During a 10-year period, 101 children with Type 1 (insulin-dependent) diabetes mellitus were admitted to the Department of Paediatrics of the University Hospital in Khartoum, Sudan. The age distribution of the patients showed a steady increase from age one to ten years followed by a sharper increase around puberty. A higher number of cases were diagnosed during the cooler compared to the warmer months of the year (p less than 0.05). Family history of Type 1 diabetes was reported in 14.9% of patients. Diabetic ketoacidosis was a presenting symptom in 82 patients (81.2%) and 93 patients (92.1%) have had at least two documented episodes of ketoacidosis during the follow-up period. Almost all patients were treated with bovine insulin given as a single dose per day. An initial remission period was not observed in any of the patients. Four years after diagnosis, the average daily dose of insulin used by the patients was greater than 2.0 U/kg body weight and the mean HbA1C was 13.4% (reference value 5.3-6.7%). Seventeen patients (16.8%) were known to have died during 399 person-years of observation resulting in a mortality rate of 42.6 per 1000 person-years of follow-up. Another 29 patients (28.7%) for no apparent reason did not attend a follow-up examination after discharge from hospital. Some of these patients might have died in other hospitals or at home. The study emphasizes the need for urgent measures to increase public awareness of diabetes and to improve methods of case-finding and management of diabetic patients.

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Overnight urinary albumin excretion (UAE) was measured in 51 patients, nine to 18 years old, with type 1 (insulindependent) diabetes mellitus and in 22 healthy subjects using radioimmunoassay. Thirteen diabetic patients (25.5%) had microalbuminuria defined as UAE rate between 20 and 200 (μg/min. Eleven of these patients were over 13 years of age. This gives a frequency of microalbuminuria of 42% (11/26) in the diabetic children and adolescents in the age group 14-18 years. UAE rate was positively correlated with both age at diagnosis and duration of diabetes. Arterial blood pressure, systolic and diastolic, glycosylated hemoglobin (HbA 1c ) and insulin dosage U.kg-1.day-1 were significantly higher (P<0.001) in the diabetic patients with microalbuminuria compared to the diabetic patients with normal UAE rate. Retinal changes were also more common in the microalbuminuric diabetic patients than in the diabetic patients without microalbuminuria (P<0.01). This study has revealed a high prevalence of microalbuminuria in young Sudanese patients with type 1 (insulin-dependent) diabetes mellitus and emphasized the importance of routine screening of diabetic children after the age of 12 years. Ann Saudi Med 1993;13(6) Despite the marked reduction in the incidence of diabetic nephropathy that occurred in recent decades, it is estimated that between 30% to 35% of the patients with type 1 (insulin-dependent) diabetes mellitus are still at risk of developing this complication [1]. Nephropathy is regarded as the most serious late diabetic complication because it is associated with 100 times greater risk of mortality than in the background population [2]. The median survival period of diabetic patients after onset of overt albuminuria was reported as less than 10 years [3]. In 1963, a sensitive method for detecting urinary albumin in low concentrations was described [4], and since then, many studies have been performed to establish the rate of urinary albumin excretion (UAE) that is predictive of later nephropathy. It was concluded from several reports that a cut-off level of 20 μg/min would include almost 80% of the patients at risk [5][6][7]. A rate of UAE between 20 and 200 (μg/min was therefore defined as microalbuminuria and is thought to signify incipient nephropathy [8]. Previous studies have shown recognizable variations in the prevalence of microalbuminuria in diabetic patients and have been inconclusive regarding the relationship between UAE and metabolic control [9][10][11][12]. The aim of the present study was to determine the prevalence of at risk values of UAE in young Sudanese diabetic patients and to explore its relation to age and glycemic control. Subjects and Methods SubjectsThe subjects were selected from the children and adolescents with type 1 diabetes who regularly attend the diabetic clinic at the University Hospital in Khartoum, Sudan. The patients who were between nine and 18 years of age and who had the disease for more than one year (62 children) were invited to participate in the study. Thirty heal...