Patient training is the key points of therapeutic strategy in patients with type 1 diabetes. It should start from the first access to the diabetic outpatient clinic. The Diabetes Care Unit of ASST Spedali Civili di Brescia created a different organizational model for taking care of type 1 diabetic patients, detailing step by step the education and training process, the aims and contents of the entire path and the roles of individual team work. Aim of the study was to evaluate, for one year our organizational model, identifying process, educational and psychological indicators. Most of them where compliant to the expected result. After evalueting the non compliant indicator we have reviewed the submit model to improve and make uniform the quality of care fore the patients with type 1 diabetes throughout the taking care in our Diabetes Care Unit.

KEYWORDS Type 1 diabetes mellitus, Educational therapy, Structured education programme, Engagement ed empowerment.

BACKGROUND The pre-prandial insulin requirement is proportional to the meal’s carbohydrate content (CHO). The CHO counting allows insulin-treated patients to determine the insulin dose at meal using the insulin / CHO ratio (the amount of carbohydrate in grams metabolized by 1UI of insulin). Technological innovation made available the bolus advisor a software (in insulin pump or glucometer) that can calculate and suggest the insulin dose by integrating the residual insulin, insulin/CHO ratio, insulin sensitivity, target glycemic, grams of CHO taken, patient’s state of health,intercurrent stress and physical activity.

PURPOSE The purpose of our study was to evaluate the impact of the use of the bolus advisor on the quality of life and the glycemic control of diabetic patients in intensive insulin therapy followed in Maggiore della Carità Hospital in Novara.

METHODS 56 consecutive patients with type 1 or type 2 diabetes in intensive insulin treatment with and without chronic complications of the disease using the bolus advisor were enrolled. During the planned outpatient visits, approximately 10 minutes of interviews were conducted using 3 questionnaires (PAID, DTSQ and Perceived Improvement in Diabetes Management-Related Factors) and social and schooling level has been evaluated. Some clinical data (HbA1c, BMI and lipid profile) were also collected.

RESULTS The questionnaire analysis revealed that, despite concerns about acute and chronic complications of diabetes, most patients are satisfied with the therapy and relationship with the diabetic team. In relation to the bolus advisor, there was a favorable impact on the fear of hypoglycemia, on the calculation of insulin dose, on self-management of the disease, and on general well-being. There was also a statistically significant reduction in glycated hemoglobin, independent of the duration of use of the bolus advisor.

CONCLUSIONS Our work documented the positive impact of bolus advisor on lifestyle quality and glycemic control suggesting that it could represent, since the onset of the disease, an effective tool for better management and self-management of diabetes.

KEYWORDS Carbo-counting, Therapeutic education, Self management, Flexibility and Quality of life.

The treatment of a chronic disease such as Diabetes Mellitus type 2 involves the persistent change of lifestyle, an appropriate self-monitoring program, and, in most cases, a continuous assumption of a pharmacological therapy. Unfortunately, in the clinical setting, an poor adhesion to pharmacological therapy is reported in 38%- 93% of patients. Education programs to diabetes self-management have been shown to be effective, but they usually have a limited accessibility. In absence of these structured programs, health care providers should rely on other educational resources. To implement a continuous control over time, several tools have been proposed, including remote monitoring. Therefore, the aim of this study was to assess whether telephone counseling activities would improve metabolic control in a population of persons with diabetes. Four hundred and eighty patients have been recruited in 11 diabetes centers in the region Campania (ITALY). Study participants have been divided in random way in two groups: the patients of the group A (240 patients) received regular telephone calls every 20 days for at least three times between the visits, for a total of nine contacts with in seven-nine months, whereas the control group (group B, n=240 patients) received standard care. The phone calls were conducted through a structured interview. The effectiveness of this interactive mode between diabetes team and person with diabetes (PwD) has been verified in terms of improvement of metabolic control (fasting blood glucose, HbA1c) and major cardiovascular risk factors (BMI, blood pressure, cholesterol and triglycerides serum levels). At the end of the study, HbA1c values improved significantly more in the Group A as compared to the Group B (1. 44% vs. 0.64%; p = 0.003). The multivariate regression analysis showed that the change in HbA1c was significantly associated to counseling intervention, independently of other confounding factors such as age, starting insulin therapy, BMI and duration of diabetes. Other parameters such as systolic and diastolic blood pressure, serum cholesterol and triglycerides levels also improved in both groups although not significantly.

CONCLUSIONS Our data show that telephone counseling could be useful to improve the metabolic control in people with diabetes, probably augmenting the adherence to drug therapy.

KEYWORDS Adherence to therapy, Diabetes, Remote monitoring.

Capillary blood glucose monitoring in the hospital population is crucial, as glycemic impairment is associated with a high morbidity and mortality. In our experience the monitoring practice appeared to be inappropriate with the real needs, and it is not related to immediate intervention leading to a modification in patients care. Therefore we analyzed the number of glycemic determinations extracted from the electronic medical records (EMR) (excluding intensive care units) of all the hospitalized subjects during the first six months of 2015. We then finalized a protocol for glucose monitoring, shared with all the hospital medical and nursing staff, based on different patients clinical conditions, with the aim to optimize the use of resources and to make these measurements uniform and significant. A systematic and more aware use of capillary blood glucose monitoring as a decision supporting tool, eventually in conjunction with an “alert” mechanism, can be a valid support to improve in-patients cares.

KEYWORDS Glucose monitoring, Hospitalization, Resources management.

Diabetes is becoming a worldwide pandemic with enormous economic and social costs for any country. Therefore, it is important, to face more effectively this emergency by relying on a healthcare organization that, in addition to making good use of the resources, allows patient access to care. It’s from this assumption that PDTA has developed; in it, a multidisciplinary team provides the patient, who is being placed at the center of system, all the tools required to manage his pathology. Objective of the study is to create a check-list that tests the appropriateness of existing PDTAs or guide specialists to creating new ones.

MATERIALS AND METHODS Collection of italian national and regional legislation on PDTAs; extraction of common and/or innovative aspects and search for evidence in literature. Aim is to create a check-list with basic points that a PDTA must contain in order to be appropriate, and 4 optional points, respectively with different weight, that a PDTA must contain to be “Appropriate and Good” or “Appropriate and Excellent”.

RESULTS 9 basic points, each score 10 and 4 optional points with increasing weight. PDTA to say must have scored 90 in the basic points; if the sum with the optional points score is ≤97 the PDTA is considered as “Appropriate and Good”, if score is >97 the PDTA is considered as “Appropriate and Excellent”.

CONCLUSIONS Since diabetic patients are often affected by two or more disabling chronic diseases perhaps specialist should start thinking about PDTA not for individual pathology, but instead PDTA for care complexity.

KEYWORDS Type 2 diabetes mellitus, Integrated Management, PDTA, Appropriateness.

Diabetes mellitus is a rapidly increasing non transmissible disease with high social and economic impact and costs. The Italian strategy against diabetes has far-reaching roots, i.e. the National Diabetes Law, which, in 1987, introduced an innovative care model characterized by patient centrality through the establishment of Territorial Diabetes Centers. The Law 115/87 has been followed by many other subsequent laws which assure a good management of diabetes, even with respect to the different economic and social changes occurred in the last decades.

Our health care system is characterized by normative sources practically developed in chronic care models pathways. Our region, Campania, boasts a variety of standards in the field of diabetes. The analysis of laws is an in-depth analysis necessary to define the welfare care processes, allowing them to be improved, when necessary, and coordinating and aligning them to the underlying scientific knowledge (Good Quality Clinical Practice, Evidence Based Medicine).

The aim of AMD Campania’s “Law and Institution” working group is to promote an active role of the diabetes specialist in the care pathway organization for the person with diabetes through the acquisition of a specific knowledge of the laws governing diabetes care (knowledge management). For this purpose, we have drafted a VADEMECUM of national and regional laws, as a tool for an easy and quick consultation, focusing our attention on the week points of Laws and their level of accomplishment in the territory. As a further step, a web survey will be carried out as a monitoring tool to detect the level of knowledge of the regulations by diabetologists operating in Campania Region.

KEYWORDS Diabetes, Diabetic Care, Knowledge management, Role of diabetes specialist.