Metabolic control and complications in Italian people with diabetes treated with continuous subcutaneous insulin infusion

BACKGROUND AND AIM

The objective of this cross-sectional study was to evaluate the degree of glycaemic control and the frequency of diabetic complications in Italian people with diabetes who were treated with continuous subcutaneous insulin infusion (CSII).

METHODS AND RESULTS

Questionnaires investigating the organisation of diabetes care centres, individuals' clinical and metabolic features and pump technology and its management were sent to adult and paediatric diabetes centres that use CSII for treatment in Italy. Information on standard clinical variables, demographic data and acute and chronic diabetic complications was derived from local clinical management systems. The sample consisted of 6623 people with diabetes, which was obtained from 93 centres. Of them, 98.8% had type 1 diabetes mellitus, 57.2% were female, 64% used a conventional insulin pump and 36% used a sensor-augmented insulin pump. The median glycated haemoglobin (HbA_1c) level was 60 mmol/mol (7.6%). The HbA_1c target (i.e. <58 mmol/mol for age <18 years and <53 mmol/mol for age >18 years) was achieved in 43.4% of paediatric and 23% of adult participants. Factors such as advanced pump functions, higher rate of sensor use, pregnancy in the year before the study and longer duration of diabetes were associated with lower HbA_1c levels. The most common chronic complications occurring in diabetes were retinopathy, microalbuminuria and hypertension. In the year before the study, 5% of participants reported ≥1 episode of severe hypoglycaemic (SH) episodes (SH) and 2.6% reported ≥1 episode of ketoacidosis.

CONCLUSIONS

Advanced personal skills and use of sensor-based pump are associated with better metabolic control outcomes in Italian people with diabetes who were treated with CSII. The reduction in SH episodes confirms the positive effect of CSII on hypoglycaemia.

CLINICAL TRIAL REGISTRATION NUMBER

NCT 02620917 (ClinicalTrials.gov).

Cochlear, auditory brainstem responses in Type 1 diabetes: relationship with metabolic variables and diabetic complications

AIMS

Few studies have analysed the presence of hearing abnormalities in diabetes. We assessed the presence of subclinical auditory alterations and their possible association with early vascular and neurological dysfunction in young adults with Type 1 diabetes of long duration.

METHODS

Thirty-one patients with Type 1 diabetes (mean age 33 ± 2.3 years, disease duration 25.7 ± 4.2 years) and 10 healthy controls underwent pure tone audiometry (PTA), distortion product otoacoustic emission (DPOAE) and auditory brainstem response (ABR) analyses. Associations with metabolic variables and chronic complications were explored.

RESULTS

Compared with healthy controls, patients with diabetes had significantly higher mean hearing thresholds, although still within the normoacusic range. DPOAE intensities at medium frequencies (2.8-4 kHz) were significantly lower in patients with diabetes. In ABR, in addition to waves I, III and V, we observed the appearance of a visible wave IV in patients with diabetes compared with controls (prevalence 61% vs. 10%, P < 0.05), and its appearance was related to a prolonged I-V interval (4.40 ± 0.62 ms vs. 4.19 ± 0.58 ms, P < 0.05). Diastolic blood pressure was higher in people with abnormal DPOAE (P < 0.05), whereas systolic blood pressure correlated with wave V and interpeak I-V interval latencies. A trend towards an association between evidence of wave IV and the presence of somatic neuropathy or abnormal cardiovascular autonomic tests was observed.

CONCLUSIONS

Young adults with long-term Type 1 diabetes have subclinical abnormalities in qualitative auditory perception, despite normal hearing thresholds, which might reflect neuropathic and/or vascular alterations.

Quantitative allocation of Bragg scattering effects in highly efficient OLEDs fabricated on periodically corrugated substrates

Bragg scattering effects in bottom-emitting organic light-emitting diodes (OLEDs) grown on corrugated aluminum-doped zinc oxide electrodes are analyzed. Periodic corrugation is introduced by structuring the oxide electrode via UV laser ablation, a process that enables flexible adjustment of the period and height of corrugation. We demonstrate that fabrication of stable and electrically efficient OLEDs on these rough substrates is feasible. Sharp spectral features are superimposed onto the broad emission spectra of the OLEDs, providing clear evidence for Bragg scattering of light from guided modes into the air cone. Theoretical analysis based on an emissive dipole model and conservation of momentum considerations allows a quantitative description of scattering and the associated dispersion relations.

Analysis of Periodical Structures Produced by Laser Interference Structuring Using Energy Dispersive X-ray Spectrometry

Laser Interference Metallurgy is a newly developed method which permits the creation of periodic patterns with a well defined long-range order on metallic surfaces. By means of interfering laser beams with sufficient high pulse power a direct structuring on the scale of microns with well known metallurgical effects such as melting, recrystallization, quenching, recovery, defect or phase formation can be obtained. In this work Energy Dispersive X-ray Spectroscopy is used to study the constitutive elements of the films at different irradiated zones. The obtained scans are compared with cross-sectional analyses by Focused Ion Beam giving important information for the interpretation of the layer structure.

Spectrum and distribution of MECP2 mutations in 64 Italian Rett syndrome girls: tentative genotype/phenotype correlation

We report a direct DNA sequencing analysis of the MECP2 gene undertaken on a further 64 Italian patients with Rett syndrome by using a LICOR 4200 Automated Sequencer. All of the girls entering the study had a consistent clinical diagnosis for this disorder. All coding regions and the flanking intronic splice site sequences were amplified as three non-overlapping fragments by using both forward and reverse primers. The results were then compared to the MECP2 reference sequences published in GenBank. Mutations of the MECP2 gene were identified in 64 of 75 (85.33%) unrelated sporadic Rett syndrome girls. Genotype/phenotype correlation studies, in particular in groups of patients with the same mutation, did not offer definitive and interesting data.

Dermatophytes and dermatophytoses in the Milan area between 1970 and 1989

Between 1970 and 1989 we examined 13,019 patients with dermatophytoses in the Milan area, Northern Italy. The results obtained during the 1980-89 period were compared with those obtained in the years 1970-79. From the data collected, tinea corporis emerged as the most frequently observed dermatophytosis, followed by tinea pedis and unguium. As far as dermatophytes are concerned, the dermatological pattern is dominated by Microsporum canis and Trichophyton rubrum. Other species, such as Epidermophyton floccosum, T. mentagrophytes, M. gypseum, T. violaceum, T. verrucosum, T. tonsurans and T. schoenleinii, have progressively become less evident. Other mycetes, such as T. megninii, T. soudanense, M. langeroni, T. vanbreuseghemii, M. ferrugineum, sporadically isolated in the 1970-79 period, have disappeared in recent years. An analysis of the distribution and frequency of the dermatophytes according to the cutaneous area affected is reported.

Onychomycoses due to Microascus cirrosus (syn. M. desmosporus)

Microascus cirrosus is very rarely the aetiological agent of onychomycosis. We report two additional cases of toenail infections caused by this fungus.

Pityriasis versicolor of the face

Pityriasis versicolor (p.v.) is a superficial mycosis occurring frequently on the face. Epidemiological and clinical data regarding cases of p.v. on the face over a period of 11 years are discussed and some explanation given for conditions which favour facial involvement. This study underlines that face lesions of p.v. are more common in children than in adults and in females than in males. The forehead is the site of facial involvement usually affected. Clinical features are variable but we often observed achromic or hypopigmented scaling lesions, smaller than trunk patches.

Tinea pedis in children

Tinea pedis is a superficial mycosis, unusual in children. Epidemiological and clinical data regarding cases of tinea pedis observed in children over a period of 20 years are discussed and some explanation given for the conditions which predisposed children to the infection. Clinical features are variable and similar to adults. Bullous lesions are more frequently seen in children. Most of the cases were seen in children over 10 years of age. Males are more often affected with tinea pedis: this is particularly true for 10 to 13 year-old children. As in adults, Trichophyton rubrum is the most frequently isolated etiological agent.

Pityriasis versicolor in the pediatric age

Pityriasis versicolor (PV) is a superficial mycosis, theoretically unusual in children. Epidemiologic and clinical data for children with PV over 11 years was collected. Some explanations are given for the conditions that favored this mycotic infection in children. This study confirms that the face is a usual site of PV in children, in contrast to its rarity as a site in adults. Clinical features are variable and similar to adults. Both sexes are equally affected. The family history is often positive for PV.

Tinea capitis in adults

Scalp ringworm is unusual after puberty. Etiological, epidemiological and clinical data regarding cases of tinea capitis in the elderly observed over a period of 15 years are discussed and some explanations are given for the conditions which favoured the mycotic infection of the scalp in adults. This study underlines that tinea capitis in the elderly is usually characterized by very variable and often atypical lesions and that female preponderance in adult cases of scalp ringworm is striking and unexplained. Moreover, all the dermatophytes we isolated from scalp lesions in children can cause tinea capitis in adults.

Drug-induced changes in the plasma membrane of Microsporum canis. A preliminary freeze--fracture study

Commercial solutions of clotrimazole, tolnaftate and tolcyclate were tested for 12 h in cultures of Microsporum canis. They induced modifications in particle distribution, a blebbing of particle-free areas and the appearance of lamellar figures on the plasma membrane of fungus cells. The first two changes in the plasma membrane might be ascribed to a modification of the spectrin-like meshwork, while the third could be the result of a crystalline organization of membrane lipids.

[Clinical and immunological study of 2 cases of systemic candidiasis]

Two cases of chronic systemic candidiasis of the infancy are presented and their immunity in vivo and in vitro is studied. The clinical course, the negative intradermal tests to Candida extract and the absence of lymphoblastic transformation to the same antigen, suggest an immunological deficit of the cell mediated immunity. The positive response to intradermal test of bacterial antigens, the clinical recovery from infections different from Candida albicans and the positivity of the patch test to DNCB suggest the possibility of a selective immunological reponse (macrophage inability of precessing Candida albicans). The authors give a pathogenic hypothesis of the two different clinical cases (granuloma and erythematous-scaly sesions), based on the different capacity in producing MIF.