Italy has made history by becoming the first country to pass a law requiring nationwide screening for celiac disease and type 1 diabetes (T1D) in children and adolescents. National Law 130/2023 mandates that all children ages 1–17 years will be offered testing, a groundbreaking step in early detection and prevention of these chronic autoimmune diseases.
These updates were shared this week during a webinar hosted by the Association of European Celiac Societies (AOECS), with presentations by Dr. Giorgio Mulè, Dr. Marco Silano, and Dr. Olimpia Vincentini. The session provided the first public look at how this program is being implemented and evaluated through the D1Ce Screen pilot project.
Why do screening programs matter? Both celiac disease and T1D often go undiagnosed until complications arise. Screening aims to:
- Prevent life-threatening diabetic ketoacidosis (DKA) at the onset of T1D.
- Identify pre-symptomatic diabetes before it causes irreversible damage.
- Diagnose celiac disease early to avoid complications like growth delays, iron deficiency, osteoporosis, and delayed puberty.
The D1Ce Screen pilot was conducted across four Italian regions (Lombardy, Campania, Marche, and Sardinia) with participation from 429 primary care pediatricians (PCPs) and over 5,500 children. Key findings from the pilot include:
- Recruitment success: 94% of the target enrollment was reached, with equal gender distribution.
- PCP involvement: Pediatricians found the program highly useful, with most rating the organization and support as “good” or “very good.”
- Blood collection feasibility: Despite some challenges, over 89% of serum samples and 96% of dried blood spot samples were sufficient for accurate testing.
The pilot screening results showed that 4.4% of children tested positive for celiac-specific antibodies (tTG), with the majority also carrying genetic susceptibility markers (HLA-DQ2/DQ8), underscoring the value of combining antibody and genetic testing. These children have been referred to specialized centers for further confirmation and follow-up care. In addition, 0.97% of children tested positive for type 1 diabetes autoantibodies, and within this group, about 0.2% had two or more autoantibodies, identifying them as being at particularly high risk for progressing to type 1 diabetes in the future.
Parents of children included in the pilot project were also surveyed on their emotional well-being before and after participation. Results showed reduced anxiety and depression symptoms in parents after the screening process and improved health-related quality of life scores, showing that early knowledge can empower rather than overwhelm families.
“The general population does accept this screening very, very well.” Dr. Silano said.
The D1Ce Screen pilot project confirmed that nationwide screening for celiac disease and type 1 diabetes is both feasible and acceptable within the Italian public health system. Families and pediatricians showed strong willingness to participate, and the program successfully identified at-risk children who were referred to specialized care.
These results pave the way for Italy to roll out a full-scale national program, creating a model that other countries could follow. By proving that large-scale screening for autoimmune diseases in children is possible, practical, and embraced by families, Italy is leading a public health initiative that has the potential to transform how celiac disease and type 1 diabetes are detected and managed worldwide.