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. 2024 Oct;26(10):4197-4202.
doi: 10.1111/dom.15779. Epub 2024 Jul 26.

Follow-up and monitoring programme in children identified in early-stage type 1 diabetes during screening in the general population of Italy

Valentino Cherubini  1 , Enza Mozzillo  2 , Dario Iafusco  3 , Riccardo Bonfanti  4 , Carlo Ripoli  5 , Flavia Pricci  6 , Olimpia Vincentini  7 , Umberto Agrimi  7 , Marco Silano  8 , Francesca Ulivi  9 , Antonio D'Avino  10 , Vito Lampasona  11 , Emanuele Bosi  11   12
Affiliations

Follow-up and monitoring programme in children identified in early-stage type 1 diabetes during screening in the general population of Italy

Valentino Cherubini et al. Diabetes Obes Metab. 2024 Oct.

Abstract

Aim: To provide guidance for follow-up and monitoring of children and adolescents identified as positive to islet autoantibodies (IA) in the general population screening for type 1 diabetes (T1D) in Italy.

Methods: Detection of IA helps to diagnose pre-symptomatic T1D, prevent diabetic ketoacidosis (DKA) and identify persons for new therapies to delay symptomatic diabetes. Italy recently became the first country to approve by law a general autoantibody screening program for T1D and celiac disease in all children and adolescents (age 1-17yr). A pilot study is currently underway in four Italian regions addressing feasibility issues to be used in the scale up to nationwide screening. Meanwhile, a group of experts developed guidance recommendations for follow-up and monitoring of identified IA positive persons.

Results: Ten key components have been identified: establishment of a registry for children and adolescents at risk; close collaboration with the national network of family paediatricians; creation of T1D centers with expertise in follow-up and monitoring; educational measures; assurance of solid IA tests; identification of appropriate metabolic tests; feed-back feasibility and acceptability questionnaires; potential access to available therapeutic interventions; valuable outcome measures including DKA incidence; costs monitoring. Distinctive features of this program include single (in addition to multiple) IA antibody-positive persons in follow-up and the use of CGM to assess risk progression, rather than the cumbersome OGTT.

Conclusion: It is expected that the proposed follow-up and monitoring program will be effective, affordable and acceptable to children and families identified in general T1D screening in Italy.

Keywords: autoantibodies; diabetic ketoacidosis; dysglycaemia; risk; screening; type 1 diabetes.

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References

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