Department of Women's and Children's Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, G. Salesi Hospital, Ancona, Italy.
Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy.
Diabetes Obes Metab. 2024 Oct;26(10):4197-4202. doi: 10.1111/dom.15779. Epub 2024 Jul 26.
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.
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.
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.
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.
为意大利 1 型糖尿病（T1D）人群筛查中鉴定为胰岛自身抗体（IA）阳性的儿童和青少年的随访和监测提供指导。
IA 的检测有助于诊断无症状 T1D，预防糖尿病酮症酸中毒（DKA），并确定新疗法的对象，以延缓症状性糖尿病的发生。意大利最近成为第一个通过法律批准在所有儿童和青少年（1-17 岁）中进行 T1D 和乳糜泻自身抗体普筛的国家。目前正在四个意大利地区进行一项试点研究，以解决在全国范围内扩大筛查时需要考虑的可行性问题。与此同时，一组专家制定了针对鉴定出的 IA 阳性者的随访和监测指南建议。
确定了 10 个关键组成部分：为处于危险中的儿童和青少年建立登记处；与全国儿科家庭医生网络密切合作；建立具有随访和监测专业知识的 T1D 中心；开展教育措施；确保进行可靠的 IA 检测；确定适当的代谢检测；反馈可行性和可接受性问卷；潜在获得可用治疗干预措施；有价值的结果测量，包括 DKA 发生率；监测成本。该计划的独特之处在于，在随访中只对单一（而非多个）IA 抗体阳性者进行监测，并且使用连续血糖监测仪（CGM）来评估风险进展，而不是繁琐的口服葡萄糖耐量试验（OGTT）。
预计在意大利进行的一般 T1D 筛查中发现的儿童和家庭将受益于本研究提出的这种有效、负担得起且可接受的随访和监测方案。
