COMPASS 31 can represent a valid, easy-to-use, quantitative assessment tool for autonomic symptoms in diabetic neuropathy, with a fair diagnostic accuracy for both cardiovascular autonomic neuropathy and diabetic polyneuropathy.

Aims: To investigate the independent effect on depression of painless diabetic polyneuropathy, painful diabetic polyneuropathy, and general and diabetes-related comorbidities. Methods: In 181 patients, the presence of painless diabetic polyneuropathy, painful diabetic polyneuropathy, comorbidities and depression was assessed using the Michigan Neuropathy Screening Instrument Questionnaire, the Michigan Diabetic Neuropathy Score, nerve conduction studies, the Douleur Neuropathique en 4 Questions, the Charlson Comorbidity Index and the Beck Depression Inventory-II. Results: In all, 46 patients met the criteria of confirmed painless diabetic polyneuropathy and 25 of painful diabetic polyneuropathy. Beck Depression Inventory-II scores indicative of mild-moderate-severe depression were reached in 36 patients (19.7%). In a multiple logistic regression analysis (including age, sex, body mass index, being unemployed, duration, haemoglobin A1c, insulin treatment, systolic blood pressure, nephropathy, retinopathy, Charlson Comorbidity Index and painful diabetic polyneuropathy), female sex (odds ratio: 5.9, p = 0.005) and painful diabetic polyneuropathy (odds ratio: 4.6, p = 0.038) were the only independent predictors of depression. Multiple regression analysis, including Douleur Neuropathique en 4 Questions and Michigan Diabetic Neuropathy Score instead of painful diabetic polyneuropathy, showed that Douleur Neuropathique en 4 Questions, in addition to female sex, was a significant predictor of depressive symptoms severity (p =0.005). Conclusion: Painful diabetic polyneuropathy is a greater determinant of depression than other diabetes-related complications and comorbidities. Painful symptoms enhance depression severity more than objective insensitivity.

OBJECTIVEWe hypothesized the meaningful coexistence of neuropathic pain and nondipping in painful diabetic polyneuropathy (PDPN). RESEARCH DESIGN AND METHODSIn 113 patients with PDPN, with painless diabetic polyneuropathy (DPN + ) and without DPN (DPN 2 ), neuropathic pain, sleep, risk for obstructive sleep apnea (OSA), autonomic function, and blood pressure (BP) circadian pattern were assessed using the Douleur Neuropathique en 4 Questions (DN4), the Medical Outcomes Study Sleep Scale, the Berlin Questionnaire, cardiovascular reflex tests, and ambulatory BP monitoring. RESULTSPatients with PDPN showed higher nighttime systolic BP (130.4 6 15.6 mmHg) than both DPN 2 (119.9 6 10.6 mmHg; P < 0.0001) and DPN + patients (124.2 6 12.3 mmHg; P < 0.05), and lower day-night difference (Δ) in systolic BP (5.5 6 6.5 vs. 8.6 6 7.7%; P < 0.05) and diastolic BP than DPN 2 patients. In a stepwise regression analysis, orthostatic hypotension, high risk for OSA, and PDPN (DN4 interview) were independent determinants of Δ in systolic BP (r = 0.46; P = 0.0001), Δ in diastolic BP, and nighttime systolic BP.CONCLUSIONS PDPN is associated with higher nocturnal systolic BP and impaired BP circadian pattern independent of pain-related comorbidities, suggesting a condition of high cardiovascular risk.Sleep problems are common in painful diabetic polyneuropathy (PDPN) (1) and contribute to the effect of pain on quality of life. Nondipping (the absence of the nocturnal fall in blood pressure [BP]) is a recognized feature of diabetic cardiac autonomic neuropathy (CAN) and is attributed to the abnormal prevalence of nocturnal sympathetic activity (2). Both sleep problems and nondipping are burdened with a negative prognostic value (2-4). This study aimed to evaluate the relationship of the circadian pattern of BP with both neuropathic pain and pain-related sleep problems in PDPN, without ignoring the role of possible confounders such as obstructive sleep apnea (OSA) (4). We hypothesized the meaningful coexistence of neuropathic pain and nondipping in PDPN. RESEARCH DESIGN AND METHODSWe selected 113 patients with diabetes after excluding neuropathies or pain unrelated to diabetic polyneuropathy (DPN) and severe comorbidities (Supplementary

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Objectives Hybrid closed loop systems (HCL) improve the management of type 1 diabetes (T1DM). T1DM adolescent patients represent a risk category also if they are in an automated insulin infusion delivery therapy. Case presentation We describe a series of four cases in which adolescent patients have adopted incorrect behaviours in the managing of HCL systems, challenging the algorithm skills. Two patients performed fabricated sensor calibrations. The other two did not perform pre-prandial insulin boluses correctly. Despite these behaviours, the algorithm corrected the glucose values in three out of four patients. Only in one case, where fabricated calibrations were too frequent, the automatic system failed to restore the glycemic balance. Conclusions Fabricated calibrations seem to be more important than uncorrected insulin boluses to challenge the HCL systems.