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Background: Regular Physical Activity (RPA) is one of the cornerstones of Type 1 Diabetes (T1D) therapy, but conflicting results are reported in the literature., Aim: To compare (RPA) and Sedentary Lifestyle (SL) among children with type 1 diabetes (T1D) and healthy peers., Subjects and Methods: Seven Italian paediatric diabetes centres enrolled 129 children with T1D and 214 healthy peers who were interviewed by a telephone questionnaire on physical activity level, sedentary lifestyle and clinical data., Results: Compared to healthy peers, children with T1D: performed the same amount of RPA, were more frequently engaged in team sports (p = 0.018), described RPA as an enjoyable activity (p = 0.033), not boring (p = 0.035), a chance to spend time with peers (p = 0.033) and to meet new friends (p = 0.016). Children with T1D were finally used to consume less snacks during watching TV (p < 0.001) or after physical activity (p < 0.001 ). HbA1c values were not related with time spent in physical activity, in watching TV or in playing video-games., Conclusions: Most interviewed children with T1D are physically active and perform the same amount of exercise as their healthy peers. They demonstrate to consider RPA a source of enjoyment and sociality and not a therapeutic imposition. (www.actabiomedica.it)

Background and Aim: To establish normal values of insulin resistance, secretion and sensitivity using respectively HOMA-IR, HOMA-beta% and QUICKI indexes in healthy Italian children and adolescents, based on fasting samples., Methods: We determined HOMA-IR, HOMA-beta% and QUICKI at baseline in 142 healthy subjects from Pediatric Centres, aged 2.7 to 19 years (10.6 +/- 3.8, Mean +/- SD), with different Tanner's pubertal Stages (TS). None had hypo/hyperglycemia (fasting plasma glucose ranging from 3.6 to 5.6 mmol/l), obesity (BMI (kg/m2) 17.9 +/- 2.4, M +/- SD), or family history for diabetes mellitus., Results: The HOMA-IR index slightly increases with Tanner's stage. As regards HOMA-beta% and QUICKI, a weak variation throughout puberty was observed. No significant correlation was observed between HOMA-IR, HOM A-beta%, QUICKI and BMI-SDS or chronologic age., Conclusions: Normal values of HOMA-IR, HOMA-beta% and QUICKI are useful tools in the clinical and epidemiological practice for baseline screening and follow-up of subjects at risk for type 2 diabetes mellitus.

Background and Aim: A panel of experts of the Italian Society of Paediatric Endocrinology and Diabetology translated into Italian the international insulin pump therapy recommendations in children and adolescents with type 1 diabetes., Methods: After an extensive review of the literature using evidence-based recommendations, several issues were taken into account, such as patient selection, advantages and disadvantages, instrument choice, insulin type, therapy planning and follow-up, emergencies, nutrition, particular occasions (like parties, holidays, sick days, travels), exercise, continuous glucose monitoring and integrated system, neonatal diabetes. The panel evaluated the cost-effectiveness of insulin pump therapy compared to multiple daily injection therapy, analysing the cost-benefit ratio., Results: Some tweak was needed due to the Italian dietetic singularity, meal schedule, climate and lifestyle. Insulin pump therapy in neonatal diabetes is a new issue and no guidelines have been published yet for this age-group. Moreover, legal issues according to the Italian law have been added and are peculiarity of our recommendations. An "informed therapeutic agreement" between the patient and his/her family and the diabetic team has to be signed before starting insulin pump therapy., Conclusions: We think that nowadays the need for clinical guidelines is important and worth the effort that all countries develop faithful adaptation into their local languages taking into account specific contexts and local peculiarities, without making substantial modifications to the original text.

Patients with type 1 diabetes require adequate amounts of macronutrients to support their training and sustain performance during regular exercise and during competitions. A frequent goal in competitive sports is to improve performance, and athletes may resort to a number of practices that can adversely affect blood glucose control and health in general in an attempt to gain a competitive advantage. These may include unsafe dietary patterns, and the use of nutritional supplements, other ergogenic aids and illegal substances. In this paper we review data on the relationship between insulin therapy and needs of single macronutrients before, during and after regular and competitive exercise in young subjects and athletes with type 1 diabetes. We also list nutrition integrators, available in the gymnasium or as over-the-counter drugs, which are increasingly being used by athletes, and describe their interactions with diabetes.

Paediatric Diabetologists aim to personalize insulin therapy in order to attain good metabolic control and good quality of life. Nowadays this goal may be obtained through many devices: syringes, pens or injectors and by several insulin preparations. In fact besides human "traditional" (regular, NPH, Lente zinc and Ultralente zinc insulins) recently, insulin analogues have been synthesized with different pharmacokinetics: short acting (Lispro and Aspart) and long acting (Glargine, Detemir). Since children with diabetes are, often, totally c-peptide negative, insulin therapy must substitute the absence of insulin production and the successful use of short acting insulin analogues requires optimal association with basal insulin. Insulin therapy regimens are adapted to the life style of children and factors affecting the diabetologist's decision to change the regimen are not only glycaemic profiles, HbAlc and metabolic control but, also, age, school needs, prevention of hypoglycaemia, meals timing etc. and, also, culture of patients and their families, compliance to the therapy, possibility to contact frequently the diabetology team, etc. In conclusion insulin regimens must reflect the life style of the diabetic patient who is educated in the strategy of intensive insulin therapy. Italy is a "long" country and the life styles are different region by region; Italian Paediatric Diabetologists are fanciful and the personalization of insulin therapy is a recent conquest thanks to the new and old insulin preparations.

Extreme customization of treatment is even more necessary when dealing with young diabetic patients as compared with adult patients. From diagnosis the pediatrician must introduce treatment in the less traumatic way possible so that the child does not perceive a derangement of his/her life. In order to preserve the quality of life the diabetic child must be able to attend birthday parties, participate in sports, and generally lead a full social life just like his/her friends. In the present paper we evaluate the characteristics of the new insulin analogues and their advantages and disadvantages with respect to the needs of patients. The wide spectrum of available insulin formulations including also the new short- and long- acting insulin analogues are of great help in conceiving a therapeutic plan closely adherent to the patient's needs. As an example, in children aged less than 5-6 years a short acting insulin may be injected immediatly after the meal. The same insulin may be useful in older patients with an incostant style of life due to social activities. On the other hand the "old" insulins may still be used for the therapeutic plan in patients with a more constant life style as to the physical exercise and intervals between the meals. In conclusion, the quality of life in the children and adolescents with diabetes may be accomplished with a flexible and personalized therapeutic plan and a great attention to the education. The latter is a very important tool for the compliance and the reduction of anxiety in patients and their parents.