Glycemic control among children and adolescents with diabetes in Southern Ethiopia: a cross-sectional study

Predictors of glycemic control among type 1 pediatric diabetes patients-Northeast Ethiopia

Introduction

Type 1 diabetes mellitus is the most common endocrine-metabolic disorder in children and adolescents worldwide. This study aims to determine the metabolic glycemic control levels and predictors among pediatric type 1 diabetes patients.

Methods

An institution-based prospective cross-sectional study was conducted from July 01, 2022 to October 30, 2022 among patients attending pediatric chronic follow-up at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia. Patients on follow-up for more than 3 months and aged under 18 years were enrolled in the study consecutively based on their visits. Data were entered into Epidata version 3.1 and exported to SPSS version 26 for analysis. Bivariate and multivariate analyses were done to identify the factors affecting glycemic control.

Result

Among 203 patients with type 1 diabetes, the average age was 8.72 ± 4.25 years, with the largest group of participants being over 10 years old (77 patients, 37%). The majority of the patients were female, totaling 126 (62.1%), and about 69 (34.0%) were in grades 7-10. Retinopathy, nephropathy, and diabetic ketoacidosis were commonly observed diabetic-related complications in this study. More than half of the patients, 107 (52.7%), had good diabetic control, while 96 (47.3%) had poor diabetic control. Factors significantly associated with poor glycemic control include having diabetes for more than 5 years (aOR: 1.45; 95% CI: 0.47, 0.91), being a third-born child (aOR: 0.22; 95% CI: 0.05, 0.92), having a comorbid disease condition (aOR: 1.84; 95% CI: 0.29, 0.92), and experiencing diabetes-related complications (aOR: 0.26; 95% CI: 0.08, 0.97).

Conclusion

The study found that glycemic control is significantly poor among pediatric patients with type 1 diabetes. As a result, these patients require special attention to prevent the long-term consequences of diabetes.

Expecting factors for inadequate glycemic control in children and adolescents with type 1 diabetes mellitus: a single center experience

Objectives

Achieving an ideal glycemic control in children and adolescents with type 1 diabetes mellitus (T1DM) is both a difficult and challenging process. We aim to highlight the expected factors contributing to inadequate glycemic control in children and adolescents with T1DM in a sample of Iraqi children and adolescents.

Methods

This was a descriptive cross-sectional study that recruited 247 T1DM patients aged < 18 years & disease duration ≥ 1 year. Data collected included socio-demographic & clinical characteristics with recent HbA1c value. Each patient was examined for signs of puberty and any lipodystrophy at insulin injection sites. Factors studied using Independent-Samples T-Test, One way ANOVA & Multivariable logistic regression.

Results

Of the 247 patients, 108 (43.7%) were males, and 139 (56.3%) were females. The mean & SD of the age of patients was 10.13 ± 3.85 years. The Mean & SD of the recent HbA1c level was 9.43 ± 2.56. HbA1c ≤ 7.5 was achieved in 27.1% of patients. Using Multivariable logistic regression to study the association between variable factors and inadequate glycemic control, showed a significant association with higher odds in terms of the older age of the patient, maternal illiteracy, presence of recurrent diabetic ketoacidosis (DKA) episodes, absence of carb counting, and presence of lipodystrophy. Higher HbA1c was also associated significantly with puberty, rural residency, poor socioeconomic status, DKA presentation, and using regular + NPH insulin regimen.

Conclusions

In the current study, inadequate glycemic control was induced by many factors, Strategies should be applied to control these factors to minimize the prospective risks of macro-vascular complications linked to T1DM in children & adolescents.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01442-2.

The effect of social support and parental monitoring on glycaemic control in adolescents with type 1 diabetes mellitus

RATIONALE

Glycaemic control is a crucial aspect of managing type 1 diabetes mellitus (T1DM). Strict glycaemic control has been proven to reduce the long-term complications of the disease.

AIMS

The aim of this study was to investigate the effect of parental involvement in diabetes care and social support on glycaemic control in adolescents with T1DM.

METHODS

In this cross-sectional study, 94 adolescents and their parents admitted to a university hospital between January and July 2023 were included in the study. The Multidimensional Scale of Perceived Social Support (PMDC-R) and Parental Monitoring Scale (MSPSS) in Diabetes Care of Adolescents with T1DM were used as data collection tools.

RESULTS

Females constituted 63.8% of the adolescents who participated in the study and the glycaemic control of females was significantly lower than males (p < 0.05). The mean HbA1c of the adolescents was 8.65 + 1.57. In the study, PMDC-R and MSPSS scores of adolescents with good and poor glycaemic control were compared. The PMDC-R of the good control group were statistically significantly higher than the poor control group (p < 0.05), but there was no significant difference between the MSPSS scores.

CONCLUSION

Parental supervision plays a protective role in adolescents, and glycaemic control is better as parental supervision increases. Paediatric nurses should collaborate with parents in diabetes management. This approach may help adolescents to be more successful in diabetes management.

Challenges in achieving adequate glycemic control among children with type 1 diabetes mellitus in a resource-limited setting: A cross-sectional study from Sudan

OBJECTIVE

To assess glycemic control and associated factors in children with type 1 diabetes mellitus (T1DM) attending the pediatric diabetes clinic in Wad-Madani City, Sudan.

METHODS

This cross-sectional observational study was conducted at a referral center in Sudan. The study population consisted of children aged 1-18 years who had been diagnosed with T1DM for more than 1 year and were under regular follow-up in the clinic. Data on their glycemic control and sociodemographic and clinical characteristics were captured.

RESULTS

Out of 211 enrolled patients, 120 (56.9 %) were females. The mean age was 11.7 years (SD = 4.0), with the mean age at diagnosis of 6.7 years (SD = 4.0). Only 6.2 % achieved adequate glycemic control. Adolescents had particularly poor control (97.8 %). The mean glycosylated hemoglobin (HBA1c) level was 10.4 % (90 mmol/mol). Inferior glycemic control was associated with advancing age, older age at diagnosis, belonging to single-parent households, less frequent self-monitoring of blood glucose (SMBG), and having a greater number of siblings or household members. A third of patients (33.8 %) had had one or more diabetes ketoacidosis (DKA) episodes in the previous year. There was a high prevalence of lipodystrophy (34.1 %) and arthropathy (25.1 %).

CONCLUSIONS

An exceptionally low proportion of children with T1DM achieved adequate glycemic control, with adolescents particularly struggling. SMBG frequency and family dynamics emerged as potential factors, highlighting the urgent need for tailored interventions and improved diabetes education in resource-limited settings.

Poor glycemic control and its associated factors among children with type 1 diabetes mellitus in Harar, eastern Ethiopia: A cross-sectional study

BACKGROUND

Poor glycemic control increases the risk of acute metabolic derangements and long-term consequences, which are the main causes of morbidity and mortality. Maintaining adequate glycemic control is challenging for children with diabetes, particularly in resource-limited settings. There is a paucity of data on the magnitude of poor glycemic control and its predisposing factors in Ethiopian particularly in this study setting. Hence, we aimed to assess the magnitude of poor glycemic control and its associated factors among children and adolescents with type 1 diabetic mellitus in Jugol and Hiwot Fana Compressive Specialized University Hospitals in Harar, eastern Ethiopia.

METHODS

A facility-based cross-sectional study was conducted among 231 children and adolescents with type 1 diabetes mellitus in Jugol and Hiwot Fana Compressive Specialized University Hospitals. Participants were included consecutively in the follow-up clinic from November 15, 2022 to January 15, 2023. Data were collected through an interviewer-administered structured questionnaire and a review of medical records. A binary logistic regression model with an adjusted odds ratio (aOR) and a 95% confidence interval (CI) was used to identify the factors associated with poor glycemic control. Statistical significance was set at p < 0.05.

RESULT

A total of 231 children and adolescents with type 1 diabetes mellitus were included. The magnitude of poor glycemic control was 166 (71.9%) with 95% CI 66.0-77.7%). In multivariable analysis, the age of the child (aOR = 0.19, 95% CI: 0.05-0.83), education of the caregiver (aOR = 4.13;95% CI: 1.82-9.46), meal frequency less than three (aOR = 3.28; 95% CI: 1.25-8.62), and consumption of forbidden foods (aOR = 3.17; 95% CI: 1.21-8.29) were factors significantly associated with poor glycemic control.

CONCLUSION

Two-thirds of participants had poor glycemic control. There was a statistically significant association between the age of the child, education of the caregiver, meal frequency, and forbidden foods with poor glycemic control. To improve glycemic control, diabetes education on meal use and selection should be conducted during follow-up along with parent education.

Glycemic Control and Associated Factors Among Children and Adolescents with Type 1 Diabetes Mellitus, Southwest Ethiopia

Purpose

Type 1 diabetes mellitus is the most common endocrine disorder among children and adolescents worldwide. Glycemic control is the ultimate goal of management of diabetes. Poor glycemic control is shown to be associated with complications of diabetes. Only a few studies have addressed the problem in Ethiopia, and this study aimed to determine the level of glycemic control and factors associated among children and adolescents with type 1 diabetes mellitus on follow up.

Methods

Institution based cross sectional study design was conducted on a total of 158 children and adolescents with type 1 diabetes on follow up at Jimma Medical Center from July to October 2022. Data were collected using structured questionnaire and entered into Epi Data 3.1 then exported to SPSS for analysis. Glycemic control was assessed based on glycosylated hemoglobin (HbA1c) level. Descriptive and inferential statistics were employed, and a p-value <0.05 was considered to declare statistical significance.

Results

The mean glycosylated hemoglobin of the participants was 9.67 ± 2.28%. Of the total study participants, 121 (76.6%) had poor glycemic control. In multivariable logistic regression, guardian or father as a primary caregiver [guardian (AOR=4.45, 95%, p=0.045), father (AOR=6.02, 95%, p=0.023)], minimal involvement of caregiver in insulin injection (AOR=5.39, 95%, p=0.002), poor blood glucose monitoring adherence (AOR=4.42, 95%, p=0.026), faced problems at health facility (AOR=4.42, 95%, p=0.018) and being admitted to hospital in the past 6 months (AOR=7.94, 95%, p=0.004) were the variables significantly associated with poor glycemic control.

Conclusion

Majority of children and adolescents with diabetes had poor glycemic control. Whereas, primary caregiver other than mother, minimal involvement of caregiver in insulin injection, and poor adherence to glucose monitoring were among the contributing factors for poor glycemic control. Therefore, adherence counseling and the participation of caregivers in diabetes management is recommended.

Type 1 diabetes in low and middle-income countries - Tanzania a streak of hope

INTRODUCTION

In several of the Low and Middle Income countries , many patients with Type 1 diabetes (T1D) are most probably not diagnosed at all which may contribute to their low incidence. As an example of a country with low income and poor resources, we have chosen to study T1D in children/young people in Tanzania.

METHODS

Analyses of casebooks and statistics at several Tanzanian hospitals treating young patients with insulin dependent diabetes, usually Type 1 diabetes, and collection of information from different organisations such a Tanzanian Diabetes Association, Life for a Child, Changing Diabetes in Children and World Diabetes Foundation.

RESULTS

The incidence in several areas is low. However, a lot of data are often missing at studied clinics and therefore the incidence might be higher, and with increased awareness in recent years the number of patients has increased many-folds. Most patients present with typical symptoms and signs of T1D, and a high proportion with plausible ketoacidosis , although this proportion has decreased from about 90% to about 40% in recent decades. Many patients have poor blood glucose control, and complications often develop already after short diabetes duration. In recent years resources have increased, awareness has increased and diabetes clinics started where staff has got training.

CONCLUSIONS

There are problems with diabetes care in Tanzania but several facts give hope for the future.