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Abstract: The project PROMODR (Progressive Model of Diabetes Register) funded by an Italian Ministry of Health grant, aimed at the realisation of a prototype regional registry for diabetes mellitus and its validation in a pilot experience. Primary data sources are the General Practitioners (GPs) and the Diabetes Centres (DCs) of the Umbria region already equipped with electronic medical records (EMR). A minimum registry data set was created consisting of personal data, metabolic indices, late diabetic complications and therapy. The GPs EMR system was modified in order to automatically identify, extract encrypt and send via e-mail to a central regional server the administrative and clinical data related to the diabetic patients. At this level the data are merged with the information derived by the DCs. The functionality of the prototype has been evaluated in a pilot experience consisting of two consecutive phases: the first collecting data from 7 GPs covering different areas of the region and a population of around 10680 inhabitants and the second one involving 13 DCs. Data from more than 12000 diabetic subjects were collected. Different examples indicators have been calculated. This pilot study showed an accurate functionality of the prototype without major errors in all the different phases of data collection and transmission. [Copyright &y& Elsevier]

Abstract: Diabetic ketoacidosis (DK) is a serious acute complication in type 1 diabetic patients caused by insulin deficiency. The early detection of insulin deprivation represents therefore an important element in routine clinical practice, especially in ketone prone subjects such as CSII (continuous subcutaneous insulin infusion) treated subjects. Different methods have been developed for ketone bodies (KB) monitoring: urine dipsticks, laboratory readings, capillary β-hydroxybutirate (BOHB) meters. Urine dipsticks are not recommended for KB monitoring because they measure only acetoacetate and not BOBH the most prevalent ketone during DK. Laboratory methods are more reliable but not useful for self monitoring. Capillary BOHB represents the most suitable method for KB monitoring in home settings. Several experiences demonstrated the accuracy and reliability of this method at different degree of ketosis and their efficacy in detecting and managing the course of DKA. A recent experience, conducted by our group, investigated the efficacy of the dynamic evaluation of capillary BOBH levels, irrespectively of the absolute value, for early detection of insulin deprivation in CSII treated subjects. Results indicated that dynamic evaluation of capillary BOHB appears as a more rapid and accurate indicator of early insulin deprivation than blood glucose and could be used for targeting effectively insulin therapy in the restoration phase. [Copyright &y& Elsevier]

Aim: To estimate type 2 diabetes mellitus (T2DM) prevalence in Russian adults.Methods: NATION is a national, epidemiological, cross-sectional study, conducted in Russia. In adults (aged 20-79 years), recruitment was stratified by age, sex, geographic region and settlement type to obtain a representative sample. Recruitment was in public areas with high numbers of people. T2DM was diagnosed by glycated haemoglobin A1c (HbA1c) levels (diabetes: HbA1c ≥6.5% [≥48mmol/mol]; pre-diabetes: HbA1c ≥5.7 to <6.5% [≥39 to <48mmol/mol]). Socio-demographic and anthropometric data were collected.Results: Blood samples from 26,620 subjects were available. Overall, 5.4% were diagnosed with T2DM (previously diagnosed: 2.5%; previously undiagnosed: 2.9%); 19.3% were pre-diabetic. T2DM prevalence increased with age (up to 70 years) and was higher among females than males (6.1% vs. 4.7%, p<0.001). The estimated proportion of subjects with pre-diabetes and T2DM tended to increase with increasing body mass index. T2DM prevalence was higher in rural versus urban populations (6.7% vs. 5.0%, p<0.001).Conclusion: In the Russian adult population, 19.3% had pre-diabetes, T2DM prevalence was 5.4%, and 54% of subjects with diabetes were previously undiagnosed. These results may help to develop a new T2DM predictive, preventative and management programme in Russia. [ABSTRACT FROM AUTHOR]

Abstract: Recent experiences in the use of diabetes registers show their ability to improve population health in a region. In the framework of the Umbria registry, we have defined general criteria for the development of a comprehensive model including new directions for active use of health information. General functions of the diabetes register have been designed for a range of stakeholders. Large scale data linkage is used to extract study cohorts and add information content to the register. Multidimensional/multilevel analysis is directly applied to define high risk strata on the basis of multiple individual, structural, contextual (ecological) and service-related components. Target subjects can be used to design specific interventions for the prevention of diabetic complications. The enhanced version of the Umbria Register involves a large group of institutional partners in a new program for clinical governance. Agreed routine health system evaluation now regards diabetes indicators as a high priority area. The data model supports information exchange across a network of national and international partners, contributing to the definition of a common benchmarking system. The present work shows that principles of evidence-based medicine can be used to underpin new ways of active use of health information. Involving policy makers and health professionals in the research and development of diabetes registers will be increasingly crucial to capture all opportunities arising from a wide application. [Copyright &y& Elsevier]

Abstract: Research and development of an external wearable artificial pancreas, although improved by recent technology achievements, still require simulation tools like the mathematical model introduced in the present study. The aim was to realize a mathematical model of insulin and glucose metabolism in type I diabetes and to test its effectiveness for development and assessment of control algorithms. A Proportional-Derivative-2nd derivative (PDD2) control algorithm was tested on a “virtual patient” constituted by the previously developed mathematical model simulating the patient response to a standard meal (90 g of carbohydrates, then increased and decreased). PDD2 controller performances were compared with the results of standard therapy (preprandial bolus) in continuous subcutaneous insulin infusion therapy (CSII). Area under the curve of glycaemic response (QG) and hyperglicemia duration (Durat) were chosen as performance indexes. In response to medium-light meals PDD2 reduced 35% of Durat and 25% of QG in respect to standard therapy. The average values of model estimated parameters on a cluster of patients give a virtual patient that supports the design and testing of control algorithms, improving the expectations and reducing the risk of experimental activities. PDD2 seems a very promising control strategy that can improve post-prandial behaviour in respect to standard therapy. [Copyright &y& Elsevier]