IDF Europe GA Munich October 16, 2005 Italian national database on diabetes and its complications. Marco A. Comaschi – AMD - Italy

The Diabetes Units in Italy Survey Total Number of Diabetes Units = 628

Total73% Hospital Units 85% Outpatient Units 79% Hospital Ambulatories68% Extra Hospital ambulatories53% Private89% Use of Electronic clinical sheet Internet connection46%

Clinical Pathways for the assessment and cure of the complications 31% ED 66% Retinopathy 51% CVD 44% Nefropathy 42% Cerebral VD 40% PVD 38% Diabetic Foot 37% Somatic Neuropathy 31% Autonomic Neuropathy

Geographic distibution of Diabetes Units in Italy 38 % 21 % 41 % Inhabitants % Northern Central Southern

Every Diabetes Unit should be the place where the diabetic person can find a plan of care of high quality and sure effectiveness

The informatic technology of the Diabetes Units is a mandatory step in order to control on real time their own activity

We need simple, effective and validate tools to evaluate the efficacy and the quality of our work

The first step in order to reach these goals is to get informations, collected by standardized and accurate methodologies

Which informations? Data that may allow to monitorate our activity Data that generate indicators The indicators allow to get an objective point of view, and to measure the quality of care To realize a control of the real quality of care

To create a list of items generated in an automatic way from the software AND PUBLISHING IT GOAL

The “Data File” of AMD Has been realized Has been published on AMD website ( Is open for everyone that would like to use it

The picture of the diabetic persons cared in 75 Italian Diabetes Units in : the data collection by AMD from the electronic sheets

Total number of patients visited in 2004: “new patients” in

Number and distribution of the 75 Diabetes Units participating to the data collecting 1

52.4% 47.6% 8.1% 89.9% Age <=353.9% % >6554.5% Total number of patients in 2004 Male Female Type of diabetes Type 1 Type 2 other New patients in 2004 Sex 2.0% 2.5 (9.4%) 2.4 (41.3%) Mean number of consulting according the therapy and % on the total Diet alone OHA Insulina 3.3 (33.2%) Combined therapy 3.3 (16.1%)

58.6% 21.3% 11.0% 9.2% HbA1c and therapy Diet alone 6.0 0.9% OHA 6.7 1.4% Insulin 7.6 Total number of patients in 2004 >= > New patients in 2004 HbA1c 62.2% 71.2% CV Risk Factors BP >130/85 LDL Chol>=100 mg/dl BMI> % Type 1 Type 2 7.5 1.6 Combined Therapy 7.7 1.7%

Sex

Type of diabetes

Age

HbA1c

HbA1c values according the therapy OHA Insulin (type 1)

CV Risk Factors

Conclusions (1) A large use of electronic clinical sheet is cheap and easily available in Europe The application of AMD Data File and Indicators is possible on each type of electronic sheet present in the international market The merging of the data and of the intermediate and final indicators gathered from several countries might allow to get a better quality of care for the diabetic persons everywhere One of the main goals should be to reach a standard system, reprehesenting the real “benchmark” of the diabetes care

Conclusions (2) For this aim, AMD is going to invite IDF Europe to hold next GA in Italy, next autumn 2006, in Venice or Genoa, in order to present and discuss the different systems of organization of the care of the diabetic persons in Europe, and to find a “Consensus” about the best one. It will be an extraordinary tool for a public proposal to Health Authorities in every Country and in EU

Thank you for your kind attention