Type 1 diabetes care delivery in Yaoundé, Cameroon: Social and political representations

Background: Increasing chronic diseases challenges the health systems of low- and middleincome countries, including Cameroon. Type 1 diabetes (T1D), among the most common chronic diseases in children, poses particular care delivery challenges. Aim: We examined social representations of patients' roles and implementation of T1D care among political decision-makers, healthcare providers and patients within families. Setting: The study was conducted in Yaoundé, Cameroon. Methods: Eighty-two individuals were included in the study. The authors conducted semistructured interviews with policy makers (n = 5), healthcare professionals (n = 7) and patients 'parents (n = 20). Questionnaires were administered to paediatric patients with T1D (n = 50). The authors also observed care delivery at a referral hospital and at a T1D-focused nongovernmental organisation over 15 days. Data were analysed using thematic content analysis and descriptive statistics. Results: Cameroonian health policy portrays patients with T1D as passive recipients of care. While many practitioners recognised the complex social and economic determinants of adherence to T1D care, in practice interactions focused on specific biomedical issues and offered brief guidance. Cultural barriers and policy implementation challenges prevent patients and their families from being fully active participants in care. Parents and children prefer an ongoing relationship with a single clinician and interactions with other patients and families. Conclusion: Patients and families mobilise experience and lay knowledge to complement biomedical knowledge, but top-down policy and clinical practice limit their active engagement in T1D care. Contribution: Children with T1D and their families, policy makers, healthcare professionals, and civil society have new opportunities to contribute to person-centred care, as advocated by the Sustainable Development Goals.

Assessment of clinical profiles, and treatment outcomes for children with diabetic ketoacidosis, in two hospitals selected from Addis Ababa, Ethiopia, 2020

Type 1 diabetes mellitus(T1DM)is a common autoimmune disorder that often presents in children. In these patients, diabetic ketoacidosis(DKA)is one of the most common and serious acute complications, which isassociated with significant morbidity and mortality. The study aimed to assess the clinical profilesand outcomesof children admitted with DKA.Objective:To assess the clinical manifestationsand treatment outcomesof DKA patients in two tertiary hospitals in Addis Ababa. Methods: A hospital-based retrospective analysis was conductedon175 pediatric diabetic ketoacidosis children, who wereadmitted to the emergency units of two hospitalsin Addis Ababafrom September 2015 to February 2020andwhose medical records contained complete pertinent data. Patients were between theages of0 to 12 years.Proportional samples were taken from each hospitaland data wascollected retrospectively using a formatted checklist. The data waschecked for its inclusiveness and enteredEpi Info. version4.6 andthen transferred into SPSS version 25 software for further analysis. Result:DKA was the presenting manifestation of Diabetes in 78.3% of patients and 21.7% were already known cases of Diabetes. Half (50.9%) of the study participants were diagnosed with DKA in the age range of 5 to 10 years and almost one-third (30.9%) were abovethe age of 10. A high-incomelevel of the caretakers wasfound to be protective against DKA during thediagnosis of T1DM. Out of the 175 children admitted, 12 passed on, resulting ina mortality rate of 6.9%.Conclusion: The majority of the known DM patients presented with DKA after the omission of insulin and a newly diagnosed T1DMat first presentation.The age of presentation and clinical symptoms of the studied participantswere likeother international studies. Community education regardingthe signs and symptoms of childhood DM can further prevent the development of DKA.[Ethiop. J. Health Dev. 2022; 36(2):000-000]Keywords: Diabetic ketoacidosis, Treatment outcome, and precipitating factors

Evaluation de la fréquence de la consommation journalière des aliments des diabétiques de type 1 et leurs fratries du district d'Abidjan, Côte d'Ivoire / Evaluation of the frequency of daily food consumption of Type 1 diabetes and their siblings in the district of Abidjan, Cote D'ivoire

Contexte. L'alimentation joue un rôle important dans la prise en charge du diabète en Côte D'Ivoire. L'objectif de ce travail est d'évaluer la fréquence de consommation journalière des aliments chez les diabétiques de type 1 (DT1) et leurs fratries du district d'Abidjan. Méthodes. Une fi che d'enquête comportant les mets Ivoiriens a été utilisée pour la réalisation de l'étude. Etaient eligibles les patients déclarés diabétiques et ayant au moins un frère ou une sœur non diabétique âgé de 5 à 21 ans. Les patients séropositifs au VIH et sous traitement antirétroviral n'ont pas été retenu dans l'étude. le logiciel Graphpad Prism version 5. Résultats. Le riz, l'attiéké et le pain de boulangerie ont été les aliments les plus consommés par les DT1 et leurs fratries (100 %). Au niveau des protéines animales, ce sont la viande dans la sauce, la viande fumée, le poisson dans la sauce et le poisson fumé qui ont été le plus consommés chez les DT1 et leurs fratries (63,15 % et 86,66 %; 68,42 % et 73,33 %; 68,42 % et 66,66 %; 68,42 % et 76,66 %). Les DT1 et leurs fratries ont consommé comme lipides, les huiles alimentaires et la sauce graine. Conclusion. Le régime alimentaire des DT1 et leurs fratries est équilibré, avec un régime plus ouvert chez la fratrie

Context. Diet plays an important role in the management of diabetes in Côte d'Ivoire. The objective of this work is to evaluate the frequency of daily food consumption in type 1 diabetics (T1D) and their siblings in the district of Abidjan. Methods. A survey sheet including Ivorian dishes was used to carry out the study. Results. Rice, attiéké and bakery bread were the foods most consumed by T1Ds and their siblings (100%). At level of animal protein, meat in sauce, smoked meat, fi sh in sauce and smoked fi sh were the most consumed among T1D and their siblings (63.15% and 86.66% ; 68.42% and 73.33% ; 68.42% and 66.66% ; 68.42% and 76.66%). T1Ds and their siblings consumed lipids, edible oils and seed sauce. Conclusion. the diet of T1D and their siblings is balanced, with a more open diet in the siblings.

Carbohydrate counting in type 1 diabetes mellitus: dietitians' perceptions, training and barriers to use

Objectives A study was undertaken to determine the perceptions, training and barriers regarding the use of carbohydrate counting in the dietary management of type 1 diabetes mellitus (T1DM) among dietitians in KwaZulu-Natal (KZN). Design A cross-sectional, descriptive study was conducted. Setting Dietitians who were registered with the Health Professions Council of South Africa (HPCSA), and working in the province of KZN at the time of the study, were invited to participate. Methods Data were collected using a self-administered electronic questionnaire distributed through SurveyMonkey, an Internet-based survey programme. Results Dietitians agreed that carbohydrate counting was a useful dietary management approach for diabetes (p < 0.05) and that it was essential to manage T1DM (p < 0.05). However, they felt it was a difficult concept for patients with T1DM to understand (p = 0.001) and teaching it to patients was time consuming (p < 0.05). Although dietitians believed that there was a strong evidence base for teaching carbohydrate counting to patients with T1DM (p < 0.05), they indicated a need for further training or education in it (p < 0.05). Barriers to using carbohydrate counting included a lack of training, confidence and experience, financial resources, time, blood glucose records and poor patient motivation and patient illiteracy (p < 0.05). Conclusions Overall, dietitians who participated in the study had a positive perception towards the use of carbohydrate counting in the management of T1DM. However, further training needs to be addressed for carbohydrate counting to be used with confidence by dietitians in KZN to optimize their management of T1DM.

COVID-19 et maladies auto-immunes dans un centre de traitement des épidémies à Dakar / COVID 19 and autoimmune diseases in an outbreak treatment center in Dakar

Introduction : Les patients présentant une affection systémique ont un risque accru d'infections. Leur prise en charge au cours de la pandémie au COVID19 constitue un défi qui doit prendre en considération plusieurs aspects. Nous rapportons les caractéristiques épidémiologiques, cliniques, et évolutives des patients COVID positifs suivis pour une maladie auto-immune (MAI). Patients et méthode : étude rétrospective, descriptive et analytique menée au centre de traitement des épidémies du centre hospitalier universitaire (CHU) Le Dantec de Dakar durant les périodes du 30 Avril au 30 Octobre 2020 puis du 30 Décembre 2020 au 30 Avril 2021. Etaient inclus tous les dossiers des patients suivis pour une maladie systémique hospitalisés pour COVID-19 confirmée à la RT-PCR. Résultats : treize patients étaient inclus dans l'étude, composés de 8 femmes et de 5 hommes. L'âge moyen était de 59 ans [16 à 74 ans]. Il s'agissait de 8 cas de maladies auto-immunes systémiques (MAIS) : polyarthrite rhumatoïde (n=3 ; 37,5%), Sjögren primitif (n=2 ; 25%), lupus systémique, dermatomyosite, arthrite à cellules géantes chacun 1 cas (12,5%) et 5 cas de maladies auto-immunes spécifiques d'organes (MASO) : maladie de Basedow (n=1 ; 20% de MASO), thyroïdite de Hashimoto (n=1 ; 20%), myasthénie (n=1 ; 20%), diabète de type 1 (n=1 ; 20%) et maladie de Biermer (n=1 ; 20%). Les formes cliniques étaient modérées (6 cas ; 46,1%), sévères (2cas ; 15,4%) et critiques (2cas ; 15,4%). Huit patients (8/13) avaient au moins une comorbidité associée. Deux décès (2/13) étaient notés. Conclusion : il n'a pas été trouvé une augmentation des complications sévères dues au COVID-19 chez les patients suivis pour une maladie auto-immune. Leur pronostic n'est pas différent de celui de la population générale.

The impact of a diabetes care team on the glycaemic control of paediatric and adolescent patients with type 1 diabetes mellitus at Tygerberg Children's Hospital

Background. A diabetes care team (DCT) may contribute to improved glycaemic control in type 1 diabetes mellitus (T1DM) patients.Hence a DCT was introduced at Tygerberg Children's Hospital (TCH) in 2009.Hypothesis. A DCT for T1DM patients improves HbA1c, reduces admission and diabetic ketoacidosis (DKA) rates and insulin dose, and decreases the prevalence of complications.Methods. In this retrospective cohort study, records of 190 T1DM patients attending the paediatric diabetic clinic at TCH between August 2004 and July 2011 were reviewed. Data extracted include: glycated haemoglobin (HbA1c) levels; total number of admissions; DKA and recurrent DKA (rDKA) admissions; insulin regimen and dose; and presence of complications. Four periods, in which specific changes to team composition occurred, were compared.Results. HbA1c levels increased from 9.0% (7.85 - 10.15) in P1 to 10.9% (9.6 - 12.2) in P2, but decreased to 9.3% (8.75 - 9.75) in P4 (p=0.02).The number of admissions decreased from 0.79 (0.46 - 1.12) to 0.18 (0.02 - 0.34) (p=0.01). The DKA rate decreased from 32.5/100 patient years to 23.5/100 patient years. The rDKA rate decreased from 18.8% in P1 to 9.6% in P4. Daily insulin injections increased from 2.97 (2.85 - 3.01)to 3.06 (3.06 - 3.23) (p=0.01). The mean insulin dose decreased from 1.19 (1.08 - 1.31) to 0.93 (0.87 - 1.00) units/kg/day (p=0.00).Conclusion. After the introduction of the DCT, HbA1c levels were less variable and hos

Incidence of hypoglycaemia in the South African population with diabetes: results from the IDMPS Wave 7 study

Objectives: Management of diabetes is a balancing act of preventing a state of hyperglycaemia while avoiding episodes of hypoglycaemia. Limited information is currently available on the incidence of hypoglycaemia in South African people diagnosed with diabetes. Data regarding the management of diabetes and incidence of hypoglycaemia in the South African population was collected as part of Wave 7 of the International Diabetes Management Practices Study (IDMPS). Design and methods: During this observational study the first 10 adult individuals with type 2 diabetes and the first five adult individuals with type 1 diabetes presenting to a study site during the two-week study period were enrolled. Setting:Patients were enrolled from the private healthcare sector in South Africa only. Subjects:A total of 445 individuals (49 diagnosed with T1D, 396 diagnosed with T2D) were included. Outcome measures:Glycated haemoglobin and hypoglycaemia data were recorded for each patient. Results:Of the patients who reported experiencing hypoglycaemia, 48.6% (17/35) among T1D individuals and 67.8% (40/71) among T2D individuals experienced hypoglycaemia over a four-week period. Furthermore, in patients who discontinued insulin treatment (n= 11), fear of hypoglycaemia was reported to influence adherence to insulin treatment by 27.3% in T1D and T2D individuals. Of the 148 patients not achieving their HbA1c target, 23.0% reported fear of hypoglycaemia as a reason. Conclusions: This report demonstrates the need to address hypoglycaemia and fear of hypoglycaemia in the South African diabetes population

Image case: celiac disease in 14 years old girl with Type 1 Diabetes Mellitus

Celiac disease is an autoimmune disease that primarily affects the small intestine. Classic symptoms in children include gastrointestinal disorders as chronic diarrhea, malabsorption and failure to grow normally. It is associated with other autoimmune diseases, such as thyroiditis and diabetes mellitus type 1 . Mild or absent gastrointestinal symptoms may be found specially in older people.Celiac disease may be presented with rare but life threatening crisis. 14 years old underbuilt anemic (iron deficiency) girl with type 1 diabetes mellitus without gastrointestinal symptoms was endoscopicaly examined for clinical suspicion of Celiac disease. On endoscopic examination there was fissurization (cracked-mud ) of the mucosa of the duodenal bulb as well as descending duodenum. Pathological examination of the endosopic biopsies confirmed the diagnosis. Upper gastrointestinal endoscopy in celiac disease usually shows scalloped (indentations and erosions) blunted duodenal mucosa, visible mucosal vessels, micronodular appearance of the mucosa and mucosal fissures(cracked-mud). Duodenal biopsy shows villous blunting with intraepithelial lymphocytosis

Pattern and outcome of Diabetic Ketoacidosis among children with Type 1 Diabetes mellitus at Ile-Ife, Nigeria

Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of Diabetes mellitus. There are few reports on the pattern and outcome of DKA in childhood diabetes in Nigeria but none on the diabetic population from Osun State, Nigeria. Objective: To determine the pattern and factors influencing the outcome of children managed for DKA at the Paediatric Endocrinology Unit of the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria, over a ten-year period. Methods: A retrospective review of the clinical records of all the children managed for Type-1 Diabetes mellitus (TIDM) over ten years (2007-2016) was done. Relevant information was obtained from the clinical records and the data were analyzed. Results: A total of 15 children with DKA comprising 8 (53.3%) males and 7 (46.7%) females were studied. The male to female ratio was 1.1:1. Twenty-eight episodes of DKA were recorded during the period, thus putting the average frequency per patient at 1.9. DKA was the first manifestation of DM in the majority (86.7%) of the subjects. The mean age at diagnosis of DM was 11.9+3.6 years with about half (53.3%) occurring during pre-adolescence. The socioeconomic status of the affected families had an inverse relationship with the frequency of DKA. Conclusion: DKA is the most common initial presentation of Type-1 DM among Nigerian children, with a high rate of recurrence and an inverse relationship with socioeconomic status

Comparative evaluation of carotid intima media thickness in paediatric type 1 diabetic children and healthy children in Ibadan and Lagos, Nigeria

Patients with type 1 diabetes are at greater risk of cardiovascular disease and atherosclerosis. Carotid in-tima­media thickness (CIMT) measured by ultrasound is a marker of atherosclerosis and can predict future cardiovascular events.The aim of this study was to measure the CIMT in paediatric type 1 diabetes patients in Ibadan and Lagos and compare results with the CIMT of non-diabetic healthy control children. Carotid ultrasound was performed and CIMT measured in 70 subjects (35 diabetic patients and 35 non-diabetic controls matched for age and sex). Mean age was 12.8±3.2 years. A slightly higher, but non-significant mean CIMT was seen in diabetic cases: mean values in type 1 diabetes patients were 0.475±0.068 and 0.476±0.069 (right and left respectively) while in controls, mean values were 0.467±0.064 and 0.468±0.054 (p=0.618 and 0.575 respectively). The CIMT in both groups correlated positively with age and body mass index (BMI). Significantly higher mean CIMT values were seen in males with type 1 diabetes on both sides. However, there was no significant correlation between CIMT and duration of illness, insulin dosage, or blood pressure. CIMT is a safe and convenient measurement, which may be helpful in predicting an increased risk of future cardiovascular disease in children with type 1 diabetes

Etude de la densité minérale osseuse et du risque de fracture chez les adultes diabétiques de type I

Introduction : L'impact du diabète de type 1 sur la masse osseuse et le risque de fracture reste un sujet de débat. Le but de ce travail est d'étudier la densité minérale osseuse et le risque de fracture au cours du diabète de type 1.Méthodes : Étude transversale cas-témoins incluant 40 patients diabétiques de type I et 40 témoins appariés selon l'âge et le sexe. Ont été exclus les sujets présentant une pathologie ou consommant un traitement pouvant être à l'origine d'une ostéoporose. La mesure de la densité minérale osseuse a été réalisée par la méthode DEXA au rachis lombaire et au col fémoral.Résultats : La densité minérale osseuse était diminuée de façon significative au rachis (p< 0,001) et au fémur (p = 0,001) chez les diabétiques de type 1 par rapport aux non diabétiques. La perte de masse osseuse chez les diabétiques était corrélée à un indice de masse corporelle plus bas (p = 0.018) ainsi qu'au déséquilibre du diabète (p= 0.012). Les fractures non traumatiques étaient plus fréquentes chez les diabétiques par rapport aux témoins (p < 0,001). Les facteurs de risque de fractures étaient les antécédents familiaux de fracture du col du fémur, l'existence d'une ostéoporose à la densitométrie, le tabagisme et l'existence d'une néphropathie. Conclusion : La perte osseuse ainsi que les fractures non traumatiques sont fréquentes au cours du diabète type I

Profil epidemiologique et clinique du diabete de type 1 chez l'enfant en milieu hospitalier dakarois

Introduction: Le diabete de type 1 (DT1) est l'une des endocrinopathies les plus frequentes chez l'enfant. L'objectif de cette etude etait de decrire les aspects epidemiologiques; cliniques et evolutifs du DT1 au Centre Hospitalier National d'Enfants Albert Royer.Patients et methodes: Il s'agissait d'une etude retrospective descriptive incluant tous les enfants ages de 0 a 15 ans hospitalises dans le service pour DT1 de 2007 a 2013. Nous avons analyse les donnees socio-demographiques; cliniques et evolutives. Resultats: Cent dix neuf (119) enfants etaient admis durant cette periode; representant une prevalence hospitaliere de 3;6 %. L'age moyen etait de 7;8 ans et le sex ratio 1;2 en faveur des garcons. L'origine etait suburbaine dans 65;9%. Le niveau socio-economique et le niveau d'education des parents etaient juges bas dans 65;9% et 63;6% respectivement. Un antecedent familial de diabete etait retrouve pour 77;3% des patients. L'acidocetose etait la circonstance de decouverte la plus frequente (86% des cas). La letalite hospitaliere etait de 6;7%. Seuls 24 patients (20;16 %) etaient regulierement suivis dans le service et 49 (41;17%) patients avaient interrompu leur suivi. Conclusion: L'augmentation croissante de la prevalence est une preoccupation de sante publique avec une implication socio-economique. Des efforts doivent etre faits pour un diagnostic precoce et un suivi de qualite. Ceci passe par la formation et le renforcement des capacites des prestataires de sante au niveau peripherique et une meilleure collaboration des differents services de prise en charge du diabete de l'enfant

The variable African diabetic phenotype: tales from the north and the south

Although most African diabetic patients are clearly phenotypically type 1 or 2, some do not easily fit into these categories. Examples are malnutrition-related diabetes mellitus (MRDM) and atypical ketosis-prone type 2 diabetes. To explore this problem we have compared two cohorts of diabetic patients from very different parts of Africa ­ rural KwazuluNatal in South Africa, and Mekelle District in northern Ethiopia. Basic demographic data were collected as well as measurements of blood pressure (BP) and glycated haemoglobin (HbA1c). South African patients were older (56±11 vs 41±16 years, p<0.001) than Ethiopian patients, and more were female (70% vs 30%, p< 0.001). Body mass index (BMI) was higher in South African patients (31.5±6.3 v 20.6±5.4, p<0.001) and 56% were obese (BMI >30.0) compared with 4% in Ethiopia (p<0.001). Hypertension (BP >140/80) affected 80% of South African patients but only 4% of the Ethiopian cohort (p<0.001). Insulin treatment was more common in the Ethiopian patients compared with South Africans (66% vs 25%, p<0.001). Duration of diabetes and HbA1c were similar in both groups. Phenotypically, 96% of the South Africans had typical type 2 diabetes, whereas only 42% of the Ethiopians had such type 2 characteristics (p<0.001). The high occurrence of apparent type 1 diabetes (42%) in the Ethiopian patients, in conjunction with their very low BMI levels and local chronic food shortages, raises the possibility as to whether at least some of this group may have MRDM

Childhood diabetes mellitus in Kano, North West, Nigeria

There is paucity of literature on childhood diabetes mellitus from developing countries and especially North west Nigeria and this has made it pertinent for documentation of the features of the disease in a major regional referral centre. The study was designed to describe the clinical presentation and outcome of childhood diabetes mellitus. Retrospective review of hospital records of paediatric patients managed for diabetes at Aminu Kano Teaching Hospital; Kano. Nigeria between January 1999 and December 2006. The age; sex; presenting features; complications; laboratory features and outcome of the patients were retrieved from the hospital records. During the years under review eleven out of 3;585 admissions were managed for Type 1 diabetes mellitus giving a prevalence rate of 3.1/1000. Male to female ratio was 1:0.6. The mean age at presentation was 10 4.5years most of the patients (72.7) belonged to the lower socio-economic classes IV and V. The duration of symptoms ranged from 6 58days with a mean of 24 22.8days. The patients presentedwith urinary tract infections (36.4); malaria (27.3) and recurrent boils (18.2). Three (27.3) of the patients had polyuria and polydypsia while only one (91) patient had polyphagia and weight loss. The mean random blood glucose on admission was 28.5 7.9mmo/L (16.9 39.2mmo/L) Four patient presented with diabetic Keloacidosis. Two patients (18.2) were discharged against medical advice while 1(9.1) patient died. Childhood Diabetes Mellitus; remains relatively uncommon in Nigeria

Le diabete sucre en Afrique subsaharienne. Aspects epidemiologiques; difficultes de prise en charge

Contrairement a une vieille opinion considerant le diabete sucre comme une maladie des pays riches; cette affection constitue de plus en plus une preoccupation majeure dans les pays en developpement et particulierement en Afrique subsaharienne. On note une croissance galopante de sa prevalence alors que parallelement les structures sanitaires n'ont pas connu un developpement adapte. L'OMS prevoit une croissance mondiale de la prevalence du diabete; qui devrait atteindre 300 millions de malades en 2025. Cette evolution est plus nette dans les pays en developpement; et particulierement en Afrique subsaharienne. Dans ces pays; cette expansion s'inscrit dans une veritable transition epidemiologique des maladies transmissibles vers les maladies non transmissibles. Ce phenomene reconnait plusieurs causes dont le vieillissement de la population; la seden- tarite et l'obesite. En dehors de l'obesite; l'hypertension arterielle est le principal facteur de risque cardio-vasculaire associe au diabete. Seul ou associe aux autres facteurs de risque; le diabete sucre est responsable d'une lourde morbidite notamment cardio-vasculaire et renale. La prise en charge connait de nombreuses difficultes : une meconnaissance de l'ampleur du probleme; le cout desmedicaments; un contexte socio-economique peu propice au regime diabetique; des infrastructures et du personnel sani- taires insuffisants. La croissance rapide de la prevalence du diabete sucre enAfrique subsaharienne constitue une menace. Il est urgent de proceder a une evaluation chiffree de la pandemie diabetique; permettant la formation en nombre consequent de personnels sanitaires qualifies; et l'acquisition d'un equipement suffisant pour une prise en charge decentralisee. Ces conditions appellent la sensibilisation et la participation de tous les acteurs intervenant dans la sante publique

Double diabetes: an emerging disease in children and young adults

Background: Studies in most countries have shown an increasing incidence of diabetes mellitus in children and young adults. Double diabetes is a newly recognized problem in children with different diagnostic and therapeutic measures. Methods: A review of over 30 literature obtained from Google; PUBMED search and journal publications on ""double diabetes"" was done to determine the incidence; pathophysiology; pathogenesis; diagnostic criteria; treatment and prevention of double diabetes in children and young adults. Results: Most of the reports on double diabetes were from western countries and Asia. Type 1 diabetes resulting from antibodies to the insulin-producing pancreatic beta cell was more prevalent in children. However; with increasing obesity the incidence of type 2 diabetes resulting from insulin resistance was high in children and young adults. Most patients with double diabetes were established type 1 diabetics; who while on insulin and on hypercaloric diet developed obesity especially during puberty and hence associated type 2 diabetes. The incidence was more in black than in white children. They presented with some clinical and laboratory features of both types 1 and 2 diabetes. Some authors advocated treatment with both insulin and oral hypoglycaemic drugs mainly metformin to improve insulin sensitivity. Prevention of childhood obesity by encouraging physical activities and dietary control would prevent double diabetes. Conclusion: Double diabetes is increasing in children and young adults. A high index of suspicion is required in obese children with diabetes