1
|
Iacopi E, Pieruzzi L, Goretti C, Piaggesi A. I fear COVID but diabetic foot (DF) is worse: a survey on patients' perception of a telemedicine service for DF during lockdown. Acta Diabetol 2021; 58:587-593. [PMID: 33439330 PMCID: PMC7803881 DOI: 10.1007/s00592-020-01653-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/01/2020] [Indexed: 12/19/2022]
Abstract
AIMS To evaluate the patients' perceptions of telemedicine visits during COVID-19 lockdown and their level of anxiety about COVID and diabetic foot (DF). METHODS In May 2020, we contacted by phone all the patients who underwent in March and April to remote monitoring visits for DF during the lockdown for COVID-19, with a structured interview, focusing on their perceptions about telemedicine service for DF and on the anxiety toward COVID and DF. RESULTS We analyzed 257 remote monitoring visits in 211 patients. Two hundred and six patients answered the follow-up interview; 177 patients (85.9%) remembered the monitoring visit, 140 (67.9%) the health care professional and 181 patients (87.9%) the reason of contact; 169 patients were alone during the visit, 37 with a relative. Patients judged useful both the monitoring during pandemic (4.35 ± 0.28 on a maximum of five) and the possibility to continue after the lockdown (4.34 ± 0.23 on a maximum of five). Eventually, we observed that DF patients were more worried by DF than by COVID on a scale from 0 (not fear at all) to 5 (terrified) (4.79 ± 0.05 vs. 3.27 ± 1.03, p < 0.05). This difference was higher in previously ulcerated patients (4.84 ± 0.03 vs. 3.03 ± 1.13, p < 0.05) and even more in amputees (4.93 ± 0.03 vs. 2.73 ± 1.21, p < 0.05). CONCLUSIONS DF patients appreciated televisits during lockdown and the continuation of this service after its end. In this context DF prevails on COVID in the worries of patients, especially if they are recurrent ones.
Collapse
Affiliation(s)
- Elisabetta Iacopi
- Diabetic Foot Section, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, PI, Italy.
| | - L Pieruzzi
- Diabetic Foot Section, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, PI, Italy
| | - C Goretti
- Diabetic Foot Section, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, PI, Italy
| | - A Piaggesi
- Diabetic Foot Section, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, PI, Italy
| |
Collapse
|
2
|
Piaggesi A, Sambataro M, Nicoletti C, Goretti C, Lacopi E, Coppelli A. Safety and effectiveness of therapeutic magnetic resonance in diabetic foot ulcers: a prospective randomised controlled trial. J Wound Care 2017; 25:704-711. [PMID: 27974006 DOI: 10.12968/jowc.2016.25.12.704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To test the efficacy and safety of therapeutic magnetic resonance (TMR) in the management of diabetic foot ulcers (DFU), the authors designed a prospective randomised controlled trial in three highly specialised diabetic foot clinics. METHOD All the patients consecutively visited in a period of 18 months were screened according to the inclusion (presence of an ulcer >1 cm2 in the foot lasting at least 6 weeks; ABPI>0.6; consent to participate in the study) and exclusion (Charcot's foot; local or systemic infections; chronic renal failure; any wearable electrically-driven life-supporting device) criteria. Patients, who were treated according to international guideline protocols, were randomised into two groups: group A received for four weeks the sham application of TMR, while group B received the active TMR for the same period. People were followed-up to 10 weeks and healing rate (HR), healing time (HT), rate of granulation tissue on wound bed (% GT), reduction of the area of the lesion (∆AL) and a score (0-3) evaluating erythema, oedema, pain and tenderness, respectively, were measured. Adverse events (AE) were registered and monitored throughout the study. RESULTS No differences were observed in HR, HT and ∆AL between the two groups during follow-up, while % GT and the scores for erythema, oedema and pain at 10 weeks showed significant (p<0.05) improvements in group B compared with group A and versus baseline. When restricted to non-ischaemic patients (ABPI>0.8), ∆AL was significantly (p<0.05) more pronounced in group B than in group A. No difference in AE occurrence was observed between the two groups. CONCLUSION Our study, despite not being able to demonstrate the effectiveness of TMR on healing rate at 10 weeks, with 4 weeks of active treatment in neuro-ischaemic DFUs, shows positive effects on clinical aspects of the DFU and is associated with a significant increase of GT in the wound bed. DECLARATION OF INTEREST The study has been fully sponsored by Thereson S.p.A., manufacturer of TMR devices.
Collapse
Affiliation(s)
- A Piaggesi
- Diabetic Foot Section, Department of Medicine, University of Pisa, Italy
| | - M Sambataro
- Metabolism Disease and Clinical Nutrition Unit, Santa Maria di Ca' Foncello Hospital, Treviso, Italy
| | - C Nicoletti
- Diabetic Foot Service, Casa di Cura Pederzoli, Peschiera del Garda, Italy
| | - C Goretti
- Diabetic Foot Section, Department of Medicine, University of Pisa, Italy
| | - E Lacopi
- Diabetic Foot Section, Department of Medicine, University of Pisa, Italy
| | - A Coppelli
- Diabetic Foot Section, Department of Medicine, University of Pisa, Italy
| |
Collapse
|
3
|
Pickwell K, Siersma V, Kars M, Apelqvist J, Bakker K, Edmonds M, Holstein P, Jirkovská A, Jude EB, Mauricio D, Piaggesi A, Reike H, Spraul M, Uccioli L, Urbancic V, van Acker K, van Baal J, Schaper N. Minor amputation does not negatively affect health-related quality of life as compared with conservative treatment in patients with a diabetic foot ulcer: An observational study. Diabetes Metab Res Rev 2017; 33. [PMID: 27792855 DOI: 10.1002/dmrr.2867] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 10/12/2016] [Accepted: 10/16/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is poor in patients with persistent diabetic foot ulcers and poor HRQoL predicts worse outcomes in these patients. Amputation is often considered a treatment failure, which is why conservative treatment is generally preferred over amputation. However, it is unclear whether minor amputation negatively affects HRQoL compared with conservative treatment in patients with diabetic foot ulcers. METHODS In the cohort of the multicenter, prospective, observational Eurodiale study, we determined difference in change of HRQoL measured by EQ-5D between patients with a diabetic foot ulcers that healed after conservative treatment (n = 676) and after minor amputation (n = 145). Propensity score was used to adjust for known confounders, attempting to overcome lack of randomization. RESULTS Baseline HRQoL was not significantly different between patients treated conservatively and undergoing minor amputation. In addition, there was no difference in the change of HRQoL between these groups. In patients who healed 6 to 12 months after the first visit, HRQoL on the anxiety/depression subscale even appeared to improve more in those who underwent minor amputation. CONCLUSIONS Minor amputation was not associated with a negative impact on HRQoL in patients with a diabetic foot ulcers. It may therefore not be considered treatment failure in terms of HRQoL but rather a viable treatment option. A randomized controlled trial is warranted to further examine the influence of minor amputations on health-related quality of life.
Collapse
Affiliation(s)
- K Pickwell
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - V Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M Kars
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Apelqvist
- Department of Endocrinology, University of Malmö, Malmö, Sweden
| | - K Bakker
- IDF Consultative Section and International Working Group on the Diabetic Foot, Heemstede, the Netherlands
| | - M Edmonds
- Diabetic Department, Kings College Hospital, London, United Kingdom
| | - P Holstein
- Copenhagen Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - A Jirkovská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - E B Jude
- Diabetes Centre, Tameside General Hospital, Ashton-under-Lyne, UK
| | - D Mauricio
- Department of Endocrinology and Nutrition, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - A Piaggesi
- Sezione Dipartimentale Piede Diabetico, Dipartimento di Area Medica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - H Reike
- Innere Abteilung, Mariannen Hospital, Werl, Germany
| | - M Spraul
- Mathias-Spital, Diabetic Department, Rheine, Germany
| | - L Uccioli
- Policlinico Tor Vergata, Department of Internal medicine, Rome, Italy
| | - V Urbancic
- Department of Endocrinology, University Medical Centre, Ljubljana, Slovenia
| | - K van Acker
- H Familie Ziekenhuis and Centre de Santé des Fagnes, Department of Endocrinology, Rumst and Chimay, Belgium
| | - J van Baal
- Department of Surgery, Twenteborg Ziekenhuis, Almelo, The Netherlands
| | - N Schaper
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
4
|
Tascini C, Lipsky B, Iacopi E, Ripoli A, Sbrana F, Coppelli A, Goretti C, Piaggesi A, Menichetti F. KPC-producing Klebsiella pneumoniae rectal colonization is a risk factor for mortality in patients with diabetic foot infections. Clin Microbiol Infect 2015; 21:790.e1-3. [DOI: 10.1016/j.cmi.2015.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 04/08/2015] [Accepted: 04/11/2015] [Indexed: 10/23/2022]
|
5
|
Siersma V, Thorsen H, Holstein PE, Kars M, Apelqvist J, Jude EB, Piaggesi A, Bakker K, Edmonds M, Jirkovska A, Mauricio D, Ragnarson Tennvall G, Reike H, Spraul M, Uccioli L, Urbancic V, van Acker K, van Baal J, Schaper NC. Importance of factors determining the low health-related quality of life in people presenting with a diabetic foot ulcer: the Eurodiale study. Diabet Med 2013; 30:1382-7. [PMID: 23758490 DOI: 10.1111/dme.12254] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/19/2013] [Accepted: 06/06/2013] [Indexed: 11/30/2022]
Abstract
AIM To identify the factors responsible for the low health-related quality of life associated with foot ulcers and the relative importance of these factors. METHODS A total of 1232 patients with a new foot ulcer, who presented at one of the 14 centres in 10 European countries participating in the Eurodiale study, were included in this cross-sectional study. Patient and ulcer characteristics were obtained as well as results from the Euro-Qol-5D questionnaire, a health-related quality of life instrument with five domains (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). To analyse the relative importance of comorbidities and ulcer- and patient-related factors for health-related quality of life, linear regression models were used to calculate the relative contributions of each factor to the fit (R(2) ) of the model. RESULTS Patients reported poor overall health-related quality of life, with problems primarily in the mobility and pain/discomfort domains. Among the comorbidities, the inability to stand or walk without help was the most important determinant of decreased health-related quality of life in all five domains. Among ulcer-related factors, ulcer size, limb-threatening ischaemia and elevated C-reactive protein concentration also had high importance in all domains. The clinical diagnosis of infection, peripheral arterial disease and polyneuropathy were only important in the pain/discomfort domain. CONCLUSIONS The factors that determine health-related quality of life are diverse and to an extent not disease-specific. To improve health-related quality of life, treatment should not only be focused on ulcer healing but a multifactorial approach by a specialized multidisciplinary team is also important.
Collapse
Affiliation(s)
- V Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Petrozza A, Summerer S, Di Tommaso G, Di Tommaso D, Piaggesi A. AN EVALUATION OF TOMATO PLANT ROOT DEVELOPMENT AND MORPHO-PHYSIOLOGICAL RESPONSE TREATED WITH VIVA® BY IMAGE ANALYSIS. ACTA ACUST UNITED AC 2013. [DOI: 10.17660/actahortic.2013.1009.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
7
|
Santaniello A, Giorgi F, Di Tommaso D, Di Tommaso G, Piaggesi A, Perata P. GENOMIC APPROACHES TO UNVEIL THE PHYSIOLOGICAL PATHWAYS ACTIVATED IN ARABIDOPSIS TREATED WITH PLANT-DERIVED RAW EXTRACTS. ACTA ACUST UNITED AC 2013. [DOI: 10.17660/actahortic.2013.1009.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
8
|
Tascini C, Gemignani G, Palumbo F, Leonildi A, Tedeschi A, Lambelet P, Lucarini A, Piaggesi A, Menichetti F. Clinical and Microbiological Efficacy of Colistin Therapy Alone or in Combination as Treatment for Multidrug ResistantPseudomonas aeruginosaDiabetic Foot Infections with or Without Osteomyelitis. J Chemother 2013; 18:648-51. [PMID: 17267344 DOI: 10.1179/joc.2006.18.6.648] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We retrospectively evaluated the safety and effectiveness of colistin alone or in combination with other antimicrobials in eight diabetic patients with severe diabetic foot infections due to multidrug resistant (MDR) Pseudomonas aeruginosa, complicated in 4 cases by osteomyelitis. All patients received colistin after other ineffective antimicrobial treatment, when MDR P. aeruginosa strains were isolated by cultural examination and together with a multidisciplinary care approach including revascularization, surgical debridement and adequate offloading. The mean duration of therapy was 72 +/- 52.9 days. Six out of 8 patients (75%) successfully benefited from colistin therapy, while 2 patients failed and/or experienced side effects that led to discontinuation of therapy. Serious adverse events (i.e. acute renal failure and pulmonary edema) were observed in 1 patient. Our data allow us to conclude that colistin, alone or in combination with other antimicrobials, is safe and effective when administered as part of a multidisciplinary approach, to promote healing of diabetic foot infection due to MDR P. aeruginosa.
Collapse
Affiliation(s)
- C Tascini
- Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Strohal R, Dissemond J, Jordan O’Brien J, Piaggesi A, Rimdeika R, Young T, Apelqvist J. EWMA Document: Debridement: An updated overview and clarification of the principle role of debridement. J Wound Care 2013; 22 Suppl:S1-S52. [DOI: 10.12968/jowc.2013.22.sup1.s1] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- R Strohal
- Department of Dermatology and Venerology, Federal University Teaching Hospital Feldkirch, Feldkirch, Austria
| | - J Dissemond
- Clinic of Dermatology, Venerology and Allercology, Essen University Hospital, Germany
| | - J Jordan O’Brien
- Centre of Education,Beaumont Hospital,Beaumont Road, Dublin, Ireland
| | - A Piaggesi
- Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy
| | - R Rimdeika
- Kaunas University Hospital, Department of Plastic and Reconstructive Surgery, Lithuania; Lithuanian University of Health Sciences, Faculty of Medicine, Lithuania
| | - T Young
- Bangor University, North Wales, United Kingdom
| | - J Apelqvist
- Department of Endocrinology, University Hospital of Malmö, Sweden
| |
Collapse
|
10
|
Piaggesi A, Vallini V, Iacopi E, Tedeschi A, Scatena A, Goretti C, Rizzo L. Iloprost in the management of peripheral arterial disease in patients with diabetes mellitus. Minerva Cardioangiol 2011; 59:101-108. [PMID: 21285935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Diabetic complications in the lower extremities, especially those secondary to diabetic macroangiopathy, have increasingly become a clinical emergency, given the high prevalence and progression of the disease. Until recently, the only approach to treating advanced stage disease was medical therapy and major amputation; however, the advent of revascularization procedures has radically improved the prognosis of patients with critical lower limb ischemia. In this setting, iloprost holds a dual position: as first-choice therapy in patients ineligible for revascularization and as complementary therapy in candidates for surgical or endovascular revascularization.
Collapse
Affiliation(s)
- A Piaggesi
- Sezione Piede Diabetico, Unità Operativa Malattie del Metabolismo e Diabetologia, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italia.
| | | | | | | | | | | | | |
Collapse
|
11
|
van Battum P, Schaper N, Prompers L, Apelqvist J, Jude E, Piaggesi A, Bakker K, Edmonds M, Holstein P, Jirkovska A, Mauricio D, Ragnarson Tennvall G, Reike H, Spraul M, Uccioli L, Urbancic V, van Acker K, van Baal J, Ferreira I, Huijberts M. Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease severity at presentation. Diabet Med 2011; 28:199-205. [PMID: 21219430 DOI: 10.1111/j.1464-5491.2010.03192.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The incidence of minor amputation may vary significantly, and determinants of minor amputation have not been studied systematically. We evaluated minor amputation rate, the determinants of minor amputation and differences in amputation rate between European centres. METHODS In the Eurodiale study, a prospective cohort study of 1232 patients (1088 followed until end-point) with a new diabetic foot ulcer were followed on a monthly basis until healing, death, major amputation or up to a maximum of 1 year. Ulcers were treated according to international guidelines. Baseline characteristics independently associated with minor amputation were examined using multiple logistic regression modelling. Based on the results of the multivariable analysis, a disease severity score was calculated for each patient. RESULTS One hundred and ninety-four (18%) patients underwent a minor amputation. Predictors of minor amputation were depth of the ulcer (odds ratio 6.08, confidence interval 4.10-9.03), peripheral arterial disease (odds ratio 1.84, confidence interval 1.30-2.60), infection (odds ratio 1.56, confidence interval 1.05-2.30) and male sex (odds ratio 1.42, confidence interval 0.99-2.04). Minor amputation rate varied between 2.4 and 34% in the centres. Minor amputation rate in centres correlated strongly with disease severity score at the moment of presentation to the foot clinic (r=0.75). CONCLUSIONS Minor amputation is performed frequently in diabetic foot centres throughout Europe and is determined by depth of the ulcer, peripheral arterial disease, infection and male sex. There are important differences in amputation rate between the European centres, which can be explained in part by severity of disease at presentation. This may suggest that early referral to foot clinics can prevent minor amputations.
Collapse
Affiliation(s)
- P van Battum
- Division of Endocrinology, Department of Medicine, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Piaggesi A, Goretti C, Mazzurco S, Tascini C, Leonildi A, Rizzo L, Tedeschi A, Gemignani G, Menichetti F, Del Prato S. A Randomized Controlled Trial to Examine the Efficacy and Safety of a New Super-Oxidized Solution for the Management of Wide Postsurgical Lesions of the Diabetic Foot. INT J LOW EXTR WOUND 2010; 9:10-5. [DOI: 10.1177/1534734610361945] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This randomized trial was done to test the effectiveness and safety of using a novel antiseptic solution (Dermacyn® Wound Care [DWC], Oculus Innovative Sciences, Petaluma, CA) in the management of the postoperative lesions on the infected diabetic foot. 40 patients with postsurgical lesions wider than 5 cm2 left open to heal by secondary intention were randomized into 2 groups. Group A was locally treated with DWC, whereas group B received povidone iodine as local medication, both in adjunct to systemic antibiotic therapy and surgical debridement if needed. Ischemia, renal failure, bilateral lesions, or immunodepression were considered as exclusion criteria. Patients were followed up weekly for 6 months. The primary endpoint was healing rate at 6 months, while secondary endpoints were healing time, time to achieve negative cultures, duration of antibiotic therapy, number of reinterventions, and adverse events. Healing rates at 6 months were significantly shorter in group A (90%) than in group B (55%; P < .01). The time taken for cultures to become negative and duration of antibiotic therapy were also significantly (P < .05) shorter in group A than in group B, whereas the number of reinterventions was significantly higher in group B (P < .05). No difference was noted in the adverse events except that for reinfections, which were more frequent in group B than in group A (P < .01). DWC is as safe as and more effective than standard local antiseptics in the management of wide postsurgical lesions in the infected diabetic foot.
Collapse
Affiliation(s)
- A. Piaggesi
- Diabetic Foot Section, Department of Endocrinology and
Metabolism Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy,
| | - C. Goretti
- Diabetic Foot Section, Department of Endocrinology and
Metabolism Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - S. Mazzurco
- Diabetic Foot Section, Department of Endocrinology and
Metabolism Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - C. Tascini
- Department of Infectious Diseases, Azienda Ospedaliero-
Universitaria Pisana, Pisa, Italy
| | - A. Leonildi
- Department of Infectious Diseases, Azienda Ospedaliero-
Universitaria Pisana, Pisa, Italy
| | - L. Rizzo
- Diabetic Foot Section, Department of Endocrinology and
Metabolism Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - A. Tedeschi
- Diabetic Foot Section, Department of Endocrinology and
Metabolism Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - G. Gemignani
- Department of Infectious Diseases, Azienda Ospedaliero-
Universitaria Pisana, Pisa, Italy
| | - F. Menichetti
- Department of Infectious Diseases, Azienda Ospedaliero-
Universitaria Pisana, Pisa, Italy
| | - S. Del Prato
- Diabetic Foot Section, Department of Endocrinology and
Metabolism Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| |
Collapse
|
13
|
Abbruzzese L, Rizzo L, Fanelli G, Tedeschi A, Scatena A, Goretti C, Macchiarini S, Piaggesi A. Effectiveness and Safety of a Novel Gel Dressing in the Management of Neuropathic Leg Ulcers in Diabetic Patients: A Prospective Double-Blind Randomized Trial. INT J LOW EXTR WOUND 2009; 8:134-40. [DOI: 10.1177/1534734609344140] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Neuropathic leg ulcers (NLUs) affect more than 10% of diabetic patients with peripheral neuropathy and represent the most common cause of ulceration of the leg in these patients. Though their pathogenesis is well known, related to the chronic neuropathic edema, the management of NLUs, mainly based on elastocompression, is still controversial, with lower healing rates than nondiabetic venous leg ulcers. The authors tested if a novel gel formulation, containing amino acids and hyaluronic acid (Vulnamin® gel; Errekappa, Milan, Italy), will improve the outcomes of NLUs when used together with elastocompression. Thirty patients affected by NLU were randomized into 2 groups, both treated with 4-layer elastocompressive bandaging: patients in group A were topically treated with the application of Vulnamin® gel, whereas patients in group B received only the inert gel vehicle. The healing rate at 3 months was evaluated as the primary endpoint, whereas the secondary endpoints were healing time, reduction in ulcer area and ulceration score in 4 weeks, number of infective complications, and overall satisfaction of patients. Healing rate was significantly ( P < .05) higher in patients in group A when compared with those in group B; healing time, patients’ satisfaction, and reduction in ulcer area and ulceration score in 4 weeks were also higher in patients in group A. However, no significant differences were found in the prevalence of infections and other adverse events. The use of Vulnamin ® gel with elastocompression is safe and effective in the management of NLUs of diabetic patients.
Collapse
|
14
|
Amanda A, Ferrante A, Valagussa M, Piaggesi A. EFFECT OF BIOSTIMULANTS ON QUALITY OF BABY LEAF LETTUCE GROWN UNDER PLASTIC TUNNEL. ACTA ACUST UNITED AC 2009. [DOI: 10.17660/actahortic.2009.807.58] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
15
|
Prompers L, Huijberts M, Schaper N, Apelqvist J, Bakker K, Edmonds M, Holstein P, Jude E, Jirkovska A, Mauricio D, Piaggesi A, Reike H, Spraul M, Van Acker K, Van Baal S, Van Merode F, Uccioli L, Urbancic V, Ragnarson Tennvall G. Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study. Diabetologia 2008; 51:1826-34. [PMID: 18648766 DOI: 10.1007/s00125-008-1089-6] [Citation(s) in RCA: 172] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2008] [Accepted: 06/06/2008] [Indexed: 12/16/2022]
Abstract
AIMS/HYPOTHESIS The aim of the present study was to investigate resource utilisation and associated costs in patients with diabetic foot ulcers and to analyse differences in resource utilisation between individuals with or without peripheral arterial disease (PAD) and/or infection. METHODS Data on resource utilisation were collected prospectively in a European multicentre study. Data on 1,088 patients were available for the analysis of resource use, and data on 821 patients were included in the costing analysis. Costs were calculated for each patient by multiplying the country-specific direct and indirect unit costs by the number of resources used from inclusion into the study up to a defined endpoint. Country-specific costs were converted into purchasing power standards. RESULTS Resource use and costs varied between outcome groups and between disease severity groups. The highest costs per patient were for hospitalisation, antibiotics, amputations and other surgery. All types of resource utilisation and costs increased with the severity of disease. The total cost per patient was more than four times higher for patients with infection and PAD at inclusion than for patients in the least severe group, who had neither. CONCLUSIONS/INTERPRETATION Important differences in resource use and costs were found between different patient groups. The costs are highest for individuals with both peripheral arterial disease and infection, and these are mainly related to substantial costs for hospitalisation. In view of the magnitude of the costs associated with in-hospital stay, reducing the number and duration of hospital admissions seems an attractive option to decrease costs in diabetic foot disease.
Collapse
Affiliation(s)
- L Prompers
- Department of Internal Medicine, University Hospital Maastricht, P. Debyelaan 25, Maastricht, the Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Prompers L, Huijberts M, Apelqvist J, Jude E, Piaggesi A, Bakker K, Edmonds M, Holstein P, Jirkovska A, Mauricio D, Tennvall GR, Reike H, Spraul M, Uccioli L, Urbancic V, Van Acker K, Van Baal J, Van Merode F, Schaper N. Delivery of care to diabetic patients with foot ulcers in daily practice: results of the Eurodiale Study, a prospective cohort study. Diabet Med 2008; 25:700-7. [PMID: 18544108 DOI: 10.1111/j.1464-5491.2008.02445.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIMS To determine current management and to identify patient-related factors and barriers that influence management strategies in diabetic foot disease. METHODS The Eurodiale Study is a prospective cohort study of 1232 consecutive individuals presenting with a new diabetic foot ulcer in 14 centres across Europe. We determined the use of management strategies: referral, use of offloading, vascular imaging and revascularization. RESULTS Twenty-seven percent of the patients had been treated for > 3 months before referral to a foot clinic. This varied considerably between countries (6-55%). At study entry, 77% of the patients had no or inadequate offloading. During follow-up, casting was used in 35% (0-68%) of the plantar fore- or midfoot ulcers. Predictors of use of casting were male gender, large ulcer size and being employed. Vascular imaging was performed in 56% (14-86%) of patients with severe limb ischaemia; revascularization was performed in 43%. Predictors of use of vascular imaging were the presence of infection and ischaemic rest pain. CONCLUSION Treatment of many patients is not in line with current guidelines and there are large differences between countries and centres. Our data suggest that current guidelines are too general and that healthcare organizational barriers and personal beliefs result in underuse of recommended therapies. Action should be undertaken to overcome these barriers and to guarantee the delivery of optimal care for the many individuals with diabetic foot disease.
Collapse
Affiliation(s)
- L Prompers
- Division of Endocrinology, Department of Internal Medicine, University Hospital Maastricht, Maastricht, the Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Prompers L, Schaper N, Apelqvist J, Edmonds M, Jude E, Mauricio D, Uccioli L, Urbancic V, Bakker K, Holstein P, Jirkovska A, Piaggesi A, Ragnarson-Tennvall G, Reike H, Spraul M, Van Acker K, Van Baal J, Van Merode F, Ferreira I, Huijberts M. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study. Diabetologia 2008; 51:747-55. [PMID: 18297261 PMCID: PMC2292424 DOI: 10.1007/s00125-008-0940-0] [Citation(s) in RCA: 589] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 01/03/2008] [Indexed: 12/22/2022]
Abstract
AIMS/HYPOTHESIS Outcome data on individuals with diabetic foot ulcers are scarce, especially in those with peripheral arterial disease (PAD). We therefore examined the clinical characteristics that best predict poor outcome in a large population of diabetic foot ulcer patients and examined whether such predictors differ between patients with and without PAD. METHODS Analyses were conducted within the EURODIALE Study, a prospective cohort study of 1,088 diabetic foot ulcer patients across 14 centres in Europe. Multiple logistic regression modelling was used to identify independent predictors of outcome (i.e. non-healing of the foot ulcer). RESULTS After 1 year of follow-up, 23% of the patients had not healed. Independent baseline predictors of non-healing in the whole study population were older age, male sex, heart failure, the inability to stand or walk without help, end-stage renal disease, larger ulcer size, peripheral neuropathy and PAD. When analyses were performed according to PAD status, infection emerged as a specific predictor of non-healing in PAD patients only. CONCLUSIONS/INTERPRETATION Predictors of healing differ between patients with and without PAD, suggesting that diabetic foot ulcers with or without concomitant PAD should be defined as two separate disease states. The observed negative impact of infection on healing that was confined to patients with PAD needs further investigation.
Collapse
Affiliation(s)
- L Prompers
- Division of Endocrinology, Department of Internal Medicine, University Hospital Maastricht, P. Debeyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Prompers L, Huijberts M, Apelqvist J, Jude E, Piaggesi A, Bakker K, Edmonds M, Holstein P, Jirkovska A, Mauricio D, Ragnarson Tennvall G, Reike H, Spraul M, Uccioli L, Urbancic V, Van Acker K, van Baal J, van Merode F, Schaper N. High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia 2007; 50:18-25. [PMID: 17093942 DOI: 10.1007/s00125-006-0491-1] [Citation(s) in RCA: 564] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2006] [Accepted: 08/14/2006] [Indexed: 12/15/2022]
Abstract
AIMS/HYPOTHESIS Large clinical studies describing the typical clinical presentation of diabetic foot ulcers are limited and most studies were performed in single centres with the possibility of selection of specific subgroups. The aim of this study was to investigate the characteristics of diabetic patients with a foot ulcer in 14 European hospitals in ten countries. METHODS The study population included 1,229 consecutive patients presenting with a new foot ulcer between 1 September 2003 and 1 October 2004. Standardised data on patient characteristics, as well as foot and ulcer characteristics, were obtained. Foot disease was categorised into four stages according to the presence or absence of peripheral arterial disease (PAD) and infection: A: PAD -, infection -; B: PAD -, infection +; C: PAD +, infection -; D: PAD +, infection +. RESULTS PAD was diagnosed in 49% of the subjects, infection in 58%. The majority of ulcers (52%) were located on the non-plantar surface of the foot. With regard to severity, 24% had stage A, 27% had stage B, 18% had stage C and 31% had stage D foot disease. Patients in the latter group had a distinct profile: they were older, had more non-plantar ulcers, greater tissue loss and more serious comorbidity. CONCLUSIONS/INTERPRETATION According to our results in this European cohort, the severity of diabetic foot ulcers at presentation is greater than previously reported, as one-third had both PAD and infection. Non-plantar foot ulcers were more common than plantar ulcers, especially in patients with severe disease, and serious comorbidity increased significantly with increasing severity of foot disease. Further research is needed to obtain insight into the clinical outcome of these patients.
Collapse
Affiliation(s)
- L Prompers
- Department of Internal Medicine, University Hospital Maastricht, P. Debeyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Tascini C, Menichetti F, Gemignani G, Palumbo F, Leonildi A, Tedeschi A, Piaggesi A. Clinical and microbiological efficacy of colistin therapy in combination with rifampin and imipenem in multidrug-resistant Pseudomonas aeruginosa diabetic foot infection with osteomyelitis. INT J LOW EXTR WOUND 2006; 5:213-6. [PMID: 16928678 DOI: 10.1177/1534734606291676] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The evaluation of the safety and effectiveness of colistin in association with rifampin and imipenem in 1 diabetic patient with severe diabetic foot infection (DFI) due to multidrug-resistant (MDR) Pseudomonas aeruginosa, complicated by osteomyelitis, is presented in this "Case Report". The patient received colistin after other ineffective antimicrobial treatment when an MDR P aeruginosa strain was isolated by cultural examination, together with a multidisciplinary care approach including surgical debridement and adequate offloading. The efficacy of combination colistin plus rifampin plus imipenem was observed with a checkerboard method and bactericidal activity of the serum. The patient received colistin combination therapy for 6 weeks with cure of the infection and without renal toxicity. These data suggest that colistin, in combination with rifampin and imipenem, is safe and effective, in promoting healing in DFI due to MDR P aeruginosa and suggest the need for controlled clinical studies.
Collapse
Affiliation(s)
- Carlo Tascini
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
| | | | | | | | | | | | | |
Collapse
|
20
|
Faglia E, Caravaggi C, Marchetti R, Mingardi R, Morabito A, Piaggesi A, Uccioli L, Ceriello A. Screening for peripheral arterial disease by means of the ankle-brachial index in newly diagnosed Type 2 diabetic patients. Diabet Med 2005; 22:1310-4. [PMID: 16176188 DOI: 10.1111/j.1464-5491.2005.01612.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIM To evaluate the prevalence of peripheral arterial disease (PAD) with the ankle-brachial index (ABI) in newly diagnosed Type 2 diabetic subjects. METHODS Between autumn 2002 and spring 2003, 2559 newly diagnosed Type 2 diabetic subjects (about 15% of the cases/year in Italy) were enrolled in 265 diabetology centres. Family history of diabetes, smoking, height, weight, waistline, fasting glycaemia, glycosylated haemoglobin, total and HDL-cholesterol and triglyceride values were collected. Claudication, cyanosis, cold foot, foot hair anomalies, skin thinning and femoral, popliteal, posterior tibial and dorsalis pedis pulses were assessed. The ABI was measured with a portable Doppler continuous-wave instrument. RESULTS An ABI < 0.9 was found in 539 (21.1%) patients. Claudication was present in 187 (7.3%). Femoral pulse was absent in 218 (8.5%), popliteal in 316 (12.3%), tibial in 563 (22.0%) and dorsalis pedis in 578 (22.6%). Foot cyanosis was observed in 88 (3.4%), cold foot in 359 (13.9%), skin thinning in 468 (18.3%) and hair anomalies in 857 (33.5%). Multivariate analysis of the variables associated with ABI < 0.9 in the univariate analysis confirmed the independent role of age [relative risk (RR) 1.02, P < 0.001, confidence interval (CI) 1.01, 1.04], claudication (RR 4.53, P < 0.001, CI 2.97, 6.93), absence of tibial pulse (RR 3.45, P < or = 0.001. CI 2.54, 4.68) and pedis pulse (RR 1.96, P < or = 0.001, CI 1.4, 2.68). CONCLUSIONS PAD, as represented by ABI < 0.9, is common in newly diagnosed Type 2 diabetic patients.
Collapse
Affiliation(s)
- E Faglia
- Internal Medicine Unit, Diabetology Centre. Policlinico Multimedica, Sesto S. Giovanni, Milano, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Giuggioli D, Sebastiani M, Cazzato M, Piaggesi A, Abatangelo G, Ferri C. Autologous skin grafting in the treatment of severe scleroderma cutaneous ulcers: a case report. Rheumatology (Oxford) 2003; 42:694-6. [PMID: 12709550 DOI: 10.1093/rheumatology/keg106] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
22
|
Piaggesi A, Rizzo L, Golia F, Costi D, Baccetti F, Ciaccio S, De Gregorio S, Vignali E, Trippi D, Zampa V, Marcocci C, Del Prato S. Biochemical and ultrasound tests for early diagnosis of active neuro-osteoarthropathy (NOA) of the diabetic foot. Diabetes Res Clin Pract 2002; 58:1-9. [PMID: 12161051 DOI: 10.1016/s0168-8227(02)00097-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To test the effectiveness of a combined approach to an early diagnosis of neuro-osteoarthropathy (NOA) of the diabetic foot, we studied a group of outpatients with active NOA, presenting for the first time to our Diabetic Foot Clinic in 1998, by means of an integrated approach designed to assess bone turnover. PATIENTS AND METHODS Fifteen consecutive diabetic patients (five Type 1 and ten Type 2 diabetic individuals, age 61.9+/-12.2 years, diabetes duration 18.7+/-8.9 years, HbA(1c) 8.4+/-1.5%) with active NOA (Group 1) were compared to nine diabetic patients with chronic stable NOA (Group 2), 14 neuropathic diabetic patients without NOA (Group 3), 13 non-neuropathic diabetic patients (Group 4) and 15 healthy controls (Group 5). Determination of serum carboxy-terminal collagen telopeptide (ICTP), bone alkaline phosphatase isoenzyme (B-ALP), osteocalcin (BGP) concentrations, as well as urinary excretion of deoxypyridinoline (DPD) were obtained in all individuals for assessment of bone reabsorption and new bone formation. Moreover in all individuals quantitative ultrasound (QUS) of the calcaneal bone was performed and mass density of lumbar spine and femur bone was determined by dual-energy X-ray absorptiometry (DEXA). RESULTS QUS was significantly lower in the active NOA patients as compared with other groups (P<0.01), while ICTP was higher in both NOA groups (P<0.01). Urinary DPD was higher in the neuropathic non-NOA group (P<0.01) than the other groups, and osteocalcin was higher in healthy controls compared to diabetic patients without NOA. QUS and ICTP were inversely correlated (r=0.44, P=0.000). QUS in the active NOA group was significantly (P<0.01) lower in the affected compared to the unaffected foot. CONCLUSION Our results indicate a possible role for an integrated approach to the diagnosis and monitoring of NOA involving the diabetic foot. DPD may identify patients at-risk for NOA, ICTP could be tested as a marker for NOA in asymptomatic cases. Finally, QUS of the calcaneal bone may be useful in discriminating active versus quiescent phases.
Collapse
Affiliation(s)
- A Piaggesi
- Department of Endocrinology and Metabolism, Division of Diabetes, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
AIMS To test the safety and effectiveness of carboxyl-methyl-cellulose dressing (Aquacel; ConvaTec, UK) in the management of deep diabetic foot ulcers, a group of consecutive out-patients attending the foot clinic of the Department of Metabolic Diseases was studied. METHODS Patients were selected according to the following inclusion criteria: a foot ulcer deeper than 1 cm for > 3 weeks, good peripheral blood supply (palpable peripheral pulses or ABPI > 0.9). Exclusion criteria were as follows: active infection, as evident from clinical signs (purulent discharge, redness, swelling, tenderness) and confirmed by culture exams, plasma creatinine > 2 mg/dl, recent episodes of ketoacidosis, malignancies, and any therapy or pathology which might interfere with the healing process. Twenty patients were enrolled in the study and having obtained their informed consent, their lesions were surgically debrided with the complete elimination of all necrotic tissue and debris up to the bleeding healthy tissue; then ulcers were staged and measured, and patients were randomly assigned to two different treatment groups. Patients in group A were dressed with saline-moistened gauze, while patients in group B were dressed with Aquacel according to the manufacturer's instructions. All patients in both groups received special post-operative shoes (Podiabetes; Zeno Buratto, Treviso, Italy) and crutches until complete re-epithelialization. Ulcers were all left to heal by secondary intent. After 8 weeks patients were blindly evaluated for: the rate of reduction of lesional volume (RLV), rate of granulation tissue (GT), number of infective complications (IC). Intralesional (ILTC) and perilesional (PLTC) temperatures were also recorded with a thermocouple surface digital thermometer, and the difference between the two values (Delta TC) was calculated. Healing time (HT, days), was then compared between the two groups. Data were compared by analysis of variance (ANOVA), linear regression, Kaplan-Meier survival analysis and Fisher's exact test. RESULTS HT was significantly shorter in Group B than in Group A (P < 0.001). RLV was significantly (P < 0.01) higher in Group B patients compared with Group A, as well as GT (P < 0.05). IC were in 1/10 Group B and in 3/10 Group A (P = 0.582). In addition, both ILTC and Delta TC were higher in Group B compared with Group A ones (P < 0.01). CONCLUSIONS Carboxyl-methyl-cellulose dressings were shown to be safe, effective and well tolerated in the management of non-ischaemic, non-infected deep diabetic foot ulcers.
Collapse
Affiliation(s)
- A Piaggesi
- Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy.
| | | | | | | | | | | |
Collapse
|
24
|
Sartucci F, Piaggesi A, Logi F, Bonfiglio L, Bongioanni P, Pellegrinetti A, Baccetti F, Navalesi R, Murri L. Impaired ascendant central pathways conduction in impotent diabetic subjects. Acta Neurol Scand 1999; 99:381-6. [PMID: 10577273 DOI: 10.1111/j.1600-0404.1999.tb07368.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Diabetic impotence is generally due to peripheral neuropathy, but a central pathway impairment has also been suggested. We evaluated somatosensory transmission in a group of impotent diabetic men to assess the role of central nervous system (CNS) involvement. MATERIALS AND METHODS Somatosensory evoked potentials (SEPs) of pudendal (pdn) and posterior tibial (ptn) nerves were recorded in 74 patients. Type and duration of diabetes, severity of sexual dysfunction, medium term metabolic control, occurrence of microangiopathic chronic complications and autonomic neuropathy were evaluated. RESULTS Our data show an impairment of central conduction times in pdn (25.7%) and ptn (39.2%) greater than peripheral nervous impairment (pdn 12.2%, ptn 8.1%), in impotent diabetic patients without any further major complication. Central nervous conduction delay resulted to be correlated with poor glycemic control. Significant evident autonomic dysfunction was found only in a minority of cases. CONCLUSION Our data might suggest that altered conduction along CNS and somatic peripheral neuropathy might develop independently. We confirm the hypothesis of a "central diabetic neuropathy" and suggest that central sensory pathways involvement, not related to peripheral impairment, could play a role in the pathogenesis of erectile dysfunction in diabetic patients.
Collapse
Affiliation(s)
- F Sartucci
- Department of Neurosciences, Institute of Neurology, University of Pisa, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
To evaluate if skin hardness in diabetic neuropathic feet was increased and if its eventual modifications could be correlated to the severity of neuropathy, we studied a group of diabetic outpatients with and without neuropathy. Patients, selected among those who were attending their routine screening for diabetic neuropathy at our diabetologic clinic, were divided into two groups according to the presence (ND+) or absence (ND-) of diabetic neuropathy with the criteria of the S. Antonio Consensus Conference on Diabetic Neuropathy. Patients then underwent an evaluation of vibration perception threshold (VPT) by means of a biotesiometer, measurement of skin hardness (DMT) by means of a durometer, and transcutaneous oxygen tension (TcPO2) determination. VPT was determined at allux (VPT-A) and external malleolus (VPT-M), DMT was measured at heel (DMT-H), at medial (DMT-M) and lateral (DMT-L) midfoot, and at posterior midcalf (DTM-C) as a control site; TcPO2 was evaluated at dorsum (TcPO2-D) and at medial midfoot (TcPO2-M), respectively. All measurements were performed on the nondominant side with the patients supine. Patients were compared with age and gender-matched healthy volunteers (Controls), who underwent the same evaluations in the same order. ND+ patients showed higher values of VPT than ND- and Controls, both at first toe and at malleolus analysis of variance (ANOVA) p<0.01), as well of DMT in all the three sites explored (ANOVA, p<0.01). Moreover, ND+ showed no difference in DMT among the sites, while both in ND- and in controls DMT-M was significantly (p<0.05) lower than DMT-H and DMT-L. No difference among the three groups were observed in TcPO2 measurements, and no difference in DMT-C was observed either. A significant correlation was observed between DMT-H and VPT-M (r2 = 0.516) and between DMT-M and VPT-A (r2 = 0.624) in ND+ patients. Skin hardness was diffusely increased in ND+ patients, and this increase strongly correlates with the severity of neuropathy. Simple, noninvasive determination of skin hardness could identify patient at potential risk to develop neuropathic foot ulcers.
Collapse
Affiliation(s)
- A Piaggesi
- Department of Metabolic Diseases, University of Pisa, Italy
| | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
To test the efficacy of surgical treatment of non-infected neuropathic foot ulcers compared to conventional non-surgical management, a group of diabetic outpatients attending our diabetic foot clinic were studied. All patients who came to the clinic for the first time from January to December 1995 inclusive with an uncomplicated neuropathic ulcer were randomized into two groups. Group A received conservative treatment, consisting of relief of weight-bearing, regular dressings; group B underwent surgical excision, eventual debridement or removal of bone segments underlying the lesion and surgical closure. Healing rate, healing time, prevalence of infection, relapse during a 6-month period following intervention and subjective discomfort were assessed. Twenty-four ulcers in 21 patients were treated in group A (17 Type 2 DM/3 Type 1 DM, age 63.24 +/- 13.46 yr, duration of diabetes 18.2 +/- 8.41 yr, HbA1c 9.5 +/- 3.8%) and 22 ulcers in 21 patients in group B (19 Type 2 DM/2 Type 1 DM, age 65.53 +/- 9.87yr, duration of diabetes 16.84 +/- 10.61 yr; HbA1c 8.9 +/- 2.2%). Healing rate was lower (79.2% = 19/24 ulcers) in group A than in group B (95.5% = 21/22 ulcers; p < 0.05), and healing time was longer (128.9 +/- 86.60 days vs 46.73 +/- 38.94 days; p < 0.001). Infective complications occurred significantly more often in group A patients (3/24, 12.5% vs 1/22, 4.5%; p < 0.05), as did relapses of ulcerations (8 vs 3; p < 0.01). There were only two minor perioperative complications in group B patients. Patients reported a higher degree of satisfaction in group B (p < 0.01) as well as lower discomfort (p < 0.05) and restrictions (p < 0.05). Thus surgical treatment of neuropathic foot ulcers in diabetic patients proved to be an effective approach compared to conventional treatment in terms of healing time, complications, and relapses, and can be safely performed in an outpatient setting.
Collapse
Affiliation(s)
- A Piaggesi
- Cattedra di Malattie del Metabolismo, Istituto di Clinica Medica II, Università di Pisa, Italy
| | | | | | | | | | | | | |
Collapse
|
27
|
Frykberg RG, Piaggesi A, Donaghue VM, Schipani E, Habershaw GM, Navalesi R, Veves A. Difference in treatment of foot ulcerations in Boston, USA and Pisa, Italy. Diabetes Res Clin Pract 1997; 35:21-6. [PMID: 9113471 DOI: 10.1016/s0168-8227(96)01359-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Primary care of the diabetic patient with foot ulcer can be provided by medically or surgically trained practitioners. We have prospectively followed 90 sequential patients with newly developed foot ulcers from two major centers. One in the USA where the primary doctor was a podiatrist and one in Europe with a diabetologist. Thirty-four patients from Boston and 56 from Pisa (mean age, 55.6; range, 26-75 years; vs. 66.5; range, 35-94; P < 0.001), matched for sex, weight, type, duration of diabetes, renal impairment and retinopathy took part. Boston patients had more severe neuropathy, assessed with clinical examination utilizing a neuropathy disability score (NDS) (16 +/- 6 vs. 6 +/- 3 (mean +/- S.D.) P < 0.001) and vibration perception threshold (46 +/- 8 vs. 35 +/- 12 V: P < 0.001) while no difference existed in the number of patients with clinical infection, a history of lower extremity by-pass operation (6 (18%) vs. 3 (5%); P = NS) and in the size and the severity of the ulcer, according to the Wagner classification. Initial treatment was similar in both centers with emphasis on outpatient ulcer debridement, pressure relieving foot-wear and topical wound care. Hospitalization was needed in five (15%) Boston and 12 (21%) Pisa patients (P = NS) while surgery was performed on five (15%) Boston and 16 (29%) Pisa patients (P = NS). The in-hospital stay was similar in both centers (1.4 +/- 4.4 vs. 2.1 +/- 5.9 days; P = NS). The most common operations in both centers were incision, drainage and bone debridement. Ulcers healed in all patients but the amount of healing time was shorter in Boston patients (6.7 +/- 4.2 vs. 10.5 +/- 6.5 weeks; P < 0.02). We conclude that despite the differences in the two systems similar success rates were achieved in the two centers while a more surgically oriented strategy may have resulted in a slightly shorter healing time.
Collapse
Affiliation(s)
- R G Frykberg
- Deaconess-Joslin Foot Center, Department of Surgery, Harvard Medical School, Boston, MA 02215, USA
| | | | | | | | | | | | | |
Collapse
|
28
|
Piaggesi A, Schipani E, Ceraudo AM, Baccetti F, Campi F, Navalesi R. Diabetologic in-service education for health professionals from non-diabetological departments. Acta Diabetol 1996; 33:277-83. [PMID: 9033968 DOI: 10.1007/bf00571565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In order to test whether or not an in-service requalification course on diabetes care for health professionals (HP) of nondiabetological departments can enhance their level of knowledge about diabetes and the quality of care for diabetic inpatients admitted for reasons other than diabetes, we carried out a requalification course involving 171 HP (161 nurses and 10 midwives) from nondiabetological departments of our hospital. Areas of intervention were: general knowledge of diabetes (GKD), bedside monitoring of blood glucose (BMG), insulin preparation and administration (IPA), diagnosis and treatment of hypoglycemic crises (DTH), and hospitalization-related problems (HRP). HP, divided into groups of about 20 each, completed a basal evaluation by means of a 25-item multiple choice questionnaire, and then attended six separate educative sessions, each of focusing on one topic, consisting of a theory lesson and an interactive exercise of equivalent length. At the end of the course, HP were re-evaluated with the same questionnaire, and their skills in BMG, IPA and DTH were tested by means of specific operational checklists, which divided each complex operation into a sequence of single operations, and then compared them with those of a control group of untrained colleagues (CG). The global knowledge of diabetes after the courses significantly improved, as gathered from the percentages of correct answers in each questionnaire (61.82% +/- 23.64% vs 31.18% +/- 20.00%; P < 0.001); separate analysis of different areas evidenced improvements in GKD (72.28% +/- 12.47% vs 31.46% +/- 20.56%; P < 0.01), BMG (68.77% +/- 15.75% vs 37.50% +/- 27.75%; P < 0.01), IPA (72.02% +/- 11.72% vs 33.45% +/- 21.22%; P < 0.05), and DTH (90.76% +/- 6.86% vs 49.82% +/- 26.68%; P < 0.05), but not in HRP. Professional skills profiles of HP, evaluated by measuring the number of errors done performing each task, were significantly (P < 0.001) better than those of CG, for BMG (1.09 +/- 0.73 vs 4.91 +/- 2.01), IPA (2.36 +/- 1.64 vs 5.64 +/- 2.25), and DHT (1.27 +/- 0.94 vs 3.82 +/- 1.12). Linear regression showed a significant (P < 0.001) correlation of skills and knowledge after the course for BMG (r2 = .49), IPA (r2 = .53), and DTH (r2 = .61). Positive although nonspecific indicators of outcomes of the course were the increase (of about 100%) of requests to our metabolic unit for diabetological consultations from other departments as well as the mentioning of diabetes in the diagnosis of discharge, and the 20% increase in the consumption of sticks for BMG. The course produced a significant improvement of knowledge and skills on specific diabetological items among participants.
Collapse
Affiliation(s)
- A Piaggesi
- 2nd Department of Internal Medicine, University of Pisa, Italy
| | | | | | | | | | | |
Collapse
|
29
|
Galetta F, Piaggesi A, Prattichizzo FA, Ceraudo AM, Cosci S, Giusti C. [Cardiovascular effects of autonomic neuropathy in insulin-dependent diabetes mellitus]. Cardiologia 1995; 40:769-73. [PMID: 8819738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The present study was designed to evaluate whether autonomic diabetic neuropathy is a marker of severe cardiovascular disease. We recruited three groups of 12 patients each with the same age, sex and body weight distribution: Group DAN + (diabetics with neuropathy), Group DAN- (diabetics without neuropathy) and Group C (healthy control group). The patients underwent two-dimensional color Doppler echocardiography and maximal electrocardiographic exercise test by cycloergometer (multistage program with 25 W increments 3 min steps). Cardiovascular autonomic function was evaluated by Ewing's tests (heart rate and blood pressure measurement during lying to standing, deep breathing, handgrip isometric stress test and Valsalva manoeuvre). Heart rate and blood pressure proved to be significantly higher in the Group DAN+, than in the other groups, either at baseline or during stress test. Only 33% of DAN+ patients proved to reach 100 W during stress test, compared to 82% of DAN- and 87% of control subjects. No DAN+ patients reached 125 W, compared with 45% of DAN- and 58% of Group C patients. Echocardiographic examination showed normal left ventricular systolic function in all groups, without any significant difference in ventricular dimensions, and impaired left ventricular diastolic function in DAN+ patients, compared to Group C subjects (peak E 66.75 +/- 8.36 vs 73.49 +/- 12.53 cm/s; peak A 72.1 +/- 13.42 vs 59.75 +/- 13.26 cm/s; E/A 0.84 +/- 0.21 vs 1.38 +/- 0.15 and isovolumetric relaxation time 101 +/- 21 vs 70 +/- 17 ms). Our data suggest that diabetic autonomic neuropathy is a marker of reduced exercise tolerance and of diastolic left ventricular dysfunction.
Collapse
Affiliation(s)
- F Galetta
- Istituto di Clinica Medica II, Universita degli Studi, Pisa
| | | | | | | | | | | |
Collapse
|
30
|
Piaggesi A, Bini L, Castro Lòpez E, Giampietro O, Schipani E, Navalesi R. Knowledge on diabetes and performance among health professionals in non-diabetological departments. Acta Diabetol 1993; 30:25-8. [PMID: 8329727 DOI: 10.1007/bf00572870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We tested the level of knowledge on diabetes and professional skills in a group of 60 non-diabetological health care professionals at the Policlinic of Pisa regarding the recognition and treatment of hypoglycaemia, the storage, mixing and administration of insulin, blood glucose stick monitoring, and the prevention and treatment of diabetic foot. The evaluation was carried out using a multiple-choice questionnaire and observation of the subjects, performance by means of pre-defined observation schedules, during the preparation and administration of a blend of rapid-intermediate insulin, the use of blood glucose sticks and the management of a simulated hypoglycaemic crisis. As regards hypoglycaemia, 90% of subjects did not give a correct definition, 88.3% were unaware of the existence of asymptomatic hypoglycaemia, and 96.6% did not give a complete answer as to the treatment of hypoglycaemia. For insulin, 51.7% did not know the standards for correct storage of insulin, 88.3% did not know the difference between "clear" and "opaque" insulins, and 91.7% ignored the required interval between administration of regular insulin and meals. For foot care, 45% admitted that the problems with diabetics' feet were frequently not controlled, and between 21.7% and 63.3% did not known the hygiene rules for feet. Assessment of the performance of the subjects using schedules revealed incorrect use of sticks and administration of insulin (80.2% mixed and 92.4% injected the insulin incorrectly). There is clearly a need for education of non-diabetological health professionals regarding the disease. This is supported by the health professionals themselves, 94.5% of whom wished to participate in a course on diabetes.
Collapse
Affiliation(s)
- A Piaggesi
- Cattedra di Malattie del Metabolismo, Università di Pisa, Italy
| | | | | | | | | | | |
Collapse
|
31
|
Piaggesi A, Castro Lòpez E, Bini L, Benzi L, Giampietro O, Schipani E, Navalesi R. Measurable deficit of autonomic and sensory nerve function in asymptomatic diabetic patients. J Diabetes Complications 1992; 6:157-62. [PMID: 1472740 DOI: 10.1016/1056-8727(92)90030-o] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In a group of 46 consecutive outpatients attending the diabetic clinic of our Metabolic Department, 30 insulin-dependent and 16 non-insulin-dependent diabetic patients in stable metabolic control, and in 38 age-matched controls, we measured vibration perception threshold with biothesiometer and autonomic function, by means of the five classical cardiovascular tests: R-R interval variations during deep breathing, Valsalva ratio, lying-to-standing, postural hypotension, and sustained handgrip. None of the patients complained of symptoms related to diabetic autonomic neuropathy (DAN) or sensory polyneuropathy. Vibration perception threshold positively correlated with Valsalva ratio (p < 0.05) and deep breathing (p < 0.01), and all of them correlated with age (p < 0.001), but not with duration of diabetes and metabolic control. Patients scored significantly lower than controls in vibration perception threshold and all of the autonomic function tests. According to the outcomes of cardiovascular tests ["Autonomic Score" (AS)] patients were divided into two different groups: presence (DAN+ = AS > or = 3) or absence (DAN- = AS < 3) of autonomic neuropathy. The DAN- group (n = 28, 60.9%) showed no significant differences from the DAN+ group (n = 18, 39.1%) in age, duration of diabetes, glycated hemoglobin, or body mass index. DAN+ patients had vibration perception threshold measured at the first toe tip and at external malleolus significantly higher than DAN- patients (p < 0.01 and p < 0.001, respectively) and controls (p < 0.005), as well as all the other cardiovascular tests except sustained handgrip. No difference in any of these items was observed between DAN- patients and controls.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- A Piaggesi
- Cattedra di Malattie del Metabolismo, Università di Pisa, Italy
| | | | | | | | | | | | | |
Collapse
|
32
|
Piaggesi A, Perata P, Vitagliano C, Alpi A. Level of Abscisic Acid in Integuments, Nucellus, Endosperm, and Embryo of Peach Seeds (Prunus persica L. cv Springcrest) during Development. Plant Physiol 1991; 97:793-7. [PMID: 16668468 PMCID: PMC1081076 DOI: 10.1104/pp.97.2.793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Free abscisic acid (ABA) in integuments, nucellus, endosperm, and embryo was determined throughout seed development of peach (Prunus persica L. cv Springcrest). Quantification of ABA was performed using combined high performance liquid chromatography-radioimmunoassay based on a monoclonal antibody raised against free (S)-ABA. In the integuments and endosperm, ABA concentration remained constant during the first 100 days after anthesis and rose in the following days when fresh weight was rapidly decreasing. In the nucellus, the ABA concentration variation pattern paralleled that of tissue growth. ABA concentration in the embryo increased constantly with the growth of the tissues to reach a maximum at the last growth stage. The role of ABA in peach seeds is discussed in relation to the development of the different seed tissues.
Collapse
Affiliation(s)
- A Piaggesi
- Dipartimento di Biologia delle Piante Agrarie, Università degli Studi di Pisa Viale delle Piagge, No. 23 56124 Pisa, Italy
| | | | | | | |
Collapse
|
33
|
Piaggesi A, Picciarelli P, Lorenzi R, Alpi A. Gibberellins in Embryo-Suspensor of Phaseolus coccineus Seeds at the Heart Stage of Embryo Development. Plant Physiol 1989; 91:362-6. [PMID: 16667026 PMCID: PMC1062000 DOI: 10.1104/pp.91.1.362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Gibberellins (GAs) in suspensors and embryos of Phaseolus coccineus seeds at the heart stage of embryo development were analyzed by combined gas chromatography-mass spectrometry (GC-MS). From the suspensor four C(19)-GAs, GA(1), GA(4), GA(5), GA(6), and one C(20) GA, GA(44), were identified. From the embryo, five C(19)-GAs GA(1), GA(4), GA(5), GA(6), GA(60) and two C(20) GAs, GA(19) and GA(44) were identified. The data, in relation to previous results, suggest a dependence of the embryo on the suspensor during early stages of development.
Collapse
Affiliation(s)
- A Piaggesi
- Dipartimento di Biologia delle Piante Agrarie, Università degli Studi di Pisa, Viale delle Piagge, 23, 56100 Pisa, Italy
| | | | | | | |
Collapse
|
34
|
Piaggesi A, Giampietro O, Picaro L, Miccoli R, Navalesi R. Individual teaching as a first-step intervention for the education of diabetic subjects. Acta Diabetol Lat 1989; 26:225-35. [PMID: 2618528 DOI: 10.1007/bf02581389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The effects of individual teaching imparted during routine diabetologic counselling on the knowledge concerning diabetes and metabolic control, were assessed in 42 outpatients (28 IDDM; 14 NIDDM), attending the diabetic clinic (study group, SG). We evaluated the outcome of a multiple-choice questionnaire and fasting blood glucose (FBG), 24-h urine glucose (UG), mean regulation index (MRI) and glycated hemoglobin (HbA1), before and 60 days after providing information about diet (D), physical exercise (E) and hypoglycemic drugs (HD) or insulin therapy (IT). Results were compared with those obtained in a group of 57 age- and sex-matched patients (36 IDDM; 21 NIDDM) who did not receive individual teaching (control group, CG). Knowledge concerning diabetes at the second evaluation was significantly higher (p less than 0.001) in SG than in CG for D and IT, although an improvement was observed in all items. SG patients showed a significant improvement of knowledge (p less than 0.05) for D, a not significant improvement for HD and IT and no change for E. No change was observed for HbA1, MRI and UG, while a significant decrease (p less than 0.05) was observed for FBG in SG. At the second evaluation, FBG of SG patients was significantly lower (p less than 0.05) than that of CG patients. Our results go to show that individual teaching can improve the level of knowledge of patients without affecting metabolic control. Individual teaching during routine diabetologic counselling represents in our opinion an effective and economic educational model.
Collapse
Affiliation(s)
- A Piaggesi
- Cattedra di Malattie del Ricambio, Universita degli Studi di Pisa, Italy
| | | | | | | | | |
Collapse
|
35
|
|
36
|
Piaggesi A, Pasca S, Giannini C, Rossi B, Giampietro O, Angelotti M, Pulitanò L, Navalesi R. Neuroelectric procedure does not discriminate between painful and paresthetic diabetic neuropathy. Funct Neurol 1989; 4:141-6. [PMID: 2737502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
To investigate whether pain and paresthesias could identify two different subclasses of small-fibre diabetic neuropathy, and to evaluate their relation to the metabolic control, we tested nerve conduction velocity (NCV) of median nerve (sensitive-SM, and motor-MM) and deep peroneal nerve (DP) in 48 diabetics (24 IDDM, 24 NIDDM) reporting pain (group A) or paresthesias (group B) that might be due to diabetic polyneuropathy. Glycated haemoglobin (HbA1c) was also assessed. No difference between group A and group B was found either in NCV, in all nerves tested, or in HbA1c. No relation was observed between NCV of nerves tested and HbA1c, duration of diabetes, age and type of diabetes in both groups.
Collapse
Affiliation(s)
- A Piaggesi
- Second Department of Clinical Medicine, University of Pisa, Italy
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Patanè F, Piaggesi A, Anastasio C. [Clinical characteristics of marginal periodontal disease in diabetics: their possible correlation in retinopathic and nonretinopathic patients]. G Stomatol Ortognatodonzia 1987; 6:45-9. [PMID: 3271792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
38
|
Miccoli R, Giampietro O, Penno G, Piaggesi A, Tognarelli M, Unterberger G, Navalesi R. A computerized information system for diabetes services. Life Support Syst 1986; 4:263-7. [PMID: 3784606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The utilization of a computer-assisted information system may be both useful and efficacious in the care and follow-up of diabetic patients. The model developed by us operates under GCOS-6 on a Microsystem 6/10 Honeywell computer (20 MB hard-disk storage, 512 kb central memory) and allows the creation of clinical data files for individual patients, statistical analysis of the data, and a print-out of clinical records. The package, which may be employed on a multi-user system, is supplied with an easy to understand user's manual. It represents an effective tool for the precise management of the care of diabetic patients and also provides several opportunities for research.
Collapse
|