ESPE Yearbook of Paediatric Endocrinology

Brief summary: This retrospective study describes a marked increase in the survival of children and youth living with Type 1 diabetes mellitus (T1D) in Tanzania, before (1991–2004), during (2005–2010) and after (2011–2019) implementation of the Life For A Child (LFAC) and Changing Diabetes in Children (CDiC) programs.

This article focuses specifically on diabetes-related mortality. It offers both a message of hope and a candid examination of the issues that youth with diabetes keep facing in Tanzania, similar to other low-resource countries. On the one hand, the authors should be congratulated for their difficult, successful and inspiring work. Over the last 30 years, the number of patients diagnosed with T1D increased more than 14-fold, from 163 before 2005, to 2353 between 2011 and 2019. Many pediatric clinics were developed; mortality, although still significant, decreased from 6 to 2%; the percent of patients lost to follow up also decreased significantly (although it is still 29%, suggesting that mortality, expected to be high in T1D patients without follow up, is likely underestimated at all times).

On the other hand, the authors highlighted a series of issues that keep slowing down further progress. First, although the incidence of T1D was grossly similar in girls and boys, the only factor significantly associated with death in a multivariate analysis was gender, likely reflecting preferential diversion of resources to boys and greater diabetes-associated stigma in girls. Second, the lack of awareness of diabetes in general negatively affects perception of T1D in the population, slowing advocacy for better management and likely contributing to poor follow up. Finally, the authors highlight the importance of the support received from CDiC (until age 18 years) and LFAC (until 25 years). Both provide not only insulin, but also education for the families and the healthcare workers, HbA1c measurement and glucose strips. Improvement of the situation over the last 12 years is attributed to the implementation of CDiC and LFAC programs although a greater commitment of the healthcare authorities in the funding of diabetes care in general was also observed. Ultimately, it is hoped that support from CDiC and LFAC leads to a full sustainable diabetes care in Tanzania as a part of universal healthcare (see 11.2 in this chapter).