Initial observations on the frequency of diabetic ketoacidosis following pilot screening for type 1 diabetes in the general Italian population

Diabetic ketoacidosis (DKA) is common at clinical onset of diabetes,1 and a delayed diabetes diagnosis is a major contributing factor.2 Fol- lowing parliament approval in September 2023 and endorsement by the Italian Paediatric Society (SIP) and the Italian Society of Paediatric Endocrinology and Diabetology (ISPED),3 Italy became the first coun- try to legislate for voluntary screening for type 1 diabetes and celiac disease (law no. 130/23 proposed by the Fondazione Italiana Diabete stating, as a public health measure, universal screening for type 1 dia- betes and celiac disease in children). This initiative aims to reduce the incidence of DKA, slow diabetes progression, and diagnose celiac dis- ease earlier. A 2024 pilot study conducted in four Italian regions (Lombardy, Marche, Campania, Sardinia), dubbed the‘D1Ce (Diabetes type 1 and Celiac disease) Screen Study’, evaluated the feasibility of general population screening for these conditions by collecting clinical data, conducting widespread screening, and communicating results to families. Positive cases were referred to specialized centres for further monitoring and treatment. However, these regions were engaged in D1Ce Screen in 2023 before project implementation in 2024 through multiple stakeholder participation, including from the Ministry of Health, the Istituto Superiore di Sanità (ISS), experts in type 1 diabetes and celiac disease, laboratories, family paediatricians, and specialized paediatric diabetes and celiac disease centres.