Physician:MY youngest diabetic patient is a three-year-old child

A diabetologist at the AB Specialist Hospital, Lagos, Dr. Akinniyi Akinmokun, says access to comprehensive care could prevent complications and deaths among patients with type 1 diabetes. Stating that his youngest diabetic patient is a three-year-old child, Akinmokun said interventions such as blood glucose control, access to insulin, and dietary monitoring are cost-saving. Experts say the exact cause of type 1 diabetes is unknown. But in most people with type 1 diabetes, the body’s immune system — which normally fights harmful bacteria and viruses — mistakenly destroys insulin-producing (islet) cells in the pancreas. They note that genetics and environmental factors appear to play a role in this process. “Once the islet cells of the pancreas are destroyed, the child produces little or no insulin, which performs the critical job of moving sugar (glucose) from the bloodstream to the body’s cells. With a diabetic, sugar enters the bloodstream when food is digested. Without enough insulin, sugar builds up in the bloodstream, where it can cause life-threatening complications if left untreated,” experts enthuse. Physicians say risk factors for type 1 diabetes in children include family history, genetics, race and exposure to various viruses, which may trigger the autoimmune destruction of the islet cells.

Speaking in an interview with UGAMATV HealthWise, Akinmokun said, “Like any other illness, if you manage type 1 diabetes very well, the possibility of getting complications and people dying from it are removed. “Type 1 diabetes particularly needs attention because you have it in young people. The youngest patient I have attended to in my clinic was a three-year-old child “You can understand that for a three-year-old to require injection and dietary monitoring, that will go a long way in preventing early complications and once they get the attention they require, you can prevent death in such patients.” He said the prominent risk factor for type 1 diabetes is genetics. According to an article published in the peer-reviewed Lancet journal titled, ‘Turning evidence into action on diabetes,’ the global burden of diabetes is staggering, as it is estimated that 463 million adults were living with diabetes and 4·2 million died as a result of the condition and its complications in 2019.

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1·1 million children and adolescents were thought to have type 1 diabetes. Crucially, the world is not on track to achieve Sustainable Development Goal 3 (4) — to reduce premature mortality from four major non-communicable diseases by a third. “The Non Communicable Disease Countdown found that meeting this target will require steep declines in diabetes-related mortality in many countries,” it noted. Akinmokun, however, attributed the seemingly high prevalence of type 1 diabetes to “better access to diagnosis, access glucose meter, a high index of suspicion in medical practice, the high chances of getting tested and that is why the rate of discovery is higher.” The Commission published by the Lancet on diabetes calls for a transformation of societies and health systems to close gaps in diabetes prevention, care, professional knowledge, and data. The Commission recognised that the diabetes epidemic is driven by an interwoven set of structural factors including poverty, inequality, aging, poor nutrition, food insecurity, low educational attainment, and environmental pollution.

“Effective interventions exist for reducing morbidity and mortality from diabetes, but the Commission found that their use is scarce in most care settings. “Barriers to provision and access are compounded by the often fragmented care pathways for the complex and multiple health needs of many people with diabetes. “This is especially true in low-income and middle-income countries, where around 80 people of people with diabetes live,” it said. The Modelling done by the Commission found that in the ten low-income and middle-income countries with the largest populations of people with diabetes, up to 800,000 premature deaths could be averted by improving diabetes diagnosis, support for management of cardiometabolic risk factors, and access to essential medicines. “Likewise, comprehensive care for type 1 diabetes — including insulin access, patient education, and blood glucose monitoring — could prevent 12,000 deaths each year in people younger than 25 years. “Using China as a case study, the Commission further estimated that pursuing a prevention strategy to improve integrated care, increase health literacy, reduce social disparities, and create a smoke-free environment that promotes healthy eating and physical activity could lead to 44 million fewer cases of diabetes and 67 million fewer cardiovascular events over 20 years,” the journal submitted. According to the World Health Organisation, type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin. “Neither the cause of Type 1 diabetes nor the means to prevent it are known. Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes, and fatigue. These symptoms may occur suddenly,” WHO said. The world health body noted that diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication, and regular screening and treatment for complications.

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