READY-T1D-assessment of Research and Service Delivery Readiness for paediatric Type 1 Diabetes: a multi-country cross-sectional study.

BACKGROUND

Type 1 diabetes (T1D) incidence is rising globally, particularly in low- and middle-income countries (LMICs) that face major gaps in access and treatment and high levels of preventable mortality. We developed READY-T1D (Research and Service Delivery Readiness in Type 1 Diabetes) to assess service provision and research preparedness in clinics providing T1D services to children and adolescents as part of the Global Collaborative for Changing Diabetes in Children (GC-CDiC).

METHODS

From November 15th, 2024, to November 14th, 2025, we conducted a cross-sectional online survey of clinics caring for individuals living with T1D aged ≤20 years across 21 countries participating in GC-CDiC. The tool enabled assessment and scoring in two domains, Service Provision and Research Preparedness, each made up of five components (score on 0-4 scale, where 4 = highest readiness). Descriptive statistics were generated for clinic characteristics, item-level metrics, component scores, and domain scores, and compared across countries.

FINDINGS: We analysed 244 clinics (69% CDiC centres, 14% satellites, 17% non-CDiC) across 21 countries. Mean scores were 2.5 (SD 0.6) for Service Provision and 1.8 (SD 0.8) for Research Preparedness, with substantial variation within countries. While resource management and accessibility scored highly, testing facilities and staffing were weaker. Basic care (HbA1c, complication screening) was common, but advanced diagnostics and continuous glucose monitoring were rare. In research, clinics reported high scheduled visit frequency, but often lacked secure data systems, funding, and ethical governance.

INTERPRETATION: Clinics providing care for children and adolescents with T1D in GC-CDiC participating countries possess core care elements and report frequent scheduled patient contact but lack comprehensive readiness for service delivery and research. Capacity varies widely both within and between countries. Priorities for investment for capacity development to improve care in studied clinics include multidisciplinary staffing, digital infrastructure, and research governance to support the Global T1D Cohort Study.

FUNDING: The study was supported by an unrestricted grant from Novo Nordisk, which had no role in study design, protocol development, data collection, analysis, interpretation, or writing of the report.