ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: World J Diabetes 2017; 8(9):429-435

This is the first paper to describe the clinical presentation and social determinants in youth with diabetes residing and cared for at a single tertiary care center in Ghana that is supported by the International Diabetes Federation’s Life for a Child (LFAC) program. As demonstrated by the ability to conduct and publish this study, LFAC not only provides insulin and diabetes supplies for patients, but is also a vehicle for clinical and research capacity building. While the robustness of study data was limited by the absence of important laboratory tests such as electrolytes and blood gas to determine diabetic ketoacidosis (DKA), or C-peptide, pancreatic auto-antibodies, and genetic studies to evaluate diabetes type, the study nonetheless adds valuable information to a very small body of literature on phenotypes and social determinants in youth with diabetes in low-income countries. The authors confirm clinical observations from similar settings including a female predominance, high rates of DKA and infections at diagnosis, a high crude death rate, and increasing apparent diabetes prevalence as clinical care becomes accessible. Unfortunately, data on glycemic control over time did not seem to be available. However, social challenges were identified including low literacy in 1/4 caregivers, absence of schooling in 1/5 youth, inappropriate grade for age in a similar number along with limited school attendance due to diabetes, and poor coping in 1/6 youth. Further investigations are needed to relate the clinical phenotypes and identified social factors to glycemic control and complications, and to develop and evaluate models of diabetes care delivery that are well-adapted to the described population and setting.