Valeria Manicardi - Academia.edu (original) (raw)

Papers by Valeria Manicardi

Acta diabetologica, 2013

Diabetes mellitus and hyperglycaemia are both independent risk factors (RF) for cardiovascular (C... more Diabetes mellitus and hyperglycaemia are both independent risk factors (RF) for cardiovascular (CV) events and increased general and CV mortality. Type 2 diabetes, which is often associated with obesity, hypertension and dyslipidaemia, is accompanied by an up to fourfold increase in the incidence of acute coronary heart disease compared to normoglycaemia, even when other CV RF are equal. In the diabetic population, acute CV events are more likely to have associated cardiac complications, such as heart failure, and CV mortality is increased by twofold–fourfold. Several patients, hospitalised in medical, cardiology and intensive care departments, have undiagnosed diabetes mellitus or elevated glucose levels at the time of admission. These conditions require intensive care in the acute phase and dedicated follow-up at discharge. The Trialogue Plus project was created with the goal of providing good clinical practice guidelines and recommendations for the management of CV risk in patien...

Cardiovascular Diabetology

Background The European Society of Cardiology (ESC) recently defined cardiovascular risk classes ... more Background The European Society of Cardiology (ESC) recently defined cardiovascular risk classes for subjects with diabetes. Aim of this study was to explore the distribution of subjects with type 2 diabetes (T2D) by cardiovascular risk groups according to the ESC classification and to describe the quality indicators of care, with particular regard to cardiovascular risk factors. Methods The study is based on data extracted from electronic medical records of patients treated at the 258 Italian diabetes centers participating in the AMD Annals initiative. Patients with T2D were stratified by cardiovascular risk. General descriptive indicators, measures of intermediate outcomes, intensity/appropriateness of pharmacological treatment for diabetes and cardiovascular risk factors, presence of other complications and overall quality of care were evaluated. Results Overall, 473,740 subjects with type 2 diabetes (78.5% at very high cardiovascular risk, 20.9% at high risk and 0.6% at moderate...

Hepatoma Research, Apr 7, 2021

Aim: In this systematic review, guidelines on non-alcoholic fatty liver disease (NAFLD) were eval... more Aim: In this systematic review, guidelines on non-alcoholic fatty liver disease (NAFLD) were evaluated, aiming at a guideline synthesis focusing on diagnosis and staging. Methods: A systematic literature search was conducted on any relevant database or institutional website to find guidelines on NAFLD assessment intended for clinical use on humans, in English, published from January 2010 to August 2020. Included guidelines were appraised using the AGREE II Instrument; those with higher scores and intended for use in adult patients were included in a comparative analysis. Results: Fourteen guidelines were included in the systematic review, eight of which reached an AGREE II score sufficiently high to be recommended for clinical use, of which one developed for pediatric patients only. British and North American guidelines received the highest scores. Most guidelines recommend a screening or case-finding approach in patients with metabolic risk factors who are at increased risk of stea...

The impact of diabetes on cardiovascular risk is particularly evident in women who are most aff e... more The impact of diabetes on cardiovascular risk is particularly evident in women who are most aff ected by major cardiovascular events, especially myocardial infarction, and have a higher mortality, confi rming the loss of protection by estrogens in childbearing age. Italian data from the AMD Annals have documented that the achievement of targets for the major CV risk factors is systematically unfavorable to women with diabetes T2: women are more obese, have a worse control of diabetes and especially a worse lipid profi le, and a higher frequency of reduction in glomerular fi ltration rate. Other studies, such as Riace and Mind It, confi rm this. In the world, women with diabetes are systematically under-treated with drugs for CV risk factors, such as ASA, ACE-I, β-blockers, statins, and hypoglycemic agents, and this may explain the failure to achieve the targets. On the contrary, the Italian data are bucking the trend by showing that there are gender diff erences in the use of these ...

Journal of Hypertension

Supplemental Digital Content is available in the text Objectives: Long-term visit-to-visit SBP va... more Supplemental Digital Content is available in the text Objectives: Long-term visit-to-visit SBP variability (VVV) predicts cerebro-cardiovascular and renal events in patients with hypertension. Whether VVV predicts hypertension and/or chronic kidney disease is currently unknown. We assessed the role of VVV on the development of hypertension and changes in renal function in patients with type 2 diabetes and normal blood pressure (NBP) in a real-life clinical setting. Methods: Clinical records from 8998 patients with type 2 diabetes, NBP, and normal estimated glomerular filtration rate (eGFR) were analyzed. VVV was measured by SD of the mean SBP recorded in at least four visits during 2 consecutive years before follow-up. Hypertension was defined as SBP at least 140 mmHg and DBP at least 90 mmHg or the presence of antihypertensive treatment. Renal function was defined as worsening of albuminuria status and/or a reduction in eGFR at least 30% from baseline. Results: After a mean follow-up time of 3.5 ± 2.8 years, 3795 patients developed hypertension (12.1 per 100 person-years). An increase of 5 mmHg VVV was associated with a 19% (P < 0.0001) and a 5% (P = 0.008) independent increased risk of developing hypertension and worsening of albuminuria, respectively. We found no association between VVV and eGFR decrease from baseline. Patients with VVV in the upper quartile (>12.8 mmHg) showed a 50% increased risk of developing hypertension (P < 0.0001) and an almost 20% increased risk of worsening albuminuria (P = 0.004) as compared with those in the lower one (<6.9 mmHg). Conclusion: Increased VVV independently predicts incident hypertension and albuminuria worsening in type 2 diabetes and NBP.

Infectious Agents and Cancer

Background The aim was to evaluate the hepatitis C virus (HCV) cascade of care in the general pop... more Background The aim was to evaluate the hepatitis C virus (HCV) cascade of care in the general population (GP) and in two high-risk populations: patients with diabetes mellitus (DM) and substance users (AS) in treatment in Reggio Emilia Province, Italy. Methods A population-based cross-sectional study was conducted that included 534,476 residents of the Reggio Emilia Province, of whom 32,800 were DM patients and 2726 AS patients. Age-adjusted prevalence was calculated using the direct method of adjustment based on the age-specific structure of EU population. Results The prevalence of HCV testing was 11.5%, 13.8%, and 47.8% in GP, DM, and AS patients respectively, while HCV prevalence was 6.5/1000, 12.6/1000, and 167/1000, respectively. The prevalence of HCV RNA positivity was 4.4/1000, 8.7/1000, and 114/1000 in the three populations, respectively. The rates of HCV RNA-positive individuals not linked to care were 27.9%, 27.3%, and 26% in GP, DM, and AS patients, respectively, while th...

Diabetes Research and Clinical Practice

Diabetes/Metabolism Research and Reviews

Diabetes Care

We read with great interest the recently published article by Cheng et al. (1). The authors note ... more We read with great interest the recently published article by Cheng et al. (1). The authors note that there was a dramatic increase in prevalence (age-standardized) between the 1980s and 2010 (3% and 9%, respectively) in the population with diabetes compared with the population without, along with a decrease in the excess risk of cardiovascular disease (CVD). The authors attribute this excess risk reduction to an improvement in primary and secondary diabetes care. However, it must be remembered that the diabetes diagnostic criteria have changed over the years. In 1997, the fasting blood glucose threshold for diagnosis went from 140 to 126 mg/dL, precisely in view of the increased risk of CVD in patients with blood glucose levels between 126 and 140 mg/dL (2). This change, combined with more frequent screening in the population at an everyounger age (3) and greater disease awareness in the population (4), means that self-reported diabetes no longer describes the same disease described in the 1980s. This phenomenon implies not only that some individuals with diabetes in the 1980s were included in the healthy population (which mathematically has a minimal impact on the CVD incidence comparison between the population

PloS one, 2018

To compare the effectiveness of integrated care with that of the diabetes clinic care model in te... more To compare the effectiveness of integrated care with that of the diabetes clinic care model in terms of mortality and hospitalisation of type 2 diabetes patients with low risk of complications. Out of 27234 people with type 2 diabetes residing in the province of Reggio Emilia on 31/12/2011, 3071 were included in this cohort study as eligible for integrated care (i.e., low risk of complications) and cared for with the same care model for at least two years. These patients were followed up from 2012 to 2016, for all-cause and diabetes-related mortality and hospital admissions. We performed a Poisson regression model, using the proportion of eligible patients included in the integrated care model for each general practitioner as an instrumental variable. 1700 patients were cared for by integrated care and 1371 by diabetes clinics. Mortality rate ratios were 0.83 (95%CI 0.60-1.13) and 0.95 (95%CI 0.54-1.70) for all-cause and cardiovascular mortality, respectively, and incidence rate rat...

Diabetes research and clinical practice, 2018

To assess the effect of metformin on cancer incidence in type 2 diabetes (T2DM), considering poss... more To assess the effect of metformin on cancer incidence in type 2 diabetes (T2DM), considering possible interactions with other glucose-lowering drugs and diabetes duration. Study cohort included diabetes patients aged 20-84 on December 2009, still alive and resident in Reggio Emilia province as of December 2011. Drug exposure was assessed for 2009-2011; subjects taking metformin continuously, with or without other hypoglycaemic drugs, were compared to subjects on diet-only therapy. The cohort was followed up from 2012 to 2014 through the cancer registry. Age- and sex-adjusted incidence rate ratios (IRRs) were computed using Poisson regression models for all sites, lung, breast, liver, colorectal, prostate and pancreatic cancer. The cohort includes 17,026 people with T2DM, 7460 taking metformin. 887 cancers occurred during follow-up, 348 among metformin users. Cancer risk was similar in T2DM patients using metformin and those on diet-only. The risk for prostate (IRR = 0.65; 95%CI:0.36...

Acta diabetologica, 2018

To describe characteristics relevant in case of an unplanned pregnancy for T1D or T2D women of ch... more To describe characteristics relevant in case of an unplanned pregnancy for T1D or T2D women of childbearing age. We analyzed the 2011 AMD-Annals dataset, compiling information from 300 clinics (28,840 T1D patients and 532,651 T2D patients). A risk score of unfavorable conditions for pregnancy included HbA1c > 8.0%; BMI ≥ 35; systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg; microalbuminuria/proteinuria; use of statins, ACE inhibitors, ARB; use of diabetes drugs other than metformin/insulin. The proportion of T2D cases increased from 30.8% (95% CI 29.9-32.4) at age 18-30 years to 67.5% (66.6-68.5) at age 36-45 years. The proportion of women with HbA1c < 7.0% was 20.4% (20.0-20.8) in T1D and 43.4% (42.8-43.9) in T2D women. Furthermore, 47.6% (47.0-48.3) of T1D women and 34.5% (33.9-35.0) of T2D women had HbA1c ≥ 8.0%. The prevalence of obesity (BMI ≥ 30) was sevenfold higher among T2D than T1D women [49.9% (49.4-50.5) and 7.4% (7.2-7.5), respectively]. T2D women were more likely...

BMC cancer, Jan 25, 2017

Aim of this study was to compare cancer incidence in populations with and without diabetes by can... more Aim of this study was to compare cancer incidence in populations with and without diabetes by cancer site. Furthermore, we aimed at comparing excess risk of cancer according to diabetes type, diabetes duration and treatment, the latter as regards Type 2 diabetes. By use of the Reggio Emilia diabetes registry we classified the resident population aged 20-84 at December 31st 2009 into two groups: with and without diabetes. By linking with the cancer registry we calculated the 2010-2013 cancer incidence in both groups. The incidence rate ratios (IRR) by cancer site, type of diabetes, diabetes duration, and as concerns Type 2 diabetes, by treatment regimen were computed using Poisson regression model and non-diabetic group as reference. The cohort included 383,799 subjects without diabetes and 23,358 with diabetes. During follow-up, we identified 1464 cancer cases in subjects with diabetes and 9858 in the remaining population. Overall cancer incidence was higher in subjects with diabete...

Politiche Sanitarie, 2014