Care for children with diabetes

The discovery of insulin 87 years ago was hailed as a miracle. It was arguably the first example of a medicine that was both life-saving and life-sustaining. Overnight lives were transformed and a new era of optimism was hailed for all people living with diabetes. The impact of the discovery was electric and in less than two years the 1923 Nobel Prize in Medicine and Physiology was awarded to Researcher Frederick Banting and his supervisor Professor John MacLeod.

The legacy of the former continues to this day. World Diabetes Day is celebrated every year on 14 November to mark the birthday of Banting who, along with his research assistant Charles Best, is widely credited with the discovery of insulin.

Over the years, this miracle drug has saved countless lives. Today, the added benefits brought by modern types of insulin, delivery systems, glucose monitoring and diabetes education, mean that the prospects for children with Type-1 diabetes in the developed world have never been brighter. Regretfully for many, this is where the good news ends. The outlook for children with Type-1 diabetes in the developing world remains poor. Many die without being diagnosed or suffer severe complications leading to an early but avoidable death.

What is diabetes?

• Type-1 diabetes occurs when the body produces no or insufficient insulin. This form of diabetes cannot be prevented and daily insulin shots are required to survive. Worldwide over 500,000 children under age 15 live with Type-1 diabetes. India alone has over 92,000 of these children.
• Type-2 diabetes occurs when the body is unable to use the insulin it produces effectively. In many cases [not all], it is possible to prevent Type-2 diabetes through diet and exercise. Type-2 diabetes is increasing among children because of sedentary lifestyles.

The most common long-term complications of diabetes are:

• Diabetic nephropathy [kidney disease], which may result in total kidney failure and in the need for dialysis or kidney transplant.
• Diabetic eye disease [retinopathy and macular oedema], damage to the retina of the eye which can lead to vision loss.
• Diabetic neuropathy [nerve disease], which can ultimately lead to ulceration and amputation of the feet and lower limbs.
• Cardiovascular disease, which affects the heart and blood vessels and may cause fatal complications such as coronary heart disease [leading to a heart attack] and stroke.

Diabetes is the fourth leading cause of death by disease globally. Every year, more than three million people die from diabetes-related causes.

A time for change

Almost a century has passed since the discovery of insulin and almost 80 years have passed since Banting, serving as wartime liaison officer between the British and North American medical services, was killed in an air disaster. With so much time having passed, it seems unthinkable that such an essential medicine is unavailable or unaffordable for our most vulnerable citizens. It is not that solutions don’t exist, they do. Answers are now available to address the issues of affordability and accessibility. The means exist to strengthen healthcare systems and provide the necessary diabetes education of both the healthcare professionals and the families of those affected by diabetes.

It is time for the organisations that can provide the interim humanitarian solutions to get on board and for key diabetes stakeholders to lay the groundwork for sustainable solutions that will benefit people with diabetes. The solutions, of course, will be more complex than simply ensuring accessibility to affordable diabetes medicines, syringes and monitoring. Country-specific solutions will be needed to address supply-chain systems, the coordination of corporate social responsibility programmes, the training of local healthcare professionals and the integration of diabetes support programmes into existing healthcare systems.

The International Diabetes Federation [IDF] is leading the way by highlighting the plight of children with diabetes in the developing world, driving awareness campaigns to educate public and bringing together those in a position to make a difference.

According to IDF figures, there are about 75,000 children worldwide living with Type-1 diabetes in desperate circumstances. The IDF supports a tiny number – 1000 children and young adults in 17 countries – through its “Life for a Child Program”. The Federation is hoping to increase this number to 10,000 in a relatively short time frame.

Become an agent of change

Every parent, school teacher, school nurse, doctor and anyone involved in the care of children should be familiar with the warning signs and alert to the diabetes threat. Children who are not diagnosed or misdiagnosed can die from DKA [diabetic coma].

Access to medicine is particularly critical to children already living with diabetes in countries like India. You can help by supporting charities like the “Life for a Child Program” that support children with diabetes. While donations to charity are well needed, an even greater need is for governments to take responsibility in providing sustainable care for children with diabetes.

The United Nations Resolution on diabetes asks all governments to “develop national policies for the prevention, treatment and care of diabetes in line with the sustainable development of their health-care systems, taking into account the internationally agreed development goals, including the Millennium Development Goals.”

We need to make sure that governments take action. You can lobby your government by writing letters and contacting politicians and government officials to find out how they are implementing the Resolution and developing programmes to care for people with diabetes. You can participate in activities to raise awareness of diabetes-issues and become an agent of change. With the help of committed organisations and individuals worldwide, the IDF wants to make access to appropriate medication and care the right of every child with diabetes and a privilege resulting from the geographic accident of birth.

History owes a debt to the pioneers of diabetes research. Surely it is time for the results of their ground-breaking research, carried out so long ago, to benefit every child with diabetes.