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

2. 42 41 78 66 20 57 28 37 98 11 21 44 14 38 The Diabetes Units in Italy 9 4 1 11 5 3 2003 Survey Total Number of Diabetes Units = 628

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

4. 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

5. Geographic distibution of Diabetes Units in Italy 38 % 21 % 41 % Inhabitants % Northern25.835.500 45 Central12.767.000 22 Southern19.242.000 33

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

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

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

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

10. 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

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

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

13. The picture of the diabetic persons cared in 75 Italian Diabetes Units in 2004 2005: the data collection by AMD from the electronic sheets

14. Total number of patients visited in 2004: 132.497 “new patients” in 2004 19.753

15. 3 2 2 2 6 5 2 2 5 8 4 4 8 5 2 7 6 Number and distribution of the 75 Diabetes Units participating to the data collecting 1

16. 52.4% 47.6% 8.1% 89.9% Age <=353.9% 35-6541.6% >6554.5% 132.497Total number of patients in 2004 Male Female Type of diabetes Type 1 Type 2 other 19.753New 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%)

17. 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 1.6 132.497Total number of patients in 2004 >=7.0 7.1-8.0 8.1-9.0 >9.0 19.753New patients in 2004 HbA1c 62.2% 71.2% CV Risk Factors BP >130/85 LDL Chol>=100 mg/dl BMI>27 63.4% Type 1 Type 2 7.5 1.6 Combined Therapy 7.7 1.7%

18. Sex

19. Type of diabetes

20. Age

21. HbA1c

22. HbA1c values according the therapy OHA Insulin (type 1)

23. CV Risk Factors

24. 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

25. 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

27. Thank you for your kind attention