Glycemic control, associated factors, acute complications of Type 1 Diabetes Mellitus in children, adolescents and young adults in Tanzania

Abstract

Objective To determine the factors associated with poor glycemic control in children (1‐10 years), adolescents (11‐18 years) and young adults (19‐40 years) with Type 1 Diabetes Mellitus (T1DM) in Kilimanjaro Christian Medical Center (KCMC) in Moshi, Mount Meru Regional Referral Hospital (MMRRH) and Meru District Hospital (MDH) in Arusha, Tanzania. Methods Cross sectional study of 150 participants conducted from January to June 2019, data was collected by structured questionnaire and analyzed using SPSS version 23. Results The mean HbA1c was 12.3 ± 2.2%, 146 had poor glycemic control (HbA1c > 7.5%). BMI, insulin regime and caretaker education were associated with poor glycemic control. There were 16 participants diagnosed in DKA and the most frequently reported complications in the prior 3 months were hyperglycemia (n = 25), DKA (n = 18) and hypoglycemia (n = 4). Conclusions Glycemic control is still very poor particularly in adolescents. Significant associations with glycemic control were higher BMI, insulin regime and guardian education. The study revealed lower prevalence of DKA at diagnosis compared to previous studies.

Poor glycemic control and associated factors among pediatric diabetes mellitus patients in northwest Ethiopia, 2020: facility-based cross sectional retrospective study design

“…This study indicated that duration of DM was not significantly associated with poor glycemic control. This is similar with studies conducted in Tanzania, and India, which found that the duration of DM was not a significant predictor of poor glycemic control 6 , 11 . But, studies conducted in Amhara region, Shanan Gibe, Egypt, Jimma, and Nekemte showed that duration of DM was significantly associated with poor glycemic control 2 , 8 , 17 , 23 , 31 .…”

“…The risk of poor glycemic control was reduced by increasing treatment dose by one IU until it reached recommended dose. However, the study conducted in Tanzania indicated that dose of treatment is not a significant predictor of poor glycemic control 6 . The discrepancy might be due to the difference in study participant, sample size and setting.…”

“…Type one diabetes mellitus (T1DM) is the most common endocrine-metabolic disorder in children and adolescents worldwide, with a prevalence of 190 per 100,000 among school aged children in USA and an annual incidence ranging from 1.7 per 100,000 in China to 40 per 100,000 in Finland 5 . Similarly diabetes affects an estimated 1.1 million children under the age of 20 worldwide, with 132 600 new cases diagnosed each year, representing a 3% annual increase 6 . The global prevalence of DM have increased considerably, specifically in Sub- Saharan Africa 7 .…”

“…Poor glycemic control constitutes a major public health issue and a key risk factor for the development of diabetes-related complications, diseases related healthcare expenses, lower life expectancy and quality of life 4 . Long-term uncontrolled hyperglycemia results several macro-vascular and micro-vascular complications such as neuropathy, nephropathy, retinopathy, cardiovascular diseases, amputations, and even premature death 6 , 12 , 13 . Several studies indicated that more than half of diabetic patients have poor glycemic control 12 , 14 – 16 .…”

Time to first optimal glycemic control and its predictors among type 1 diabetic children in Bahir Dar city public referral hospitals, North West Ethiopia: a retrospective follow up study

“…Both in developed and developing nations, the prognosis for children with T1DM is poor [9]. As a result, OGC oscillated from 2.6-9.8% in Tanzania [12,13], 24% in Cameron [9], 24% in Sudan [14] 28% in Egypt [15]; 20.9% in Jordan [16] 39.1% in Saudi Arabia [17] and 33,36% in California [18] and Bulgaria [19] respectively. Many are not detected and those diagnosed have dramatically reduced their life expectancy by 1 year, [20].…”