Incidence, prevalence, costs and quality of care of type 1 diabetes in Italy, age 0-29 years: The population-based CINECA-SID ARNO Observatory, 2002-2012.
To assess temporal trend in incidence (2003-12) and prevalence (2002-12) of type 1 diabetes in children and young adults, direct costs and selected indicators of quality of care under the coverage of the universalistic Italian National Health System (NHS).



The ARNO Observatory, a healthcare monitoring system based on administrative data, identified a population-based multiregional cohort of subjects aged 0-29 years. Type 1 diabetes was defined by at least two prescriptions of insulin over 12 months and continuous insulin-treatment in the following year. Indicators of quality of care and directs costs were assessed in persons with diabetes and in people without diabetes, individually matched for age, gender and health unit (1:4 ratio). We identified 2357 incident cases of type 1 diabetes aged 0-29 years (completeness of ascertainment, 99%). Incidence rates were similar in ages 0-14 (15.8, 95% CI 14.9-16.8) and 15-29 years (16.3, 15.4-17.2), with no significant trend. Prevalence increased from 137 to 166.9/100,000, particularly in the age 15-29 years. Direct costs accounted for € 2117 in persons with diabetes and € 292 in control individuals. A statistically significant decreasing trend in hospitalization for acute complications was evident (p < 0.001), which was almost completely due to ketoacidosis. People with at least one HbA1c measurement over the year were 48.5%.



We showed high incidence and increasing prevalence of type 1 diabetes in young adults in Italy, which impact on direct costs under the universalistic coverage of the NHS.
Dept. of Medical Sciences, University of Torino, Italy. Electronic address: graziella.bruno@unito.it.
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Bruno
Unit of Cancer Epidemiology, "Città della Salute e della Scienza" Hospital-University of Turin and CPO Piemonte, Turin, Italy.
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Pagano
CINECA Interuniversity Consortium, Health Department, Bologna, Italy.
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Rossi
CINECA Interuniversity Consortium, Health Department, Bologna, Italy.
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Cataudella
CINECA Interuniversity Consortium, Health Department, Bologna, Italy.
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De Rosa
Unit of Metabolic Diseases and Clinical Dietetics, Alma Mater Studiorum University, Bologna, Italy.
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Marchesini
Dept. of Endocrinology and Metabolism, Section of Metabolic Diseases and Diabetes, University of Pisa, Italy.
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Miccoli
Dept. of Clinical Medicine and Surgery, University of Napoli Federico II, Napoli, Italy.
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Vaccaro
Endocrinology, Diabetes and Metabolism, Dept. of Medicine, University and University Hospital of Verona, Italy.
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Bonora
D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D016883:Diabetic Ketoacidosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D016527:Drug Costs; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D017721:Hospital Costs; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D007558:Italy / Q000453:epidemiology; D008297:Male; D009313:National Health Programs / Q000191:economics; D015995:Prevalence; D019984:Quality Indicators, Health Care / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
Direct costs; Incidence; Prevalence; Survey; Type 1 diabetes