Joint and distinct risk factors associated with micro- and macrovascular complications in a cohort of type 2 diabetic patients cared through disease management.

We analysed the risk factors associated with diabetic complications in the cohort of patients assisted by a type 2 diabetes mellitus (T2DM) shared-care program. We analysed registry data from 16,136 T2DM patients. Of them, 4,781 had microangiopathy, 3,469 CV events. They were 70.5 ± 17.1 years old, 50% were male, disease duration 13.3 ± 7.8 years, BMI 28.7 ± 4.9 kg/m², HbA1c 7.08 ± 1.23%, FBG 134.7 ± 35.7 mg/dl, 2hPPBG 163.9 ± 47.8 mg/dl, 12.5% smokers. Cholesterol 202.5 ± 37.6 mg/dl, HDL 51.4 ± 20.4 mg/dl, LDL 126.5 ± 36.0 mg/dl, triglyceride 146.2 ± 72.4 mg/dl, SBP 137.8 ± 14.2 mmHg, DBP 80.7 ± 10.8 mmHg, 10-year CV risk score 13.7 ± 9.1; 70.4% had no microangiopathy-i.e. renal, retinal, peripheral nerve disease-and 78.5% of patients had no CV events. Age-adjusted risk factors associated with diabetic complications were male gender, HbA1c, 2hPPBG, HDL, and triglyceride. FBG and SBP were associated with microangiopathy, whereas smoking with cardiovascular events. Optimal targets were reached in: FBG 17%, 2hPPBG 8%, HbA1c 21%, cholesterol 17%, HDL 8%, LDL 5%, triglyceride 20%, SBP 13%, DBP 30%. Drug profiles showed 13% using metformin, 28% sulphonilureas, 26% bitherapy, 4% insulin; 12% statins, 16% anti-platelets, 27% anti-hypertensives, 2% anti-coagulants. T2DM patients showed an acceptable CV risk profile. Joint risk factors for diabetic complications were male gender, HbA1c, 2hPPBG, HDL, and triglyceride. Distinct risk factors were FBG and SBP for micro- and smoking for macrovascular disease. A targeted-to-treat approach needs more attention in the care of T2DM patients.

Assessment of readability and learning of easy-to-read educational health materials designed and written with the help of citizens by means of two non-alternative methods.

OBJECTIVES: We compared two non-alternative methods to assess the readability and learning of easy-to-read educational health materials co-written by physicians, educators and citizens. METHODS: Data from seven easy-to-read materials were analyzed. Readability formulae, and ad hoc data on readability and learning were also computed. RESULTS: The respondents had a mean age of 48.5 +/- 8.3 (SD) years (range 31-57 years). More than two thirds of them were females. About half of the participants had a 'secondary' education or more. According to the readability scores - 54 on average - the booklets resulted to be "easy" for a reader who had received a 'secondary education' or more. Of the 747 participants, 70% of them found the booklet's language to be 'easy' or 'very easy' and 28% 'sufficiently easy' for laypersons to understand. About 98% of the readers found the booklets useful. After reading the booklet 92% (simple knowledge rate) of the readers answered the cognitive items correctly. The after-minus-before net increase in knowledge was 24 +/- 16% and ranged from 8 to 40% (cognitive or knowledge delta). CONCLUSIONS: The availability of readability scores is complementary and it does not replace the need to assess readability and learning by means of structured and tailored questionnaires.

Evaluation of easy-to-read information material on healthy life-styles written with the help of citizens' collaboration through networking.

The objective of this study was to evaluate if easy-to-read information material on the prevention of chronic-degenerative diseases through healthy lifestyle co-written by communicators, educators, physicians and citizens -using a networking strategy- could be judged comprehensible. Readability scores were computed. The survey involved 100 individuals attending our centralized booking centre for medical appointments during an "index week". They filled out an anonymous questionnaire, just before and after they had read the material. Readability and comprehensibility frequencies were calculated. The participants had a mean age of 59.1+/-15.1 (SD) years (range 19-81yrs), 62% were females. Twenty-six percent of them had received no education, 30% "primary", 28% "secondary", and 14% had a "degree". According to readability scores, the booklet was "readable" by all persons who had finished primary school. Of the 100 participants, 40 percent found the booklet's language to be "easy" or "very easy", 46% "sufficiently easy", and 14% "difficult" for laypersons to understand. Ninety-four percent of them found no unintelligible words in the text. Education levels showed no differences. Readers' answers were more correct after they had read the booklet. The pre-test showed that 61+/-26% of the readers answered the comprehensibility items correctly. After reading the booklet, 81+/-17% of them gave correct answers. The after-minus-before net increase in knowledge was +20% (95% CIs +8 to +32%). The booklet was designed and written using a networking strategy with the help of the local population. It was found to be easy to read and quite clear.

Surveillance of dietary habits and lifestyles among 5-6 year-old children and their families living in Central-North Italy.

OBJECTIVES: To study dietary habits and behaviours of a representative sample of 5-6-year-old children and their families. METHODS: A stratified population sample of the general population (5508 children out of 5551 residents) born in 1997 and attending a nursery school was analysed. Weight and height were measured. Information was collected via questionnaire. A "normal" body mass index (BMI) ranged between 13.61-18.09 and 13.31-19.79 kg/m2 for boys and girls respectively. RESULTS: The response rate was 89%. 79% of the boys had a normal BMI, 0.9% had a low BMI, 18% were overweight, and 1.8% was obese; 87% of the girls had a normal BMI, 2.6% had a low BMI, 10% were overweight, and 0.7% were obese. The main sources of dietary information were professionals of the national health system and mass-media. The main barriers to healthy dietary habits were busy daily activities, working timetable, time needed to cook and tasty and healthy food cost. The main changes in dietary habits occurred in the family habits after a child's birth. CONCLUSIONS: Our findings showed a crucial role played by professionals of the national health system and by mass-media on eating behaviours among children and their parents. Birth of a child is a receptive context to promote healthy habits.

Non-HDL cholesterol predicts coronary heart disease in primary prevention: findings from an Italian 40-69 year-old cohort in general practice.

OBJECTS: Non-HDL cholesterol is now recommended as an index of risk associated with combined dyslipidemia, and it has also been found useful in predicting coronary heart disease (CHD) risk in patients with diabetes. We studied the association between known CHD risk factors, enclosed non-HDL cholesterol, and a "high CHD risk condition", i.e. a "5-years CHD risk >15%" in general practice. METHODS: We studied 4,085 40-69 year-old diabetic (no. 489) and non-diabetic (no. 3,596) individuals from an opportunistic cohort. Cross-sectional descriptive statistics, and age- and gender-adjusted multiple logistic exponential betas have been calculated. RESULTS: About 12% of the participants had diabetes. Age- and gender-adjusted comparison showed that all the study variables were significantly worse in diabetic vs. non-diabetic individuals (except cigarette smoking, total blood cholesterol and the ratio of total to HDL cholesterol). They had a mean "5-year CHD-risk" significantly higher than non-diabetic individuals (18.8+/-11.9% vs 7.5+/-6.9%, P<0.01), and a four-fold prevalence of "5-years CHD risk >15%" (55.4% vs 11.1%, P<0.01). As to diabetic individuals, the study variables associated to a "high CHD risk condition" were cigarette smoking, systolic blood pressure, and non-HDL blood cholesterol levels. As to non-diabetic individuals cigarette smoking, systolic blood pressure, and HDL (inversely) and non-HDL blood cholesterol levels were associated to a "high CHD risk condition". CONCLUSIONS: Non-HDL cholesterol--and cigarette smoking and systolic blood pressure--strongly predicted a "high CHD risk condition" both in diabetic and non-diabetic individuals.

[Relationship between the assessment of coronary risk using the Italian chart and the assessment with the New Zealand chart]. / Relazione tra la valutazione del rischio coronarico calcolato con la carta italiana e quella neozelandese.

OBJECTIVE: To describe the distribution of coronary risk in primary prevention using both the New Zealand and Italian charts, and to assess whether there is a relationship between the two scales built on data from populations at different natural coronary risk. DESIGN: Descriptive study. SETTING: Carpi's district, Territorial Health Authority in Modena province. PARTICIPANTS: Population between 40 and 69 years old without any background of cardiovascular disease. MAIN MEASURES: The variables studied corresponded to the Jackson's New Zealand table and the Italian Progetto Cuore's one. Concordance was assessed with the kappa coefficient. RESULTS: We studied 1850 men and 2235 women with an average age of 56 years. The percentage of 'high' coronary risk men and women at the New Zealand's chart was 27% and 8% respectively. Ten percent of 'high' risk men and no woman were found at the Italian chart. The kappa coefficient to evaluate the agreement on high risk men between the two charts was 'moderate' (kappa = 0.403). No estimation was allowed for women. CONCLUSION: There was moderate agreement between the New Zealand and the Progetto Cuore charts.

Characteristics of an Italian diabetic population and long-term changes in glycaemic control at varying body weight categories.

OBJECTIVES: To describe the characteristics of a diabetic population in a primary care setting, and to evaluate changes in glycaemic control at varying body weight categories. METHODS: We collected 4,610 valid baseline and three years follow-up paired data sheets sent from 77% of the general practitioners adhering to our shared-care program (257 GPs out of 521) for people with type 2 diabetes. Three conventional body weight categories were defined: "normal" (BMI, < or = 25 kg/m2), "overweight" (BMI 25.0-29.9), "obesity" (BMI > or = 30). According to weight status we calculated descriptive statistics and follow-up paired changes. RESULTS: A fifth of the diabetic patients had a "normal" BMI, about 45% was "overweight" and 34% was "obese". At follow-up, the glycaemic control significantly improved both in "normal" and "overweight" people, while it significantly worsened in "obese" ones. CONCLUSIONS: Our data confirm the crucial role played by body weight and its changes in diabetic patients.

Improving the cardio-respiratory fitness in older people and cardiac patients: findings from an Italian participatory research.

OBJECTIVE: We performed a before-after study--in the setting of a participatory research--aimed at improving the cardio-respiratory fitness in older people and cardiac patients by means of tailored advices on diet and exercise administered by trained personnel. METHODS: A volunteer sample of 336 patients underwent a 2-km walk test before and after a comprehensive assessment of health status and after the administration of tailored advices on healthy diet and a personalized exercise program at home by trained personnel. The main outcome measures were before-after changes in the cardiorespiratory fitness index and in the oxygen consumption at a "fast 2-km walking test". RESULTS: The participants had a mean age of 60.9 +/- 6.5 years (range 50-78 years), 62.5% were males. At the end of the study period (3 months), we found a significant improvement of all the exercise test parameters. CONCLUSIONS: A simple diet and exercise individualized 3 months program--administered by trained personnel--was effective at improving the cardio-respiratory fitness in older people and cardiac patients.

Association of obesity and central fat distribution with carotid artery wall thickening in middle-aged women.

BACKGROUND AND PURPOSE: The association between obesity and atherosclerotic disease is controversial. In the present analysis, we evaluated whether common carotid intima-media thickness (IMT) and area, 2 markers of preclinical atherosclerosis, were increased in obese subjects. METHODS: More than 5000 middle-aged women (n=5062; age, 30 to 69 years) living in the area of Naples, Southern Italy, were recruited for a prospective, currently ongoing study on the etiology of cardiovascular disease and cancer in the female population (the Progetto ATENA study). A subsample of 310 participants underwent high-resolution B-mode ultrasound examination, and the IMTs, intima-media areas, and lumen diameters of common carotid arteries were measured with a semiautomated computerized program. Subjects were divided into 3 groups on the basis of the recently published obesity guidelines for body mass index (BMI), a marker of general obesity, and tertiles of waist-to-hip ratio (WHR), a marker of regional obesity. RESULTS: Women with a BMI >/=30 kg/m(2) showed higher systolic and diastolic blood pressures, triglycerides, and fasting glucose and insulin, as well as lower high-density lipoprotein concentrations, than subjects with lower BMI. A gradual increase in common carotid IMT and intima-media area was observed when lean women (0.94+/-0.01 mm and 19.8+/-0.5 mm(2), respectively) were compared with overweight (0.98+/-0.01 mm and 21.0+/-0.4 mm(2)) and obese (1.02+/-0.02 mm and 22.6+/-0.8 mm(2), P<0.005 for linear trend) individuals. Similarly, women in the highest tertile of WHR (>0.85) had adverse risk factor profiles and thicker carotid intima-media complex than those in the first 2 tertiles (P<0.01 and P<0.05 for IMT and intima-media area, respectively). In multivariate analyses, BMI and WHR were significant predictors of carotid wall thickness, independently of other traditional and nontraditional cardiovascular risk factors (age, blood pressure, lipid abnormalities, fasting insulin). CONCLUSIONS: The present results indicate a graded and independent association between general and abdominal obesity-reflected by high BMI and WHR-and carotid artery wall thickening in a population of middle-aged women.

Varicose veins of the lower limbs and venous capacitance in postmenopausal women: relationship with obesity.

OBJECTIVE: The purpose of this study was to examine the association between body mass index (BMI), venous capacitance, and clinical evidence of varicose veins after adjustment for sex hormones in postmenopausal women. METHODS: This study group of the DIANA (DIet and ANdrogens) project (a randomized controlled trial on the effect of some dietary changes on sex hormone pattern in women with elevated androgenic hormone levels in Italy) was comprised of 104 healthy volunteer postmenopausal women, aged 48 to 65 years. The main outcome measures were physical examination to determine the presence and severity of varicose veins and plethysmographic measurement of lower limb venous capacitance and outflow. RESULTS: Women in the upper quartile of BMI (>30 kg/m(2)) showed a positive association with clinical evidence of varicose veins (odds ration, 5.8; 95% CI, 1.2 to 28.2) after adjustment for age, estradiol, testosterone, and sex hormone binding globulin. No association was found between BMI and plethysmographic measurements of venous parameters. CONCLUSION: Obesity is associated with clinical evidence of varicose veins independently from the influence of sex hormones in postmenopausal women and is not associated with venous capacitance. Increased body weight increases the risk of varicose veins.