Livio Luzi1,2, Michele Carruba3,4, Roberta Crialesi5, Stefano Da Empoli6, Regina Dagani7,8, Elisabetta Lovati9,10, Antonio Nicolucci11, Cesare C Berra12, Elisa Cipponeri12, Ketty Vaccaro13, Andrea Lenzi14,15,16. 1. Department of Biomedical Sciences for Health, University of Milan, Milan, Italy. livio.luzi@unimi.it. 2. Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS Multimedica, Via Milanese 300, 20099, Sesto San Giovanni, Milan, Italy. livio.luzi@unimi.it. 3. Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy. 4. Centre for Study and Research on Obesity of the University of Milan, Milan, Italy. 5. National Institute of Statistics of Italy - ISTAT, Rome, Italy. 6. Institute for Competitiveness - I-COM, Rome, Italy. 7. Italian Diabetes Society Foundation Association - AMD Lombardy, Milan, Italy. 8. Health Agencies in the Territories (ASST) Rhodense, Milan, Italy. 9. Italian Diabetes Society - SID Lombardy, Pavia, Italy. 10. I.R.C.C.S. Policlinico San Matteo, Pavia, Italy. 11. Centre for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy. 12. Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS Multimedica, Via Milanese 300, 20099, Sesto San Giovanni, Milan, Italy. 13. Fondazione CENSIS, Rome, Italy. 14. Health City Institute, Rome, Italy. 15. Department Experimental Medicine, La Sapienza University, Rome, Italy. 16. Biotechnology and Life Sciences of Prime Minister Council - CNBBSV, Rome, Italy.
Abstract
BACKGROUND: Since 2010, more than half of World population lives in Urban Environments. Urban Diabetes has arisen as a novel nosological entity in Medicine. Urbanization leads to the accrual of a number of factors increasing the vulnerability to diabetes mellitus and related diseases. Herein we report clinical-epidemiological data of the Milano Metropolitan Area in the contest of the Cities Changing Diabetes Program. Since the epidemiological picture was taken in January 2020, on the edge of COVID-19 outbreak in the Milano Metropolitan Area, a perspective addressing potential interactions between diabetes and obesity prevalence and COVID-19 outbreak, morbidity and mortality will be presented. To counteract lock-down isolation and, in general, social distancing a pilot study was conducted to assess the feasibility and efficacy of tele-monitoring via Flash Glucose control in a cohort of diabetic patients in ASST North Milano. METHODS: Data presented derive from 1. ISTAT (National Institute of Statistics of Italy), 2. Milano ATS web site (Health Agency of Metropolitan Milano Area), which entails five ASST (Health Agencies in the Territories). A pilot study was conducted in 65 screened diabetic patients (only 40 were enrolled in the study of those 36 were affected by type 2 diabetes and 4 were affected by type 1 diabetes) of ASST North Milano utilizing Flash Glucose Monitoring for 3 months (mean age 65 years, HbA1c 7,9%. Patients were subdivided in 3 groups using glycemic Variability Coefficient (VC): a. High risk, VC > 36, n. 8 patients; Intermediate risk 20 < VC < 36, n. 26 patients; Low risk VC < 20, n. 4 patients. The control group was constituted by 26 diabetic patients non utilizing Flash Glucose monitoring. RESULTS: In a total population of 3.227.264 (23% is over 65 y) there is an overall prevalence of 5.65% with a significant difference between Downtown ASST (5.31%) and peripheral ASST (ASST North Milano, 6.8%). Obesity and overweight account for a prevalence of 7.8% and 27.7%, respectively, in Milano Metropolitan Area. We found a linear relationship (R = 0.36) between prevalence of diabetes and aging index. Similarly, correlations between diabetes prevalence and both older people depending index and structural dependence index (R = 0.75 and R = 0.93, respectively), were found. A positive correlation (R = 0.46) with percent of unoccupied people and diabetes prevalence was also found. A reverse relationship between diabetes prevalence and University level instruction rate was finally identified (R = - 0.82). Our preliminary study demonstrated a reduction of Glycated Hemoglobin (p = 0.047) at 3 months follow-up during the lock-down period, indicating Flash Glucose Monitoring and remote control as a potential methodology for diabetes management during COVID-19 lock-down. HYPOTHESIS AND DISCUSSION: The increase in diabetes and obesity prevalence in Milano Metropolitan Area, which took place over 30 years, is related to several environmental factors. We hypothesize that some of those factors may have also determined the high incidence and virulence of COVID-19 in the Milano area. Health Agencies of Milano Metropolitan Area are presently taking care of diabetic patients facing the new challenge of maintaining sustainable diabetes care costs in light of an increase in urban population and of the new life-style. The COVID-19 pandemic will modify the management of diabetic and obese patients permanently, via the implementation of approaches that entail telemedicine technology. The pilot study conducted during the lock-down period indicates an improvement of glucose control utilizing a remote glucose control system in the Milano Metropolitan Area, suggesting a wider utilization of similar methodologies during the present "second wave" lock-down.
BACKGROUND: Since 2010, more than half of World population lives in Urban Environments. Urban Diabetes has arisen as a novel nosological entity in Medicine. Urbanization leads to the accrual of a number of factors increasing the vulnerability to diabetes mellitus and related diseases. Herein we report clinical-epidemiological data of the Milano Metropolitan Area in the contest of the Cities Changing Diabetes Program. Since the epidemiological picture was taken in January 2020, on the edge of COVID-19 outbreak in the Milano Metropolitan Area, a perspective addressing potential interactions between diabetes and obesity prevalence and COVID-19 outbreak, morbidity and mortality will be presented. To counteract lock-down isolation and, in general, social distancing a pilot study was conducted to assess the feasibility and efficacy of tele-monitoring via Flash Glucose control in a cohort of diabeticpatients in ASST North Milano. METHODS: Data presented derive from 1. ISTAT (National Institute of Statistics of Italy), 2. Milano ATS web site (Health Agency of Metropolitan Milano Area), which entails five ASST (Health Agencies in the Territories). A pilot study was conducted in 65 screened diabeticpatients (only 40 were enrolled in the study of those 36 were affected by type 2 diabetes and 4 were affected by type 1 diabetes) of ASST North Milano utilizing Flash Glucose Monitoring for 3 months (mean age 65 years, HbA1c 7,9%. Patients were subdivided in 3 groups using glycemic Variability Coefficient (VC): a. High risk, VC > 36, n. 8 patients; Intermediate risk 20 < VC < 36, n. 26 patients; Low risk VC < 20, n. 4 patients. The control group was constituted by 26 diabeticpatients non utilizing Flash Glucose monitoring. RESULTS: In a total population of 3.227.264 (23% is over 65 y) there is an overall prevalence of 5.65% with a significant difference between Downtown ASST (5.31%) and peripheral ASST (ASST North Milano, 6.8%). Obesity and overweight account for a prevalence of 7.8% and 27.7%, respectively, in Milano Metropolitan Area. We found a linear relationship (R = 0.36) between prevalence of diabetes and aging index. Similarly, correlations between diabetes prevalence and both older people depending index and structural dependence index (R = 0.75 and R = 0.93, respectively), were found. A positive correlation (R = 0.46) with percent of unoccupied people and diabetes prevalence was also found. A reverse relationship between diabetes prevalence and University level instruction rate was finally identified (R = - 0.82). Our preliminary study demonstrated a reduction of Glycated Hemoglobin (p = 0.047) at 3 months follow-up during the lock-down period, indicating Flash Glucose Monitoring and remote control as a potential methodology for diabetes management during COVID-19 lock-down. HYPOTHESIS AND DISCUSSION: The increase in diabetes and obesity prevalence in Milano Metropolitan Area, which took place over 30 years, is related to several environmental factors. We hypothesize that some of those factors may have also determined the high incidence and virulence of COVID-19 in the Milano area. Health Agencies of Milano Metropolitan Area are presently taking care of diabeticpatients facing the new challenge of maintaining sustainable diabetes care costs in light of an increase in urban population and of the new life-style. The COVID-19 pandemic will modify the management of diabetic and obesepatients permanently, via the implementation of approaches that entail telemedicine technology. The pilot study conducted during the lock-down period indicates an improvement of glucose control utilizing a remote glucose control system in the Milano Metropolitan Area, suggesting a wider utilization of similar methodologies during the present "second wave" lock-down.
Entities:
Keywords:
COVID-19; Diabetes and obesity prevalence; Telemonitoring of blood glucose; Urban diabetes
Authors: Renae Smith-Ray; Erin E Roberts; Devonee E Littleton; Tanya Singh; Thomas Sandberg; Michael Taitel Journal: JMIR Public Health Surveill Date: 2020-06-18
Authors: Michael Letko; Stephanie N Seifert; Kevin J Olival; Raina K Plowright; Vincent J Munster Journal: Nat Rev Microbiol Date: 2020-06-11 Impact factor: 78.297
Authors: Przemysław Śleszyński; Paulina Legutko-Kobus; Mark Rosenberg; Viktoriya Pantyley; Maciej J Nowak Journal: Int J Environ Res Public Health Date: 2022-04-27 Impact factor: 4.614
Authors: Stefano Omboni; Raj S Padwal; Tourkiah Alessa; Béla Benczúr; Beverly B Green; Ilona Hubbard; Kazuomi Kario; Nadia A Khan; Alexandra Konradi; Alexander G Logan; Yuan Lu; Maurice Mars; Richard J McManus; Sarah Melville; Claas L Neumann; Gianfranco Parati; Nicolas F Renna; Philippe Ryvlin; Hugo Saner; Aletta E Schutte; Jiguang Wang Journal: Connect Health Date: 2022-01-04
Authors: Debora Wilke Franco; Janine Alessi; Taíse Rosa de Carvalho; Gabriel Luiz Kobe; Giovana Berger Oliveira; Carolina Padilla Knijnik; Bibiana Amaral; Alice Scalzilli Becker; Beatriz D Schaan; Gabriela Heiden Telo Journal: Prim Care Diabetes Date: 2022-09-30 Impact factor: 2.567