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1. The rehabilitation of children and adolescents with severe or medically complicated obesity: an ISPED expert opinion document

Author

Grugni, Graziano, Licenziati, Maria Rosaria, Valerio, Giuliana, Crinò, Antonino, Maffeis, Claudio, Tanas, Rita, Morino, Giuseppe Stefano, Ambruzzi, Amalia, Balsamo, Antonio, Bellone, Simonetta, Bernasconi, Sergio, Bianchi, Vanessa, Bobbio, Adriana, Bruzzi, Patrizia, Buongiovanni, Carmen, Calcagno, Annalisa, Calcaterra, Valeria, Canali, Teresa, Cerutti, Franco, Corciulo, Nicola, Cotugno, Fortunato, Cuccarolo, Giuliano, D’Amico, Osvaldo, Di Bonito, Procolo, Di Candia, Stefania, Di Pietrantonio, Violetta, Di Pietro, Mario, Filannino, Grazia, Fintini, Danilo, Forziato, Claudia, Franceschi, Roberto, Franzese, Adriana, Galeazzi, Daniela, Gargantini, Luigi, Franca Giusti, Lia, Gualtieri, Antonella, Laura Iezzi, Maria, Iughetti, Lorenzo, Lera, Riccardo, Limauro, Raffaele, Lombardi, Francesca, Lucchesi, Sonia, Macchiaroli, Annamaria, Maltoni, Giulio, Manco, Melania, MIRAGLIA DEL GIUDICE, Emanuele, Modestini, Elisabetta, Morandi, Anita, Mozzillo, Enza, Nanni, Laura, Nicolosi, Alessandra, Pellegrin, Maria Chiara, Peruzzi, Sonia, Peverelli, Paola, Purromuto, Salvatore, Ragusa, Letizia, Rosato, Teresa, Salvo, Caterina, Sartori, Chiara, Sticco, Maura, Elisabeth Street, Maria, Trifirò, Giuliana, Vianelli, Patrizia, Yiannakou, Pietro, IAFUSCO, Dario, Grugni, Graziano, Licenziati, Maria Rosaria, Valerio, Giuliana, Crinò, Antonino, Maffeis, Claudio, Tanas, Rita, Morino, Giuseppe Stefano, Ambruzzi, Amalia, Balsamo, Antonio, Bellone, Simonetta, Bernasconi, Sergio, Bianchi, Vanessa, Bobbio, Adriana, Bruzzi, Patrizia, Buongiovanni, Carmen, Calcagno, Annalisa, Calcaterra, Valeria, Canali, Teresa, Cerutti, Franco, Corciulo, Nicola, Cotugno, Fortunato, Cuccarolo, Giuliano, D’Amico, Osvaldo, Di Bonito, Procolo, Di Candia, Stefania, Di Pietrantonio, Violetta, Di Pietro, Mario, Filannino, Grazia, Fintini, Danilo, Forziato, Claudia, Franceschi, Roberto, Franzese, Adriana, Galeazzi, Daniela, Gargantini, Luigi, Franca Giusti, Lia, Gualtieri, Antonella, Iafusco, Dario, Laura Iezzi, Maria, Iughetti, Lorenzo, Lera, Riccardo, Limauro, Raffaele, Lombardi, Francesca, Lucchesi, Sonia, Macchiaroli, Annamaria, Maltoni, Giulio, Manco, Melania, MIRAGLIA DEL GIUDICE, Emanuele, Modestini, Elisabetta, Morandi, Anita, Mozzillo, Enza, Nanni, Laura, Nicolosi, Alessandra, Pellegrin, Maria Chiara, Peruzzi, Sonia, Peverelli, Paola, Purromuto, Salvatore, Ragusa, Letizia, Rosato, Teresa, Salvo, Caterina, Sartori, Chiara, Sticco, Maura, Elisabeth Street, Maria, Trifirò, Giuliana, Vianelli, Patrizia, and Yiannakou, Pietro

Subjects
medicine.medical_specialty, Pediatric Obesity, Adolescent, Pediatric endocrinology, medicine.medical_treatment, 030209 endocrinology & metabolism, Adolescents, Childhood obesity, Children, Multidimensional approach, Obesity, Rehabilitation, Severe obesity, 03 medical and health sciences, Health services, 0302 clinical medicine, 030225 pediatrics, Epidemiology, Medicine, Humans, Child, Competence (human resources), business.industry, medicine.disease, Clinical Psychology, Psychiatry and Mental Health, Family medicine, Expert opinion, Physical therapy, business, Human
Abstract

Severe/medically complicated obesity in childhood, and particularly in adolescence, is a real disability that requires an intensive and continuous approach which should follow the procedures and schedule of rehabilitation medicine. Given the lack of a specific document focusing on children and adolescents, the Childhood Obesity Study Group set out to explore the available evidence for the treatment of severe or medically complicated obesity and to set standards tailored to the specific context of the Italian Health Service. Through a series of meetings and electronic communications, the writing committee (selected from members of the Study Group) selected the key issues, explored the literature and produced a draft document which was submitted to the other experts until the final synthesis was approved by the group. In brief, the following issues were involved: (1) definition and epidemiology; (2) identification of common goals designed to regain functional competence and limit the progression of metabolic and psychological complications; (3) a multi-professional team approach; (4) the care setting. This paper is an expert opinion document on the rehabilitation of severe and medically complicated obesity in children and adolescents produced by experts belonging to the Childhood Obesity Study Group of the Italian Society for Pediatric Endocrinology and Diabetology (ISPED).

Published
2017

2. Early cardiovascular autonomic dysfunction, beta cell function and insulin resistance in obese adolescents

Author

Rabbone, I, Bobbio, Adriana, Rabbia, F, Bertello, Mc, Ignaccoldo, Mg, Saglio, E, Morello, F, Veglio, Franco, Pacini, G, and Cerutti, Franco

Subjects
Blood Glucose, Adolescent, Blood Pressure, Body Mass Index, Autonomic Nervous System Diseases, Cardiovascular Diseases, Heart Rate, Risk Factors, Case-Control Studies, Child, Female, Humans, Insulin, Insulin Resistance, Insulin-Secreting Cells, Obesity
Abstract

The aim of this study was to assess the metabolic and cardiovascular autonomic phenotype in adolescent obesity.Eighteen non diabetic obese individuals and ten lean age-matched control adolescents were included in the study. All subjects underwent Oral Glucose Tolerance Test (OGTT) with insulin and glucose determination for the calculation of AUC, OGIS, QUICKI, and disposition index. Cardiovascular assessments included 24-hour Holter ECG for HRV measurements, ABP monitoring and echocardiography.Obese adolescents had higher serum lipids, reduced insulin sensitivity and higher insulin resistance. Obese individuals showed indeed a normal beta-cell function, with insulin AUC and disposition index similar to controls. However, obese adolescents presented a progressive reduction ofvagal indexes (RMSSD, HF) and an increase in sympathetic indexes (LF, LF/HF), which correlated with OGIS and beta-cell function parameters.Adolescent obesity is characterized by insulin resistance with normal beta-cell function. Metabolic modifications may lead to an early impairment of the autonomic pattern.

Published
2009

3. The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020

Author

Valentino Cherubini, Monica Marino, Andrea E. Scaramuzza, Valentina Tiberi, Adriana Bobbio, Maurizio Delvecchio, Elvira Piccinno, Federica Ortolani, Stefania Innaurato, Barbara Felappi, Francesco Gallo, Carlo Ripoli, Maria Rossella Ricciardi, Filomena Pascarella, Filomena A. Stamati, Felice Citriniti, Claudia Arnaldi, Sara Monti, Vanna Graziani, Fiorella De Berardinis, Cosimo Giannini, Francesco Chiarelli, Maria Zampolli, Rosaria De Marco, Giulia Patrizia Bracciolini, Caterina Grosso, Valeria De Donno, Barbara Piccini, Sonia Toni, Susanna Coccioli, Giuliana Cardinale, Marta Bassi, Nicola Minuto, Giuseppe D’Annunzio, Claudio Maffeis, Marco Marigliano, Angela Zanfardino, Dario Iafusco, Assunta S. Rollato, Alessia Piscopo, Stefano Curto, Fortunato Lombardo, Bruno Bombaci, Silvia Sordelli, Chiara Mameli, Maddalena Macedoni, Andrea Rigamonti, Riccardo Bonfanti, Giulio Frontino, Barbara Predieri, Patrizia Bruzzi, Enza Mozzillo, Francesco Rosanio, Adriana Franzese, Gavina Piredda, Francesca Cardella, Brunella Iovane, Valeria Calcaterra, Maria Giulia Berioli, Anna Lasagni, Valentina Pampanini, Patrizia Ippolita Patera, Riccardo Schiaffini, Irene Rutigliano, Gianfranco Meloni, Luisa De Sanctis, Davide Tinti, Michela Trada, Lucia Paola Guerraggio, Roberto Franceschi, Vittoria Cauvin, Gianluca Tornese, Francesca Franco, Gianluca Musolino, Giulio Maltoni, Valentina Talarico, Antonio Iannilli, Lorenzo Lenzi, Maria Cristina Matteoli, Erica Pozzi, Carlo Moretti, Stefano Zucchini, Ivana Rabbone, Rosaria Gesuita, Cherubini, Valentino, Marino, Monica, Scaramuzza, Andrea E, Tiberi, Valentina, Bobbio, Adriana, Delvecchio, Maurizio, Piccinno, Elvira, Ortolani, Federica, Innaurato, Stefania, Felappi, Barbara, Gallo, Francesco, Ripoli, Carlo, Ricciardi, Maria Rossella, Pascarella, Filomena, Stamati, Filomena A, Citriniti, Felice, Arnaldi, Claudia, Monti, Sara, Graziani, Vanna, De Berardinis, Fiorella, Giannini, Cosimo, Chiarelli, Francesco, Zampolli, Maria, De Marco, Rosaria, Bracciolini, Giulia Patrizia, Grosso, Caterina, De Donno, Valeria, Piccini, Barbara, Toni, Sonia, Coccioli, Susanna, Cardinale, Giuliana, Bassi, Marta, Minuto, Nicola, D'Annunzio, Giuseppe, Maffeis, Claudio, Marigliano, Marco, Zanfardino, Angela, Iafusco, Dario, Rollato, Assunta S, Piscopo, Alessia, Curto, Stefano, Lombardo, Fortunato, Bombaci, Bruno, Sordelli, Silvia, Mameli, Chiara, Macedoni, Maddalena, Rigamonti, Andrea, Bonfanti, Riccardo, Frontino, Giulio, Predieri, Barbara, Bruzzi, Patrizia, Mozzillo, Enza, Rosanio, Francesco, Franzese, Adriana, Piredda, Gavina, Cardella, Francesca, Iovane, Brunella, Calcaterra, Valeria, Berioli, Maria Giulia, Lasagni, Anna, Pampanini, Valentina, Patera, Patrizia Ippolita, Schiaffini, Riccardo, Rutigliano, Irene, Meloni, Gianfranco, De Sanctis, Luisa, Tinti, Davide, Trada, Michela, Guerraggio, Lucia Paola, Franceschi, Roberto, Cauvin, Vittoria, Tornese, Gianluca, Franco, Francesca, Musolino, Gianluca, Maltoni, Giulio, Talarico, Valentina, Iannilli, Antonio, Lenzi, Lorenzo, Matteoli, Maria Cristina, Pozzi, Erica, Moretti, Carlo, Zucchini, Stefano, Rabbone, Ivana, and Gesuita, Rosaria

Subjects
COVID - 19, Adolescent, type 1 diabetes, Endocrinology, Diabetes and Metabolism, Longitudinal Studie, Diabetic Ketoacidosis, socioeconomic status, DKA, Diabetes Mellitus, Humans, Longitudinal Studies, Child, Pandemics, Settore MED/38 - Pediatria Generale e Specialistica, Pandemic, type 1 diabete, Incidence, COVID-19, diabetes onset, Communicable Disease Control, Italy, Diabetes Mellitus, Type 1, socioeconomic statu, Human, Type 1
Abstract

Aim/HypothesisTo compare the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in Italy during the COVID-19 pandemic in 2020 with the frequency of DKA during 2017-2019.MethodsForty-seven pediatric diabetes centers caring for >90% of young people with diabetes in Italy recruited 4,237 newly diagnosed children with type 1 diabetes between 2017 and 2020 in a longitudinal study. Four subperiods in 2020 were defined based on government-imposed containment measures for COVID-19, and the frequencies of DKA and severe DKA compared with the same periods in 2017-2019.ResultsOverall, the frequency of DKA increased from 35.7% (95%CI, 33.5-36.9) in 2017-2019 to 39.6% (95%CI, 36.7-42.4) in 2020 (p=0.008), while the frequency of severe DKA increased from 10.4% in 2017-2019 (95%CI, 9.4-11.5) to 14.2% in 2020 (95%CI, 12.3-16.4, pConclusions/InterpretationThere was an increase in the frequency of DKA and severe DKA in children newly diagnosed with type 1 diabetes during the COVID-19 pandemic in 2020, with no apparent association with the severity of COVID-19 infection severity or containment measures. There has been a silent outbreak of DKA in children during the pandemic, and preventive action is required to prevent this phenomenon in the event of further generalized lockdowns or future outbreaks.

Published
2022

4. Diabetic ketoacidosis at the onset of disease during a national awareness campaign: A 2-year observational study in children aged 0-18 years

Author

Rabbone I., Maltoni G., Tinti D., Zucchini S., Cherubini V., Bonfanti R., Scaramuzza A., Lera R., Bobbio A., Piccinno E., Reinstadler P., Felappi B., Prandi E., Gallo F., Frongia AP., Ripoli C., Lo Presti D., Tomaselli L., Cardinale G., Stamati FA., Citriniti F., Suprani T., Graziani V., De Berardinis F., Zampolli M., De Marco R., Cavalli C., Lazzaro N., De Donno V., Toni S., Piccini B., Lenzi L., Mainetti B., Coccioli MS., d'Annunzio G., Minuto N., Aloe S., Lucchesi D., Cirillo S., Sordelli M., Del Vecchio F., Salzano LG., Meschi F., Iughetti L., Predieri B., Franzese A., Mozzillo Enza., Iafusco D., Cadario F., Savastio S., Piredda G., Cardella F., Iovane B., Calcaterra V., Berioli MG., Biagioni M., Randazzo E., Patera I., Schiaffini R., Rutigliano I., Lasagni A., Innaurato S., Gaiero A., Fichera G., Trada M., Guerraggio L., Cauvin V., Franceschi R., Tornese G., Salvatoni A., Marigliano M., Sabbion A., Maffeis C., Arnaldi C., Rabbone, I., Maltoni, G., Tinti, D., Zucchini, S., Cherubini, V., Bonfanti, R., Scaramuzza, A., Lera, R., Bobbio, A., Piccinno, E., Reinstadler, P., Felappi, B., Prandi, E., Gallo, F., Frongia, Ap., Ripoli, C., Lo Presti, D., Tomaselli, L., Cardinale, G., Stamati, Fa., Citriniti, F., Suprani, T., Graziani, V., De Berardinis, F., Zampolli, M., De Marco, R., Cavalli, C., Lazzaro, N., De Donno, V., Toni, S., Piccini, B., Lenzi, L., Mainetti, B., Coccioli, Ms., D'Annunzio, G., Minuto, N., Aloe, S., Lucchesi, D., Cirillo, S., Sordelli, M., Del Vecchio, F., Salzano, Lg., Meschi, F., Iughetti, L., Predieri, B., Franzese, A., Mozzillo, Enza., Iafusco, D., Cadario, F., Savastio, S., Piredda, G., Cardella, F., Iovane, B., Calcaterra, V., Berioli, Mg., Biagioni, M., Randazzo, E., Patera, I., Schiaffini, R., Rutigliano, I., Lasagni, A., Innaurato, S., Gaiero, A., Fichera, G., Trada, M., Guerraggio, L., Cauvin, V., Franceschi, R., Tornese, G., Salvatoni, A., Marigliano, M., Sabbion, A., Maffeis, C., Arnaldi, C., Rabbone, Ivana, Maltoni, Giulio, Tinti, Davide, Zucchini, Stefano, Cherubini, Valentino, Bonfanti, Riccardo, Scaramuzza, Andrea, Lera, Riccardo, Bobbio, Adriana, Piccinno, Elvira, Reinstadler, Petra, Felappi, Barbara, Prandi, Elena, Gallo, Francesco, Frongia, Anna Paola, Ripoli, Carlo, Lo Presti, Donatella, Tomaselli, Letizia, Cardinale, Giuliana, Stamati, Filomena Andreina, Citriniti, Felice, Suprani, Tosca, Graziani, Vanna, De Berardinis, Fiorella, Zampolli, Maria, De Marco, Rosaria, Cavalli, Claudio, Lazzaro, Nicola, De Donno, Valeria, Toni, Sonia, Piccini, Barbara, Lenzi, Lorenzo, Mainetti, Benedetta, Coccioli, Maria Susanna, D’Annunzio, Giuseppe, Minuto, Nicola, Aloe, Monica, Lucchesi, Sonia, Cirillo, Dante, Sordelli, Silvia, Delvecchio, Maurizio, Lombardo, Fortunato, Salzano, Giusy, Meschi, Franco, Iughetti, Lorenzo, Predieri, Barbara, Franzese, Adriana, Mozzillo, Enza, Iafusco, Dario, Cadario, Francesco, Savastio, Silvia, Cardella, Francesca, Iovane, Brunella, Calcaterra, Valeria, Berioli, Maria Giulia, Biagioni, Martina, Randazzo, Emioli, Patera, Ippolita Patrizia, Schiaffini, Riccardo, Rutigliano, Irene, Lasagni, Anna, Innaurato, Silvia, Gaiero, Alberto, Fichera, Grazziella, Trada, Michela, Guerraggio, Lucia, Cauvin, Vittoria, Franceschi, Roberto, Tornese, Gianluca, Salvatoni, Alessandro, Marigliano, Marco, Sabbion, Alberto, Maffeis, Claudio, and Arnaldi, Claudia

Subjects
Blood Glucose, Male, medicine.medical_specialty, Pediatrics, endocrine system diseases, Diabetic ketoacidosis, Adolescent, 030209 endocrinology & metabolism, Disease, 03 medical and health sciences, 0302 clinical medicine, diabetic ketoacidosis, Patient Education as Topic, Diabetes mellitus, Epidemiology, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Child, Type 1 diabetes, diabetes, business.industry, Incidence (epidemiology), Incidence, epidemiology, Infant, Newborn, diabetic ketoacidosi, nutritional and metabolic diseases, Infant, medicine.disease, Diabetes Mellitus, Type 1, Italy, diabete, Child, Preschool, Pediatrics, Perinatology and Child Health, Observational study, Female, business, Prevention campaign
Abstract

ObjectiveAfter a previous survey on the incidence of diabetic ketoacidosis (DKA) at onset of type 1 diabetes in children in 2013–2014 in Italy, we aimed to verify a possible decline in the incidence of DKA at onset during a national prevention campaign.DesignProspective observational study.SettingMulticentre study throughout Italy.InterventionNational awareness campaign started in November 2015 and held until December 2017.PatientsDuring 2016 and 2017 we collected data on all patients aged 0–18 years with new-onset diabetes.Main outcome measuresDKA (pH ResultsRecords (n=2361) of children with newly diagnosed type 1 diabetes were collected from 58 out of 68 (85.3%) centres of the original survey participants and 100% of the previously surveyed tertiary centres. Overall, DKA was observed in 1124 patients, with an increased rate when compared with the previous survey (47.6% vs 38.5%, p=0.002), and severe DKA in 15.3%. In children below 6 years, DKA was observed in 323 out of 617 (52.5%) and severe DKA in 16.7%; in this age group, occurrence of DKA reduced by 21.3% (p=0.009). DKA treatment according to the ISPED guidelines was adopted in 95% of the centres, with a 27% improvement (p=0.025).ConclusionsDuring a 2-year awareness campaign, DKA at onset of diabetes in children and adolescents 0–18 years is still common and increased when compared with the 2013–2014 survey.

Published
2020

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