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Survey on the use of insulin pumps in Italy: comparison between pediatric and adult age groups (IMITA study)

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Abstract

Aims

The aim of the study was to evaluate and compare continuous subcutaneous insulin infusion (CSII) use in pediatric and adult age groups.

Methods

Data were collected with a questionnaire sent by e-mail to CSII-experienced Diabetes Centers. The questionnaire assessed: (1) number of CSII-treated patients; (2) patient demographic data and characteristics; (3) structure and organization of Diabetes Centers providing CSII therapy; (4) pump characteristics (conventional pump, sensor-augmented pump); and (5) CSII dropouts.

Results

A total of 217 out of 1093 Italian centers participated: 51 pediatric (23.5 %) and 166 (76.5 %) adult centers (AP). Compared to a survey performed in 2005, there was a significant increase in the number of pediatric units when compared to adult units (112 vs 37 %, respectively, p < 0.05). Pediatric age is characterized by a greater concern for quality of life and injections, and a higher dropout rate (10.6 vs 8.9 %) mainly related to pump wearability and site reactions. A complete diabetes-care team is associated with a superior use of technology (fewer dropouts, increased CGM and advanced bolus use) which is, however, still used in a small percentage of patients.

Conclusions

In Italy, the number of CSII-treated pediatric patients (PP) is growing more significantly when compared to adults. Only 60 % of all patients are using advanced functions and 20 % are using CGMs continuously. This confirms the great interest in diabetes technology that is growing in pediatric diabetologists. However, much improvement is warranted in the organization and specialized training of pediatric, adult and transitional facilities.

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Author information

Author notes

    Authors and Affiliations

    1. Pediatric Department and Diabetes Research Institute (OSR-DRI), IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy

      R. Bonfanti

    2. Unit of Endocrine Disease and Diabetology, A.O Papa Giovanni XXIII, Bergamo, Italy

      G. Lepore

    3. Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy

      L. Bozzetto

    4. Unit of Diabetology and Endocrinology, P.O. Metropolitano, ASL 3, Genoa, Italy

      A. Corsi

    5. Department of Endocrinology and Diabetology, ASL Salerno, Salerno, Italy

      V. Di Blasi

    6. Unit of Diabetology, A.O. Spedali Civili, Brescia, Italy

      A. Girelli

    7. Division of Endocrinology, Diabetology and Metabolism, A.O Città della Salute e della Scienza, Turin, Italy

      G. Grassi

    8. Department of Pediatrics, Second University of Naples, Naples, Italy

      D. Iafusco

    9. Department of Pediatrics, University of Turin, Turin, Italy

      I. Rabbone

    10. Unit of Endocrinology and Diabetes, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy

      R. Schiaffini

    11. Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Aldo Moro, Bari, Italy

      L. Laviola

    12. Department of Medicine, DIMED, Metabolic Diseases, University of Padua, Padua, Italy

      D. Bruttomesso

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    1. R. Bonfanti
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    Consortia

    the Italian Study Group on Diffusion of CSII in Italy

    Corresponding author

    Correspondence to R. Bonfanti.

    Ethics declarations

    Conflict of interest

    D.B. has received lecture fees from Eli Lilly, LifeScan, Roche Diagnostics and Sanofi Aventis and has provided advisory services to Abbott. L.L. has received speaker fees from Abbott, Astra Zeneca, Bayer, Eli Lilly, MSD, Novartis, Novo Nordisk, Roche Diagnostics, Sanofi Aventis and Takeda and has provided advisory services to Astra Zeneca, Eli Lilly, Novartis, Novo Nordisk, Roche Diagnostics, Sanofi Aventis and Takeda. G.L. has received speaker fees from Medtronic, Sanofi Aventis and Eli Lilly and has provided advisory services to Novo Nordisk. R.B. has received fees for consulting from Roche Diagnostics, Eli Lilly and Sanofi Aventis and a travel grant from Animas and has provided advisory services to Medtronic. A.C. has received speaker fees from Medtronic. V.D.B. has received speaker fees from Eli Lilly, Menarini and Sanofi Aventis. A.G. has attended conferences organized by Eli Lilly as a contributor. G.G. has provided advisory services to Eli Lilly, Abbott and Becton–Dickinson and received speaker fees from Menarini, Roche Diagnostics and Medtronic. I.R. has received speaker fees from Eli Lilly, Roche Diagnostics and Sanofi Aventis. R.S. has received speaker fees from Eli Lilly and has provided advisory services to Roche Diagnostics and Abbott. L.B. and D.I. declare no competing financial interests exist. The remaining authors declare that they have no conflict of interest.

    Human and animal rights disclosure

    This article does not contain any studies with human or animal subjects performed by the any of the authors.

    Informed consent

    None.

    Additional information

    Managed by Antonio Secchi.

    R. Bonfanti and G. Lepore have equally contributed to the paper.

    A complete list of members of the Italian Study Group on Diffusion of CSII can be found in the “Appendix,” and they have to be considered co-authors.

    Appendix: Members of the Italian Study Group on Diffusion of CSII

    Appendix: Members of the Italian Study Group on Diffusion of CSII

    All the following primary investigators and clinical centers, listed by region or city (affiliation), participated in this study:

    Abruzzo

    Atri (TE), V. Montani and P. Colleluori; Avezzano (AQ), V. Paciotti and P. Alfidi; Castel di Sangro (AQ), J. Grosso; Chieti, S. Tumini and P. Cipriano (Diabetologia Pediatrica) and E. Vitacolonna and G. Di Vieste (Diabetologia Universitaria Policlinico); Lanciano (CH), A. Minnucci and D. Antenucci; Pescara, G. La Penna and M. Taraborrelli; Sulmona (AQ), B. Macerala.

    Basilicata

    Potenza, G. Citro.

    Calabria

    Cosenza, G. De Morelli; Catanzaro, A. Gnasso and C. Irace (Malattie del Metabolismo, Università degli Studi Magna Graecia) and F. Citriniti (Diabetologia); Crotone, N. Lazzaro; Locri (RC), M. Bruzzese and F. Mammì; Paola (CS), F. De Berardinis and E. Santoro.

    Campania

    Avellino, G. Corigliano and M. Corigliano; Caserta, M. Parillo (Diabetologia UOC Geriatria ed Endocrinologia e Malattie del Ricambio AORN “S. Anna e S. Sebastiano”) and M. Schettino (Diabetologia UOC Medicina Interna AORN “S. Anna e S. Sebastiano”); Cava de’Tirreni (SA), V. Di Blasi and R. Fresa; Napoli, G. Annuzzi and L. Bozzetto (Diabetologia Università Federico II), V. Bassi and C. Santinelli (PO S.G. Bosco, ASL Na1-Centro), P. Buono and E. Mozzillo (Diabetologia Pediatrica Università Federico II), G. Corigliano and V. Russo (Diabetologia AID), E. De Feo (Diabetologia AORN A. Cardarelli), K. Esposito and M. Petrizzo (Seconda Università), A. Foglia (Ospedale dei Pellegrini), A. Gatti (Diabetologia Ospedale San Gennaro), S. Gentile and G. Guarino (Dipartimento di Medicina Clinica e Sperimentale, Seconda Università), and A. Zanfardino and S. Confetto (Diabetologia Pediatrica “G. Stoppoloni” Seconda Universita di Napolì); Salerno, C. Lambiase and A. Vitale.

    Emilia Romagna

    Bologna, S. Zucchini and G. Maltoni (Pediatria AOU di Bologna S. Orsola-Malpighi), G. Forlani and S. Moscatiello (Policlinico S. Orsola-Malpighi); Cesena, T. Suprani and M. Bensa; Ferrara, F. Tomasi and M. Monesi; Forlì, M. Nizzoli and S. Acquati; Guastalla-Correggio (RE), G. Chierici and B. Milli; Modena, L. Iughetti and B. Predieri (UO Pediatria Università Modena-Reggio Emilia) and R. Cavani and S. Romano (Servizio Diabetologico Azienda USL); Montecchio (RE), V. Manicardi and M. Michelini; Parma, M.C. Cimicchi and D. Ugolotti (Ambulatori Diabetologici Distretto), I. Zavaroni and A. Dei Cas (SS Endocrino-Metabolica, AOU Parma), E. Dall’Aglio and M. Papi (Malattie del Ricambio e Diabetologia, AOU Parma), and S.M. Tardio and M.C. Calderini (Trattamento intensivo del diabete, AOU Parma); Piacenza, S. Riboni and L. d’Amato (Pediatria) and D. Zavaroni and L. Gastaldi (Az. USL); Ravenna, A. Cirillo and V. Graziani (Pediatria) and P. Di Bartolo and F. Pellicano (Diabetologia AULS); Reggio Emilia, C. Di Seclì and V. Manicardi (AUSL) and S. Amarri and A. Lasagni (Pediatria, AO Santa Maria Nuova); Rimini, A. Marsciani and A. Pedini; Scandiano (RE), U. Pagliani and C. Rossi.

    Friuli-Venezia Giulia

    Monfalcone (GO), C. Tortul, B. Brunato, and R. Assaloni; Pordenone (PN), G. Zanette; Sacile (PN), P. Livolsi; Trieste, A. Petrucco and K. Tercelj (SO Distretto 1), E. Manca (ASS1 Triestina, Distretto 2), R. Candido and E. Tommasi (ASS 1Triestina, Distretto 3), and G. Tornese and E. Faleschini (UCO Clinica Pediatrica, IRCCS Burlo); Udine, L. Tonutti and S. Agus (SOC Endocrinologia e Metabolismo), M. Zanatta and A. Rosolen (AOU S. Maria della Misericordia), and A. Comici (SOC Pediatria, Ospedale San Antonio).

    Lazio

    Frascati (RM), F.M. Graziano and I. Misischi; Frascati (RM), P. Falasca; Gaeta (LT), F. Tuccinardi; Latina, G.P. Ricciardi and P. Di Masa (ASL Latina Distretto 1 UOSD), M. Ragonese and L. Cipolloni (Cavalieri di Malta, Diabetologia), R. Buzzetti, C. Moretti, and G. Leto (Ospedale S.M. Goretti—Polo Pontino Università Sapienza); Palidoro (RM), A. Crino` and S. Bocchini; Roma, P. Pozzilli and A.R. Maurizi (Università Campus Biomedico); P. Di Perna and M. Giuliano (ASL Roma C, Servizio di Endocrinologia e Diabetologia), S. Frontoni and I. Malandrucco (Ospedale S. Giovanni Calibita Fatebenefratelli, Servizio di Endocrinologia e Diabetologia), D. Pitocco (Università Cattolica Policlinico Gemelli, UO Diabetologia), R. Scalpone and F. Toscanella (IDI, IRCCS—UO Diabetologia), M. Cappa and D.Benevento (Ospedale Pediatrico Bambino Gesù, UOC Endocrinologia e Diabetologia), C. Ventura and V. Bonato (Ospedale Israelitico, UOS Endocrinopatie e Malattie del Metabolismo), M. De Bernardinis and M.G. Cavallo (Università Sapienza Policlinico Umberto I—+Servizio di Diabetologia), F. Leonetti (Università Sapienza Policlinico Umberto I, UOS Malattie Metaboliche e Diabetologia), S. Morano and E. Mandosi (Università Sapienza Policlinico Umberto I, Fisiopatologia Medica ed Endocrinologia, Clinica Medica V), E. Cicconetti and G. Ciampittiello (Policlinico Tor Vergata, UOC Diabetologia), D. Lauro, M.A. Marini and D. Sabato (Università Tor Vergata Policlinico Tor Vergata, UOC Endocrinologia e Diabetologia), G. Pugliese, A. Napoli (AO S. Andrea, Servizio Diabetologia), F. Massimiani and D. Fava (AO S. Giovanni Addolorata, UOSD Malattie Metaboliche e Diabetologia), P. Gargiulo and N. Mecca (Università Sapienza, Endocrinologia “A”), C. Tubili, M.R. Nardone and L. Morviducci (AO S. Camillo Forlanini, UOS di Diabetologia), M.L. Manca-Bitti and S. Arcano (Università Tor Vergata Policlinico Tor Vergata, Centro di Diabetologia Pediatrica), S. Leotta and C. Suraci (Ospedale Sandro Pertini, UOC Dietologia, Diabetologia e Malattie Metaboliche), F. Chiaramonte, F Strollo and N. Visalli (Polo Ospedaliero S. Spirito, Diabetologia e Dietologia); Terracina (LT), E. Forte and C. Palmacci; Viterbo, C. Arnaldi and D. Tosini.

    Liguria

    Genova, A. Corsi and P. Ponzani (ASL 3 Ospedale La Colletta), M. Patrone, R. Guido, and A. Aglialoro (ASL3 Ospedale Villascassi), G. Ghisoni and F. Fabbri (ASL 3 Poliambulatorio Nervi), C. Bordone, D. Maggi, and R. Cordera (UOC Malattie del Metabolismo e Diabetologia, IRCCS San Martino, Università, IST), and N. Minuto and G. D’Annunzio (Istituto Giannina Gaslini); Imperia, D. Speranza and M. Siri; La Spezia, S. Carro and A. Zappa (S.S.D. Centro Antidiabetico, Ospedale del levante ligure) and S. Parmigiani and S. Nieri (S.C. Pediatria, Ospedale del Levante Ligure); Pietraligure (SV), L. Briatore and G. Calvo.

    Lombardia

    Alzano Lombardo (BG), F. Querci; Bergamo, G. Lepore and R. Trevisan; Brescia, A. Girelli and S. Bonfadini (UO Diabetologia) and E. Prandi and B. Felappi (Clinica Pediatrica); Castellanza (VA), F. Locatelli and V. Fuso; Cinisello (MI), A. Rocca and E. Meneghini; Cologno Monzese (MI), C. Massafra and T. Terni; Como, P. Elli; Cremona, P. Ruggeri and E. Carrai; Cusano Milanino (MI), N. Musacchio and C.A. Lovagnini Scher; Desio (MI), G. Marelli and V. Vilei; Esine (BS), D. Richini and C. Inversini; Gallarate (VA), I. Franzetti and M. Bonacina; Mariano Comense (CO), A. Ciucci and L. Sciangula; Luino (VA), E. Duratorre; Milano, M. Bonomo and F. Bertuzzi (AO Niguarda Cà Granda), E. Chebat and M. Muratori (AO Sacco), A. Scaramuzza and G.V. Zuccotti (AO Sacco Clinica Pediatrica), P.M. Bollati and P. Colapinto (AO San Carlo Borromeo), E. Orsi and E. Palmieri (Fondazione IRCCS Cà Granda, Policlinico), A. Laurenzi and C. Molinari (Ospedale San Raffaele), A. Rigamonti, V. Favalli, and G. Frontino (Clinica Pediatrica Ospedale San Raffaele), and A. Veronelli and B. Zecchini (AO San Paolo); Paderno Dugnano (MI), A. Bianchi and G. Torchio; Pavia, E. Lovati; Piario (BG), G. Ghilardi; Rho (MI), R. Dagani and D. Carugo; Rozzano (MI), C. Berra and G. Favacchio; Sondrio, E. Fochesato and A. Pissarelli; Sesto San Giovanni (MI), L. Bucciarelli and M. Bulgheroni; Tradate (VA), L. Guerraggio and S. Zonca; Treviglio (BG), A.C. Bossi and D. Berzi; Vimercate (MI), I. Mangone and E. Cazzaniga.

    Marche

    Ancona (AN), R.A. Rabini and M. Boemi (UA Malattie Metaboliche e Diabetologia, INRCA), E. Faloia and M. Boscaro (Clinica Endocrinologica, Ospedali Riuniti), and G. Sternari, A. Iannilli, and V. Cherubini (Diabetologia Pediatrica, Ospedale Salesi); Camerino (MC), N. Busciantella Ricci and M.G. Cartechini; Macerata (MC), A.M. Tesei and G. Maolo; San Benedetto del Tronto e Ascoli Piceno (AP), M. Galetta and G. Vespasiani; Senigallia (AN), G. Tinti and S. Manfrini.

    Molise

    Campobasso, A. Aiello and S. Di Vincenzo; Termoli (CB), C. Vitale and P. Di Caro.

    Piemonte

    Alessandria, R. Lera and A. Secco; Carmagnola (TO), A. Lesina and F. Romeo; Chieri (TO), C. Origlia and C. Giorda; Chivasso (TO), A.M. Chiambretti and R. Fornengo; Cuneo, V. De Donno and F. Gallarotti; Nichelino (TO), R. Manti and L. Marafetti; Novara, F. Cadario and S. Savastio; Novi Ligure (AL), P. Barbieri; Torino, P. Massucco and A. Alì (S. Luigi di Gonzaga), C. Gottero (Ospedale Maria Vittoria), M. Degiovanni, S. Bertaina, G. Grassi, and G. Maghenzani (Citta della Salute e della Scienza), and MG Ignaccolo and D. Tinti (Endocrinologia e Diabetologia Pediatrica, AO Città della Salute e della Scienza di Torino); Tortona (AL), F. Fontana.

    Puglia

    Bari, F. Giorgino and G. Stefanelli (Endocrinologia Università), L. Cavallo and C. Zecchino (Pediatria Università), and E. Piccinno and F. Ortolani (Ospedale Pediatrico Giovanni XXIII); Brindisi, F. Gallo and F. Moramarco; Casarano (LE), A. Marino and G. Sparasci; Fasano (BR), G. Mileti; Foggia, O. Lamacchia and G. Picca; Francavilla Fontana (BR), M.S. Coccioli; Gallipoli (LE), F. Micale; Lecce, R. Serra and I. Romano; Mola (BA), T. Savino; S. Giovanni Rotondo (FG), S. De Cosmo and A. Rauseo (Endocrinologia) and M. Delvecchio and R. Lapolla (Pediatria); Taranto, A.F. Braione; Trani (BT), G. Papagno.

    Sardegna

    Cagliari, M. Baroni, M, Melis, and E. Cossu (Diabetologia Università di Cagliari) and M. Songini and V.M. Cambuli (Ospedale San Michele AO).

    Sicilia

    Catania, D. Lo Presti and T.A. Timpanaro (AOU Policlinico, Diabetologia Pediatrica), A. Chiavetta and M.R. Garofalo (UO Diabetologia), and L. Tommaselli and A. Tumminia (Endocrinologia, Ospedale Garibaldi Nesima, Università); Marsala, A.M. Scarpitta; Messina, A. Di Benedetto and L. Giunta (AOU Policlinico, Medicina Interna) and F. Lombardo andG. Salzano (UOCClinica Pediatrica); Palermo, F.Cardella and R. Roppolo (UOS Diabetologia Pediatrica); Partinico (PA), V. Provenzano and M. Fleres.

    Toscana

    Empoli, S. Migliorini and A. De Luca; Firenze, A. Leopardi and C. Beltrami (Diabetologia ASL 10), S. Toni, G. Guasti, and L. Lenzi (AOU Meyer), and C. Lamanna and E. Mannucci (AOU Careggi); Livorno, S. Lucchesi and G. Dicianni; Pisa, M. Aragona and S. Del Prato; G. Federico and B. Marchi.

    Trentino Alto Adige

    Bolzano (BZ), B. Fattor and J. Eisath (Ospedale Centrale) and B. Pasquino, P. Reinstadler, and P. Kaufmann (Dipartimento di Pediatria); Merano (BZ), G. Incelli and S. Rauch; Trento, T. Romanelli (Ospedale Santa Chiara, Diabetologia Adulti) and V. Cauvin and R. Franceschi (Ospedale S. Chiara, Diabetologia Pediatrica).

    Umbria

    Città di Castello (PG), C. Soldani and R. Scattoni; Perugia, R. Norgiolini and R. Celleno (AO “Santa Maria della Misericordia,” Clinica Pediatrica) and E. Torlone and G.B. Bolli (AO “Santa Maria della Misericordia,” Diabetologia); Spoleto (PG), C. Lalli and M. Scarponi.

    Valle d’Aosta

    Aosta: A. Bobbio and M. Bechaz.

    Veneto

    Bassano del Grappa (VI), A. Pianta and A. Marangoni; Belluno, C.N. Aricò and C. Alagona; Castelfranco Veneto (TV), L. Confortin and E. Rossi; Chioggia, A. Boscolo Bariga and A. Nogara; Cittadella (PD), M. Bettio and V. Frison; Conegliano Veneto (TV), G.L. Guidoni; Contarina (VE), C. Fongher; Dolo-Mirano (VE), M.L. Contin, A. Cosma, and S. Vianello; Legnago (VR), L. Bondesan and A. Morea; Montebelluna (TV), A. Volpi and A. Coracina; Monselice (PD), G. Panebianco; Montecchio Maggiore (VI), S. Lombardi and S. Costa; Padova, E. Cipponeri, M. Vedovato, and R. Scotton (Malattie del Metabolismo, Dipartimento Medicina Interna-DIMED, Università), C.M. Monciotti and A. Galderisi (Cl. Pediatrica, Università), and M.G. Dalfrà and A. Lapolla (UO Diabetologia e Dietetica, Università); Portogruaro-S. Donà di Piave (VE), M. Zanon; Rovigo, G. Lisato and F. Mollo; Schio (VI), F. Calcaterra and M. Miola; Treviso, A. Paccagnella and M. Sambataro; Venezia, E. Moro; Verona (VR), M. Trombetta and C. Negri (Azienda Ospedaliera Universitaria Integrata) and A. Sabbion and C. Maffeis (Pediatria, ULSS20 e Università); Vicenza (VI), M. Strazzabosco and C.A. Mesturino (Ospedale Civile) and R. Mingardi (Casa di Cura Villa Berica).

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    Bonfanti, R., Lepore, G., Bozzetto, L. et al. Survey on the use of insulin pumps in Italy: comparison between pediatric and adult age groups (IMITA study). Acta Diabetol 53, 403–412 (2016). https://doi.org/10.1007/s00592-015-0810-4

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    • DOI: https://doi.org/10.1007/s00592-015-0810-4

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