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Majaliwa ES, Minja L, Ndayongeje J, Ramaiya K, Mfinanga SG, Mmbaga BT. Survival of children and youth with type 1 diabetes mellitus in Tanzania. Pediatr Diabetes 2022; 23:1560-1566. [PMID: 36193929 DOI: 10.1111/pedi.13425] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Survival from type 1 diabetes Mellitus is low in lower-income countries with underdeveloped health systems. Support programs from partners like life for a child (LFAC) and changing diabetes in children (CDiC) were implemented in Tanzania in 2005 to provide diabetes care to children and youth. No evaluation of survival has been done since their implementation. OBJECTIVE To assess the survival of children and youth living with diabetes mellitus (CYLDM) in Tanzania. METHODS A retrospective data collection from 39 clinics of CYLDM was done by extracting data from the diabetes registry between 1991 and 2019. Three cohort were analyzed (1) Cohort 1991-2004 (pre-implementation), (2) Cohort 2005-2010 (during implementation), and (3) 2011-2019 (after the implementation of LFAC/CDiC). Data were analyzed using STATA-version 14. RESULTS A total of 3822 data of CYLDM were extracted, mean age at diagnosis was 13.8 (±5) years. Approximately fifty-one percent (50.8%) were male. The total observation time was 28 years, and the Median duration of diabetes of 5 (IQR2, 8) years. Total death was 95 (3%), with a mean age at death of 17.7 (SD 4.7) years. The last cohort (2011-2019) had more diagnosis 2353 (72.7%), as compared to the <2005 cohort with only 163(5%). The survival improved from 59% before 2005 to 69% in the last cohort (2011-2019). CONCLUSION The implemented programs have facilitated the diagnosis and retention of CYLDM in the health care system. In doing so, it has also increased the survival probability in Tanzania compared to the early 90s.
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Affiliation(s)
- Edna Siima Majaliwa
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | | | - Sayoki G Mfinanga
- National Institute for Medical Research, Dar es Salaam, Tanzania.,Department of Epidemiology and Statistics, The Muhimbili University of Health and Allied Sciences, School of Public Health, Dar es Salaam, Tanzania.,Alliance for Africa Research and Innovation (A4A), Dar es Salaam, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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2
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Antonio-Villa NE, García-Tuomola A, Almeda-Valdes P, Vidrio-Velázquez M, Islas-Ortega L, Madrigal-Sanromán JR, Zaballa-Lasso C, Martínez-Ramos-Méndez A, De la Garza-Hernández NE, Bustamante-Martínez JF, González-Galvez G, Valadez-Capetillo M, Sanchez-Ruiz KL, Castillo-Galindo C, Yepez-Rodríguez AE, Polanco-Preza MA, Ceballos-Macías JJ, Valenzuela-Montoya JC, Escobedo-Ortiz AR, Ferreira-Hermosillo A, Rodríguez-Sanchez E, Romero-Zazueta A, Miracle-López S, Figueroa-Andrade MH, Faradji RN. Glycemic control, treatment and complications in patients with type 1 diabetes amongst healthcare settings in Mexico. Diabetes Res Clin Pract 2021; 180:109038. [PMID: 34487758 DOI: 10.1016/j.diabres.2021.109038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/11/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
AIMS Type 1 diabetes (T1D) is a growing chronic disease. Evidence of whether the healthcare setting affects management and glycemic control is scarce. We evaluate outcomes in patients with T1D in private and public healthcare settings in Mexico, registered in the National T1D Registry in Mexico (RENACED-DT1). METHODS Biochemical parameters, diabetes education, and treatment were analyzed considering the data registered in the last visit. Development of chronic complications was determined during follow-up. RESULTS We included 1,603 patients; 71.5% (n = 1,146) registered in the public system, and 28.5% (n = 457) in a private institution. Patients in the public setting had higher HbA1c (8.6%, IQR: 7.3%-10.5% vs 7.7%, IQR: 7.0%-8.8%; p < 0.001). Indicators of diabetes education, glucose monitoring, and use of insulin-pumps were lower in the public setting. Patients in the public setting were at higher risk of diabetic chronic kidney disease, retinopathy, and neuropathy. Diabetes knowledge was a mediator between type of healthcare setting and the likelihood of achieving glycemic control. CONCLUSIONS Patients registered in public healthcare settings have an adverse metabolic profile and higher risk of complications. Social factors need to be addressed in order to implement multidisciplinary measures focused on diabetes education for patients with T1D in Mexico.
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Affiliation(s)
- Neftali Eduardo Antonio-Villa
- MD/PhD (PECEM), Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico; Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Aili García-Tuomola
- Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición"Salvador Zubirán, Mexico City, Mexico; Endocrinology, Centro Medico ABC, Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición"Salvador Zubirán, Mexico City, Mexico
| | | | - Laura Islas-Ortega
- Pediatric Endocrinology, Hospital del Niño DIF Hidalgo, Pachuca, Hidalgo, Mexico
| | | | | | | | | | - Jorge F Bustamante-Martínez
- Internal Medicine Department, Servicios de Salud de Nayarit, Hospital General de Tepic, Tepic, Nayarit, Mexico
| | - Guillermo González-Galvez
- Endocrinology, Instituto Jalisciense de Investigación en Diabetes y Obesidad S. C, Guadalajara, Jalisco, Mexico
| | | | - Karla L Sanchez-Ruiz
- Clínica de Diabetes, Secretaría de Salud del Estado de Durango, Durango, Durango, Mexico
| | | | | | - Miguel A Polanco-Preza
- Endocrinology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | | | - Julio C Valenzuela-Montoya
- Pediatric Endocrinology, Hospital De Gineco-Pediatría No. 31 IMSS, Mexicali, Baja California Norte, Mexico
| | - Ana R Escobedo-Ortiz
- Endocrinology, Hospital General Dr. Miguel Silva, Secretaria de Salud, Morelia, Michoacán, Mexico
| | - Aldo Ferreira-Hermosillo
- Endocrinology, Unidad de Investigación Médica en Enfermedades Endocrinas. Centro Médico Nacional Siglo XXI, IMSS, Mexico
| | | | | | - Sigfrido Miracle-López
- Endocrinology, Hospital Angeles Lomas, Huixquilucan, México; Associate Investigator, Centro de Investigación en Ciencias de la Salud (CICSA) Universidad, Anáhuac, Mexico
| | | | - Raquel N Faradji
- Endocrinology and Diabetes, Clinica EnDi, Mexico City, Mexico; Endocrinology, Centro Medico ABC, Mexico City, Mexico.
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Souris KJ, Caballero Gonzales MDC, Barrington C, Klatman EL, Anderson BJ, Duarte E, Middlehurst AC, Nostas MC, Ogle GD. 'La Vida Normal': Young people adapting to Type 1 diabetes in Bolivia. Chronic Illn 2021; 17:189-204. [PMID: 31064208 DOI: 10.1177/1742395319843172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To identify challenges and coping strategies of young people with Type 1 diabetes (T1D) and their families in Bolivia through qualitative analysis of interviews with beneficiaries of Centro Vivir con Diabetes (CVCD), a diabetes health center supported by the International Diabetes Federation Life for a Child (LFAC) program. METHODS Eighteen young people aged 14-33 and at least one caregiver participated in semi-structured interviews in five cities in Bolivia from May to June 2016. Interviews were recorded, transcribed, and analyzed using inductive thematic analysis. RESULTS Participants described needing guidance at diagnosis and facing stigma in communities. Young people expressed that life with T1D was 'la vida normal' (a normal life), although interpretations of normalcy varied. For some, 'la vida normal' meant resistance to T1D; for others it indicated acceptance. DISCUSSION Access to interdependent spheres of support allowed young people to form a new normal around T1D. Receiving supplies through the CVCD/LFAC partnership maintained family connection to clinical care, CVCD education helped families share in T1D management, and peer support mitigated stigma for young people. Programs like CVCD that combine supply-based aid with clinical education for whole families, create effective support for young people with T1D in low- and middle-income countries.
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Affiliation(s)
- Katherine J Souris
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Emma L Klatman
- International Diabetes Federation Life for a Child Program, Diabetes NSW & ACT, Glebe, Sydney, Australia
| | | | | | - Angela C Middlehurst
- International Diabetes Federation Life for a Child Program, Diabetes NSW & ACT, Glebe, Sydney, Australia
| | | | - Graham D Ogle
- International Diabetes Federation Life for a Child Program, Diabetes NSW & ACT, Glebe, Sydney, Australia
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Kahkoska AR, Dabelea D. Diabetes in Youth: A Global Perspective. Endocrinol Metab Clin North Am 2021; 50:491-512. [PMID: 34399958 PMCID: PMC8374087 DOI: 10.1016/j.ecl.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Diabetes is a common disease among pediatric populations in the United States and worldwide. The incidence of type 1 and type 2 diabetes is increasing, with disproportional increases in racial/ethnic subpopulations. As the prevalence of obesity continue to increase, type 2 diabetes now represents a major form of pediatric diabetes. The management of diabetes in youth centers on maintaining glycemic control to prevent acute and chronic complications. This article summarizes the epidemiology, etiology, management, and complications of type 1 and type 2 diabetes in youth, as well as future directions and opportunities.
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Affiliation(s)
- Anna R Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall 2205A, Chapel Hill, NC 27599, USA.
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado School of Medicine, Anschutz Medical Campus, 13001 East 17th Avenue, Box B119, Room W3110, Aurora, CO 80045, USA
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Gregory GA, Guo J, Klatman EL, Ahmadov GA, Besançon S, Gomez ED, Fawwad A, Ramaiya K, Wijesuriya MA, Orchard TJ, Ogle GD. Costs and outcomes of "intermediate" vs "minimal" care for youth-onset type 1 diabetes in six countries. Pediatr Diabetes 2020; 21:628-636. [PMID: 31970828 DOI: 10.1111/pedi.12988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/02/2019] [Accepted: 01/13/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Data are needed to demonstrate that providing an "intermediate" level of type 1 diabetes (T1D) care is cost-effective compared to "minimal" care in less-resourced countries. We studied these care scenarios in six countries. METHODS We modeled the complications/costs/mortality/healthy life years (HLYs) associated with "intermediate" care including two blood glucose tests/day (mean HbA1c 9.0% [75 mmol/mol]) in three lower-gross domestic product (GDP) countries (Mali, Tanzania, Pakistan), or three tests/day (mean HbA1c 8.5% [69 mmol/mol]) in three higher-GDP countries (Bolivia, Sri Lanka, Azerbaijan); and compared findings to "minimal" care (mean HbA1c 12.5% [113 mmol/mol]). A discrete time Markov illness-death model with age and calendar-year-dependent transition probabilities was developed, with inputs of 30 years of complications and Standardized Mortality Rate data from the youth cohort in the Pittsburgh Epidemiology of Diabetes Complications Study, background mortality, and costs determined from international and local prices. RESULTS Cumulative 30 years incidences of complications were much lower for "intermediate care" than "minimal care", for example, for renal failure incidence was 68.1% (HbA1c 12.5%) compared to 3.9% (9%) and 2.4% (8.5%). For Mali, Tanzania, Pakistan, Bolivia, Sri Lanka, and Azerbaijan, 30 years survival was 50.1%/52.7%/76.7%/72.5%/82.8%/89.2% for "intermediate" and 8.5%/10.1%/39.4%/25.8%/45.5%/62.1% for "minimal" care, respectively. The cost of a HLY gained as a % GDP/capita was 141.1%/110.0%/52.3%/41.8%/17.0%/15.6%, respectively. CONCLUSIONS Marked reductions in complications rates and mortality are achievable with "intermediate" T1D care achieving mean clinic HbA1c of 8.5% to 9% (69-75 mmol/mol). This is also "very cost-effective" in four of six countries according to the WHO "Fair Choices" approach which costs HLYs gained against GDP/capita.
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Affiliation(s)
- Gabriel A Gregory
- Life for a Child Program, Diabetes NSW, Glebe, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Jingchuan Guo
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Emma L Klatman
- Life for a Child Program, Diabetes NSW, Glebe, New South Wales, Australia
| | - Gunduz A Ahmadov
- The Endocrine Center, Baku, Azerbaijan.,Azerbaijan Medical University, Baku, Azerbaijan
| | | | | | - Asher Fawwad
- Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | | | - Mahen A Wijesuriya
- Diabetes Association of Sri Lanka, National Diabetes Centre, Colombo, Sri Lanka
| | - Trevor J Orchard
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Graham D Ogle
- Life for a Child Program, Diabetes NSW, Glebe, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
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Jenkins A, Januszewski A, O’Neal D. The early detection of atherosclerosis in type 1 diabetes: why, how and what to do about it. Cardiovasc Endocrinol Metab 2019; 8:14-27. [PMID: 31646294 PMCID: PMC6739889 DOI: 10.1097/xce.0000000000000169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/22/2019] [Indexed: 12/11/2022]
Abstract
The major cause of morbidity and often premature mortality in people with type I diabetes (T1D) is cardiovascular disease owing to accelerated atherosclerosis. We review publications relating to the rationale behind, and clinical tests for, detecting and treating early atherosclerosis in people with T1D. Currently available tools for atherosclerosis assessment include risk equations using vascular risk factors, arterial intima-media thickness, the ankle-brachial index, coronary artery calcification and angiography, and for more advanced lesions, intravascular ultrasound and optical coherence tomography. Evolving research tools include risk equations incorporating novel clinical, biochemical and molecular tests; vascular MRI and molecular imaging. As yet there is little information available to quantify early atherosclerosis. With better means to control the vascular risk factors, such as hypertension, dyslipidaemia and glycaemic control, and emerging therapies to control novel risk factors, further epidemiologic and clinical trials are merited to facilitate the translation into clinical practice of robust means to detect, monitor and treat early atherosclerosis in those with T1D.
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Affiliation(s)
- Alicia Jenkins
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales
- Department of Endocrinology, St. Vincent’s Hospital, Fitzroy, Victoria, Australia
| | - Andrzej Januszewski
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales
- Department of Endocrinology, St. Vincent’s Hospital, Fitzroy, Victoria, Australia
| | - David O’Neal
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales
- Department of Endocrinology, St. Vincent’s Hospital, Fitzroy, Victoria, Australia
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Ogle GD, von Oettingen JE, Middlehurst AC, Hanas R, Orchard TJ. Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels. Pediatr Diabetes 2019; 20:93-98. [PMID: 30471084 DOI: 10.1111/pedi.12801] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 12/16/2022] Open
Abstract
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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Affiliation(s)
- Graham D Ogle
- Life for a Child Program, Sydney, New South Wales, Australia.,Diabetes NSW & ACT, Sydney, New South Wales, Australia
| | | | - Angela C Middlehurst
- Life for a Child Program, Sydney, New South Wales, Australia.,Diabetes NSW & ACT, Sydney, New South Wales, Australia
| | - Ragnar Hanas
- Life for a Child Program, Sydney, New South Wales, Australia.,Sahlgrenska Academy, University of Gothenburg, Institute of Clinical Sciences and Department of Pediatrics, NU Hospital Group, Uddevalla Hospital, Gothenburg, Sweden
| | - Trevor J Orchard
- Life for a Child Program, Sydney, New South Wales, Australia.,Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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