the CS group than in the ES group, although a significantly higher number of antihypertensive, glucose and lipid-lowering prescriptions was reported in the former than in the latter group. Physicians using ES paid significantly more attention to collecting data concerning cardiovascular risk factors, which were also more up-to-date compared with those recorded by physicians using CS. Conclusions: This sub-analysis of the EFFECTUS study indicates a higher attention to the collection and management of data on major cardiovascular risk factors in physicians using ES than in those using CS. Our findings may suggest a potential way to improve global cardiovascular risk management in the clinical practices of Italy. [ABSTRACT FROM AUTHOR]

Background: We aimed to study the impact of diabetes background on COVID-19 progression from swab testing to health outcomes in type 2 diabetes (T2DM).Methods: From the database of the diabetes units of Piedmont-Italy we extracted records of T2DM patients, which were linked with the swab-testing-database, and the database of hospital discharges. Five outcomes (PCR testing, PCR testing positivity, hospitalization, Intensive Care Unit (ICU), death) were evaluated using robust Poisson models.Results: Among 125,021 T2DM patients, 1,882 had a positive PCR test. Of these patients, 49.4% were hospitalized within 30 days, 11.8% were admitted to an ICU, and 27.1% died. Greater probability of death was associated with age, male sex, liver and renal impairment, Hba1c above 8%, and former smoking. Hospitalization and ICU admission were mainly affected by age, male sex, hypertension, and metabolic control. Notably, ICU admissions were reduced in very elderly people. No outcomes were associated with educational level.Conclusions: Hospitalization and ICU admission are heavily affected by age and local triage policy. A key finding was that men who were >75 years old and poorly compensated were highly vulnerable patients. Renal and/or hepatic impairment are additional factors. This information may be useful for addressing intervention priorities. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to investigate the factors (clinical, organizational or doctor-related) involved in a timely and effective achievement of metabolic control, with no weight gain, in type 2 diabetes., Research Design and Methods: Overall, 5.5 million of Hab1c and corresponding weight were studied in the Associazione Medici Diabetologi Annals database (2005-2017 data from 1.5 million patients of the Italian diabetes clinics network). Logic learning machine, a specific type of machine learning technique, was used to extract and rank the most relevant variables and to create the best model underlying the achievement of HbA1c<7 and no weight gain., Results: The combined goal was achieved in 37.5% of measurements. High HbA1c and fasting glucose values and slow drop of HbA1c have the greatest relevance and emerge as first, main, obstacles the doctor has to overcome. However, as a second line of negative factors, markers of insulin resistance, microvascular complications, years of observation and proxy of duration of disease appear to be important determinants. Quality of assistance provided by the clinic plays a positive role. Almost all the available oral agents are effective whereas insulin use shows positive impact on glucometabolism but negative on weight containment. We also tried to analyze the contribution of each component of the combined endpoint; we found that weight gain was less frequently the reason for not reaching the endpoint and that HbA1c and weight have different determinants. Of note, use of glucagon-like peptide-1 receptor agonists (GLP1-RA) and glifozins improves weight control., Conclusions: Treating diabetes as early as possible with the best quality of care, before beta-cell deterioration and microvascular complications occurrence, make it easier to compensate patients. This message is a warning against clinical inertia. All medications play a role in goal achievements but use of GLP1-RAs and glifozins contributes to overweight prevention., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: A multicentre, randomized, double-blind, placebo-controlled, parallel-group study aimed to define the potential positive effect of dipeptidyl peptidase-4 inhibition on left ventricular systolic function (LVSF) beyond glycemic control in type 2 diabetes mellitus (T2DM) (DYDA 2™ trial)., Methods: Individuals with fairly controlled T2DM and asymptomatic impaired LVSF were randomized in a 1:1 ratio to receive for 48 weeks either linagliptin 5 mg daily or placebo, in addition to their stable diabetes therapy. Eligibility criteria were age ≥ 40 years, history of T2DM with a duration of at least 6 months, HbA1c ≤ 8.0% (≤ 64 mmol/mol), no history or clinical signs/symptoms of cardiac disease, evidence at baseline echocardiography of concentric LV geometry (relative wall thickness ≥ 0.42), and impaired LVSF defined as midwall fractional shortening (MFS) ≤ 15%. The primary end-point was the modification from baseline to 48 weeks of MFS. As an exploratory analysis, significant changes in LV global longitudinal strain and global circumferential strain, measured by speckle tracking echocardiography, were also considered. Secondary objectives were changes in diastolic and/or in systolic longitudinal function as measured by tissue Doppler., Results: A total of 188 patients were enrolled. They were predominantly males, mildly obese, with typical insulin-resistance co-morbidities such as hypertension and dyslipidemia. Mean relative wall thickness was 0.51 ± 0.09 and mean MFS 13.3% ± 2.5., Conclusions: DYDA 2 is the first randomized, double-blind, placebo-controlled trial to explore the effect of a dipeptidyl peptidase-4 inhibitor on LVSF in T2DM patients in primary prevention regardless of glycemic control. The main characteristics of the enrolled population are reported., Trial Registration: ClinicalTrial.gov Identifier: NCT02851745.

Early intensive therapy in type 2 diabetes can prevent complications. Nevertheless, metabolic control is often sub-optimal in newly diagnosed patients. This web-based survey aimed to evaluate opinions of physicians about treatment, priorities, and barriers in the care of patients first referred to diabetes clinics. Data on physician attitudes toward therapeutic preferences for two clinical case models (same clinical profile, except HbA1c levels of 8.6 and 7.3% at the first access, respectively) were collected. Participants were asked to rank from 1 (most important) to 6 (least important) a list of priorities and barriers associated with the care of new patients. Overall, 593 physicians participated. In both case models, metformin and education were primary options, although their combination with other classes of drugs varied substantially. Main priorities were "to teach the patient how to cope with the disease" and "to achieve HbA1c target"; main barriers were "lack of time" and "long waiting list". At multivariate analyses, physicians from the South of Italy had a twofold higher likelihood to attribute a rank 1–2 to organizational barriers than those operating in the North (South vs. North: OR: 2.4; 95% CI 1.4–4.1; Center vs. North: OR: 2.4; 95% CI 0.9–3.2). In the absence of a widely accepted evidence-based therapeutic algorithm driving the therapeutic choices according to the patient characteristics, prescriptions vary according to physician preferences. Education is perceived as a key-strategy, but organizational barriers and geographic disparities are an obstacle. These findings can drive new strategies to reduce clinical inertia, attitudes variability, and geographic disparities.

Background: The Evaluation of Final Feasible Effect of Ultra Control Training and Sensitization (EFFECTUS) study is aimed at implementing global cardiovascular (CV) risk management in Italy., Hypothesis: To evaluate the impact of diabetes mellitus (DM) on attitudes and preferences for clinical management of global CV risk among physicians treating diabetic or nondiabetic patients., Methods: Involved physicians were asked to submit data into a study-designed case-report form, covering the first 10 adult outpatients consecutively seen in May 2006. All available clinical data were centrally analyzed for global CV risk assessment and CV risk profile characterization. Patients were stratified according to the presence or absence of DM., Results: Overall, 1078 physicians (27% female, ages 50 ± 7 y) collected data of 9904 outpatients (46.5% female, ages 67 ± 9 y), among whom 3681 (37%) had a diagnosis of DM at baseline. Diabetic patients were older and had higher prevalence of obesity, hypertension, dyslipidemia, and associated CV diseases than nondiabetic individuals (P<0.001). They had higher systolic blood pressure, total cholesterol, triglycerides, and creatinine levels, but lower high-density lipoprotein cholesterol levels than nondiabetic patients (P<0.001). Higher numbers of blood pressure and lipid-lowering drugs and antiplatelet agents were used in diabetic than in nondiabetic patients (P<0.001)., Conclusions: The EFFECTUS study confirmed higher CV risk and more CV drug prescriptions in diabetic than in nondiabetic patients. Presence of DM at baseline significantly improved clinical data collection. Such an approach, however, was not paralleled by a better control of global CV risk profile, which was significantly worse in the former than in the latter group., (© 2011 Wiley Periodicals, Inc.)

Background: Physicians' adherence to cardiovascular (CV) guidelines has been found to be poor. In this regard, accuracy in keeping medical records could play an important role. This study was devised to describe which data are present in medical records from a large sample of physicians and to investigate the association and the link between completeness in recording and clinical appropriateness., Methods: The data extracted from medical records of 1078 doctors (general practitioners, cardiologists, and diabetologists) were analyzed, with a focus on CV prevention. The percentage of recorded data of several CV clinical variables was calculated. A multivariate analysis was performed to investigate the association between doctors' and patients' characteristics and different patterns in recording. Finally, the completeness in recording was calculated with a score and plotted against three indicators of appropriateness., Results: The only risk factor that achieved a good standard of registration was blood pressure (89%). Low-density lipoprotein and waist circumference were largely under-recorded, whereas lifestyle data collection was almost negligible. Age, specialization, and use of electronic records increase the accuracy in recording. When one CV risk factor was predominant, the probability of having other risk factors recorded was reduced. A significant increase in the proportion of patients treated according to guidelines was found in doctors who were more accurate in recording., Conclusion: A link exists between accuracy in recording with both quality of care and adherence to guidelines. Specific training of all doctors in this field should be considered.