Glycemic Control in Kenyan Children and Adolescents with Type 1 Diabetes Mellitus

Ngwiri, Thomas; Were, Fred; Predieri, Barbara; Ngugi, Paul; Iughetti, Lorenzo

doi:10.1155/2015/761759

Cited by 61 publications

(59 citation statements)

References 25 publications

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“…We found that the mean HbA1c of the study population was 10.3 ± 2.9% and that more than three-quarters (76%) of the patients in this study were not adequately controlled (HbA1c >7.5%), values similar to those obtained in Tanzania and Kenya [27, 32] but worse than values observed in developed countries [14, 33]. A number of factors including irregular supply of insulin, non-availability of structured diabetes programs, and lack of acceptance of chronic diseases within the society (employer/school) may contribute to this difference.…”

Section: Discussionsupporting

confidence: 80%

Predictors of glucose control in children and adolescents with type 1 diabetes: results of a cross-sectional study in Cameroon

et al. 2017

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BackgroundIn sub-Saharan Africa the prognosis of children with type 1 diabetes is poor. Many are not diagnosed and those diagnosed have a dramatically reduced life expectancy (less than one year). The purpose of this study was to identify the predictors of glucose control in children and adolescents with type 1 diabetes.MethodsThis hospital based cross-sectional study involved 76 children/adolescents (35 boys and 41 girls, mean age of 15.1 ± 3.1 years) with type 1 diabetes included in the “Changing Diabetes in Children” (CDiC) program and attending the clinics for children living with type 1 diabetes in the North West Region of Cameroon. Data on glycosylated haemoglobin (HbA1c) was obtained from hospital records of participants. Information on socio-demographic characteristics and diabetes related practices were obtained from participants using a structured questionnaire. Odds ratios (OR) were calculated using logistic regression models to assess the association between determinants and good glyceamic control.ResultsThe study population had a mean HbA1c of 10.3 ± 2.9%. Bivariate analysis indicated that having a mother as the primary caregiver (OR 0.07, 95% CI 0.02–0.2), being on 2 daily insulin injections (OR 0.2, 95% CI 0.1–0.5) and good blood glucose monitoring (BGM) adherence (OR 0.1, 95% CI 0.04–0.3) were significantly (p < 0.001) associated with better HbA1c. Minimal/moderate caregiver involvement in BGM (OR 7.7, 95% CI 2.7–22.0) and insulin injection (OR 14.9, 95% CI 4.8–46.5) were significantly (p < 0.001) associated with poor outcome. Multivariate analysis showed that having a mother as the primary caregiver (OR 0.02, 95% CI 0.002–0.189) was an independent predictor of good glucose control.ConclusionsThis study has shown that the mother’s involvement in the diabetes management of their children and minimal/moderate caregiver involvement in the task of insulin injection are the most important determinants for good and poor glucose control respectively. It is currently unclear whether the direct involvement of the mother is causal or whether “mother as a primary caregiver” is just an indicator for a setting in which good diabetes treatment is possible.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-017-2534-8) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 80%

Predictors of glucose control in children and adolescents with type 1 diabetes: results of a cross-sectional study in Cameroon

et al. 2017

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“…The values of glycemic control in this study are similar to the study from Ngwiri et al [20], where children and adolescents with T1DM from Sub-Saharam Africa presented a median HbA 1 of 11 %. An interesting result was that age above 12 years was significantly associated with poor glycemic control.…”

Section: Discussionsupporting

confidence: 90%

Elevated glycated hemoglobin levels impair blood pressure in children and adolescents with type 1 diabetes mellitus

Oliveira

Nascimento

Tibana

et al. 2016

Diabetol Metab Syndr

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BackgroundDeregulation of glycemic and glycated hemoglobin (HbA1) levels accelerate the progression of cardiovascular complications in type 1 diabetes mellitus (T1DM). The aim of this study was to investigate the association between HbA1 and changes in blood pressure of children and adolescents with T1DM.MethodsA total of 60 children and adolescents were recruited and allocated into two groups (prehypertension and control group). Blood pressure and HbA1 were measured by the oscillometric method and high-performance liquid chromatography, respectively.ResultsThe prehypertensive group had (P < 0.05) higher disease duration, body weight, Z score for body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP) and a higher HbA1 when compared with the control children and adolescents. Multiple regression to predict alterations in DBP from HbA1 adjusted for age, disease duration, and body mass index demonstrated a positive relationship with DBP (P < 0.05). A 1 % increase in HbA1 was associated with 1.73 mmHg increase in DBP.ConclusionsHigh levels of HbA1 may be associated with increased blood pressure in T1DM. A tight control of HbA1 levels may provide long-term cardiovascular protection in children and adolescents with T1DM.

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“…In the lowest level, designated 1A, human insulin (if available), is given through two injections daily. In many countries, only pre‐mixed insulin is used as this is the only insulin provided in the public health system . Health facilities frequently lack any capacity to measure blood glucose .…”

Section: Introductionmentioning

confidence: 99%

Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

et al. 2018

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Optimal care for children and adolescents with type 1 diabetes is well described in guidelines, such as those of the International Society for Pediatric and Adolescent Diabetes. High‐income countries can usually provide this, but the cost of this care is generally prohibitive for lower‐income countries. Indeed, in most of these countries, very little care is provided by government health systems, resulting in high mortality, and high complications rates in those who do survive. As lower‐income countries work toward establishing guidelines‐based care, it is helpful to describe the levels of care that are potentially affordable, cost‐effective, and result in substantially improved clinical outcomes. We have developed a levels of care concept with three tiers: “minimal care,” “intermediate care,” and “comprehensive (guidelines‐based) care.” Each tier contains levels, which describe insulin and blood glucose monitoring regimens, requirements for hemoglobin A1c (HbA1c) testing, complications screening, diabetes education, and multidisciplinary care. The literature provides various examples at each tier, including from countries where the life for a child and the changing diabetes in children programs have assisted local diabetes centres to introduce intermediate care. Intra‐clinic mean HbA1c levels range from 12.0% to 14.0% (108‐130 mmol/mol) for the most basic level of minimal care, 8.0% to 9.5% (64‐80 mmol/mol) for intermediate care, and 6.9% to 8.5% (52‐69 mmol/mol) for comprehensive care. Countries with sufficient resources should provide comprehensive care, working to ensure that it is accessible by all in need, and that resulting HbA1c levels correspond with international recommendations. All other countries should provide Intermediate care, while working toward the provision of comprehensive care.

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Glycemic Control in Kenyan Children and Adolescents with Type 1 Diabetes Mellitus

Cited by 61 publications

References 25 publications

Predictors of glucose control in children and adolescents with type 1 diabetes: results of a cross-sectional study in Cameroon

Predictors of glucose control in children and adolescents with type 1 diabetes: results of a cross-sectional study in Cameroon

Elevated glycated hemoglobin levels impair blood pressure in children and adolescents with type 1 diabetes mellitus

Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

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