Recent ISPAD Endorsed Events

Dates: June, 2024 for a duration of 12 months. Location: Tanzania

Allied Healthcare Diabetes Educator course for Africa (ADECA) is a new initiative sponsored by ISPAD and Life For a Child LFAC.

We are excited to announce that he 2nd ADECA course (Allied Healthcare Paediatric Diabetes Educator Course For Africa) which is sponsored by ISPAD and LFAC  started in June 2024 with 15 nurses from 9 countries (Tanzania, Kenya, Nigeria, Ghana, Cameroun, Ethiopia, Uganda, Malawi, Liberia). This is a Training the Trainers course that will last 1 year and will equip the nurses with the knowledge and skills not only to support parents, children and young people with diabetes but be able to train other members of their MDT.  The faculty is made up of both ISPAD and ASPAE (African Society for Paediatric and Adolescent Endocrinology) members.

Course Director Dr Chizo Agwu

Dates: October 5-7, 2023. Location: Abu Dhabi-United Arab Emirates

The 7th ASPED-ISPAD Diabetes Academy is an initiative by the Arab Society of Pediatric Endocrinology (ASPED) in collaboration with ISPAD and is exclusively sponsored by Abbott, Gulf, and UAE. The diabetes academy scientific committee from ISPAD included Prof. Carine De Beaufort (ISPAD Past President) and ASPED committee included Prof. Asma Deeb (ASPED President) and Prof. Nancy Elbarbary(Chair of diabetes research and diabetes guidelines committee of ASPED).

The 7th ASPED-ISPAD Diabetes Academy Report Nancy Elbarbary and Asma Deeb Diabetes Unit, Department of Pediatrics, Faculty of medicine, Ain Shams University, Cairo, Egypt Paediatric Endocrinology Department, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates

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The 7th ASPED-ISPAD Diabetes Academy is an initiative by the Arab Society of Pediatric Endocrinology (ASPED) in collaboration with International Society of Pediatric and Adolescence Diabetes (ISPAD) and is exclusively sponsored by Abbott, Gulf, and UAE. The 7th ASPED/ISPAD Diabetes academy was held on 5-7 November 2023, Sheikh Shakhbout Medical City and Radisson Blu Yas Island -Abu Dhabi - United Arab Emirates. The diabetes academy scientific committee from ISPAD included Prof. Carine De Beaufort (ISPAD former president) and ASPED committee included Prof. Asma Deeb (ASPED President) and Prof. Nancy Elbarbary(Chair of diabetes research and diabetes guidelines committee of ASPED).

The academy targets young healthcare professionals in the field of pediatric endocrinology and diabetes with a primary focus on actively supporting training and education in the region. An expert faculty panel from both ISPAD and ASPED from 16 different countries selected candidates following a competitive enrolment process, announced on each organization’s respective websites. This year 54 candidates were accepted (out of 89 applicants) from 20 countries.

The curriculum is delivered in three main formats: plenary, workshop and interactive sessions. The plenary sessions covered delaying the development of type 1 diabetes and screening of type 1 diabetes. This is together with novel therapeutic approaches and use of artificial intelligence in diabetes as well as technology in diabetes management as artificial pancreas advanced hybrid closed loop(AHCL), diabetes emergencies and controversy in DKA management , microvascular complications of diabetes, monogenic and rare types of diabetes, psychology case presentations and interactive discussion , nutrition interactive session, technology case presentation on CGM and pump therapy , obesity and type 2 diabetes in children as well as and developing a research program in diabetes and tips on good diabetes research.

Moreover, in groups workshops, the focus was on research methodology, clinical cases, psychology and technology within smaller groups, which provided a forum for candidates to present either a diabetes research project or unique presentation of a clinical case. Winners selected by the steering committee members presented in the final plenary session. These intensive 2 and half days course has consistently aimed and successfully provided a concrete educational platform for seamless exchange of clinical and scientific information. Fifty-four delegates from 16 countries participated in this 2 and half -day program that aims to increase diabetes skills and knowledge from diabetes care in the principles of diabetes research methodology in ASPED region.

ISPAD speakers presented different lectures in plenary sessions as well as moderating the small group workshops session.

ISPAD faculty presenters:

Well-rounded curriculum (reviewed and enhanced by ISPAD education committee) to include comprehensive diabetes care for children, including:

• Delaying the development of T1DM
• Management of antibody-positive stage 2 T1DM
• Updates on stem cell transplant
• Time in Tight Range (TITR) target with Hybrid closed loop
• Update on the artificial pancreas Hybrid closed loop and interpretation of CGM data
• Artificial intelligence use in diabetes
• Software use in diabetes management
• CGM real world data in ASPED regional experience
• DKA Guidelines; updates and controversy
• Microvascular complications of diabetes and its relation to time in range
• Screening for type 1 diabetes
• Obesity & type 2 diabetes treatment including pharmacotherapy, surgery and digital management of childhood obesity
• Psychology in Paediatric Diabetes
• Monogenic diabetes; an update on Diagnosis and management
• Developing a Research Program in Diabetes and tips on good diabetes research
• Technology case presentation on CGM & pump therapy
• Interactive session on nutrition management of diabetes
• Heavy emphasis on ISPAD guidelines and standardization of treatment by faculty and participants including 2022 guidelines.
• High audience engagement with faculty, interesting topics in different diabetes field

 

Graduation of 15 African Paediatric Diabetes Nurse Educators following completion of the Allied Healthcare Paediatric Diabetes Nurse Educator Course for Africa (ADECA).

Fifteen nurses from 7 Sub-Saharan African countries (Nigeria. Ghana, Tanzania, Cameroon, Malawi, Uganda, Kenya) graduated as Paediatric Diabetes Nurse Educators after attending and passing the final phase of the 1-year ADECA course in Moshi Tanzania.

The 1-year hybrid course consisted of a mixture of online E-Learning,’ In person’ clinical workshops and training in Tanzania, work-based assessments in their home countries and completion and presentation of projects related to childhood diabetes. 

There are approximately 60,000 children and young people with diabetes in Africa, glycaemic outcomes are poor for many and complication rates high. The course Director, Dr Chizo Agwu explained ‘the ADECA course was borne out of a need to contribute to improving the outcomes for these children. The nurses are already having some impact as we heard many inspiring stories of how they have been applying what they have learnt to date’. 

The course is funded by ISPAD and Life For A Child. During the graduation ceremony both the Past President of ISPAD Carine de Beaufort and current president David Maahs congratulated the nurses on completing the course and wished them well in their future endeavours.

The General Manager of Life For a Child, Graham Ogle, also wished them well and encouraged them to continue to practise all they have learnt and remain active in the field of paediatric diabetes. 

The certificates were handed out by the Dean, Faculty of Nursing, Kilimanjaro Christian Medical Centre, Dr Janeth Rogath.  Many ISPAD and ASPAE (African Society for Paediatric and Adolescent Endocrinology) members contributed to the course either in developing the curriculum, delivering lectures via Zoom, or travelling to Tanzania for the clinical workshops.

These include:

• Paediatric Diabetes Nurse Educators (Carole Gelder, Helen Phelan, Angie Middlehurst, Anna Lindholm Olinder, Lizbeth Hudson, Marian Abdi)
• Dietitians (Sandhya Narayanan, Francesca Annam, John Pemberton, Esther Kerina)
• Psychologist (Dominic Bray),
• Persons with Diabetes including members of Tanzania Diabetes Youth Association,
• Paediatric Endocrinologists (Kandi Muze, Chizo Agwu, Debra Cohen, Joyce Mbogo, Emmanuel Ameyaw, Julia Von Oettinger).

In addition, all the nurses were supported by their local mentors (Paediatric Endocrinologists) who supervised their case reports, projects and completed work-based assessments. All 15 nurses are now members of ISPAD.

We wish them every success!

 

Dates: October 11-12, 2022. Location: Abu Dhabi-United Arab Emirates

ISPAD and ASPED have the pleasure to invite Paediatricians who have completed basic Pediatric training and are currently working in the field of Pediatric and Adolescent Diabetes at the level of fellows, specialists, or junior consultants.

Dates: June 6, 2022 for a duration of 12 months. Location: Tanzania

Allied Healthcare Diabetes Educator course for Africa (ADECA) is a new initiative sponsored by ISPAD and LFAC.

It starts on Monday, June 6, 2022 and for a duration of 12 months.

The Allied Health Care Professionals Paediatric Diabetes Educator Course for Africa (ADECA) is a diabetes education and management course that will target qualified nurses and allied health professionals working in Africa and train them to become paediatric diabetes educators. The course development has been led by International Society for Paediatric and Adolescent Diabetes (ISPAD)  supported by Life For a Child (LFAC) and African Society for Paediatric and Adolescent Endocrinology (ASPAE). ADECA is a 12 month  hybrid course which includes a combination of E-learning,  in person (face to face) modules as well as work based assessments.  

• Course Director: Dr Chizo Agwu
• Training Directors: Dr Debra Cohen, Angie Middlehurst, Dr Joyce Mbogo and Dr Kandi Muze
• Faculty: Dr Debra Cohen, Mrs Angie Middlehurst, Dr Kandi Muze, Dr Joyce Mbogo, Dr Emmanuel Ameyaw, Dr Sandya Narayanan (Dietician)
• Project Administrator: Mr Savegod Moshe
• Sponsors: ISPAD (International Society for Paediatric and Adolescent Diabetes) and LFAC (Life For A Child)

For more information, please contact the Project Team by email: [email protected]

Interim Report of the Allied Healthcare Paediatric Diabetes Educator Course for Africa (ADECA ) program to date

Date 23rd September 2022

Introduction:

There are approximately 60,000 children with childhood diabetes living in sub-Saharan Africa. The clinical outcome for many is poor as the rates of complications are high. Many children depend on donor insulin and test strips. Food insecurity remains a challenge. Care requires a well-trained multidisciplinary team to support children and families to improve clinical outcomes. It requires education that is targeted, opportunistic, culturally, linguistically and age- appropriate, and repeated. Whilst there are programs for training Paediatric Endocrinologists (PETCA/PETCWA), none exists for training nurses, dieticians etc.

The ADECA program was designed to fill this void and contribute to changing the narrative of poor care. The ADECA course is a 1-year hybrid course consisting of 3 months E-learning module, 2 weeks in person intensive practical course in Tanzania, 8 months’ work-based assessment in their home country and project and a final in person assessment back in Tanzania. The curriculum was co-produced by members of ISPAD and ASPAE (African Society for Paediatric and Adolescent Endocrinology) (African Society of Paediatric and Adolescent Endocrinology) (African Society for Paediatric and Adolescent Diabetes). Each module is formally evaluated. The course is accredited by Tanzanian Nursing Association for CPD (Continuing Professional Development) points. Following announcement of the course on the ASPAE WhatsApp group for 1 week, we received 630 applicants. 330 nurses and 300 dietitians.

A decision was made to focus on nurses for the pilot. Each applicant submitted a personal statement, a letter of support from Employer confirming that the nurse will be allowed to work in Paediatric diabetes specialty for at least 3 years and a local mentor who ran either a children’s or adolescent diabetes clinic to support their learning. 144 nurses were shortlisted (42% from Nigeria, 27% Kenyan, 8% each from Ghana and Cameroon, 7% from Tanzania, 6% from Malawi and 1% each from Uganda and Malawi. (See fig 1). From the shortlisted, 15nurses were chosen (4 Tanzanian, 4 Nigerian, 3 Kenyan, 1 Ghanaian, 1 Ugandan, 1 Cameroonian, 1 Malawian) for the pilot. Each nurse was assigned to an international mentor to support their learning.

Phase 1 (Online E-Learning module):

The course which started 1st of June 2022 was hosted on 360Learning platform which is a ‘Learning Management System’ that allows for collaborative engagement between faculty and the learners. It also allows faculty to track progress of the learners. Prior to the start of the course, the nurses and their local mentors attended an online seminar to ensure they understood course outline, requirements, and assessments. The nurses then completed a Pre course MCQ test. The 12-week course consisted of 19 (30 minutes) pre-recorded videos, 7 case scenarios with questions covering a wide range of topics. The aim was to equip the nurses with basic theoretical knowledge of paediatric diabetes.

Time spent on the platform was prospectively monitored and nurses were reminded that they needed to view all the lectures. Although unstable internet connections were a constant complaint, 13/15 nurses spent the required minimum of 9 hours on the platform. Analysis shows that the nurses spent a median of 12hours on the platform with one nurse spending 66 hours on the platform. In addition to the Pre-recorded videos, the faculty held additional 13 7 webinars on the Zoom platform. These were Q&A sessions to clarify the lectures. These webinars were also supported by some ‘visiting’ faculty. The international mentors held additional small group sessions to support the nurses learning.

During this phase of the course, the nurses were expected to attend clinics in their local centre, ‘adopt’ a family with diabetes to understand their journey and challenges with living with Type 1 diabetes. The nurses were expected to prepare a 10-minute case presentation which they will present during the 2nd phase of the course to their peers and faculty. The phase 1 was evaluated by the nurses undertaking Pre-course and post course MCQ test. They also produced video recordings describing their views and opinions about the online course. All the nurses have now achieved the required 80% pass mark.

Phase 2:

In person Practical Course in Dar es Salaam Tanzania (5 th September to 15th September 2022). The opening ceremony was attended by different local dignitaries including the Regional Chief Medical Officer, the Acting Director of Nursing, Representatives from Tanzania Diabetes Association, Tanzania Paediatric Associations and Tanzania Diabetes Youth Association. It was also featured in the local press (see figure 2). The Nigerian Ambassador to Tanzania also visited in the 2nd week of the course to encourage the Nigerian delegates.

This was an ‘immersive course.’ The nurses were expected to ‘live’ as if they had type 1 diabetes on different regimens. This helped them to learn ‘how to count carbohydrates in food,’ initiate insulin in a newly diagnosed child and calculate dose of insulin prior to a meal, use of correction doses and adjustment of insulin doses. They attended and observed clinic consultations at Muhimbili National Hospital, participated in role play sessions (to improve their communication and teaching skills), took part in practical sessions on various aspects of diabetes care, Q&A sessions with children and young people with diabetes and their families. Had lectures and workshops. A highlight was visiting a local market to learn about making heathy choices and carbohydrate counting of locally available foodstuff.

All the nurses successfully presented a 10-minute case presentation to faculty and peers. It was not all work as there was also an active social program as the nurses participated in talent shows, fashion shows, quizzes etc. To successfully complete this phase, all nurses were individually formally evaluated in 4 areas:

1. Ability to ‘count carbohydrates’ in food
2. Ability to accurately calculate and initiate insulin either multiple daily injection regimen (including correction doses and basal insulin and insulin: carbohydrate ratio) or twice daily regimen using Regular insulin and NPH
3. Ability to teach ‘Sick day Rules’ including advising on use of ketone test strips to
4. Ability to teach aspects of hypoglycaemia management and prevention The nurses completed a feedback form and the course scored well. See attached. The participants are now back to their home countries on the next phase of the course which will be based on work-based assessment.

The nurses completed a feedback form and the course scored well. See attached. The participants are now back to their home countries on the next phase of the course which will be based on workbased assessment.

 

VIth ISPAD-VAPES "Diabetes and Rare Diseases"

Dates: November 18-19, 2021. Location: Online

After the success of the previous five ISPAD/VAPES meetings (2011 to 2019), local organizers (Varna Pediatric Endocrine Society-VAPES) aim to attract any interested pediatric endocrinologists, pediatricians, postgraduate trainees, medical students and nurses in 2021.

Further information available here.

November 20-22, 2020

Because of the cancellation of the in-person ISPAE-ISPAD 2020 meeting planned to be held at Chandigarh, India due to the SARS-CoV-2 pandemic, an online Pediatric Diabetes Update-2020 (PDU2020) was organized with support from the Indian Society for Pediatric and Adolescent Endocrinology (ISPAE), International Society for Pediatric and Adolescent Diabetes (ISPAD) and Association of Diabetes Educators (ADE).

Because of the cancellation of the in-person ISPAE-ISPAD 2020 meeting planned to be held at Chandigarh, India due to the SARS-CoV-2 pandemic, an online Pediatric Diabetes Update-2020 (PDU2020) was organized with support from the Indian Society for Pediatric and Adolescent Endocrinology (ISPAE), International Society for Pediatric and Adolescent Diabetes (ISPAD) and Association of Diabetes Educators (ADE) on 20th, 21st and 22nd November 2020.

The 3-day event covered topics ranging from basic sciences to advanced technologies in type 1 diabetes and discussions on important aspects o type 2 diabetes, neonatal diabetes, and other rarer types of diabetes. A dedicated half-day session for allied health professionals on practical aspects of type 1 diabetes management and a symposium for general pediatricians covering obesity and metabolic syndrome completed the whole spectrum of childhood diabetes and related disorders.

The event saw a total of 1787 registrations, more than 500 log-ins for live sessions, and the Facebook live streaming reached more than 1000 participants. The delegates were from India, Bangladesh, Sri Lanka and Kuwait. Overseas faculty for the meeting included Drs Gregory Forlenza (Denver, Colorado), Priya Prahalad (Stanford, California), Kate Gajewska (Dublin, Ireland), Debra Sadie, Anna-Pham Short (Sydney, Australia) and Steven James ( Sunshine Coast, Australia).

A host of Indian faculty including pediatric endocrinologist, dieticians and diabetes educators participated in the meeting. The content of the meeting, the selection of speakers, and adherence to timing were highly appreciated by the participants.

 

October 8-10, 2019, Yaoundé, Cameroon

Organized and funded by ISPAD, University of Minnesota (USA) and Changing Diabetes in Children Cameroon (CDiC), ISPAD's First DIP (Diabetes in Practice) Training of Trainers course, took place in Yaoundé, Cameroon, Central Africa, from October 8 to 10, 2019.

Cameroon is located in Central Africa with approximately 23 million inhabitants. Nearly 600 children have been diagnosed with diabetes and 10 childhood diabetes clinics established since 2009 (CDiC Project). Cases remain underestimated, with a high mortality rate due to lack of trained healthcare personnel/teams. In this context, the course aimed to increase awareness among healthcare workers. In attendance were 12 doctors (including 4 pediatric endocrinologists), 10 nurses, 2 dietitians, 2 CDiC and 4 representatives of the Ministry of Health of Cameroon. The course was delivered by a team of five professionals, from University of Minnesota, led by Professor Antoinette Moran.

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REPORT OF FIRST ISPAD DIABETES IN PRACTICE (DIP): TRAIN THE TRAINERS CONFERENCE

8th-10th October 2019. Yaoundé, Cameroon

Organisers:

• Dr Fomenky Njiandock, Pediatric Endocrinologist (PETCA Graduate)
• Dr Chetcha Adele Bodieu, Pediatric Endocrinologist (PETCWA Graduate)
• Dr Mbono Ritha, Pediatric Endocrinologist Dr Sap Suzanne, Pediatric Endocrinologist

Supervisors:

• Pr Jean Claude Mbanya
• Pr Sobngwi Eugene
• Dr Dehayem Mesmin

Trainers:

• Pr Antoinette Moran (University of Minnesota Children’s Hospital, USA)
• Dr Angela Badaru (University of Minnesota Children’s Hospital, USA)
• Carol Brunzell (University of Minnesota Children’s Hospital, USA)
• Terra Clausen (University of Minnesota Children’s Hospital, USA)
• Dr Phil Plager (University of Minnesota Children’s Hospital, USA)

Sponsors:

• ISPAD
• University of Minnesota Children’s Hospital
• CDiC Cameroon

Addressed to ISPAD, ASPAE, CDiC, Ministry of Public Health Cameroon

INTRODUCTION

Childhood diabetes is one of the most common complex chronic metabolic diseases of childhood characterized by a permanent rise in blood glucose.

According to the statistics from the International Diabetes Federation (IDF) of 2017, 96000 children under the age of 15 are diagnosed with diabetes each year, type I diabetes accounting for more than 90% of cases and an increasing number of diabetes in children under 5 years of age has been observed since 1995.

In Africa, type I diabetes accounts for only 5-10% of cases in the general population. This figure is underestimated because many children die in the community or in health facilities due to lack of early diagnosis and adequate management due to complications related to the disease. Cameroon has nearly 600 children diagnosed with diabetes. This underestimation is believed to be due to community ignorance, lack of knowledge of health care workers and also a lack of trained staff to manage this disease.

We have come a long way in Cameroon with 10 childhood diabetes clinics being established through the development of the CDiC (Changing Diabetes in Children) project since 2009, led by Prof. Jean Claude Mbanya's team. Much remains to be done. Although childhood diabetes management equipment (insulin, syringes, glucometers and strips) is free, we still see poor follow-up of these patients, and hence a high mortality rate associated with the condition.

This justifies why the Paediatric Endocrinologists in Cameroon in association with the Ministry of Public Health of Cameroon, solicited the assistance of Prof Antoinette Moran’s team of the University of Minnesota, USA. The International Society for Pediatric and Adolescent Diabetes (ISPAD), which is the reference institution in the childhood diabetes recommendations, very generously supported this venture, as it has already been done in other African countries, together with CDiC Cameroon, and an ISPAD DIP training of trainers course was organized in Cameroon in order to increase the level of awareness among health care workers wherever they may be in the country.

The general national aim for pediatric diabetes in Cameroon is to screen, diagnose and properly manage children living with diabetes early to ensure "No deaths related to childhood diabetes", which is the leitmotif of ISPAD.

Thus, the curriculum of this training focused on diagnosis (clinical and biological signs), adequate management (insulin therapy, adjustment of insulin doses based on review of glucose measurement or according to the amount of carbohydrates consumed in the diet and intensity of physical exercise) as well as sick day and management of emergencies (acute and chronic) related to childhood diabetes.

The objectives were based on the following findings: The mortality of children with diabetes in Africa remains very high and more than half of the health care workers (doctors and nurses) are not well trained nor very confident in the management of childhood diabetes.

ACTIVITIES CARRIED OUT

The training took place from the 8 th – 10 th October, 2019 in the conference room of the GTLABO laboratory at Tsinga, Yaoundé - Cameroon under the supervision of the Ministry of Public Health. The trainers were representatives of the ISPAD (Pr Antoinette Moran, Pr Ass. Angela Badaru, Dr. Phil Plager, Carol Brunzell, Terra Clausen) of the University of Minnesota in the United States. Professor Jean Claude Mbanya presided over the opening ceremony. The training was attended by 12 doctors of which 4 pediatric endocrinologists (02 trained in Petcwa-Lagos and Petca-Nairobi respectively and two others trained in France), 4 adult endocrinologists, 2 Paediatricians, 2 general practitioners and 10 nurses from 8 out of 10 regions of Cameroon, 02 dieticians, CDiC and Ministry of Public Health representatives. The two official languages, French and English were used throughout the training, with the help of 3 interpreters.

The seminar began at 8:30 a.m. on the first day with the reception of the participants followed by the welcome address from the pediatric endocrinologists. In their remarks, they stated that the main objective of this training was to provide extensive training to key medical staff about diagnosis, early and chronic management, emergency management related to complications of childhood diabetes. These trained personnel are then to serve as trainers among fellow staff, caregivers, patients and their various communities at large about childhood diabetes.

The rest of day 1 and subsequent days of the conference went on as follows:

1. A brief journey of where we were before 2009, how far Cameroon has gone since then and the current state of the different clinics as well as the shortcomings was presented by the adult endocrinologist who has mainly been in charge of the CDiC project in Cameroon since 2009. Participants went on to share the expectations they had of the seminar. Most participants hoped that at the end of the seminar they should be able to diagnose more cases of diabetes in children in their communities, learn more about how to handle insulin, the different types of insulin, their action and how to calculate / adjust insulin doses based on meals (carbohydrate counting) and blood sugars more confidently, how to diagnose and manage diabetic emergencies, how to build efficient diabetes teams.
2. The training proper on day 1 began at 11 am after a group photo and coffee break with a presentation on the pathophysiology and the situation of pediatric diabetes in Africa. A presentation on diet and carbohydrate counting followed the first presentation. Carbohydrate counting was practically demonstrated at lunch time (and at every meal thereafter) by labeling all food items with the amount of carbohydrates contained per portion, thanks to our dietitian and instructor, Carol Brunzell. This exercise helped participants have a visual representation of how to advise patients on meal portions and carbohydrate content in relation to insulin doses and adjustments. The afternoon continued with presentations on types and action of insulin and its adjustment according to blood sugar levels and carb content of the food. The evening ended with a "walk in their shoes" session which aimed to make participants live through what diabetic children go through on a daily basis. Each participant, after receiving a free glucometer, strips and an insulin syringe, were able to take their blood glucose, interpret blood sugar numbers, draw the adequate dose of insulin and administer it.
3. The second day of the seminar began at 8:30 a.m. with listening to the experience of the trainers (diabetic patient, parent of a diabetic child). We understood that living with diabetes is not easy at all. It is a very long and difficult way where good and bad days rub shoulders. But the lesson learned was that the diabetic child can live as long and normal a life as any other non-diabetic child if diagnosed early and well followed-up. Then we were taught on the diagnosis and appropriate management of diabetic emergencies (diabetic hypoglycemia and ketoacidosis) as well as the management of diabetes in particular situations (school, illness, physical activities). Very interesting practical clinical cases were discussed, with particular focus on using blood glucose levels to adjust insulin doses.
4. The third day was marked by lectures on the management of micro and macro vascular complications as well as obesity and type II diabetes. The latter sees its prevalence and incidence increase with the increase in the number of obese children. This increase is linked to our poor eating habits (consumption of high-calorie foods: too much fat, too much sugar... etc.), physical inactivity (lack of physical exercise, number of hours spent in front of the television... etc.). Obesity is now considered a disease of civilization. The focus has been on the early diagnosis of children at risk of developing obesity knowing that childhood obesity is a major risk factor for the development of type II diabetes, hypertension, hepatopathy and cancer in adulthood, so it is important to take care of it early. A presentation on therapeutic education followed. This therapeutic education which is the cornerstone for better monitoring of childhood diabetes should be continuous and done with patience, be carried out by a qualified staff. It can be done individually or as a group.
5. The training ended on the afternoon of the 3rd day with the award of certificates of participation to all participants as well as the handing out of gifts to the trainers by the representative of the Minister of Public Health. A family photo was also taken to commemorate this event.
6. A local leadership session consisting of the home team only, was held immediately after the conference. The aim was for the newly-trained Cameroon trainers to develop a roadmap for the proper functioning of our childhood diabetes teams over the next 1 year.

The following recommendations were made from this meeting:

To the medical staff:

• Maintain efficient teamwork that is essential for the smooth running of our clinics
• All children should be on NPH+ Actrapid, instead of Mixtard, because this provides greater flexibility in dose adjustments and hence better glycemic control
• Organize awareness and staff training sessions within our health facilities as well as in the community once every 3 months. In particular, nurses need extra training.
• Create a collaboration between health workers and traditional doctors, clergy and thought leaders since, according to our remarks, these people are the main people our diabetic patients go to for alternate options of treatment or “cure”. This would help the patients to be taken care of if these community leaders refer them early or re-direct them to health facilities.
• Maintain and enhance the registry that already exists and improve on the data collection for better visibility in statistics and actions to be taken for the future.
• Collect data on each diabetes activity on the ground every month and give reports of all activities every 3 months.

To the Ministry of Public Health:

• Increase human resources: Training and recruitment of qualified staff on childhood diabetes
• Continuous training of already qualified staff for knowledge upgrade
• The posting of trained staff in the management of childhood diabetes to other posts of duty is strongly discouraged. If, however, this becomes indispensable, such trained staff should strictly be posted within health facilities where a diabetes clinic already operates. This is not only to ensure the adequate follow-up of the diabetic child, but also to reduce costs of training in the future.
• Each clinic should have a diabetes nurse educator, a dietician for children, a therapeutic educator trained in childhood diabetes, a psychologist, a doctor (if possible) motivated in the management of childhood diabetes.

BRIEF SUMMARY OF LONGTERM FOLLOW-UP PLANS:

1. Following the first ever ISPAD DIP training in Cameroon, there is a need for ongoing training and assessment of knowledge of participants, especially for the nurses. We therefore suggested the creation of a WhatsApp group where all trainers / participants will be added. The group will serve as a forum for monthly online training by assigned pediatric endocrinologists, with quizzes at the end to assess knowledge. There shall be daily ongoing support in case of any on-site problems so they are resolved promptly. This forum shall be initially monitored by the four pediatric endocrinologists.
2. Reports of activities at various clinics will be obtained once every 3 months.
3. We strongly intend to start working on a five year plan for childhood diabetes in Cameroon. The first meeting still has to be scheduled.
4. A reunion of local conference participants will be held in 1 year to revise the plan.
5. We plan to have a larger nationwide conference scheduled to take place in 18-24 months’ time. We would want to involve more pediatricians, general practitioners, dietitians, psychologists, nurses, traditional healers, stakeholders, patients and caregivers.

CONCLUSION:

This conference was a major stride towards building solid diabetes care teams in Cameroon. The caliber of teaching was second to none and we are very grateful to all our instructors and sponsors for this wonderful opportunity. We heartily thank all our sponsors for their unwavering support in making this conference a reality. We definitely will work towards the realisation of our short and long term goals in seeing that the diabetic child in Cameroon has a well-trained, confident team of professionals they can rely on for the best quality of healthcare and life they can get.

February 4, 2018, Park Hyatt, Hyderabad, India

On February 4, 2018, David Maahs, Secretary General of ISPAD, attended the ISPAD Premeeting Symposium on Childhood Diabetes in Hyderabad, India.