<scp>ISPAD</scp>
            Clinical Practice Consensus Guidelines 2022: Management of the child, adolescent, and young adult with diabetes in limited resource settings

Virmani, Anju; Brink, Stuart; Middlehurst, Angela C; Mohsin, Fauzia; Giraudo, Franco; Sarda, Archana; Ajmal, Sana; Oettingen, Julia E. Von; Pillay, Kubendran; Likitmaskul, Supawadee; Calliari, Luis Eduardo P.; Craig, Maria E.

doi:10.1111/pedi.13456

Cited by 7 publications

(6 citation statements)

References 95 publications

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“…From this review, three initial vignettes of children with moderate to severe DKA were established, according to the ISPAD classification. 17 The age of the hypothetical patients, as well as the symptoms and signs presented, classified by physiological system, are based on eight retrospective studies of T1DM and DKA cases hospitalized in countries in the African region, focusing on patients' symptomatology prior to diagnosis. 10,11,[18][19][20][21][22][23] Laboratory values shown are the disturbances that ISPAD classifies as "moderate to severe" in a DKA.…”

Section: Methodsmentioning

confidence: 99%

Using Clinical Vignettes to Understand the Complexity of Diagnosing Type 1 Diabetes in Sub-Saharan Africa

Le Bec,

Kam,

Aebischer Perone

et al. 2023

RRTM

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Lack of awareness, access to insulin and diabetes care can result in high levels of morbidity and mortality for children with type 1 diabetes (T1DM) in sub-Saharan Africa (SSA). Improvements in access to insulin and diabetes management have improved outcomes in some settings. However, many people still present in diabetic ketoacidosis (DKA) in parallel to misdiagnosis of children with T1DM in contexts with high rates of communicable diseases. The aim of this study was to highlight the complexity of diagnosing pediatric T1DM in a healthcare environment dominated by infectious diseases and lack of adequate health system resources. This was done by developing clinical vignettes and recreating the hypothetico-deductive process of a clinician confronted with DKA in the absence of identification of pathognomonic elements of diabetes and with limited diagnostic tools. A non-systematic literature search for T1DM and DKA in SSA was conducted and used to construct clinical vignettes for children presenting in DKA. A broad differential diagnosis of the main conditions present in SSA was made, then used to construct a clinician's medical reasoning, and anticipate the results of different actions on the diagnostic process. An examination of the use of the digital based Integrated Management of Childhood Illness diagnostic algorithm was done, and an analysis of the software's efficiency in adequately diagnosing DKA was assessed. The main obstacles to diagnosis were low specificity of non-pathognomonic DKA symptoms and lack of tools to measure blood or urine glucose. Avenues for improvement include awareness of T1DM symptomatology in communities and health systems, and greater availability of diagnostic tests. Through this work clinical vignettes are shown to be a useful tool in analyzing the obstacles to underdiagnosis of diabetes, a technique that could be used for other pathologies in limited settings, for clinical teaching, research, and advocacy.

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Section: Methodsmentioning

confidence: 99%

Using Clinical Vignettes to Understand the Complexity of Diagnosing Type 1 Diabetes in Sub-Saharan Africa

Le Bec,

Kam,

Aebischer Perone

et al. 2023

RRTM

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“…While recognizing and supporting the value of using CGM for children with T1DM [ 59 , 60 ], the International Society for Pediatric and Adolescent Diabetes (ISPAD) does not make a specific recommendation to initiate CGM at the point of diagnosis for children with T1DM. We propose that this step should be taken, even in low-resource settings [ 61 ]. The long-term benefits of proactive glucose control with CGM for children with T1DM are compelling.…”

Section: Cgm In Guidelines For Diabetes Managementmentioning

confidence: 99%

Expanding the Role of Continuous Glucose Monitoring in Modern Diabetes Care Beyond Type 1 Disease

et al. 2023

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Application of continuous glucose monitoring (CGM) has moved diabetes care from a reactive to a proactive process, in which a person with diabetes can prevent episodes of hypoglycemia or hyperglycemia, rather than taking action only once low and high glucose are detected. Consequently, CGM devices are now seen as the standard of care for people with type 1 diabetes mellitus (T1DM). Evidence now supports the use of CGM in people with type 2 diabetes mellitus (T2DM) on any treatment regimen, not just for those on insulin therapy. Expanding the application of CGM to include all people with T1DM or T2DM can support effective intensification of therapies to reduce glucose exposure and lower the risk of complications and hospital admissions, which are associated with high healthcare costs. All of this can be achieved while minimizing the risk of hypoglycemia and improving quality of life for people with diabetes. Wider application of CGM can also bring considerable benefits for women with diabetes during pregnancy and their children, as well as providing support for acute care of hospital inpatients who experience the adverse effects of hyperglycemia following admission and surgical procedures, as a consequence of treatment-related insulin resistance or reduced insulin secretion. By tailoring the application of CGM for daily or intermittent use, depending on the patient profile and their needs, one can ensure the cost-effectiveness of CGM in each setting. In this article we discuss the evidence-based benefits of expanding the use of CGM technology to include all people with diabetes, along with a diverse population of people with non-diabetic glycemic dysregulation. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-023-01431-3.

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Section: Introductionmentioning

confidence: 99%

“…Guidelines have been published for the use of glycemic metrics in clinical practice for diabetes management in children [15][16][17][18]. In less-resourced areas of the world such as Africa, the use of self-monitored capillary glucose is prohibitively expensive and a point of care clinic HbA1c may be the main and sometimes the only metric for the assessment of glycemic control and for guiding insulin dosing [16]. However, if HbA1c overestimates the MBG of youth with diabetes living in Africa, as it does for African diaspora populations, then treatment to HbA1c target might lead to inadvertent over prescription of insulin and more frequent occurrence of hypoglycemia [14].…”

Section: Introductionmentioning

confidence: 99%

Can HbA1c Alone Be Safely Used to Guide Insulin Therapy in African Youth with Type 1 Diabetes?

et al. 2023

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Introduction. The relationship of HbA1c versus the mean blood glucose (MBG) is an important guide for diabetes management but may differ between ethnic groups. In Africa, the patient’s glucose information is limited or unavailable and the management is largely guided by HbA1c. We sought to determine if the reference data derived from the non-African populations led to an appropriate estimation of MBG from HbA1c for the East African patients. Methods. We examined the relationship of HbA1c versus MBG obtained by the continuous glucose monitoring in a group of East African youth having type 1 diabetes in Kenya and Uganda (n = 54) compared with the data obtained from A1c-derived average glucose (ADAG) and glucose management indicator (GMI) studies. A self-identified White (European heritage) population of youth (n = 89) with type 1 diabetes, 3–18 years old, living in New Orleans, LA, USA metropolitan area (NOLA), was studied using CGM as an additional reference. Results. The regression equation for the African cohort was MBG (mg/dL) = 32.0 + 16.73 × HbA1c (%), r = 0.55, p < 0.0001 . In general, the use of the non-African references considerably overestimated MBG from HbA1c for the East African population. For example, an HbA1c = 9% (74.9 mmol/mol) corresponded to an MBG = 183 mg/dL (10.1 mmol/L) in the East African group, but 212 mg/dL (11.7 mmol/L) using ADAG, 237 mg/dL (13.1 mmol/L) using GMI and 249 mg/dL (13.8 mmol/L) using NOLA reference. The reported occurrence of serious hypoglycemia among the African patients in the year prior to the study was 21%. A reference table of HbA1c versus MBG from the East African patients was generated. Conclusions. The use of non-African-derived reference data to estimate MBG from HbA1c generally led to the overestimation of MBG in the East African patients. This may put the East African and other African patients at higher risk for hypoglycemia when the management is primarily based on achieving target HbA1c in the absence of the corresponding glucose data.

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ISPAD Clinical Practice Consensus Guidelines 2022: Management of the child, adolescent, and young adult with diabetes in limited resource settings

Cited by 7 publications

References 95 publications

Using Clinical Vignettes to Understand the Complexity of Diagnosing Type 1 Diabetes in Sub-Saharan Africa

Using Clinical Vignettes to Understand the Complexity of Diagnosing Type 1 Diabetes in Sub-Saharan Africa

Expanding the Role of Continuous Glucose Monitoring in Modern Diabetes Care Beyond Type 1 Disease

Can HbA1c Alone Be Safely Used to Guide Insulin Therapy in African Youth with Type 1 Diabetes?

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