INS and diabetes mellitus: The suboptimal attainment of glycemic targets observed in the African T1DM cohort is similar to the results of the primary IDMPS wave 7 study in which only 22% achieved a HbA1c <7%.[14] Physician-reported reasons for nonachievement of glycemic targets include lack of insulin titration, fear of hypoglycaemia, cost of medicine and strips, and lack of diabetes education; these reasons are also similar to the primary IDMPS wave 7 study results,[14] suggesting that developing countries share comparable challenges.