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Objective: To investigate the relationship between beliefs of physicians relative to intensive metabolic control in type 2 diabetes and levels of HbA1c obtained in a sample of their patients.Research Design and Methods: Physicians' beliefs were investigated through a questionnaire sent to a sample of self-selected clinicians participating in a nationwide initiative aimed at assessing the relationship between the quality of care delivered to patients with type 2 diabetes and their outcomes. At the same time, physicians were asked to collect clinical data on a random sample of their patients, stratified by age (<65 vs. > or = 65 years). Mean HbA1c levels in the study population were thus evaluated according to target fasting blood glucose (FBG) used by their physicians.Results: Of 456 physicians, 342 (75%) returned the questionnaire. Among the responders, 200 diabetologists and 99 general practitioners (GPs) recruited 3,297 patients; 2,003 of whom were always followed by the same physician and 1,294 of whom were seen by different physicians in the same structure on different occasions. Only 14% of the respondents used target FBG levels < or = 6.1 mmol/l, whereas 38% pursued values >7.8 mmol/l, with no statistically significant difference between diabetologists and GPs. The analysis of the relationship between FBG targets and metabolic control, restricted to those patients always seen by the same physician, showed a strong linear association, with mean HbA1c values of 7.0 +/- 1.6 for patients in the charge of physicians pursuing FBG levels < or = 6.1 mmol/l and 7.8 +/- 1.8 for those followed by physicians who used target values >7.8 mmol/l. After adjusting for patients' and physicians' characteristics, the risk of having HbA1c values > 7.0% was highly correlated with physicians' beliefs. Patients followed by different physicians in the same unit showed a risk of inadequate metabolic control similar to that of patients followed by physicians adopting a nonaggressive policy.Conclusions: Doctors adopt extremely heterogeneous target FBG levels in patients with type 2 diabetes, which in turn represent an important independent predictor of metabolic control. To improve patient outcomes, physicians-centered educational activities aimed at increasing the awareness of the potential benefits of a tight metabolic control in patients with type 2 diabetes are urgently needed. [ABSTRACT FROM AUTHOR]

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]

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]