Paediatric screening in Italy as a gateway to secondary prevention in type 1 diabetes.

This article explores Italy's pioneering national paediatric screening initiative for type 1 diabetes (T1D), the first of its kind to be mandated by the Italian law for the general population aged 1-17 years. This initiative is designed to facilitate early detection and secondary prevention of T1D and coeliac disease (CD), aiming to identify children in presymptomatic stages of T1D, regardless of family history. Emphasis is placed on autoantibody screening for T1D and CD to refine risk prediction and enhance secondary prevention efforts. Furthermore, the anti-CD3 + T cell monoclonal antibody teplizumab, which may be considered at present for compassionate use only, represents a step forward in delaying T1D onset in stage 2 patients. Italy's comprehensive screening law, passed in 2023, allows for early detection of T1D minimising the risk of consequences such as DKA at diagnosis. The screening will also advance our understanding of T1D disease pathogenesis and progression. These insights advocate for tailored prevention strategies, thus improving the design of clinical trials.