Letters to the Editor

of this population, 95%[2] have type 2 diabetes. In front of this huge pandemic, problems faced by children with type 1 diabetes are often overlooked. To address the critical gap in the management of type 1 diabetes in India, the Changing Diabetes in Children (CDiC) program was launched by Novo Nordisk Education Foundation in September 2011. The objective of the program is giving children, who are below the poverty line, access to comprehensive diabetes care.

and knowledge gained in coping with this chronic disease in children with other healthcare professionals. The current phase of this program will continue up to December 2014.

The changing diabetes in the children program is operational in nine countries in the world, which includes Bangladesh, Cameroon, Democratic Republic of the Congo (DRC), Guinea, Tanzania, Ethiopia, Kenya, and Uganda. Until now, 4026 children have been enlisted in this program in India and over 10,000 children across the nine countries. To reach out to every corner of our country, there are 21 centers across India. Additionally, there are 25 satellite centers which are attached to these main centers, which serve the purpose of penetration into the smaller towns to reach out to those children with type 1 diabetes who cannot come to the main centers on a regular basis. Each child with type 1 diabetes participating in this program is provided comprehensive diabetes care, which includes free insulin and syringes, glucometer, test strips, diagnostic tests, namely, HbA1c, CBC, microalbuminuria, and fundus.


Insulin is no doubt the lifeline for these children with type 1 diabetes, but it cannot be managed only by taking insulin, it is very important that the children also learn more about the disorder and its management since it has to be managed 24 × 7. Hence, so far more than 200 patient education camps have been held in partnership with the CDIC centers to help children manage their diabetes and live better. Each camp has three components, namely, diabetes education, experience sharing, and fun activities. In addition, several innovative child friendly patient education tools, which include toys to teach basics of diabetes and comic books on diabetes education, have been created to help them understand how to self-manage their diabetes. Apart from the primary objectives of improving access to proper medication, monitoring, diagnostics, consulting, and patient education, the CDiC program also incorporates other elements of diabetes management. This includes training of healthcare professionals (HCPs) to enhance their capabilities in diagnosis and treatment of children with type 1 diabetes and setting up of a registry for children from poor families with type 1 diabetes. So far, more than 1500 HCP s including diabetes educators have been trained. A training manual prepared by ISPAD on Diabetes Management in children and the adolescents has been distributed to more than 1700 HCPs. The CDiC program also envisages sharing best practices

Kanakatte Mylariah Prasanna Kumar Consultant Endocrinologist, Bangalore Diabetes Hospital, India Address for correspondence: Dr. KM Prasanna Kumar, Bangalore Diabetes Hospital, 16/M, Miller Tank Bed Area, Thimmaiah Road, Vasanth Nagar, Bangalore - 560 002, India. E-mail: [email protected]

1. 2.

Available from: http://www.idf.org/diabetesatlas/5e/south-east-asia. Last accessed on 2013 Aug 07. Available from: http://www.apiindia.org/medicine_update_2013/ chap40.pdf. Last accessed on 2013 Aug 07. Access this article online Quick Response Code: Website: www.ijem.in DOI: 10.4103/2230-8210.126591

Depression and type 2 diabetes in developed and developing countries Sir, Diabetes patients are more exposed to depression. This association might yield higher rates of mortality, morbidity and costs of health-care. [1] The world evaluation of depression prevalence in diabetes patients seems to vary according to the prosperity and health-care system of each country.[2] Hence, what are the factors of impact on the gap of depression rate within type 2 diabetes (T2D) in developing and developed countries? What are the care possibilities to reduce the depression rate in developing countries compared with developed countries? To answer this question, we achieved a transversal study in the University Hospital of Fez, Morocco. The study included 142 T2D patients. The average age of patients was 56.68-year-old, without significant difference in gender ration. The depression

Indian Journal of Endocrinology and Metabolism / Jan-Feb 2014 / Vol 18 | Issue 1


Letters to the Editor

prevalence in our patients was 33.1%. Factors connected to the depression of MoroccanT2D are summarized in Table 1. The prevalence of T2D was significantly higher compared with the general population. It varies between 12% and 44%. Indeed, the prevalence of T2D is lower in western countries; it is elevated in developing countries.[3,4] The literature review revealed that depression of T2D patients is mostly associated to unchangeable factors such as the duration of evolution and arterial hypertension, which are common factors in developed and developing countries.[3]

Salma Bensbaa, Chadya Araab1,2, Saïd Boujraf2,3, Farida Ajdi Departments of Endocrinology, Diabetology and Nutrition, and 1 Psychiatry, University Hospital of Fez, 2Clinical Neuroscience Laboratory, 3Department of Biophysics and Clinical MRI Methods, Faculty of Medicine, University of Fez, Morocco Corresponding Author: Saïd Boujraf, Clinical Neuroscience Laboratory, Department of Biophysics and Clinical MRI Methods, Faculty of Medicine, University of Fez, Morocco. E-mail: [email protected]



Besides, depression of T2D patients is strongly connected the low educational level of patients, a lack of social security. These two factors are dominant in developing countries.[5]


Indeed, in developing countries factors such as lack of social, lower educational level, strong poverty level and resources and financial difficulties constitute the economical outline of stress responsible for insecurity feeling toward chronic disease such T2D.


Furthermore, the health-care of T2D patients might require referencing the patients to specialist that might be involved including psychiatrists, which are not available geographically within joint distance for many patients. Therefore, we do consider the challenge of treatment approach of T2D patients. It is necessary to integrate diabetes within a framework of biopsychosocial and political approach. We suggest integrating T2D patient in coordinated multidisciplinary strategy of health-care. This should include a health-care staff sensitive to the screening and managing the psychological state T2D patients and risk factors of the depression. This could be achieved through improving the general life condition including eradicating illiteracy and generalizing the social security for forward improvement of access to health-care. Table 1: Risk factors related to depression in Moroccan T2D patients Risk Low Lack of Duration Presence factors of educational social of evolving of high depression level security diabetes longer blood in T2D than 5 years pressure P value





Threshold of significant result: P

Depression and type 2 diabetes in developed and developing countries.

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