Type 1 diabetes in Laos, 2016-2021

Abstract

Objective: Before 2016, no child was known to survive type 1 diabetes (T1D) in Laos, a lower-middle income country (LMIC) in South-east Asia. In partnership with the Laos government, a non-government organization (NGO) called Action4Diabetes (A4D) has since been providing insulin, blood glucose monitoring kits, HbA1c testing, and emergency hospital expenses for Laotian children and young people (CYP) with T1D, and education for healthcare professionals. Here, we report the demographics and clinical outcomes of the CYP with T1D enrolled in A4D's Clinic Support Programme.

Research design and methods: We collated and analyzed data on all known CYP with T1D in Laos, including gender, age and presentation at diagnosis, duration of diabetes, hospital admissions, and glycemic control during follow-up.

Results: Fifty-three CYP (30 male; 57%) were diagnosed with T1D at a mean age of 11.3 years. Thirty CYP (57%) presented in diabetic ketoacidosis (DKA) at diagnosis. As at 16 August 2021, mean duration of T1D was 2.3 years. Forty-five CYP (85%) remained on active follow-up. Mean HbA1c for all 53 CYP was 8.7% (72 mmol/mol). Average HbA1c for the CYP in the age ranges of 1-5 years, 6-10 years, 11-15 years, 16-20 years, and 21-25 years, was 7.9% (63 mmol/mol), 8.2% (66), 8.4% (68), 9.4% (79), and 8.4% (68), respectively.

Conclusions: This is the first report on the status of T1D care in Laos, achieved through close partnership between the government and an NGO from 2016 to 2021. More global efforts to improve T1D care outcomes in Laos and other LMICs are urgently needed.

Keywords: Laos; lower-middle income country; non-government organization; type 1 diabetes.

FIGURE 1

Patients with diabetes enrolled in the A4D programme in Laos, 2016–2021. Flow diagram showing all the patients who have been enrolled into the A4D programme between February 2016 and March 2021

FIGURE 2

Geographical distribution of patients with diabetes enrolled in the A4D programme in Laos, 2016–2021. Map showing the number of patients with diabetes enrolled into A4D to‐date in each of the 17 provinces of Laos as well as the Vientiene Capital City prefecture which has the largest number of patients enrolled so far. Where applicable, the number of patients who are lost to follow‐up is denoted in (*) and those who have deceased are denoted as (**). All the patients were clinically diagnosed to have type 1 diabetes, except for two patients who were diagnosed at 6 months or younger and are presumed to have neonatal diabetes; one of them is denoted as (1ⁿ) and the other one has died (1ⁿ**)