Italy is the first country in the world to introduce free screening on the entire pediatric population to detect type 1 diabetes and celiac antibodies. Both are autoimmune diseases.
The project will initially be activated in LOmbardy, Marche, Campania and Sardinia. In these four regions, the Free Choice Paediatricians (PLS) participating in the study will recruit children aged 2, 6 and 10 on a voluntary basis. Auto-antibodies related to type 1 diabetes and celiac disease will be measured and the presence of two genetic variants associated with these pathologies will be evaluated.
Why is it important to know beforehand?
At the moment there is no cure for type 1 diabetes. It is an autoimmune disease that lasts forever. Nor are there therapies that can prevent it from appearing. «The advantage of implementing screening for T1D and celiac disease in the pediatric population – as a note from the ISS explains – derives from the possibility of identifying children at risk or of early diagnosing children who are affected by these pathologies. Scientific research conducted all over the world shows, in fact, that timely diagnosis and interventions strongly reduce both acute risks and long-term consequences of these diseases in people who are affected by them”
In fact, «in cases of type 1 diabetes the diagnosis still too often occurs due to an acute onset of ketoacidosis, a serious metabolic imbalance that requires rapid hospitalization of the patient in the emergency room and which can leave permanent damage or even endanger the child’s life.
In cases of celiac diseaseearly identification is useful, not only for the treatment of symptoms directly linked to celiac disease, but above all for the prevention of long-term complications that can arise in unrecognized cases.”
Diabetes affects 0.22% of pediatric children
According to the International Diabetes Federation (IDF), in 2021 almost 10% of the world‘s adult population is diabetic (536.6 million people) and 1.2 million children and adolescents (age 1 in 350 children by the age of 18; the incidence has recently increased, particularly in children under 5 years of age. Although type 1 can occur at any age, T1D typically manifests with two peaks, between ages 4 and 6 or between ages 10 and 14.
In 2022, approximately 130 new diagnoses of type 1 diabetes mellitus were made at the San Raffaele hospital in Milan.
In Italy, there are approximately people with type 1 diabetes 300mila with a prevalence of 0.5% of the entire Italian population, a prevalence of 0.22% in pediatric children, and a constantly increasing incidence. T1D occurs every year in 12.26 children out of 100 thousand, more frequently in males than females (13.13 vs 11.35 respectively) and 25-40% begin with a potentially lethal diabetic ketoacidosis.
The incidence, and consequently the prevalence, of T1D have constantly grown over the last decades throughout the world, today becoming the most widespread chronic disease of childhood and adolescence, therefore representing an emerging problem for public health.
“Saving children and families from the usually traumatic onset of type 1 diabetes is the first objective of the law,” he clarifies. Professor Emanuele BosiHead of Internal Medicine at San Raffaele and scientific drafter of the provision.
Symptoms of diabetes
If we had to summarize i symptoms of childhood diabeteslet’s remember the rule of the three “Ps”:
Polyuria. Pee very often, so much so that you have to get up even at night to do it, or, in younger children, pee on yourself after diapering.
Polydipsia. Increased thirst with the need to drink continuously.
polyphagia. Increased appetite associated with weight loss.
These inconsistencies should catch the eye: although the child eats a lot, lose weight and he is tired and despite drinking a lot, he is dehydrated.
Celiac disease strikes approximately 1% of the population
Celiac disease affects approximately 1% of the general population. On average, around 9 thousand diagnoses are made in Italy every year with a prevalence of the disease of 0.41%. From the 2021 data, 241,729 celiacs have been diagnosed in Italy, of which 70% (168,385) belong to the female population and the remaining 30% (73,344) to the male population. (Ministry of Health Report, 2021). The average male:female ratio of 1:2, which in some regions reaches 1:3, indicates a greater spread of the pathology in the female population. If we consider the distribution by age group, celiac disease mainly affects the adult population (88.69%), followed by the 3.5-10 year age group (10.27%), 12 month-3.5 year age group (1 .02%) and, finally, in a minimal percentage (0.02%), from the range including children from 6 months to one year of age.
«Diagnoses of celiac disease have increased significantly over the years: from just over 60 thousand cases in 2007 to over 240 thousand in 2021, the latest official data. But there remain too many who are not intercepted: only 40% of patients already have a diagnosis and can therefore be treated. All those who have celiac disease but don’t know it yet unknowingly expose themselves to the risk of even very serious complications”, he explains Rossella Valmarana, President of the Italian Celiac Association -Aic, which followed the process of the law, asking for the involvement of patient associations. (We wrote about it here)
The project
The project, promoted by the Ministry of Health and the Istituto Superiore di Sanità, is made possible by law 15 September 2023, n. 130, was presented today during a conference at the ISS headquarters, attended by the vice-president of the Chamber Giorgio Mulè, the president of the Social Affairs commission of the Chamber Ugo Cappellacci and the president of the ISS Rocco Bellantone. The initiative, it emerged during the conference, is the first in the world that provides screening regulated by state law, as also underlined by a recent article published by the journal Science and a comment in the Lancet.
For the project the law provides for the expenditure of 3.85 million euros for each of the years 2024 and 2025 and of 2.85 million euros per year starting from the year 2026. The results will be collected by the Higher Institute of Health and evaluated by an Observatory, also established by law at the Ministry of Health.
Opening photo, Peejhunt by Pixabay