Current systemic management of Type 1 diabetic children in resource-constrained settings in Africa - a scoping review of the evidence

Type 1 diabetes (T1D) is a chronic autoimmune disease requiring lifelong insulin therapy, regular glucose monitoring, diabetes education, and continuous multidisciplinary care. While the management of T1D has substantially improved in high-income countries, children living in resource-constrained settings, particularly in African Least Developed Countries (LDCs), continue to face considerable challenges in accessing timely diagnosis, insulin, trained healthcare professionals, and structured long-term care. These barriers contribute to poor glycaemic control, frequent episodes of diabetic ketoacidosis, preventable complications, and increased mortality. The available evidence on the current systemic management strategies remains fragmented and there is currently no comprehensive overview of how systemic management of paediatric T1D is organized across African LDCs. Existing studies vary considerably in their focus, and study design, making it difficult to identify effective management strategies, healthcare delivery models, and persistent gaps in care. The aim of this scoping review is to systematically identify, map, and synthesize the available evidence on the systemic management of children and adolescents with Type 1 diabetes in African Least Developed Countries. The review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews and will be reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). The review question has been developed using the Population–Concept–Context (PCC) framework. Electronic database searches will be conducted in PubMed, Scopus, and Web of Science, complemented by a structured search of grey literature using Google and selected grey literature repositories. Studies published between 2000 and 2026 will be considered. Eligibility criteria have been predefined to include studies reporting systemic management approaches for children and adolescents with Type 1 diabetes in African Least Developed Countries. Study selection will follow a two-stage screening process, and data will be extracted using a standardized data charting form. The extracted data will be synthesized descriptively using summary tables and a narrative synthesis. As this is a scoping review, no formal critical appraisal of included studies will be conducted. The review is expected to provide a comprehensive overview of existing systemic management approaches, including for example healthcare delivery models, diabetes education, insulin provision and multidisciplinary care. Furthermore, it aims to identify barriers and facilitators to effective diabetes management, map the geographical distribution of the available evidence, and highlight areas where evidence is limited or absent. Where appropriate, the findings will be discussed in comparison with diabetes care in Germany as an example of a high-income healthcare system. The findings of this review are expected to contribute to a better understanding of current diabetes care for children in African Least Developed Countries, identify priorities for future research, and provide evidence to inform for example healthcare practice, and policy development aimed at strengthening paediatric Type 1 diabetes care in resource-constrained settings.