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1. Author response for 'Effectiveness of a closed‐loop control system and a virtual educational camp for children and adolescents with type 1 diabetes: a prospective multicenter real‐life study'

Author

null Valentino Cherubini, null Ivana Rabbone, null Maria Giulia Berioli, null Sara Giorda, null Donatella Lo Presti, null Giulio Maltoni, null Chiara Mameli, null Marco Marigliano, null Monica Marino, null Nicola Minuto, null Enza Mozzillo, null Elvira Piccinno, null Barbara Predieri, null Carlo Ripoli, null Riccardo Schiaffini, null Andrea Rigamonti, null Giuseppina Salzano, null Davide Tinti, null Sonia Toni, null Angela Zanfardino, null Andrea Enzo Scaramuzza, null Rosaria Gesuita, and null vEC Study Group

Subjects
Type 1 diabetes, medicine.medical_specialty, Physical medicine and rehabilitation, business.industry, medicine, medicine.disease, business, Life study
Published
2021
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2. Differences between Transient Neonatal Diabetes Mellitus Subtypes can Guide Diagnosis and Therapy

Author

Riccardo Bonfanti, Dario Iafusco, Ivana Rabbone, Giacomo Diedenhofen, Carla Bizzarri, Patrizia Ippolita Patera, Petra Reinstadler, Francesco Costantino, Valeria Calcaterra, Lorenzo Iughetti, Silvia Savastio, Anna Favia, Francesca Cardella, Donatella Lo Presti, Ylenia Girtler, Sarah Rabbiosi, Giuseppe D’Annunzio, Angela Zanfardino, Alessia Piscopo, Francesca Casaburo, Letizia Pintomalli, Lucia Russo, Valeria Grasso, Nicola Minuto, Mafalda Mucciolo, Antonio Novelli, Antonella Marucci, Barbara Piccini, Sonia Toni, Francesca Silvestri, Paola Carrera, Andrea Rigamonti, Giulio Frontino, Michela Trada, Davide Tinti, Maurizio Delvecchio, Novella Rapini, Riccardo Schiaffini, Corrado Mammì, Fabrizio Barbetti, Monica Aloe, Simona Amadeo, Claudia Arnaldi, Marta Bassi, Luciano Beccaria, Marzia Benelli, Giulia Maria Berioloi, Enrica Bertelli, Martina Biagioni, Adriana Bobbio, Stefano Boccato, Oriana Bologna, Franco Bontempi, Clara Bonura, Giulia Bracciolini, Claudia Brufani, Patrizia Bruzzi, Pietro Buono, Roberta Cardani, Giuliana Cardinale, Alberto Casertano, Maria Cristina Castiglione, Vittoria Cauvin, Valentino Cherubini, Franco Chiarelli, Giovanni Chiari, Stefano Cianfarani, Dante Cirillo, Felice Citriniti, Susanna Coccioli, Anna Cogliardi, Santino Confetto, Giovanna Contreas, Anna Corò, Elisa Corsini, Nicoletta Cresta, Fiorella De Berardinis, Valeria De Donno, Giampaolo De Filippo, Rosaria De Marco, Annalisa Deodati, Elena Faleschini, Valentina Fattorusso, Valeria Favalli, Barbara Felappi, Lucia Ferrito, Graziella Fichera, Franco Fontana, Elena Fornari, Roberto Franceschi, Francesca Franco, Adriana Franzese, Anna Paola Frongia, Alberto Gaiero, Francesco Gallo, Luigi Gargantini, Elisa Giani, Chiara Giorgetti, Giulia Bianchi, Vanna Graziani, Antonella Gualtieri, Monica Guasti, Gennaro Iannicelli, Antonio Iannilli, Ignaccolo Giovanna, Dario Ingletto, Stefania Innaurato, Elena Inzaghi, Brunella Iovane, Peter Kaufmann, Alfonso La Loggia, Rosa Lapolla, Anna Lasagni, Nicola Lazzaro, Lorenzo Lenzi, Riccardo Lera, Gabriella Levantini, Fortunato Lombardo, Antonella Lonero, Silvia Longhi, Sonia Lucchesi, Lucia Paola Guerraggio, Sergio Lucieri, Patrizia Macellaro, Claudio Maffeis, Bendetta Mainetti, Giulio Maltoni, Chiara Mameli, Francesco Mammì, Maria Luisa Manca-Bitti, Melania Manco, Monica Marino, Matteo Mariano, Marco Marigliano, Alberto Marsciani, Costanzo Mastrangelo, Maria Cristina Matteoli, Elena Mazzali, Franco Meschi, Antonella MIgliaccio, Anita Morandi, Gianfranco Morganti, Enza Mozzillo, Gianluca Musolino, Rosa Nugnes, Federica Ortolani, Daniela Pardi, Filomena Pascarella, Stefano Passanisi, Annalisa Pedini, Cristina Pennati, Angelo Perrotta, Sonia Peruzzi, Paola Peverelli, Giulia Pezzino, Anita Claudia Piona, Gavina Piredda, Carmelo Pistone, Elena Prandi, Barbara Pedieri, Procolo Di Bonito, Anna Pulcina, Maria Quinci, Emioli Randazzo, Rossella Ricciardi, Carlo Ripoli, Rosanna Roppolo, Irene Rutigliano, Alberto Sabbio, Silvana salardi, Alessandro Salvatoni, Anna Saporiti, Rita Sardi, Mariapiera Scanu, Andrea Scaramuzza, Eleonardo Schiven, Andrea Secco, Linda Sessa, Paola Sogno Valin, Silvia Sordelli, Luisa Spallino, Stefano Stagi, Filomena Stamati, Tosca Suprani, Valentina Talarico, Tiziana Timapanaro, Antonella Tirendi, Letizia Tomaselli, Gianluca Tornese, Adolfo Andrea Trettene, Stefano Tumini, Giuliana Valerio, Claudia Ventrici, Matteo Viscardi, Silvana Zaffani, Maria Zampolli, Giorgio Zanette, Clara Zecchino, Maria Antonietta Zedda, Silvia Zonca, Stefano Zucchini, Bonfanti, R., Iafusco, D., Rabbone, I., Diedenhofen, G., Bizzarri, C., Patera, P. I., Reinstadler, P., Costantino, F., Calcaterra, V., Iughetti, L., Savastio, S., Favia, A., Cardella, F., Presti, D. L., Girtler, Y., Rabbiosi, S., D'Annunzio, G., Zanfardino, A., Piscopo, A., Casaburo, F., Pintomalli, L., Russo, L., Grasso, V., Minuto, N., Mucciolo, M., Novelli, A., Marucci, A., Piccini, B., Toni, S., Silvestri, F., Carrera, P., Rigamonti, A., Frontino, G., Trada, M., Tinti, D., Delvecchio, M., Rapini, N., Schiaffini, R., Mammi, C., and Barbetti, F.

Subjects
Proband, Male, Pediatrics, Potassium Channels, Endocrinology, Diabetes and Metabolism, Datasets as Topic, Diagnosis, Differential, Diagnostic Techniques, Endocrine, Female, Humans, Infant, Infant, Newborn, Italy, Mutation, Potassium Channels, Inwardly Rectifying, Remission Induction, Retrospective Studies, Sulfonylurea Receptors, Diabetes Mellitus, Infant, Newborn, Diseases, Diseases, Gastroenterology, Diabetes mellitus genetics, Endocrinology, Settore MED/13, Retrospective Studie, Diagnosis, Medicine, Endocrine pancreas, Transient Neonatal Diabetes Mellitus, 6q24 TNDM, KATP TNDM, Sulfonylureas, Sulfonylureas, Sulfonylurea Receptor, biology, Diabetes Mellitu, General Medicine, Metformin, Inwardly Rectifying, Settore MED/03, 6q24 TNDM, medicine.symptom, Endocrine, hormones, hormone substitutes, and hormone antagonists, medicine.drug, Human, endocrine system, medicine.medical_specialty, KATP TNDM, ABCC8, Transient Neonatal Diabetes Mellitus, Internal medicine, Diabetes mellitus, Macroglossia, Endocrine pancreas, business.industry, medicine.disease, Newborn, Diagnostic Techniques, Transient neonatal diabetes mellitus, Differential, biology.protein, Sulfonylurea receptor, business
Abstract

Objective Transient neonatal diabetes mellitus (TNDM) is caused by activating mutations in ABCC8 and KCNJ11 genes (KATP/TNDM) or by chromosome 6q24 abnormalities (6q24/TNDM). We wanted to assess whether these different genetic aetiologies result in distinct clinical features. Design Retrospective analysis of the Italian data set of patients with TNDM. Methods Clinical features and treatment of 22 KATP/TNDM patients and 12 6q24/TNDM patients were compared. Results Fourteen KATP/TNDM probands had a carrier parent with abnormal glucose values, four patients with 6q24 showed macroglossia and/or umbilical hernia. Median age at diabetes onset and birth weight were lower in patients with 6q24 (1 week; −2.27 SD) than those with KATP mutations (4.0 weeks; −1.04 SD) (P = 0.009 and P = 0.007, respectively). Median time to remission was longer in KATP/TNDM than 6q24/TNDM (21.5 weeks vs 12 weeks) (P = 0.002). Two KATP/TNDM patients entered diabetes remission without pharmacological therapy. A proband with the ABCC8/L225P variant previously associated with permanent neonatal diabetes entered 7-year long remission after 1 year of sulfonylurea therapy. Seven diabetic individuals with KATP mutations were successfully treated with sulfonylurea monotherapy; four cases with relapsing 6q24/TNDM were treated with insulin, metformin or combination therapy. Conclusions If TNDM is suspected, KATP genes should be analyzed first with the exception of patients with macroglossia and/or umbilical hernia. Remission of diabetes without pharmacological therapy should not preclude genetic analysis. Early treatment with sulfonylurea may induce long-lasting remission of diabetes in patients with KATP mutations associated with PNDM. Adult patients carrying KATP/TNDM mutations respond favourably to sulfonylurea monotherapy.

Published
2021

3. Diabetes and Prediabetes in Children With Cystic Fibrosis: A Systematic Review of the Literature and Recommendations of the Italian Society for Pediatric Endocrinology and Diabetes (ISPED)

Author

Stefano Zucchini, Donatella Lo Presti, Riccardo Schiaffini, Valentino Cherubini, Dorina Pjetraj, Claudia Piona, Fortunato Lombardo, Valeria Calcaterra, Anna Paola Frongia, Sonia Toni, M. C. Matteoli, Giuseppe d'Annunzio, Vittoria Cauvin, Elvira Piccinno, Andrea Scaramuzza, Barbara Predieri, Claudio Maffeis, Giulio Maltoni, Enza Mozzillo, Alberto Casertano, Ivana Rabbone, Roberto Franceschi, Stefano Passanisi, Adriana Franzese, Mozzillo, E., Franceschi, R., Piona, C., Passanisi, S., Casertano, A., Pjetraj, D., Maltoni, G., Calcaterra, V., Cauvin, V., Cherubini, V., D'Annunzio, G., Franzese, A., Frongia, A. P., Lombardo, F., Lo Presti, D., Matteoli, M. C., Piccinno, E., Predieri, B., Rabbone, I., Scaramuzza, A. E., Toni, S., Zucchini, S., Maffeis, C., and Schiaffini, R.

Subjects
Blood Glucose, recommendation, Pediatrics, medicine.medical_specialty, Cystic Fibrosis, Pediatric endocrinology, Endocrinology, Diabetes and Metabolism, cystic fibrosis-related diabete, Cystic fibrosis-related diabetes, cystic fibrosis-related diabetes, 030209 endocrinology & metabolism, Review, prediabetes, Cystic fibrosis, Diseases of the endocrine glands. Clinical endocrinology, Prediabetic State, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, abnormal glucose tolerance, continuous glucose monitoring, glargine insulin, oral glucose tolerance test (OGTT), recommendations, systematic review, Diabetes mellitus, medicine, Diabetes Mellitus, Humans, Hypoglycemic Agents, Insulin, 030212 general & internal medicine, Prediabetes, Glycemic, Insulin glargine, business.industry, Glucose Tolerance Test, RC648-665, medicine.disease, Prognosis, Comorbidity, Disease Progression, prediabete, business, medicine.drug
Abstract

Cystic fibrosis related diabetes (CFRD) is a comorbidity of cystic fibrosis (CF) that negatively impacts on its clinical course. Prediabetes is an important predictor of either CFRD development and unfavorable prognosis of CF in both pediatric and adult patients. International guidelines recommend insulin only in case of CFRD diagnosis. Whether early detection and treatment of prediabetes may contribute to improve the clinical course of CF is still debated. A subgroup of pediatric diabetologists of the Italian Society for Pediatric Endocrinology and Diabetology (ISPED) performed a systematic review of the literature based on predefined outcomes: impact of pre-diabetes on clinical outcomes and on the risk of developing CFRD; diagnosis of diabetes and pre-diabetes under 10 years of age; effectiveness of therapy on glycemic control, impact of therapy on pulmonary function and nutritional status. Thirty-one papers were selected for the analysis data presented in these papers were reported in tables sorted by outcomes, including comprehensive evidence grading according to the GRADE approach. Following the grading of the quality of the evidence, the entire ISPED diabetes study group achieved consensus for the Italian recommendations based on both evidence and clinical experience. We concluded that in patients with CF, prediabetes should be carefully considered as it can evolve into CFRD. In patients with CF and prediabetic conditions, after complete evaluation of the OGTT trend, glucometrics, glycemic values measured during pulmonary exacerbations and/or steroid therapy, early initiation of insulin therapy could have beneficial effects on clinical outcomes of patients with CF and prediabetes.

Published
2021

4. Author response for 'Cardiovascular risk factors in children and adolescents with type 1 diabetes in Italy: a multicentric observational study'

Author

F. Cardella, Claudia Piona, Raffaele Buganza, Nicola Minuto, Donatella Lo Presti, R Roppolo, Marco Marigliano, Valentino Cherubini, Vittoria Cauvin, Enza Mozzillo, Ippolita Patrizia Patera, Stefano Zucchini, Fortunato Lombardo, Elena Fornari, Angela Zanfardino, T. Suprani, P. Reinstadler, Barbara Predieri, Elisa Giani, Ivana Rabbone, Riccardo Bonfanti, and C. Maffeis

Subjects
Type 1 diabetes, Pediatrics, medicine.medical_specialty, business.industry, Cardiovascular risk factors, medicine, Observational study, medicine.disease, business
Published
2020
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5. Has COVID-19 Delayed the Diagnosis and Worsened the Presentation of Type 1 Diabetes in Children?

Author

Rabbone, Ivana, Schiaffini, Riccardo, Cherubini, Valentino, Maffeis, Claudio, Scaramuzza, Andrea, Diabetes Study Group of the Italian Society for Pediatric Endocrinology and Diabetes (Enrica Bertelli, Lucia, Ferlito, Adriana, Bobbio, Eleonardo, Schieven, Maurizio, Delvecchio, Giulio, Maltoni, Petra, Reinstadler, Barbara, Felappi, Francesco, Gallo, Carlo, Ripoli, Filomena, Pascarella, Filomena, A Stamati, Donatella Lo Presti, Felice, Citriniti, Stefano, Tumini, Maria, Zampolli, Rosaria De Marco, Claudio, Cavalli, Valeria De Donno, Sonia, Toni, Maria Susanna Coccioli, Giuseppe, D'Annunzio, Paola Sogno Valin, Dante, Cirillo, Silvia, Sordelli, Fortunato, Lombardo, Riccardo, Bonfanti, Chiara, Mameli, Predieri, Barbara, Adriana, Franzese, Dario, Iafusco, Silvia, Savastio, Gavina, Piredda, Francesca, Cardella, Valeria, Calcaterra, Emioli, Randazzo, Anna, Favia, Tosca, Suprani, Alessandra, Lasagni, Novella, Rapini, Irene, Rutigliano, Alberto, Gaiero, Luisa De Sanctis, Vittoria, Cauvin, Marta, Minute, Gianluca, Tornese, Francesca, Franco, Gianluca, Musolino, Marco, Marigliano, Silvia, Innaturato, Claudia, Arnaldi), Rabbone, Ivana, Schiaffini, Riccardo, Cherubini, Valentino, Maffeis, Claudio, Scaramuzza, Andrea, Tornese, Gianluca, Rabbone, I., Schiaffini, R., Cherubini, V., Maffeis, C., Scaramuzza, A., Italian Study Group of Diabetes of, Isped, and Iafusco, D

Subjects
Research design, Male, Pediatrics, Delayed Diagnosis, Cross-sectional study, Endocrinology, Diabetes and Metabolism, Clinical Laboratory Technique, 0302 clinical medicine, COVID-19 Testing, 030212 general & internal medicine, Viral, Child, Emergency Service, Delayed Diagnosi, COVID-19, diabetes mellitus type 1, Italy, Adolescent, Child, Preschool, Clinical Laboratory Techniques, Coronavirus Infections, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Diabetic Ketoacidosis, Emergency Service, Hospital, Female, Humans, Infant, Pandemics, Pneumonia, Viral, SARS-CoV-2, Betacoronavirus, medicine.symptom, Human, Type 1, medicine.medical_specialty, Diabetic ketoacidosis, 030209 endocrinology & metabolism, Asymptomatic, Diabetic Ketoacidosi, 03 medical and health sciences, Hospital, Diabetes mellitus, Internal Medicine, medicine, Diabetes Mellitus, Preschool, Advanced and Specialized Nursing, Cross-Sectional Studie, Type 1 diabetes, Pandemic, business.industry, Coronavirus Infection, Emergency department, Pneumonia, medicine.disease, business
Abstract

OBJECTIVE To evaluate whether the diagnosis of pediatric type 1 diabetes or its acute complications changed during the early phase of the coronavirus disease 2019 (COVID-19) pandemic in Italy. RESEARCH DESIGN AND METHODS This was a cross-sectional, web-based survey of all Italian pediatric diabetes centers to collect diabetes, diabetic ketoacidosis (DKA), and COVID-19 data in patients presenting with new-onset or established type 1 diabetes between 20 February and 14 April in 2019 and 2020. RESULTS Fifty-three of 68 centers (77.9%) responded. There was a 23% reduction in new diabetes cases in 2020 compared with 2019. Among those newly diagnosed patients who presented in a state of DKA, the proportion with severe DKA was 44.3% in 2020 vs. 36.1% in 2019 (P = 0.03). There were no differences in acute complications. Eight patients with asymptomatic or mild COVID-19 had laboratory-confirmed severe acute respiratory syndrome coronavirus 2. CONCLUSIONS The COVID-19 pandemic might have altered diabetes presentation and DKA severity. Preparing for any “second wave” requires strategies to educate and reassure parents about timely emergency department attendance for non–COVID-19 symptoms.

Published
2020

6. Cardiovascular risk factors in children and adolescents with type 1 diabetes in Italy: a multicentric observational study

Author

F. Cardella, Claudia Piona, R Roppolo, T. Suprani, Enza Mozzillo, Claudio Maffeis, Barbara Predieri, Riccardo Bonfanti, Marco Marigliano, Ivana Rabbone, Nicola Minuto, Raffaele Buganza, Elisa Giani, Fortunato Lombardo, Elena Fornari, Vittoria Cauvin, Angela Zanfardino, Ippolita Patrizia Patera, Stefano Zucchini, Donatella Lo Presti, P. Reinstadler, Valentino Cherubini, Fornari, E., Piona, C., Rabbone, I., Cardella, F., Mozzillo, E., Predieri, B., Lo Presti, D., Cherubini, V., Patera, I. P., Suprani, T., Bonfanti, R., Cauvin, V., Lombardo, F., Zucchini, S., Zanfardino, A., Giani, E., Reinstadler, P., Minuto, N., Buganza, R., Roppolo, R., Marigliano, M., and Maffeis, C.

Subjects
Male, cardiovascular risk, cardiovascular risk factors, medicine.medical_specialty, Cross-sectional study, type 1 diabetes, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, Logistic regression, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, children, Risk Factors, Internal medicine, Prevalence, Internal Medicine, medicine, Humans, cardiovascular risk factor, 030212 general & internal medicine, adolescents, Child, Type 1 diabetes, medicine.diagnostic_test, business.industry, adolescents, cardiovascular risk, cardiovascular risk factors, children, type 1 diabetes, Anthropometry, medicine.disease, Physical activity level, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Italy, Cardiovascular Diseases, Child, Preschool, adolescent, Pediatrics, Perinatology and Child Health, Cohort, Female, Lipid profile, business, Cohort study
Abstract

Aims to assess the prevalence of cardiovascular risk factors (CVRFs) and to identify the variables associated with CVRFs in a cohort of children and adolescents with Type 1 Diabetes. Methods 2,021 subjects, 2-18 year-old, were recruited in 17 Italian Pediatric Diabetes Centers. Anthropometric, blood pressure, biochemical (HbA1c, lipid profile, ACR), insulin therapy, physical activity level, smoking and family socio-economic status data were collected. CVRFs prevalence and their distribution were analyzed according to age and binary logistic regression was performed with positivity for at least one major CVRF (BMI-SDS>+2SD, blood pressure>90th percentile, LDL cholesterol>100 mg/dl) as dependent variable and age, duration of illness, gender, HbA1c and physical activity, as independent variables. Results The prevalence of CVFRs not at the recommended target was respectively: 32.5% one CVRF, 6.7% two CVRFs and 0.6% three CVRFs, with no significant differences across the 3 age groups (2-10, 10-15, 15-18 years). In the total sample, HbA1c and inadequate physical activity were associated with a higher probability of having at least one major CVRF. This probability was associated with physical activity in the 2-10-year-old group, with physical activity and HbA1c in the 10-15-year-old group and with HbA1c only in subjects older than 15 years. Conclusions More than 30% of subjects had at least a major CVRF. Early detection of CVRFs may be useful to enforce the therapeutic intervention in this subgroup, in order to reduce the risk to develop cardiovascular complications. This article is protected by copyright. All rights reserved.

Published
2020

7. Skin and subcutaneous thickness at injecting sites in children with diabetes: ultrasound findings and recommendations for giving injection

Author

Carmela Ingegnosi, Donatella Lo Presti, and Kenneth Strauss

Subjects
Type 1 diabetes, medicine.medical_specialty, business.industry, Endocrinology, Diabetes and Metabolism, Insulin, medicine.medical_treatment, Ultrasound, Pen needles, medicine.disease, Surgery, medicine.anatomical_structure, Skin fold, Diabetes mellitus, Pediatrics, Perinatology and Child Health, Internal Medicine, medicine, Abdomen, Buttocks, business
Abstract

Background Children who inject insulin need clear guidelines as to the length of needle best for them. We studied the distance from surface to muscle in children in order to make needle choices which are evidence-based. Methods One hundred one children with type 1 diabetes were divided into three groups according to age: 2–6, 7–13, and 14–17 yr. The thickness of skin and subcutaneous (SC) tissue was measured by ultrasound in all injection sites. Results Skin thickness varied from 1.58 mm in the arm of the youngest children to 2.29 mm in the buttocks of the adolescents. Values decreased progressively based on age (2–6 < 7–13 < 14–17) and on body site (arm

Published
2012
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