To assess the incidence of Type 1 Diabetes Mellitus (T1DM) during the period 2012-2017, the frequency and severity of ketoacidosis (DKA) at diabetes onset, and the factors associated with DKA in children and adolescents younger than 18 years old in the Abruzzo region, Italy. All incident cases of T1DM (0-17 years old) diagnosed between January 2012 and December 2017 were included. Data about the patients were obtained from two independent sources; insulin prescriptions and medical records. Clinical data at diabetes onset, as well as demographic and non-demographic data, including center of first hospitalization, distance to regional reference center and number of pediatricians (per 1000 residents younger than 18 years) were collected and evaluated. During 2012-2017 period, 177 patients were diagnosed with T1DM. In 2012, T1DM incidence was 15.6 per 100,000/year; in 2013, 16.4 per 100,000/year; in 2014, 11.6 per 100,000/year; in 2015, 14.2 per 100,000/year; in 2016, 16.2 per 100,000/year and in 2017, 12.2 per 100,000/year. DKA was present in 29.3% of patients, 6.9% with severe DKA. The DKA presence was correlated to age (p<0.02), ethnicity (p<0.04), being transferred to a specialist center instead of being directly admitted to one (p<0.002) and the number of pediatricians in the population (p<0.01). The DKA severity was associated with the delay of transfer (p<0.04). Being admitted directly to a specialist center is very important and it could be expression of high alertness of pediatricians. Availability of well-trained pediatricians is necessary for the prevention of DKA. (www.actabiomedica.it).

Introduction. This study examined the possible association between numeracy skills and glycemic outcomes in children with type 1 diabetes. Methods. The study used a cross-sectional design and collected data from 7 centres of the Hvidoere Study Group. HbA1c was measured centrally. Numeracy was assessed using the specific 5-item Diabetes Numeracy Test (DNT-5) and the international, general Wordless Mathematical Test (WMT). The HbA1c predictive multivariate generalised linear model was constructed using the adjusted R-squared index for model selection. Pearson's correlation coefficient was calculated between observed and predicted HbA1c levels in the training and testing datasets. Results. 306 adolescents aged 12-18 (mean age 14.96 ± 1.68) years and diabetes duration of 6.57 (± 3.75) participated in this study. Numeracy skills, as assessed by the WMT but not DNT 5, predicted the HbA1c levels after adjustment for sociodemographic and clinical factors. The correlation between observed and predicted HbA1c levels was consistent in both datasets and was 0.34 (N=155) and 0.37 (N=61) for the training and test datasets, respectively (p=0.412). The effect size for the WMT-based predictive model of HbA1c adjusted for clinical and socioeconomic factors was significantly higher (p<0.05) than the single-parameter-based model. Conclusion. Numeracy, as assessed by an international general math test, is a good predictor of HbA1c in children and adolescents with type 1 diabetes. The basic and short WMT is a potentially effective tool in personalised clinical pediatric diabetes practice. Therapy planning should consider adjusting therapy to compensate for lower numeracy skills and/or training to improve the patient’s numerical proficiency.