Organization and regional distribution of centers for the management of children and adolescents with diabetes in Italy

The incidence of type 1 diabetes in childhood is increasing by 3 % per year, placing growing demands on healthcare professionals and medical expenditures. Aim of this study wars to assess the organization of care to children with diabetes in Italy

Epidemiology of diabetic ketoacidosis in Italy,Epidemiologia della chetoacidosi diabetica in Italia

Ketoacidosis is a potentially life-threatening complication in patients with type 1 diabetes mellitus (T1DM), particularly children.If diabetic ketoacidosis (DKA) is diagnosed late, the child riskscerebral edema, permanent neurological damage or even death.There have been only few studies of DKA in Italy.From January-May 2014 a nation-wide observational, retro-spective study of DKA at diabetes onset was done by the Pe-diatric Diabetology Study Group (PDSG) of the Italian Society ofPediatric Endocrinology and Diabetes (ISPED), involving 76 Italiancenters. DKA was defined using ISPAD criteria; 7457 new casesof T1DM were recruited from mainland Italy and the island of Si-cily and 770 from Sardinia, in the period 2004-2013. On the main-land and in Sicily, DKA at diabetes onset was about 32.9% (95%CI 31.8-34.0%), and there was 6.6% (95% CI 6.02-7.20%) of thesevere form. Mild and severe DKA risk was significantly higher inchildren aged 0-4 years; no significant temporal trend was foundin the study period. Patients living in Sardinia or having a first-degree relative with T1DM were at significantly lower risk of DKAat diabetes onset. In the ten-year study period three children diedof DKA at onset and four suffered permanent neurological lesions.From November 2011-April 2012 the PDSG conducted a retro-spective study based on a sample of 2025 patients with T1DM,aged 0-18 years, involving 29 national centers for pediatric dia-betes. The incidence of DKA was 2.4% (IC 95% 1.8-3.1), withchildren older than ten years at significantly higher risk, probablydue to shortages of insulin. Multiple analysis showed a higher riskof DKA in those using a rapid-acting insulin analog and in those with high HbA1c. Young mothers and low levels of education werealso associated with DKA.In conclusion, although a wide network of specialized home pedia-tricians and pediatric diabetes centers is spread across the coun-try, the incidence of DKA at diabetes onset is still high. Further socialand health-system efforts are needed to boost awareness of thisrisk and to reduce damages and costs related to the complication