ESPE Yearbook of Paediatric Endocrinology

Lancet. 2021 Nov 13;398(10313):1837-1850. https://pubmed.ncbi.nlm.nih.gov/34774146/

Brief Summary: This review summarizes key aspects of type 1 diabetes (T1D), such as epidemiology, pathogenesis, risk factors and management. While reviewing and discussing these topics, the central theme of the review is the burden of T1D and the challenges encountered in its daily management in low- and middle-income countries (LMICs).

2021 was a special year for T1D, marking the centenary of the discovery of insulin. Several papers were published in 2021-2022 reviewing the enormous progresses made in the last 100 years in the field of insulin therapy (1,2). Whilst celebrating these achievements, reflections on global disparities in the management of T1D cannot be ignored. The burden of T1D among children and adolescents remains disproportionate in LMICs. This is due to lack of early detection and diagnosis of this condition and related comorbidities and complications, due to limited and inappropriate infrastructures, diagnostic and management capacities. Alarmingly, only 20% of countries in central and south Asia, Mali, Mozambique have access to insulin. Access to technology, which has revolutionized the treatment of this condition in high income countries, is still limited in LMICs.

The incidence of T1D is increasing worldwide, but there is lack of epidemiological data from LMICs. Studies looking at the pathogenesis and risk factors for T1D primarily include populations from high income countries, therefore limiting the understanding of the effect of specific environmental or socio-demographic factors in LMICs. The Covid-19 pandemic further accentuated some of the issues in LMICs, with disruptions in supplies of insulin, glucose strips and need to rationalize their use due to increased costs.

Therefore, there is a need of clear plans and more investments to improve access to insulin and essential technologies to improve the diagnosis and management of T1D in young people living in LMICs.

References: 1. Mathieu C, Martens PJ, Vangoitsenhoven R. One hundred years of insulin therapy Nat Rev Endocrinol 2021;17:715–725. 2. Sims EK, Carr ALJ, Oram RA, DiMeglio LA, Evans-Molina C. 100 years of insulin: celebrating the past, present and future of diabetes therapy. Nat Med 2021;27:1154–1164.