Childhood diabetes in Africa

Piloya, Thereza; Sunni, Muna; Moran, Antoinette

doi:10.1097/med.0000000000000262

Cited by 38 publications

(43 citation statements)

References 52 publications

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“…As a third step, telemedicine might be developed to deliver specialized advice in regions with limited access or care . Nevertheless, electricity, internet and technological devices may not be available in some rural underdeveloped areas where remote consultation may be a challenging goal to achieve …”

Section: Telehealthmentioning

confidence: 99%

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes technologies

et al. 2018

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Section: Telehealthmentioning

confidence: 99%

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes technologies

et al. 2018

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“…These deficiencies in T1D care have profound impacts. Mortality rates are very high in children and adolescents, and for those who do survive, blood glucose control is poor and early chronic diabetes complications are frequent . These stark differences in outcomes compared to well‐resourced countries are tragic for patients and families and deeply distressing for health professionals.…”

Section: Introductionmentioning

confidence: 99%

Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

et al. 2018

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Optimal care for children and adolescents with type 1 diabetes is well described in guidelines, such as those of the International Society for Pediatric and Adolescent Diabetes. High‐income countries can usually provide this, but the cost of this care is generally prohibitive for lower‐income countries. Indeed, in most of these countries, very little care is provided by government health systems, resulting in high mortality, and high complications rates in those who do survive. As lower‐income countries work toward establishing guidelines‐based care, it is helpful to describe the levels of care that are potentially affordable, cost‐effective, and result in substantially improved clinical outcomes. We have developed a levels of care concept with three tiers: “minimal care,” “intermediate care,” and “comprehensive (guidelines‐based) care.” Each tier contains levels, which describe insulin and blood glucose monitoring regimens, requirements for hemoglobin A1c (HbA1c) testing, complications screening, diabetes education, and multidisciplinary care. The literature provides various examples at each tier, including from countries where the life for a child and the changing diabetes in children programs have assisted local diabetes centres to introduce intermediate care. Intra‐clinic mean HbA1c levels range from 12.0% to 14.0% (108‐130 mmol/mol) for the most basic level of minimal care, 8.0% to 9.5% (64‐80 mmol/mol) for intermediate care, and 6.9% to 8.5% (52‐69 mmol/mol) for comprehensive care. Countries with sufficient resources should provide comprehensive care, working to ensure that it is accessible by all in need, and that resulting HbA1c levels correspond with international recommendations. All other countries should provide Intermediate care, while working toward the provision of comprehensive care.

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“…There may be a role for genetic factors including HLA genotypes, while exposure to microbial agents may correlate with decreased auto‐immune disease development according to the hygiene hypothesis . Environmental exposures such as toxins may diminish beta cell reserve, while entities such as malnutrition related diabetes, so‐called African diabetes or tropical diabetes, could potentially explain the clinical phenotypes, although more detailed characterization of these diabetes types remains subject to debate . Finally, monogenic diabetes could be considered in a few of these patients, although currently there are no available molecular data to support this.…”

Section: Discussionmentioning

confidence: 99%

High rates of ocular complications in a cohort of Haitian children and adolescents with diabetes

Robinson

Altenor²,

Carpenter

et al. 2018

Pediatr Diabetes

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In this cohort of Haitian youth, DR and cataracts occur prematurely. Low-insulin requirements years after diagnosis, possibly allowing for prolonged undetected hyperglycemia prediagnosis, may explain complication risk. The phenotypes of diabetes in pediatric populations of African ancestry may be distinct. Ophthalmologic evaluation should possibly start at diagnosis, and screening guidelines may need to be adapted.

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Childhood diabetes in Africa

Abstract: Here, we review the known epidemiology, pathophysiology, complications, and treatment of diabetes in children in Africa.

Cited by 38 publications

References 52 publications

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes technologies

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes technologies

Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

High rates of ocular complications in a cohort of Haitian children and adolescents with diabetes

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