Clinical profile of diabetes at diagnosis among children and adolescents at an endocrine clinic in Ghana

AIM To determine the clinical features of diabetes in children and adolescents in Ghana.METHODS Retrospective review of clinical features of all children and adolescents with new-onset diabetes seen at the paediatric endocrinology clinic of Komfo Anokye Teaching Hospital in Kumasi, from February 2012 to Auguest 2016. RESULTS One hundred and six subjects presented with diabetes. Ninety(84.9%) were diagnosed by clinical features and family history as type 1, and 16(15.1%) type 2. For type 1 subjects, age range at diagnosis was 0.9-19.9 year(y), peak age of onset 12-13 year, and 3.3% were < 5 year, 21.1% 5-< 10 year, 45.6% 10-< 15 year and 30.0% 15-< 20 year. Seventy-one point one percent were female. Common clinical features were polyuria(100%), polydipsia(98.9%), and weight loss(82.2%). Mean BMI SD was -0.54, range -3.84 to 2.47. 60.0% presented in diabetic ketoacidosis(DKA). Nine had infections at onset(skin, abscess, leg ulcer). Mean± SD HbA 1c at diagnosis was 12.7% ± 1.9%(115±21 mmol/mol). Four have since died: Hypoglycaemia(2), recurrent DKA(1), osteosarcoma(1). Two other type 1 cases died of DKA at presentation in emergency before being seen by the paediatric endocrinologist. Crude mortality rate including these 2 cases was 32.2/1000 patient years. Type 2 cases were 81% female, age of onset 9-19 year. Mean BMI SD was 1.49, range -0.87 to 2.61. Forty-three point eight percent presented in DKA. All type 2 cases had acanthosis nigricans. Overall, 9.8% did not have home refrigeration, most using clay pot evaporative cooling for insulin storage. CONCLUSION Type 1 occurs with a female preponderance and high DKA rates. Type 2 also occurs. Typology based on clinical features is difficult. Community and professional awareness is warranted.

Epidemiology and phenotypes of diabetes in children and adolescents in non-European-origin populations in or from Western Pacific region

BACKGROUND Type 1 diabetes(T1D)incidence varies substantially between countries/territories,with most studies indicating increasing incidence.In Western Pacific region(WPR),reported rates are much lower than European-origin populations.In contrast,there are reports of substantial numbers of young people with type 2 diabetes(T2D).A deeper understanding of T1D and T2D in the WPR may illuminate factors important in pathogenesis of these conditions.Furthermore,with varying resources and funding for diabetes treatment in this region,there is a need to more clearly determine the current burden of disease and also any gaps in knowledge.AIM To compile and summarise published epidemiologic and phenotypic data on childhood diabetes in non-European populations in and from WPR.METHODS Research articles were systematically searched from PubMed(MEDLINE),Embase,Cochrane library,and gray literature.Primary outcome measures were incidence and prevalence,with secondary measures including phenotypic descriptions of diabetes,including diabetes type categorization,presence of diabetic ketoacidosis(DKA)at onset,autoantibody positivity,Cpeptide levels,and human leucocyte antigen phenotype.Extracted data were collected using a customized template.Three hundred and thirty relevant records were identified from 16 countries/territories,with analysis conducted on 265(80.3%)records published from the year 2000.RESULTS T1D incidence ranged from<1-7.3/100000 individuals/year,rates were highest in emigrant/mixed populations and lowest in South-East Asia,with most countries/territories(71.4%)having no data since 1999.Incidence was increasing in all six countries/territories with data(annual increases 0.5%-14.2%,highest in China).Peak age-of-onset was 10-14 years,with a female case excess.Rate of DKA at onset varied from 19.3%-70%.Pancreatic autoantibodies at diagnosis were similar to European-origin populations,with glutamic acid decarboxylase-65 autoantibody frequency of 44.1%-64.5%,insulinoma-associated 2 autoantibody 43.5%-70.7%,and zinc transporter-8 autoantibody frequency 54.3%(one study).Fulminant T1D also occurs.T2D was not uncommon,with incidence in Japan and one Chinese study exceeding T1D rates.Monogenic forms also occurred in a number of countries.CONCLUSION T1D is less common,but generally has a classic phenotype.Some countries/territories have rapidly increasing incidence.T2D is relatively common.Registries and studies are needed to fill many information gaps.

Access to insulin delivery devices and glycated haemoglobin in lower-income countries

BACKGROUNDYoung people with type 1 diabetes in low-and-middle income countries facemany challenges in accessing care, with various essential supplies needed forsurvival and long-term health.AIMTo study insulin delivery devices and glycated haemoglobin (HbA1c) testing.METHODSA survey was conducted in 2019 of leading diabetes centres in 41 countriessupported by the Life for a Child Program. The survey covered numerous aspectsconcerning availability and costs at all levels of the health system, local usagepatterns and attitudes, obstacles, and other aspects.RESULTSThirty-seven countries returned the survey (90.2% response rate). Key findingsincluded: Syringe use was most common (83.1%), followed by insulin pens(16.7%) and pumps (0.2%). 48.6% of public health systems did not providesyringes, even with a co-payment. Use of suboptimal syringe/needlecombinations was common. Needles were generally reused in almost all countries(94.3%, n = 35). Aside from donated supplies, there was variable access to HbA1ctesting within public health facilities, and, when available, patients often had tocover the cost. Provision was further compromised by numerous problemsincluding stock-outs, and challenges with understanding the test, equipmentmaintenance, and refrigeration.CONCLUSIONLarge gaps exist for adequate access to appropriate insulin delivery devices andHbA1c testing. Public health systems in low-and-middle income countries shouldincrease affordable provision. There are also needs for specific health professional training and diabetes education;elimination of customs duties and taxes;development of inexpensive, robust HbA1c testing methods that do not requirerefrigeration of testing supplies;differential pricing schemes;and other solutions.