ESPE Yearbook of Paediatric Endocrinology

jcmbanya@yahoo.co.uk Pediatr Diabetes 2022; 23: 33–37. doi: 10.1111/pedi.13294

Brief Summary: Despite provision of free insulin by the Changing Diabetes in Children (CDiC) program, mortality remains high in children and adolescents with type 1 diabetes (T1D) in Cameroon, in particular in rural settings and in families with no formal education.

This is the first of two articles on the strengths and weaknesses of the “Changing Diabetes in Children“ (CDiC) program, a public-private partnership implemented by Novo Nordisk. It provides free insulin, glucose meters and test strips, as well as basic diabetes education in youth with diabetes and their families. This study describes the characteristics of the 517 patients enrolled in the program in Cameroon between 2010 and 2015. Most patients were enrolled within a few months of their initial diagnosis of T1D. Despite the provision of free insulin and glucose meters, 53 deaths were reported (10% of the patients) over this period. The causes of death remain mostly unknown, but living in a rural setting and lack of formal education were 2 factors significantly associated with mortality.

Overall, this article demonstrates that there is much more to diabetes care than provision of free insulin and blood glucose monitoring. It emphasizes the magnitude of the challenge that families, health professionals and health authorities face in a low-income country to improve diabetes care: understanding the epidemiology and characteristics of T1D in the country, training health professionals, decreasing stigmatization, screening for complications, and advocating for resources are only a few of the areas that come to mind and require urgent attention.