Type 2 diabetes mellitus (T2DM) is an important risk factor for peripheral artery disease (PAD). Ankle-Brachial Index (ABI) was found associated with a higher cardiovascular (CV) risk and mortality. The main goals of this study were to establish the prevalence of PAD in a T2DM population, and assess the relationship between PAD and the CV risk calculated with the CUORE Project score (CPS) (https://www.cuore.iss.it/). The association between the ABI, the main risk factors for PAD and T2DM complications was also investigated. Two hundred patients were consecutively enrolled. The prevalence of PAD in this population was 17%. The CV risk tended to be higher (p = 0.0712) in the group with a pathological ABI than in the group with a normal ABI. Glycated hemoglobin (r = -0.1591; p = 0.0244), total cholesterol (r = -0.1958; p = 0.0054), LDL cholesterol (r = -0.1708; p = 0.0156) and systolic blood pressure (r = -0.1523; p = 0.0313) correlated significantly and inversely with the left ABI. The frequency of diabetic retinopathy was significantly higher in the group with a pathological ABI (p = 0.0316). The data reveal a high prevalence of PAD in patients with T2DM. The CPS confirmed that patients with a pathological ABI have tendency to a higher CV risk. The results point to the importance of an accurate CV assessment - also measuring individuals' ABI and calculating their CPS - to better pinpoint those at high risk of PAD, especially among patients with T2DM.

Introduction: When Italy was placed under lockdown to contain the COVID-19 pandemic from 9 March to 18 May 2020, alternative approaches to delivering care—such as telemedicine—were promoted for patients with chronic diseases like diabetes mellitus (DM). The aim of this study was to analyze patients’ perception of, and satisfaction with the telehealth services offered during the COVID-19 emergency at an outpatient diabetes care unit in Italy. Methods: A cross-sectional survey was conducted on 250 patients with type 2 diabetes mellitus who regularly attended our diabetes care unit. Data were collected by means of telephone interviews, asking patients how they perceived the telehealth services, and their satisfaction with the televisit and computer-based care. A standardized questionnaire was administered: there were questions answered using a five-point Likert scale, and one open-ended question. Patients’ demographic, anthropometric and biological data were collected from their medical records. Correlations between patients’ characteristics, their perception of telemedicine, and their satisfaction with the televisit were examined. Spearman’s rank-order correlation coefficient ρ (rho) and Kendall’s rank correlation coefficient τ (tau) were used as nonparametric measures of the strength of the association between the scores obtained for the two ordinal variables, Perception and Satisfaction, and between other clinical parameters. Principal component analysis (PCA) was also used to assess overall links between the variables. Results: Almost half of the interviewees expressed a strongly positive perception of the medical services received, and more than 60% were very satisfied with the telehealth service provided during the COVID-19 emergency. There was a strong correlation between patients’ perception and satisfaction ratings (p<0.0001). Duration of disease showed a significant positive correlation with patients’ satisfaction with their medical care. By means of PCA, it was found that BMI correlated inversely with both perception and satisfaction. Following a qualitative analysis of patients’ answers to the open-ended question, contact with their specialist was important to them: it was reassuring and a source of scientifically correct information about their disease and the association between COVID-19 and diabetes. Conclusions: Based on our telephone interviews, patients appreciated the telehealth approach and were satisfied with it, regardless of the characteristics of their disease. Telemedicine proved essential to avoid interrupting the continuity of care, and therefore had not only clinical, but also psycho-social repercussions.

Background. Type 2 diabetes mellitus (T2DM) is an important risk factor for peripheral artery disease (PAD). Measuring the Ankle-Brachial Index (ABI) in patients with diabetes is a simple way to screen for PAD. In the last decade, pathological ABI values (≤ 0.9; ≥1.3) were found associated with a higher cardiovascular (CV) risk and mortality. The role of classic risk factors for PAD in patients with diabetes is still unclear, and there is no specific PAD risk scoring system for these patients. The main goals of this study were to establish the prevalence of PAD in a T2DM population, and assess the relationship between PAD and the CV risk calculated with the CUORE Project score (CPS) (https://www.cuore.iss.it/). The association between the ABI, the main risk factors for PAD and T2DM complications was also investigated. Methods. Two hundred patients attending the Diabetes Clinic run by the ULSS 6 District Health Unit in Padua (north-east Italy) were consecutively enrolled, and their left and right ABI were measured. Twenty-seven patients with a history of CV events were excluded for the purpose of calculating the CPS, which was thus recorded for a total of 173 patients. Results. The prevalence of PAD in this study population was 17%. The CV risk calculated with the CPS tended to be higher (p = 0.0712) in the group with a pathological ABI than in the group with a normal ABI (0.91–1.29). The distribution of patients in the different CV risk classes did not differ significantly (p = 0.2208) between the two groups (pathological vs normal ABI). Glycated hemoglobin (r = -0.1591; p = 0.0244), total cholesterol (r = -0.1958; p = 0.0054), LDL cholesterol (r = -0.1708; p = 0.0156) and systolic blood pressure (r = -0.1523; p = 0.0313) correlated significantly and inversely with the left ABI. The frequency of diabetic retinopathy differed significant (p = 0.0316) between the two groups (pathological vs normal ABI), and was higher in the group with a pathological ABI. Conclusions. The data collected reveal a high prevalence of PAD in patients with T2DM, consistently with studies conducted in other countries. The CPS confirmed that patients with a pathological ABI have tendency to a higher CV risk. Overall, the present results point to the importance of an accurate CV assessment – also measuring individuals’ ABI and calculating their CPS - to better pinpoint those at high risk of PAD, especially among patients with T2DM.

Background/Objectives: Long-term continuous positive airway pressure (CPAP) management involves both engagement with care and sustained treatment outcomes. We aimed to characterize long-term follow-up attendance, longitudinal adherence, and multidomain treatment outcomes in patients with obstructive sleep apnea (OSA). Methods: We studied 172 adults with OSA who entered a real-world CPAP care pathway. Long-term attendance was evaluated among patients with ≥30 months of potential follow-up from CPAP prescription, with 24- and 36-month thresholds examined in sensitivity analyses. Longitudinal adherence and multidomain outcomes were assessed among patients with available follow-up data. Results: Among 114 patients in the primary long-term follow-up risk set, 80 (70.2%) attended; attendance was similar using 24- and 36-month thresholds (68.5% and 72.8%). Older age was associated with greater attendance (odds ratio 1.58 per 10-year increase, 95% confidence interval 1.10–2.28). Among 94 patients with paired adherence data, adherence according to available device-recorded nights was 78.7% at first and 79.8% at long-term follow-up, although 11.7% changed adherence category. At long-term assessment, device-recorded CPAP adherence, device-derived respiratory control (predefined residual apnea-hypopnea index [AHI] < 5 events/hour criterion), absence of residual sleepiness, and perceived treatment benefit were observed in 79.8%, 47.8%, 87.8%, and 89.3% of patients with available data, respectively. Among 71 patients with complete multidomain data, 45.1% simultaneously met all four predefined treatment-domain criteria, increasing to 63.4% using residual AHI < 10 events/hour. Conclusions: Care-pathway attendance and treatment outcomes represent distinct dimensions of long-term CPAP management. Similar aggregate adherence according to available device-recorded nights across assessments may conceal individual differences in adherence classification between observation intervals, while treatment outcomes are only partially concordant. Multidimensional reassessment may therefore identify clinically relevant discordance beyond adherence alone.