Why do so few diabetic patients attend dialysis centers in central Italy?

We report the prevalence of end-stage diabetic nephropathy treated by hemodialysis in the Lazio region, which includes the City of Rome, with a total population of over 5 million people. The percentage of diabetic patients among those attending the dialysis centers was 5% (n = 59), which is below the figures reported for both Northern Europe or Southern Italy (Sicily). A higher number (40%) of patients were affected by non-insulin treated diabetes. This figure is similar to that reported in Southern Italy, but highly discordant from the Northern European data where the large majority of diabetics on hemodialysis are affected by insulin-treated diabetes. Genetic differences and the type of diet may account for the difference in prevalence of end-stage nephropathy between Northern and Southern Caucasians affected by diabetes.