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Introduction: Type 1 diabetes in Africa has been associated with high mortality attributed mainly to poor insulin access. Free insulin provision programs for people with type 1 diabetes have been introduced across Africa recently. We aimed to determine the mortality rate and associated factors in a cohort of children and adolescents with type 1 diabetes who receive free insulin treatment in sub‐Saharan Africa. Methods: We conducted a retrospective analysis using the Changing Diabetes in Children (CDiC) medical records in Cameroon between 2011 and 2015. Results: The overall mortality rate was 33.0 per 1000 person‐years (95% CI 25.2–43.2). Most deaths (71.7%) occurred outside of the hospital setting, and the cause of death was known only in 13/53 (24.5%). Mortality was substantially higher in CDiC participants followed up in regional clinics compared to the main urban CDiC clinic in Yaounde; 41 per 1000 years (95% CI 30.8–56.0) versus 17.5 per 1000 years (95% CI 9.4–32.5), and in those with no formal education compared to those who had some level of education; 68.0 per 1000 years (95% CI 45.1–102.2) versus 23.6 per 1000 years (95% CI 16.5–33.8). In Cox proportional multivariable analysis, urban place of care (HR = 0.23, 95% CI 0.09–0.57; p = 0.002) and formal education (HR = 0.42, 95% CI 0.22–0.79; p = 0.007) were independently associated with mortality. Conclusion: Despite free insulin provision, mortality remains high in children and adolescents with type 1 diabetes in Cameroon and is substantially higher in rural settings and those with no formal education. [ABSTRACT FROM AUTHOR]

Background: Patient education is essential in management of type 1 diabetes (T1D). Objective: To evaluate the short‐term impact of patient education through WhatsApp on the knowledge of the disease and glycemic control of adolescents and young adults living with T1D in a resource‐limited setting. Methods: A double arm non‐randomized clinical trial was carried out in two clinics for diabetes in Cameroon, over a period of 2 months. The intervention consisted in providing four sessions of patient education through WhatsApp to an intervention group compared to a control group with their classic follow‐up. We evaluate their knowledge on diabetes, acute events, and glycemic control, before and after intervention. Results: We recruited 54 patients of which 25 subjects and 29 controls. Median age was 19 (17‐20) and 19 (17‐21) years for the intervention and control group, respectively. There was a significant improvement of knowledge on diabetes in the intervention group from 13/20 to 16/20 (P < 0.01) after 2 months, compared to a slight decrease in control group (from 11.6/20 to 11.3/20 (P = 0.33). The mean proportion of acute complications decreased from 28% to 16% (P = 0.46) in the intervention group, and increased from 7% to 34%, P = 0.01 in the control group. There was no improvement in glycosylated hemoglobin level in both groups. Conclusion: Patient education through social network helped to improve knowledge on T1D and to reduce acute complications without an improvement of glycemic control after 2 months. [ABSTRACT FROM AUTHOR]

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Background: Diabetes is a growing health concern in developing countries, with Cameroon population having an estimated 6% affected. Of note, hospital attendees appear to be increasing all over the country, with fluctuating numbers throughout the annual calendar. The aim of the study was to investigate the relationship between diabete hospitalization admission rates and climate variations in Yaounde.Methods: A retrospectively designed study was conducted in four health facilities of Yaounde (Central Hospital, University teaching hospital, Biyem-Assi and Djoungolo District Hospitals), using medical records from 2000 to 2008. A relationship between diabetes (newly diagnosed diabetes patients or decompensated diabetics) hospitalization admissions and climate variations was determined using the "2000-2008" national meteorological database (precipitation and temperature).Results: The monthly medians of precipitation and temperature were 154mm and 25 °C, respectively. The month of October received 239mm of precipitation. The monthly medians of diabetic admissions rates (newly diagnosed or decompensated diabetes patients) were 262 and 72 respectively. October received 366 newly diagnosed diabetics and 99 decompensated diabetics. Interestingly, diabetic hospitalization admissions rates were higher during the rainy (51 %, 1633/3232) than the dry season, though the difference was non-significant. The wettest month (October) reported the highest cases (10 %, 336/3232) corresponding to the month with the highest precipitation level (239mm). Diabetes hospitalization admissions rates varied across health facilities [from 6 % (189/3232) in 2000 to 15 % (474/3232) in 2008].Conclusion: Diabetes is an important epidemiological disease in the city of Yaounde. The variation in the prevalence of diabetes is almost superimposed to that of precipitation; and the prevalence seems increasing during raining seasons in Yaoundé. [ABSTRACT FROM AUTHOR]

OBJECTIVE -- To evaluate day-to-day variations of insulin needs in type 2 diabetic patients with end-stage renal disease (ESRD) on maintenance hemodialysis. RESEARCH DESIGN AND METHODS -- We developed a 24-h euglycemic clamp in patients who received an average of 2,200 calories in a standardized three-meal and two-snack regimen per day, adjusted to body size and sex. Intravenous insulin was adjusted every 30 min to achieve 5.5 ± 1.1 mmol/l glycemia over 24 h prehemodialysis, during hemodialysis session, and 24 h posthemodialysis in 10 type 2 diabetic patients, aged 55.7 ± 8.7 years with 11.9 ± 4.5 years diabetes duration, undergoing maintenance hemodialysis for 2.3 ± 2.3 years. Insulin requirements were derived from the dose of insulin administered to maintain euglycemia per period of time and day-to-day comparisons performed. RESULTS -- Mean capillary glycemia was 5.5 ± 0.3 mmol/l prehemodialysis and 5.3 ± 0.2 mmol/l posthemodialysis (P = 0.39). Pre- and posthemodialysis areas under the glucose curve were comparable. This was achieved by infusing 23.6 ± 7.7 IU/24 h prehemodialysis vs. 19.9 ± 4.9 IU/24 h posthemodialysis, indicating a 15.3% decrease posthemodialysis (P = 0.09). Basal insulin needs decreased from 0.4 ± 0.1/h prehemodialysis to 0.3 ± 0.1/h posthemodialysis (P = 0.01). Total boluses were decreased by 2.2 ± 3.1 IU (P =0.15). Changes in blood urea did not correlate with changes in insulin needs (r = 0.1, P = 0.79). CONCLUSIONS--The present study has demonstrated a significant 25% reduction in basal insulin requirements the day after dialysis compared with the day before. No significant change in boluses was observed, and overall the reduction of total insulin requirements was -15% equivalent to -4 IU/day posthemodialysis of marginal statistical significance. [ABSTRACT FROM AUTHOR]