Diabetes 1: Pediatric screening reduces ketoacidosis by 26%

Pediatric screening for type 1 diabetes and celiac disease reduced diabetic ketoacidosis (DKA) cases by 26% and severe cases by 49% in the four regions involved in the D1Ce pilot project. These are the results of a study published in the journal Diabetes, Obesity and Metabolism, which demonstrates for the first time the tangible impact and usefulness of the screening programs established by Law 130/23. The study was coordinated by the Italian Society of Pediatric Diabetology and Endocrinology (SIEDP), which conducted a retrospective study on the incidence of early-onset diabetic ketoacidosis in 58 Italian pediatric centers in 2023 and 2024, comparing the regions involved in the D1Ce study, preparatory to the implementation of Law 130 (Lombardy, Marche, Campania, and Sardinia), with those not involved. Co-authored by the Italian Diabetes Foundation (FID), which supported the development and approval of Law 130.

"The data are clear," states Valentino Cherubini, president of SIEDP and first author of the study. "In the regions where the screening project was launched, children had a significantly lower probability of being diagnosed with diabetes in ketoacidosis, even severe ketoacidosis. This is an unequivocal sign that prevention works and that the involvement and training of pediatricians makes a difference." The D1Ce (Diabetes type 1 and Celiac disease Screen Study) project, implemented by the Istituto Superiore di Sanità in collaboration with a pool of experts and private pediatricians, a statement states, aimed to define a screening procedure that could lead to better implementation of Law 130/23. The goal was to provide the Ministry of Health with the tools to draft the law's implementing decrees. The project involved private pediatricians who, appropriately trained and made aware of the risks of unmanaged type 1 diabetes, performed screening tests on the children they followed.

Thanks to the commitment of Giorgio Mulè, Vice President of the Chamber of Deputies, and the Italian Federation of Children's Federations (FID), Italy became the first country in the world to introduce a free and voluntary screening program for type 1 diabetes and celiac disease in children. Approved unanimously in September 2023, Law 130/23 aims to diagnose these two autoimmune diseases early, preventing complications like DKA, which can be life-threatening, cause coma, require intensive care, and worsen the long-term management of type 1 diabetes. "We supported this law," emphasized Nicola Zeni, President of the Italian Federation of Children's Federations (FID), "because too many children are diagnosed late and, along with their families, face the trauma of an early diagnosis with serious complications. Today, thanks to this new study, we have further proof that our commitment has already saved lives. It is essential to begin implementing the law in all Italian regions as soon as possible."

Specifically, the study compared data collected at 58 Italian pediatric diabetes centers on 2,398 new diagnoses of type 1 diabetes. Among children living in the regions participating in the D1Ce program, a 26% reduction in the likelihood of ketoacidosis at diagnosis and a 49% reduction in the likelihood of severe ketoacidosis were observed. Surprisingly, the effect was evident as early as 2023, before screening began, demonstrating the crucial role of pediatrician training and raising awareness among families. "This result exceeds expectations," states Andrea Scaramuzza, principal investigator of the study. "It wasn't just the screening itself, but the cultural shift among doctors and families that reduced, above all, severe cases."

This study "demonstrates that the union between foundations, science, specialized and local medicine, politics, and people with diabetes can improve public health," remarks Francesca Ulivi, Director General of Fid and one of the authors of the publication. "We will continue to work not only to make diabetic ketoacidosis a rarity in Italy, so that no child dies from a missed diagnosis or suffers lifelong consequences, but also to ensure that type 1 diabetes can finally be prevented and cured."