Diabetes in Children and Adolescents: Basic Training for Healthcare Professionals in Developing Countries∗∗Based on the Changing Diabetes in Children (CDiC) Sub-Saharan African collaborative initiative of NovoNordisk, Roche Diagnostics and ISPAD

Type 1 diabetes mellitus is the most common of all the pediatric and adolescent endocrine disorders despite its overall relative rarity in the developing world where infectious diseases and malnutrition are rampant. Diabetes is often not even considered so death at diagnosis occurs in more than 90% of youngsters all too often. Diabetes symptoms can be subtle, masquerade or co-exist with HIV/AIDS and many other overwhelming infections such as (cerebral) malaria, gastroenteritis, parasitic infestation and sepsis. When health care professionals and even parents are aware of symptoms such as dehydration with concomitant enuresis or excess urination, or even simpler questions such as ants at the site of urination, then training to question the possibility of diabetes allows appropriate confirmation, insulin and fluid management and recognition of diabetic ketoacidosis. Once diagnosed, costs of insulin as well as blood glucose testing can be overwhelming but new initiatives by ISPAD working with pharmaceutical and medical industry initiatives as well as health ministries and private donations can raise awareness, offer education for health care workers, general physicians and pediatricians and drastically cut DKA rates. Earlier diagnosis means less morbidity and mortality and lower health care costs. Ongoing treatment strategies, group education and support for health profesionals as well as patients and their families all work together successfully to improve diabetes diagnosis and ongoing care incrementally as outlined in this chapter.