Prevalence and incidence of clinically recognized cases of Type 1 diabetes in children and adolescents in Rwanda, Africa

Marshall, Sara L.; Edidin, Deborah V.; Arena, Vincent C.; Becker, Dorothy J.; Bunker, Clareann H.; Gishoma, Crispin; Gishoma, Francois; LaPorte, Ronald E.; Kaberuka, Vedaste; Sibomana, Laurien; Orchard, Trevor J.

doi:10.1111/dme.12701

Cited by 40 publications

(57 citation statements)

References 17 publications

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“…Next come countries in southeast Europe which usually manifest a moderate risk for T1D with incidences around 10/100 000 person‐years. Last, but not least, incidences as low as 1 to 5 cases/100 000 person‐years are not uncommon in Latin America, Africa, and Asia …”

Section: Epidemiologymentioning

confidence: 99%

Incidence and trend of type 1 diabetes and the underlying environmental determinants

Xia

Xie

Huang

et al. 2018

Diabetes Metabolism Res

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A wealth of epidemiological studies concerning the distribution of type 1 diabetes (T1D) around the world have pointed to the appreciable variation in the incidence of T1D among disparate age groups, ethnicities, and geographical locations. On the whole, the incidence of childhood T1D has been on the rise, and a plausible inverse relationship between the initial incidence rate and the following annual increase in incidence has been raised. Countries that used to exhibit lower incidences tend to have steep annual increase whereas those with already-established high incidences are more likely to show a modest increase or even stabilization in T1D incidence. Environmental agents considered responsible for the current evolving pattern of T1D incidence will be detailed, mainly including the increasing prevalence of childhood obesity, viral infections in a chronic manner, maternal-child interaction such as breastfeeding, and latitude-ultraviolet B-vitamin D pathway. Certain rationale has been put forward in an attempt to explain the potential association between environmental agents and development of T1D. For instance, accelerator hypothesis regards insulin resistance as the promoter of earlier disease onset in obese children whereas the negative correlation of microbial infections in background populations with incidence of T1D represents the basic component of the hygiene hypothesis. Further investigations are still warranted to verify these theories across multiple ethnic groups and to identify additional contributors to the variation in T1D incidence.

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Section: Epidemiologymentioning

confidence: 99%

Incidence and trend of type 1 diabetes and the underlying environmental determinants

Xia

Xie

Huang

et al. 2018

Diabetes Metabolism Res

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“…This level of care has devastating outcomes. There is a high early mortality from ketoacidosis at onset, because of misdiagnosis or late diagnosis, and later from hypoglycemia and ketoacidosis . There are also high rates of early complications, with devastating long‐term complications in some .…”

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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“…Glucagon is not commonly available. Based on a national registry, the prevalence of type 1 diabetes was estimated to be 0.016% of the 0- to 26-year-old population, corresponding to about 1,200 known cases [34]. …”

Section: Resultsmentioning

confidence: 99%

“…In 2006, a position statement from the Lyon joint meeting of all pediatric endocrine societies set out a statement of minimal acceptable care for children with pediatric endocrine disorders and diabetes [44]. Since then, while major progress has taken place, many patients remain undiagnosed, the prevalence and severity of diabetes complications are staggering, and early mortality is unacceptably high [11, 12, 34, 45]. …”

Section: Discussionmentioning

confidence: 99%

“…Indeed, in Rwanda, the only published country for which national data are available, the prevalence of diabetes was estimated at 0.0164% of the 0- to 25-year-old population [34]. Although it is likely that many patients die without being diagnosed [12, 34, 47], this figure is one order of magnitude lower than the prevalence reported in various non-African populations [48]. Nevertheless, with the increase in capacity in pediatric endocrinology in sub-Saharan Africa, there are now thousands of children and adolescents in need of a global management approach for type 1 diabetes, including access to insulin and glucagon.…”

Section: Discussionmentioning

confidence: 99%

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Insights from the WHO and National Lists of Essential Medicines: Focus on Pediatric Diabetes Care in Africa

Rowlands

Ameyaw²,

Rutagarama

et al. 2018

Horm Res Paediatr

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Background: Access to essential medicines in pediatric endocrinology and diabetes is limited in resource-limited countries. The World Health Organization (WHO) maintains two non-binding lists of essential medicines (EMLs) which are often used as a template for developing national EMLs. Methods: We compared a previously published master list of medicines for pediatric endocrinology and diabetes with the WHO EMLs and national EMLs for countries within the WHO African region. To better understand actual access to medicines by patients, we focused on diabetes and surveyed pediatric endocrinologists from 5 countries and assessed availability and true cost for insulin and glucagon. Results: Most medicines that are essential in pediatric endocrinology and diabetes were included in the national EMLs. However, essential medicines, such as fludrocortisone, were present in less than 30% of the national EMLs despite being recommended by the WHO. Pediatric endocrinologists from the 5 focus countries reported significant variation in terms of availability and public access to insulin, as well as differences between urban and rural areas. Except for Botswana, glucagon was rarely available. There was no significant relationship between Gross National Income and the number of medicines included in the national EMLs. Conclusions: Governments in resource-limited countries could take further steps to improve EMLs and access to medicines such as improved collaboration between health authorities, the pharmaceutical industry, patient groups, health professionals, and capacity-building programs such as Paediatric Endocrinology Training Centres for Africa.

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Prevalence and incidence of clinically recognized cases of Type 1 diabetes in children and adolescents in Rwanda, Africa

Cited by 40 publications

References 17 publications

Incidence and trend of type 1 diabetes and the underlying environmental determinants

Incidence and trend of type 1 diabetes and the underlying environmental determinants

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

Insights from the WHO and National Lists of Essential Medicines: Focus on Pediatric Diabetes Care in Africa

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