AMD Annals 2020 – Synopsis on Type 1 Diabetes. Evaluation of AMD quality indicators of type 1 diabetes care in Italy

STUDY OBJECTIVE This new edition of the “Annali AMD” aim to show how T1DM quality care has evolved two years after the last evaluation. DESIGN AND METHODS The processing regards data of 34705 patients, involving 258 centres and referring to data updated to 2018. Our data concerns socio-demographic and clinical characteristics of patients as well as the volume of activity. The indicators selection is based on a consistent share of the current Indicator List adopted - Revision 8 of 19 June 2019, available on the AMD Annals website. RESULTS The amount of new diagnoses is confirmed at 3%, while first accesses has increased to 7.3%. Gender distribution shows a slight prevalence for males and there is an increase in the adult and elderly population. Data shows a general improvement in monitoring of main clinical parameters, specifically albuminuria monitoring (+13.4%). Among favourable outcomes stands out the share of patients with C-LDL <100 mg/dl (+4.2%), offset by the slight reduction of subjects with T1DM and blood pressure at target level. (-1.3%). We observed a trend of continuous improvement with regard to HbA1c, C-LDL, micro/macroalbuminuria and smoking. The proportion of patients with reduced GFR has increased by 4 % compared to the 2018 Annals. The slight increase of subjects with high blood pressure and high BMI deserves a closer attention. The share of subjects treated with CSII has increased from 12.6% to 18.1% over two years, reflecting the increasing access to the use of technologies for T1DM care. In addition, the percentage of subjects in lipid-lowering treatment increased from 30.4% to 34.5% while the percentage of subjects treated with at least one antihypertensive drug remained stable. The prevalence of chronic complications is still underestimated, however current indicators show a trend of increased prevalence of myocardial infarction and history of cardiovascular disease. CONCLUSIONS A comparison of population distribution by score class Q shows that the proportion of subjects with Q < 25 scores has fallen further over two years and, at the same time, the share with a score Q of between 25 and 40 has increased, a significant sign of an improvement in the overall quality of care. KEY WORDS type 1 diabetes mellitus; AMD indicators; quality of care; AMD Annals.