As pediatric endocrinologists, we know that with appropriate medical care and access to medications, technology, education, and support, the children we care for with diabetes can thrive and live productive, healthy lives. But this is not the case for thousands of children around the world. In many developing countries, children succumb to the ravages of diabetes because they do not have access to these basic components of care. For example, in Mali, children live, on average, 12 months after they are diagnosed. Worldwide, many children do not even receive insulin. To combat this, the International Diabetes Federation (IDF) has established the “Life for a Child” program, which provides insulin, clinical care, glucose testing equipment, and education to about 1000 children and families in Rwanda, the Congo, Tanzania, Nigeria, Bolivia, Fiji, Papua New Guinea, Philippines, India, Sri Lanka, Nepal, Uzbekistan, Mail, Zimbabwe, and Azerbaijan. The IDF is working to double the size and scope of this program over the next year by asking health care providers to mobilize the diabetes community in support of Life for A Child (www.lifeforachild.org)
Delayed diagnosis due to a low level of awareness of the symptoms of diabetes, especially in young children, occurs in all countries. The diabetic ketoacidosis (DKA) rates at onset of diabetes in the US are high, 25-40%. It is difficult to recognize increased thirst and urination in children in diapers, nursing, or drinking from bottles. Delay in diagnosis often results in DKA, and children can become comatose or die before diabetes is treated. The IDF and the International Society for the Study of Diabetes in Adolescence and Pediatrics (ISPAD) are launching a worldwide campaign to reduce the incidence of DKA at diagnosis. The impetus for this is the successful campaign that was conducted in Parma, Italy from 1991 to 1998 (Vanelli M, et al. Diabetes Care 1999;22:7-9). Pamphlets and posters about the signs and symptoms of this disease were placed in schools, child care centers, and pediatricians' offices. As a result, the DKA rate dropped from 78% to 12.5%. A tool box that contains materials to be used with the media and in public venues to raise awareness is available at www.worlddiabetesday.org/dka. Health care providers and the general public are being asked to do what they can to make the world aware that children contract this disease.
The diabetes pandemic affects over 246 million people worldwide. Within 10 years, this number is expected to grow to 380 million. The global incidence of type 1 diabetes in youth has been increasing at a rate of 3% a year (www.eatlas.idf.org, EURODIAB ACE Study Group. Lancet 2000;355:873-6). An estimated 65 000 children under 15 years of age develop type 1 diabetes each year. Type 2 diabetes is also increasing at an alarming rate due to the global increase in childhood obesity.
On World Diabetes Day, November 14, 2008, the IDF will focus the world on a simple message—No Child Should Die of Diabetes. By raising awareness about the plight of children, their susceptibility to DKA, and the Life for a Child program, World Diabetes Day 2008 gives us the chance to demand that children have early detection of diabetes, improved access to and delivery of care, sufficient diabetes supplies, medications and technology, and better self-management education and training. If this can be accomplished, this generation of children burdened with diabetes, and those that follow, will grow to be healthy members of the world community.
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