2023-11-06 10:22:56
by Stefano Parini
Diabetes is one of the most frequent chronic diseases in the pediatric field, with a prevalence between zero and 18 years of one in a thousand in peninsular Italy, which increases to 3-4 in a thousand in Sardinia.
I am a grandmother of 5 grandchildren. Unfortunately, one of these has diabetes mellitus. I heard about a recent law regarding diabetes in children: what is it?
Stefano Parini, internal medicine doctor, ASL Ferrara, Association of Diabetologists (GO TO THE FORUM) answers
Law no. 130 of 15 September 2023, Provisions concerning the definition of a diagnostic program for the identification of type 1 diabetes mellitus (DM1) and celiac disease in the pediatric population establishes a national observatory at the Ministry of Health, which will start a screening from 2024 aimed to detect DM1 antibodies in children; it will thus be possible to identify those at risk of DM1 early, possibly to be treated with available therapies. Diabetes is one of the most frequent chronic diseases in the pediatric field, with a prevalence between zero and 18 years of one in a thousand in peninsular Italy, which increases to 3-4 in a thousand in Sardinia; the autoimmune form is the most widespread in childhood (93%), followed by monogenic diabetes (6%), while type 2 diabetes accounts for less than 1%.
The antibodies
one of the most complex chronic diseases of childhood, it requires multidisciplinary management by a dedicated specialist team; It therefore requires many resources and high professionalism. DM1 cannot be prevented; the risk factors which – interacting with genetic predisposition – trigger the autoimmune reaction are still unclear. It is believed that the predisposition to the disease becomes evident after contact with common infectious or dietary agents, with destruction of pancreatic beta cells and progressive failure of insulin production; when the mass of beta cells reaches a critical threshold, estimated at the residual 20-30%, the disease begins. This process can be detected early by looking for specific antibodies.
The therapy
In the face of numerous lines of research, the only therapy available is the monoclonal antibody teplizumab, which has been shown to delay the clinical onset of DM1 by approximately two years in non-diabetic (but high-risk) relatives of patients with DM1, with at least two autoantibodies and dysglycemia. For now authorized only in the USA, where it has a very high estimated cost per treatment cycle (14 days), 193,900 dollars; this will make it unavoidable to select candidates with characteristics that predict their effectiveness. The screening provided for by law no. 130 will also concern celiac disease, a disease with a prevalence of one in a hundred, of autoimmune origin, which can be associated with type 1 diabetes mellitus.
November 6, 2023 (modified November 6, 2023 | 09:22)
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