Increasing incidence and clinical burden of paediatric type 1 diabetes in Italy: insights from a large administrative database

BACKGROUND: Paediatric type 1 diabetes (T1D) is a chronic disease that represents a global public health concern. Italian data describing epidemiology, comorbidity burden, and healthcare resource utilisation (HCRU) of paediatric T1D remain fragmented, mostly deriving from regional registries or limited cohorts. METHODS: A retrospective observational analysis was conducted using Italian administrative databases corresponding to ~ 12,000,000 individuals. Patients with T1D aged < 18 years were identified during 2010-2023 using diagnostic proxies (insulin prescriptions or diabetes-related hospitalisations). Epidemiological analyses were restricted to healthcare entities with continuous data availability during 2018-2022. Demographic and clinical characteristics were evaluated at baseline. Comorbidity onset, HCRU, and direct costs were assessed during follow-up. RESULTS: A total of 3,220 paediatric patients with T1D were identified. Between 2018 and 2022, T1D incidence increased from 16.4 to 22.4 cases/100,000 individuals aged < 18 years (compound annual growth rate [CAGR] + 8.1%), while the prevalence reached 256 cases/100,000 in 2022 (CAGR + 10.0%). Most patients had minimal comorbidity at diagnosis. During follow-up, autoimmune conditions were the most common comorbidities, especially thyroid (8.9%) and coeliac disease (6.0%), often emerging within the first year post-diagnosis. HCRU was the highest during the first year, with frequent diabetes-related hospitalisations and prescriptions of diabetes medications. Hospitalisation-related costs declined, whereas pharmaceutical costs increased over time. CONCLUSIONS: Paediatric T1D is an expanding chronic condition in Italy, characterised by early clustering of autoimmune comorbidities and substantial healthcare utilisation at diagnosis. These findings highlight the need for structured surveillance and coordinated care pathways to support long-term management and healthcare planning.