Trends in drug prescriptions to diabetic patients from 2000 to 2008 in Italy's Lombardy Region: a large population-based study.

OBJECTIVE: To analyze the prescribing patterns of antidiabetic and cardiovascular medications among diabetics in the most highly populated Italian Region, from 2000 to 2008. METHODS: Data were obtained from the Lombardy Region administrative health databases. The standardized prevalence of antidiabetic and cardiovascular drugs use was calculated within each study year. The prescription trends of initial treatment with antidiabetic drugs were also analyzed. RESULTS: From 2000 to 2008 there was an increase in the proportion of patients treated with biguanides (from 53.4% to 66.5%; p<0.0001) while those receiving sulfonylurea decreased (from 78.6% to 56.4%; p<0.0001). A sharp increase of metformin (as monotherapy) as initial treatment was also observed (from 15.2% to 48.8%; p<0.0001). The percentage of patients receiving renin-angiotensin system inhibitors, lipid-lowering drugs and antiplatelets increased between 2000 and 2008, from respectively 45.1% to 63.3%, 13.6% to 43.2% and 21.6% to 40.9 (p<0.0001). Multivariate analyses indicated that changes in prescriptions were statistically significant for both antidiabetic and cardiovascular drugs. CONCLUSION: This study documents progressive changes in the prescription of antidiabetic and cardiovascular drugs in accordance with guidelines. However, the use of metformin as first line therapy was still suboptimal and cardiovascular preventive strategies were only partially implemented in community practice.

[Educational activities for the prevention of diabetic foot: foot complications at the Center for Diabetes of Rovigo]. / L'attività educativa per la prevenzione delle ulcere nel piede diabetico: i risultati del CAD di Rovigo.

Diabetic patients with neuropathic or vascular foot ulcers are described and stratified according to their background risk profiles, as these relate to socioeconomic, behavioural and clinical variables. Of the 464 patients admitted to the foot clinic between January 2000 and December 2001 only 39% had been involved in educational activities for diabetic foot prevention. Seventy-five percent of the patients experienced neurologic problems; 76% socioeconomic risk factors, also related to the economical situation (unsuitable shoes, no sessions with the pedicure). Among the 112 patients with ulcers relapses, in spite of the participation to educational interventions, unsuitable shoes were the most frequently reported precipitating factor. Larger samples and prospective multicentre studies are required to assess the possible yield of educational interventions aiming at controlling the care burden and at avoiding the risk of major amputations.

[Administrative data as source for epidemiological research: clinical pathways of diabetic patients]. / I database amministrativi come fonti di ricerca epidemiologica: il percorso clinico-assistenziale del diabete mellito.

UNLABELLED: Objectives 1. To assess if record linkage of two different databases could improve the quality and understand the epidemiology of diabetes and its complications. 2. To analyse how hospitalization relates to the natural history of the disease and to its pharmaceutical management. 3. To document how pharmacoepidemiology could be a challenging tool for clinicians. 4. To identify critical areas where improvement of care would be specifically important. METHODS: Data came from two large databases, the drugs prescription and the hospital discharge forms of the Local Health Unit of Rovigo, Italy, collected through 2000. A casecontrol design was adopted to compare two cohorts identified by prescription of antidiabetic vs any other drugs and the linkage to their hospitalizations over the index period. The study was focused on people > or = 50 year in order to concentrate the attention on NIDDM. A population of 5.603 patients were identified as diabetic and 63.155 were the controls. The prevalence of diabetes was 3.6% in the general population and 8.1% in 50 year and older. The hospitalizations analysis revealed differences between cases and controls in term of longer duration of stay (10.1 vs 8.4 days), higher in-hospital mortality (5.5% vs 5%) and higher presence of cardiovascular complications. Of the 2.922 hospitalizations registered for diabetics, 43% did not report the specific ICD-9-CM code for diabetic disease (250.x). Record linkage of these administrative databases offers new opportunities to improve the comprehension of the natural history of diabetic disease. The identification of diabetic patients from prescription data allows a more reliable picture of the hospitalization than the simple analyses of hospital discharge forms. Up to 43% of hospitalizations in the diabetic cohort did not report the specific diabetic disease diagnosis, compared to the 25% reported in a previous observation where linkage was not applied. The lack of this code registration during hospitalization can reflect a scant perception of the importance of diabetes as the major determinant of complications and could open a discussion table with other clinicians, general practitioners and health care professionals.

Hashimoto's thyroiditis and Graves' disease associated with retroperitoneal fibrosis.

Retroperitoneal fibrosis is a rare disease of uncertain pathogenesis. However, its possible association with several immunopathologic conditions, the possibility of systemic involvement by the fibrous process, the presence of various autoantibodies, and the frequent response to immunosuppressive treatment all support an autoimmune pathogenesis. Riedel's thyroiditis is a rare disease the pathogenesis of which is also thought to be immune-mediated based on its optimal response to steroids; Riedel's thyroiditis is also frequently reported in association with retroperitoneal fibrosis. We describe here two cases of autoimmune thyroid disease associated with retroperitoneal fibrosis, the first with features of primary myxedema, the second of primary thyrotoxicosis. Histology of retroperitoneal fibrosis is documented and it is compatible with an immunopathologic condition. Thus, these two cases add further support to the hypothesis of an autoimmune pathogenesis of retroperitoneal fibrosis and indicate the importance of carefully monitoring for the development of other autoimmune disorders, i.e., of the thyroid gland, in patients with retroperitoneal fibrosis.

[An area-wide survey of problems of domiciliary care of diabetic patients]. / Problemi dell'assistenza domiciliare al paziente diabetico non autosufficiente nell'ULSS 18 di Rovigo.

Diabetes is a chronic and invalidating illness, therefore diabetic patients are eligible for home care. In one of the districts of the Veneto region the main data on diabetic patients cared at home were collected, in order to know their main characteristics and problems, and the problems nurses encounter in their daily care. Three meetings were planned with home care nurses, to update their knowledge and render more effective and appropriate their care plans, The main problems are related to a. the lack of a caring project at district level, b. the lack of care protocols for the glicemic monitoring and for the management of the hypoglicemic crises; c. the lack of nurses' autonomy in the management of insulin therapy; and d. the time needed for the care of diabetic foot. A course was planned, in order to offer answers to the problems encountered by nurses and proposals for changes were made, included a nurse-doctor integrated record for diabetic patients.