High incidence of type 1 diabetes among children of North African migrants in Emilia-Romagna Region, Italy

In the last few decades, many studies have reported an increasing global incidence of Type 1 Diabetes (T1D), especially in younger children. The differences between different ethnic and age groups have underlined both the importance of environmental and genetic factors in the development of the pathology, as studies on migrant populations have already demonstrated. Objectives: Evaluate the incidence of T1D and DKA prevalence in North African vs Italian children aged 0 to 14 years from 1st January 2015 to 31st December 2018, in Emilia Romagna Region, Italy. Methods: Clinical and epidemiological data about childhood onset T1D in E-R region were retrospectively collected and matched using 3 different data sources (Clinical registries, hospital discharge records and regional lists of exemptions for pathology). T1D cumulative incidence was calculated basing on the number of inhabitants in the region as a whole and subdividing the Italian and North African groups. Results: 365 new T1D onset were diagnosed (M 50.1%). DKA was present in 33% of cases (severe DKA 10.4%). Median age at T1D onset was 8.2 ± 3.7 yrs. Total cumulative incidence was 15.4/100.000/year and no increasing trend was recorded in the incidence of diabetes in the study period. In particular, North African cases were 52 with a cumulative incidence of 62.2/100.000/year, statistically significant compared to cumulative incidence of the Italian cases alone 13.1/100.000/year (p value <0.001). The annual incidence did not differ in the 4 years for both groups. No difference as for DKA cases and median age at T1D onset between the groups. Conclusions: The incidence of T1D in the pediatric age was significantly higher in the North African population than in the Italian one. Surprisingly, the incidence was much higher than not only that of the host country, but also of the country of origin, suggesting an explosive mix of genetic and environmental factors causing the increase in newly diagnosed cases.