Type 1 diabetes mellitus in Gabon

Abstract

Background and ObjectiveType 1 diabetes mellitus (T1DM) is the most frequent endocrinopathy in children. Its replacement therapy requires insulin, without which, death is inevitable. This treatment is expensive and a financial burden for diabetic children and their families, especially in Africa.In the absence of a national T1DM register, the purpose of this study was to describe epidemiological aspects of type 1 diabetes in children in Gabon, specify the difficulties met by the patients during the follow-up and identify factors explaining poor therapeutic observance and metabolic control.Material and methodsProspective transversal monocentric study. Data were firstly extracted from the registers of the Endocrinology Department of the University Hospital of Libreville (CHUL), Gabon, between 2010 and 2017.Secondly, patients were interviewed by telephone about the availability and cost of insulin, their self-monitoring of blood glucose, and diet.Results306 patients (154 girls and 152 boys) were diagnosed with T1D during the study period and followed-up in the Endocrinology Department at CHUL. Mean age at diagnosis was 17 ± 7 years (5% of patients were over 5 years of age, 30% were >20 years old). Mean follow-up period was 4.0 ± 2.0 years. 16% of the patients were hospitalized at least 2 times per month for ketoacidosis.Hospital mortality was about 7%. Number of factors linked with poor therapeutic observance (high cost of treatment, lack of patients’ therapeutic education, etc.) were identified.ConclusionT1D prevalence is constantly increasing worldwide, but at slower pace in Africa in comparison to developed countries. Difficulties to access to high standard care and population poverty in Sub-Saharan Africa, represents a major independent factor of poor therapeutic observance.

Global estimates of incidence of type 1 diabetes in children and adolescents: Results from the International Diabetes Federation Atlas, 10th edition

“…Increases were most pronounced in the African, Middle East and North Africa Regions. For the African Region, this is due to new data from Gabon (10) and Eritrea (11), as well as updated data from Tanzania (12) that were higher than previous estimates and also extrapolated to various other countries in sub-Saharan Africa without any data. For the Middle East and North Africa Region, new data from Algeria increased estimates.…”

“…These data continue to show great differences globally, with incidence in the highest country (Finland) over fifty times higher than various countries in South Asia, Africa, South and Central America and the Western Pacific. It must be noted that some countries had studies that are quite dated, and also there is also the strong possibility of underestimation of incidence rates because of death through missed diagnosis in some countries (2,4,10,13). However, both Finland and Japan have recent data and well-resourced health systems but still have a 24-fold difference in rates 0-14 years (52.2 versus 2.2 per 100,000 per year).…”

Rapid increases in observed incidence and prevalence of Type 1 diabetes in children and youth in Mali, 2007–2016

“…Incidence rates (per 100,000 population < 15 years/years) in the five sub‐Saharan reports range from 0.3 in Ethiopia to 2.9 in Nigeria, with a higher rate of 10.1 in Sudan (which is an Arab‐African population). Three countries have rates for insulin‐dependent diabetes in older populations: In Ethiopia the whole population rate was 2.1/100,000/years, 7 in Rwanda for <26 years the rate was 2.7/100,000/years, 5 and in Gabon, the rate for <30 years was 2.9/100,000/years 27 . These rates are substantially lower than in Northern European‐ and Arab‐origin populations, where incidence rates are generally 20–60 per 100,000/ years 1,8 …”

“…Worldwide, onset of T1D tends to peak between 10 and 14 years of age 28,38 . However, there have been some research in Africa showing a later onset, with peak between 15 and 19 years in Tanzania 4 and Rwanda, 5 25–29 years in Ethiopia, 7 and an average age at diagnosis in Gabon 27 reported to be 17 years. Our study was consistent with these studies.…”

Survival of children and youth with type 1 diabetes mellitus in Tanzania

“…Globally, survival for children and youth living with type 1 diabetes mellitus (CYLDM) has been increasing tremendously as shown by several studies 1–3 . CYLDM in sub‐Saharan Africa (SSA) and other lower‐income countries 4–7 have not seen similar improvement in survival as those in high‐income countries, 8 in some countries the survival of children has been documented to be as low as 1 year after diagnosis 6,9 . Lack of appropriate care results in acute complications, including diabetic ketoacidosis, hypoglycaemia, and infections, which cause high mortality in SSA 7,10,11 …”