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Hosp Pract (1995). 2020 Mar 20. doi: 10.1080/21548331.2020.1745509. [Epub ahead of print]

Ongoing and planned activities to improve the management of patients with Type 1 diabetes across Africa; implications for the future.

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Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, United Kingdom.
Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Health Economics Centre, University of Liverpool Management School, Liverpool, UK.
Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Steve Biko Road Prinshof 349-Jr, Pretoria, 0002 South Africa.
National Department of Health, Pretoria, South Africa.
School of Pharmacy, Postgraduate Program in Medicines and Pharmaceutical Services, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
Departamento de Gestão e Incorporação de Tecnologias e Inovação em Saúde, Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde, Ministry of Health of Brazil, Esplanada dos Ministérios, Bloco G, Brasília, Distrito Federal, Brazil.
Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
Faculty of Medicine, Department of Internal Medicine, University of Botswana and Department of Medicine, Princess Marina Hospital, Gaborone, Botswana.
Department of Pharmacy, Central Medical Stores, Gaborone, Botswana.
Botswana Essential Drugs Action Program, Ministry of Health and Wellness, Nelson Mandela Drive, Gaborone, Botswana.
Effective Basic Services (eBASE) Africa, Ndamukong Street, Bamenda, Cameroon, Africa.
Adelaide University, Adelaide, Australia.
Department of Public Health, University of Bamenda, P.O. Box 39, Bambili, Cameroon.
Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana.
Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, P.O Box 19676-00202, Nairobi, Kenya.
Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia.
Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria.
Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria.
Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.
Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.
Department of Health, Tshilidzini Hospital, Shayandima, Limpopo Province, South Africa.
Charlotte Maxeke Medical Research Cluster, Johannesburg, South Africa.
National Medicines Board, Federal Ministry of Health, Khartoum, Sudan.
Unaizah College of Pharmacy, Qassim University, Buraidah, Saudi Arabia.
Eswatini Medical Christian University, P.O Box A624, Swazi Plaza, Mbabane, Kingdom of Eswatini.
Raleigh Fitkin Memorial Hospital, Manzini, Kingdom of Eswatini.
Department of Pharmacy, University of Zambia, Lusaka, Zambia.
Department Of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
Independent Health Systems Consultant, Harare, Zimbabwe.
Independent consumer advocate, 11a Lydia Street, Brunswick, Victoria 3056, Australia.
Liverpool Reviews and Implementation Group, Whelan Building, University of Liverpool, Liverpool, UK L69 3GB.
Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq.
NHS Lothian Director of Pharmacy, NHS Lothian, Edinburgh, UK.
Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, M13 9PL, UK.
NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK.


Background: Currently about 19 million people in Africa are known to be living with diabetes, mainly Type 2 diabetes (T2DM) (95%), estimated to grow to 47 million people by 2045. However, there are concerns with early diagnosis of patients with Type 1 diabetes (T1DM) as often patients present late with complications. There are also challenges with access and affordability of insulin, monitoring equipment and test strips with typically high patient co-payments, which can be catastrophic for families. These challenges negatively impact on the quality of care of patients with T1DM increasing morbidity and mortality. There are also issues of patient education and psychosocial support adversely affecting patients' quality of life. These challenges need to be debated and potential future activities discussed to improve the future care of patients with T1DM across Africa. Methodology: Documentation of the current situation across Africa for patients with T1DM including the epidemiology, economics, and available treatments within public healthcare systems as well as ongoing activities to improve their future care. Subsequently, provide guidance to all key stakeholder groups going forward utilising input from senior level government, academic and other professionals from across Africa. Results: Whilst prevalence rates for T1DM are considerably lower than T2DM, there are concerns with late diagnosis as well as the routine provision of insulin and monitoring equipment across Africa. High patient co-payments exacerbate the situation. However, there are ongoing developments to address the multiple challenges including the instigation of universal health care and partnerships with non-governmental organisations, patient organisations and pharmaceutical companies. Their impact though remains to be seen. A range of activities have been documented for all key stakeholder groups to improve future care. Conclusion: There are concerns with the management of patients with T1DM across Africa. A number of activities have been suggested to address this and will be monitored.

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