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

Background and aims 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). Methods and results 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%. Conclusion 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