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

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. [ABSTRACT FROM AUTHOR]