O-38: Scaling integrated type 1 diabetes care for children and young adults in Kenya: lessons from nationwide implementation of the CDiC program

Introduction

In many low- and middle-income countries, including Kenya, Type 1 Diabetes (T1D) in children and young adults remains under-prioritized. This has resulted in gaps in timely diagnosis, limited access to quality care, inadequate healthcare provider (HCP) training, weak data systems, and persistent stigma. The Changing Diabetes in Children (CDiC) program was scaled nationally to address these systemic barriers and improve T1D outcomes.

Objectives

To evaluate the progress and challenges of integrating T1D care into the public health system for children and young adults across all 47 counties in Kenya.

Methods

A programmatic review of CDiC implementation was conducted using routine service data, training records, and program reports from 2024 and 2025. Key indicators included patient enrolment, geographic coverage, HCP capacity building, and system-level integration of T1D services.

Results

The program achieved nationwide coverage in phases from launch in 2011 to 2025, enrolling 8,150 children and young adults living with T1D. It enhanced reach through a network of hubs and spokes within public and select mission hospitals. Capacity building initiatives were mainly through continuous medical education.

Achievements:Total of 65 clinics establishedT1D return on investment (ROI) developedImproved linkage to careEnhanced training materials for HCPs and patientsEstablishment of a diabetes centre of excellence in diabetes education, awareness and resources

Conclusions

The nationwide scale-up of CDiC demonstrates that integration of T1D care into public health systems in resource-limited settings is feasible and impactful. However, sustained progress requires targeted investment in HCP pre-service and in-service training, strengthened data systems, updated patient education materials, stigma reduction strategies, and increased domestic financing. These findings provide critical insights for scaling T1D care in similar low-resource contexts.