Introduction mobile phone technology is increasingly used to overcome traditional barriers to limiting access to diabetes care. This study evaluated mobile phone ownership and willingness to receive and pay for mobile phone-based diabetic services among people with diabetes in South-West, Nigeria. Methods two hundred and fifty nine patients with diabetes were consecutively recruited from three tertiary health institutions in South-West, Nigeria. Questionnaire was used to evaluate mobile phone ownership, willingness to receive and pay for mobile phone-based diabetic health care services via voice call and text messaging. Results 97.3% owned a mobile phone, with 38.9% and 61.1% owning smartphone and basic phone respectively. Males were significantly more willing to receive mobile-phone-based health services than females (81.1% vs 68.1%, p=0.025), likewise married compared to unmarried [77.4% vs 57.1%, p=0.036]. Voice calls (41.3%) and text messages (32.4%), were the most preferred modes of receiving diabetes-related health education with social media (3.1%) and email (1.5%) least. Almost three-quarter of participants (72.6%) who owned mobile phone, were willing to receive mobile phone-based diabetes health services. The educational status of patients (adjusted OR [AOR]: 1.7{95% CI: 1.6 to 2.1}), glucometers possession (AOR: 2.0 [95% CI: 1.9 to 2.1) and type of mobile phone owned (AOR: 2.9 [95% CI: 2.8 to 5.0]) were significantly associated with the willingness to receive mobile phone-based diabetic services. Conclusion the majority of study participants owned mobile phones and would be willing to receive and pay for diabetes-related healthcare delivery services provided the cost is minimal and affordable.

Double diabetes otherwise known as hybrid diabetes, a new variant, is a combination of both type 1 and type 2 diabetes in children and adolescents. It is a diabetes variant increasing in prevalence in developed countries because of epidemic obesity among children and adolescents but extremely rare in developing countries. Double diabetes is characterized by features of both type 1 (diabetes auto-antibodies) and type 2 (obesity and insulin resistance). This occurrence can either develop on a background of type 1 diabetes due to an abnormal increase in weight from physiological growth spurt in adolescents or from high insulin dosage developing on a background of type 2 diabetes. The variant has been linked to possible increased cardiovascular risks and worsened morbidity including poor glycaemic control. Here, we report a case of a 17-year-old girl who developed features of type 2 diabetes on a background of type 1 diagnosed 6 years after T1D diagnosis.

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Type 2 diabetes mellitus (T2DM) is emerging as a new clinical disorder among children and adolescents. Although there is increasing prevalence of this clinical entity among adolescents worldwide, its diagnosis among Nigerian children and adolescents is still uncommon, hence, the reason many physicians still misdiagnose T2DM in adolescents as type 1 diabetes mellitus for reason of age of onset. Here, we present a 15-year old, overweight, girl who presented with history of polyuria, polydipsia and weight loss; her blood glucose level was 14.3 mmol/l, glycated haemoglobin 12.4% and glycosuria (3+), with no ketonuria or proteinuria. She was initially diagnosed as type 1 diabetes and managed with multiple doses of insulin by the pediatric team until she was later reviewed by the endocrinology unit. The diagnosis was later changed to early-onset T2DM (Youth-onset T2DM) based on a BMI of 29.75 kg/m 2 , presence of acanthosis nigricans, absence of ketosis, preserved beta-cell function as shown by normal serum C-peptide levels, absence of anti-glutamic acid decarboxylase (GAD) antibodies and islet cell antibody, and also response to oral anti-diabetic agents while her insulin therapy was discontinued. Therefore, a possibility of T2DM should be suspected in childhood and adolescent with diabetes associated with overweight or obesity, relatives with T2DM and features of insulin resistance (IR) like acanthosis nigricans, hypertension, dyslipidaemia, non-alcoholic fatty liver disease (NAFLD), hyperandrogenism, or polycystic ovarian syndrome (PCOS).

BACKGROUNDMost occurrences of type 1 diabetes cases in any population are sporadic rather than familial. Hence, type 1 diabetes among siblings is a rare occurrence. Even more rare is for three or more siblings to develop type 1 diabetes. In this report, we describe a case of a Nigerian family in which type 1 diabetes occurred in three siblings among four children with neither parent having diabetes. All three siblings are positive for glutamic acid decarboxylase and anti-islet cell antibodies.CASE SUMMARYThere were four siblings (three males and one female) born to a couple without a diagnosis of diabetes. The eldest child (male) was diagnosed with diabetes at the age of 15, the second child (female) was diagnosed at the age of 11 and the fourth child (male) was diagnosed at the age of 9. All the siblings presented with similar osmotic symptoms and were diagnosed of diabetic ketoacidosis. All of them had markedly reduced serum C-peptide levels with high levels of glutamic acid decarboxylase and insulinoma-associated protein-2 antibodies. We could not perform genetic analysis of HLA-DR, DQ and CTLA4 in the siblings as well as the parents; hence haplotypes could not be characterized. Both parents of the probands have no prior history of diabetes, and their blood glucose and glycated hemoglobin levels were within normal ranges. The third child (male) has no history suggestive of diabetes, and his blood glucose and glycated hemoglobin have remained within normal ranges.CONCLUSIONAlthough the occurrence of type 1 diabetes in proband siblings is uncommon, screening for diabetes among siblings especially with islet autoantibodies should be encouraged.