Background: Since 2017, people with type 1 diabetes (T1D) in Italy began to use spontaneously an Artificial Pancreas Systems (APS) with off-label use of existing insulin pumps, continuous glucose monitors (CGM), and open source software (known as OpenAPS). Aim of this study is to understand if closing the loop with OpenAPS is effective to improve the glucose control in T1D diabetes. Methods: We studied 30 people (male/female = 19/11; age = 35.9 years ± 12.52 DS) with T1D who shared and self-reported their data and experiences from using this system. All the people included in the study used a CGM Dexcom G5 and insulin pump Dana Diabecare R; the implementation of OpenAPS realized a so called hybrid closed loop system. Main outcomes were A1c and % of time into hypoglycemia (glycemia < 70 mg%, %TIHypo), before and 3 months after closing the loop. Secondary outcomes were % of time into hyperglycemia (glycemia > 180 mg%, %TIHyper) and time into range (glycemia between 70 and 180 mg%, TIR). Results: We observed a significant decrease of A1c (from 7.17% ± 0.49 DS to 6.61% ± 0.47 DS; p < 0.05) and of %TIHypo (from 8.55% ± 5.81 DS to 2.48% ± 1.16 DS). We also observed a decrease of TIHyper and an increase of TIR, but the differences were not statistically significant. All patients were satisfied of OpenAPS use and only one patient dropped out, on advice of his diabetologist. No any serious adverse event was recorded (diabetic ketoacidosis, serious hypoglycemia). Discussion and Conclusions: Closing the loop with OpenAPS in people with T1D is effective in decreasing A1c and %TIHypo, without any serious adverse event. Of note, these results were obtained with people who showed a good baseline metabolic control (A1c of 7.17%). However, we need to study OpenAPS implementation on a larger sample of people with T1D and with a more prolonged follow-up. Disclosure V. Provenzano: None. E. Guastamacchia: None. D. Brancato: None. G. Cappiello: None. A. Maioli: None. R. Mancini: None. G. Crispino: None. A. De Monte: None. S. Turco: None. G. Tonolo: None.

Abstract. Metformin, the drug of choice in the treatment of type 2 diabetes mellitus (DM2), in addition to aspirin (ASA), the drug prescribed for cardioprotection of diabetic and non-diabetic patients, have an inhibitory effect on cancer cell survival. The present population-based study conducted in the province of Trieste (Italy), aimed to investigate the prevalence of DM2 in patients with colorectal adenocarcinoma (CRC) and survival for CRC in diabetic and nondiabetic patients. All permanent residents diagnosed with a CRC between 2004 and 2007 were ascertained through the regional health information system. CRC-specific and relative survival probabilities were computed for each group of patients defined by CRC stage, presence or absence of DM2 treated with metformin, and presence or absence of daily ASA therapy. A total of 515 CRC patients without DM2 and 156 with DM2 treated with metformin were enrolled in the study. At the time of CRC diagnosis, 71 (14%) nondiabetic and 39 (25%) diabetic patients were taking ASA daily. The five-year relative survival for stage III CRC was 101% [95% confidence interval (CI) =76-126] in the 18 patients with DM2 treated with metformin and ASA, 55% (95% CI=31-78) in the 23 without DM2 treated with ASA, 55% (95% CI=45-65) in the 150 without DM2 not taking ASA, and 29% (95% CI=13-45) in the 43 with DM2 treated with metformin, however not with ASA. The findings support the hypothesis of a possible inhibitory effect of metformin and ASA on CRC cells. Randomized controlled trials are required to verify this hypothesis.

In our registry diabetic patients treated with primary PCI for AMI had a worse in-hospital and 30-day outcome than nondiabetic patients. Adjunct pharmacologic treatment with abciximab was associated to a better prognosis only in diabetic patients.

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Objective: The aim of this study was to evaluate whether implementation of an integrated regional program can be effective in producing improvement in diabetes care. Methods: Friuli Venezia Giulia is an Italian region accounting for about 1,250,000 population. A diabetic patients register based on administrative databases merging accounted in 2015 for a morbidity prevalence rate of 6.7%. Guidelines on diabetes integrated care were approved by the regional government. They were disseminated through a multifaceted intervention based on training, incentives to family physicians, primary care reorganization, modeling and proactive medicine. The program was assessed through the before-after intervention measure of process indicators. Analysis excluded gestational patients, those who didn’t consent for privacy reasons and those not included in the same family physician administrative list over the study period. Results: Regionally, significant improvement in 2016 vs. 2015 was observed for all measures. Analysis included 54593 patients. The percentage of patients who received one ore more: A1C test arose from 73.8% in 2015 to 79.1% in 2016 (+7.2%), Microalbuminuria test arose from 44.7% in 2015 to 56.3 in 2016 (+26.0%), Blood Creatinine test arose from 70.7% in 2015 to 76.2% in 2016 (+7.8%), Lipid profile arose from 69.6% in 2015 to 72.6% in 2016 (+4.3%). Those who received at least one Fundus Oculi arose from 42.1% in 2014-2015 to 47.9% in 2015-2016 (+13.8%). Hospital specific diabetes patients admission rate decreased from 342/1000 in 2015 to 328/1000 in 2016 (-4.2%). However, there was significant regional variation among all measures. Conclusions: The evidence based introduction of an integrated professional and organizational intervention improved adherence to diabetes specific process measures in 2016 compared with 2015 baseline for patients assisted in Friuli Venezia Giulia region. A better integration with hospital care and a partial revision of IT system are needed. Disclosure A. Mariotto: None. A. De Monte: None.