Mortality and low C-peptide levels in children and young people diagnosed with type 1 diabetes in Cameroon: a case series from the young-onset diabetes in sub-Saharan Africa study.

Type 1 diabetes-associated mortality in Africa remains high despite several coordinated international initiatives. Therefore, understanding the causes of death will guide context-specific public health interventions. This descriptive case series examined the number and causes of death among children and young people (CYP) with type 1 diabetes (T1D) in the young-onset diabetes in sub-Saharan Africa (YODA) study in Cameroon. Among 313 CYP recruited between 2019 and 2022, 23 deaths were recorded (56.5% male). At recruitment, the median (IQR) age at diagnosis was 16 (13-18) years, BMI 21.5 (18.9-24.7) kg/m, and plasma C-peptide concentration 116 (37-210) pmol/L, respectively. Causes of death included hypoglycaemia (7 cases), diabetic ketoacidosis (5 cases), infections (4 cases), undefined causes (4 cases), chronic liver disease (2 cases), and chronic kidney disease (1 case). Most deaths (17/23, 73.9%) occurred in individuals with significantly low plasma C-peptide levels (<200 pmol/L), signifying severe insulin deficiency. Hypoglycaemia deaths (85.7%, 6/7) were also common at significantly low C-peptide levels (<200 pmol/L). Nearly half (11/23, 47.8%) of the deaths occurred outside the hospital setting. These findings describe a possible relationship between low C-peptide and mortality for CYP living with T1D in Cameroon which should be investigated thoroughly prospectively.