1
|
Eshetu K, Regassa LD, Dehresa M, Genete D. Chronic Microvascular Complication of Type 1 Diabetes Mellitus and Its Predictors Among Children with Type 1 Diabetes Mellitus in Ethiopia; A Single Center Experience: Ambi Directional Cohort Study. Pediatric Health Med Ther 2024; 15:201-212. [PMID: 38808177 PMCID: PMC11130991 DOI: 10.2147/phmt.s456541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024] Open
Abstract
Introduction Type 1 diabetes mellitus is the most common pediatric endocrine disorder. Poor glycemic control in diabetes mellitus can result in microvascular complications (retinopathy, neuropathy, and nephropathy). There is no study done in our setting either about prevalence of pediatric type 1 diabetes mellitus or chronic microvascular complication among these patients, which gap this study is expected to fill. Objective This study aimed to assess the risk and predictors of chronic microvascular complication of type 1 diabetes mellitus among children with diabetes at Haramaya University Hiwot Fana Compressive Specialized Hospital from September 10, 2021 to January 30, 2023. Methods A hospital-based Ambi directional cohort study was conducted. Survival data are described by follow-up time and Kaplan-Meier graph. To determine predictors associated with chronic microvascular complication we used a Poisson regression optimal model selected using the information criterion. All associations are tested at the 95% confidence level and a reported IRR P-value less than 0.05 is declared as a significant association between variables. Results A total of 124 children with type 1 diabetes mellitus were followed with total 407.5 years risk time. The overall incidence rate of chronic microvascular complication was 83 per 1000 population per year (95% CI: 59-116). The median time for detection of microvascular complication was 7 years after diagnosis. Being male with IRR 1.71 (95% CI: 0. 0.81-3.56), being at pubertal age IRR 1.91 (95% CI: 1.05-3.48), longer diabetes mellitus duration IRR 1.13 (95% CI: 1.07-1.28), and poor glycemic control IRR 1.50 (95% CI: 0.46-4.97) were found to be at higher risk for chronic microvascular complication. Conclusion There was high incidence of chronic microvascular complication of diabetes mellitus. Being pubertal age group and more than 3 years duration after diagnosis had statistically significant association with complication.
Collapse
Affiliation(s)
- Konjit Eshetu
- Department of Pediatrics and Child Health, School of Medicine, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Lemma Demissie Regassa
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Merga Dehresa
- Department of Maternal and Child Health, School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Desta Genete
- Department of Ophthalmology, School of Medicine, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| |
Collapse
|
2
|
Majaliwa ES, Muze K, Godfrey E, Byashalira K, Mmbaga BT, Ramaiya K, Mfinanga SG. Latent tuberculosis in children and youth with type 1 diabetes mellitus in Dar es Salaam, Tanzania: a cross section survey. BMC Infect Dis 2023; 23:740. [PMID: 37904143 PMCID: PMC10614349 DOI: 10.1186/s12879-023-08753-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/25/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Data for latent tuberculosis in patients with type 1 Diabetes in Africa is limited. We assessed the prevalence of latent tuberculosis in youth and children with type 1 Diabetes in Dar es Salaam -Tanzania. METHODS Our cross-sectional study recruited children and youth with T1DM by stage of puberty, glycaemic control, and age at diagnosis from January to December 2021 in Dar es Salaam. Participants were screened for the presence of latent Tuberculosis using the QuantiFERON test. A positive test was considered to have latent TB. RESULTS Of the 281 participants, the mean age was 19 (± 6) years, 51.2% were female, and 80.8% had either a primary or secondary level of education at baseline. The prevalence of latent TB was 14.9% and was slightly higher in females (52.4%) than in males. This difference, however, was insignificant (p > 0.05). On the other hand, the proportion of latent TB was significantly higher in uncontrolled HbA1c levels (76.2%) than in those with controlled HbA1c (23.8%) [p = 0.046]. Duration of diabetes and age at diagnosis did not affect the occurrence of latent Tuberculosis [p > 0.05]. Meanwhile, in the regression model, participants with latent TB were more likely to have uncontrolled HbA1c. [p = 0.045] CONCLUSIONS: Despite the methodological limitations, this survey highlights the high prevalence of latent TB among children and youth with diabetes; shouting for better control. These results clearly show the need to screen for Tuberculosis in children and youth with diabetes and start them on prevention as per protocol, especially in tuberculosis-endemic areas like Tanzania.
Collapse
Affiliation(s)
- Edna S Majaliwa
- Kilimanjaro Christian Medical University College, Box 2240, Moshi, Kilimanjaro, United Republic of Tanzania.
- Muhimbili National Hospital, Box 65000, Dar es Salaam, United Republic of Tanzania.
| | - Kandi Muze
- Muhimbili National Hospital, Box 65000, Dar es Salaam, United Republic of Tanzania
| | - Evance Godfrey
- Muhimbili National Hospital, Box 65000, Dar es Salaam, United Republic of Tanzania
| | - Kenneth Byashalira
- Kilimanjaro Christian Medical University College, Box 2240, Moshi, Kilimanjaro, United Republic of Tanzania
- Kibong'oto Infectious Diseases Hospital, Sanya Juu, Siha, United Republic of Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College, Box 2240, Moshi, Kilimanjaro, United Republic of Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Kaushik Ramaiya
- Shree Hindu Mandal Hospital, Dar es Salaam, United Republic of Tanzania
| | - Sayoki G Mfinanga
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
- School of Public Health, Department of Epidemiology and Statistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Alliance for Africa Research and Innovation, Dar es Salaam, United Republic of Tanzania
| |
Collapse
|
3
|
Catamo E, Robino A, Dovc K, Tinti D, Tamaro G, Bonfanti R, Franceschi R, Rabbone I, Battelino T, Tornese G. Screening of lipids and kidney function in children and adolescents with Type 1 Diabetes: does age matter? Front Endocrinol (Lausanne) 2023; 14:1186913. [PMID: 37334303 PMCID: PMC10272791 DOI: 10.3389/fendo.2023.1186913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction The purpose of this study was to evaluate lipid profile and kidney function in children and adolescents with Type 1 Diabetes. Methods This was a retrospective study including 324 children and adolescents with Type 1 Diabetes (48% females, mean age 13.1 ± 3.2 years). For all participants, demographic and clinical information were collected. The prevalence of dyslipidemia and kidney function markers were analyzed according to age. Multivariate linear regression analyses were performed to test the association of lipids or markers of renal function with demographic and clinical information (sex, age, disease duration, BMI SDS, HbA1c). Results In our study the rate of dyslipidemia reached 32% in children <11 years and 18.5% in those ≥11 years. Children <11 years presented significantly higher triglyceride values. While the albumin-to-creatinine ratio was normal in all individuals, 17% had mildly reduced estimated glomerular filtration rate. Median of HbA1c was the most important determinant of lipids and kidney function, being associated with Total Cholesterol (p-value<0.001); LDL Cholesterol (p-value=0.009), HDL Cholesterol (p-value=0.045) and eGFR (p-value=0.001). Conclusion Dyslipidemia could be present both in children and adolescents, suggesting that screening for markers of diabetic complications should be performed regardless of age, pubertal stage, or disease duration, to optimize glycemia and medical nutrition therapy and/or to start a specific medical treatment.
Collapse
Affiliation(s)
- Eulalia Catamo
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Burlo Garofolo, Trieste, Italy
| | - Antonietta Robino
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Burlo Garofolo, Trieste, Italy
| | - Klemen Dovc
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Endocrinology, Diabetes and Metabolism, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Davide Tinti
- Center for Pediatric Diabetology, Azienda Ospedaliero-Universitaria (AOU) Città Della Salute e Della Scienza, Torino, Italy
| | - Gianluca Tamaro
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Burlo Garofolo, Trieste, Italy
| | - Riccardo Bonfanti
- Diabetes Research Institute, Department of Pediatrics, IRCCS San Raffaele Hospital, Milano, Italy
| | | | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, Università Del Piemonte Orientale, Novara, Italy
| | - Tadej Battelino
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Endocrinology, Diabetes and Metabolism, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gianluca Tornese
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Burlo Garofolo, Trieste, Italy
| |
Collapse
|
4
|
Owusu BA, Ofori-Boateng P, Forbes A, Doku DT. Knowledge of young people living with type 1 diabetes and their caregivers about its management. Nurs Open 2023; 10:2426-2438. [PMID: 36448367 PMCID: PMC10006669 DOI: 10.1002/nop2.1498] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/23/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
AIMS AND OBJECTIVE We sought to investigate knowledge and skills of type 1 diabetes (T1D) management among young people living with the disease and their caregivers. Our aim is to provide baseline evidence to inform T1D self-management education for young people living with the disease and their caregivers. BACKGROUND Both local and international guidelines recommend ongoing T1D self-management education for people living with the disease. This is because T1D often develops among young people who rarely have the competencies to adequately manage their condition. However, the extent to which young people living with T1D and their caregivers can self-manage this chronic disease in a low-resource country like Ghana is unknown. METHODS Using a phenomenological study design, semi-structured interviews were conducted with 28 young people living with type 1 diabetes, 12 caregivers and 6 healthcare providers in southern Ghana. Data were collected at homes, hospitals and support group centres of participants via face-to-face interviews, photovoice and video-conferencing. The data were analysed thematically using QSR NVivo 11. RESULTS The young people living with T1D and their caregivers demonstrated knowledge and skills in the self-monitoring of blood glucose, and the treatment of hyperglycaemia. Areas of more marginal or lack of knowledge were concerning carbohydrate counting, severe hypoglycaemia and the management of intercurrent illnesses. Young persons living with T1D and their caregivers received their management information from healthcare and non-healthcare providers. Access to diabetes self-management education influenced T1D management knowledge and practices. CONCLUSION Young people living with type 1 diabetes and their caregivers possessed limited scope of knowledge on type 1 diabetes self-management. Multiple sources of T1D knowledge were found, some of which may not be helpful to patients. The knowledge gaps identified compromises transitional independence and self-management capacity. RELEVANCE TO CLINICAL PRACTICE It is important for clinicians and organizations that provide T1D education to provide diabetes self-management education also on managing hypoglycaemia, carbohydrate counting and managing T1D during intercurrent life events among young people living with T1D. NO PATIENT OR PUBLIC CONTRIBUTION Patients and their caregivers were interviewed as research participants. They did not conceptualize, analyse, interpret or prepare the manuscript.
Collapse
Affiliation(s)
| | - Prince Ofori-Boateng
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.,Cape Coast Teaching Hospital, Central Region, Cape Coast, Ghana
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, London, UK
| | - David Teye Doku
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| |
Collapse
|
5
|
Ludvigsson J, Edna M, Ramaiya K. Type 1 diabetes in low and middle-income countries - Tanzania a streak of hope. Front Endocrinol (Lausanne) 2023; 14:1043370. [PMID: 37033222 PMCID: PMC10080134 DOI: 10.3389/fendo.2023.1043370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Johnny Ludvigsson
- Crown Princess Victoria Children's Hospital and Division of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- *Correspondence: Johnny Ludvigsson,
| | - Majaliwa Edna
- Department of Pediatrics and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Kaushik Ramaiya
- Hindu Mandal Hospital, Dar es Salaam, Tanzania
- Tanzanian Diabetes Association, Dar es Salaam, Tanzania
| |
Collapse
|
6
|
Majaliwa ES, Minja L, Ndayongeje J, Ramaiya K, Mfinanga SG, Mmbaga BT. Survival of children and youth with type 1 diabetes mellitus in Tanzania. Pediatr Diabetes 2022; 23:1560-1566. [PMID: 36193929 DOI: 10.1111/pedi.13425] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Survival from type 1 diabetes Mellitus is low in lower-income countries with underdeveloped health systems. Support programs from partners like life for a child (LFAC) and changing diabetes in children (CDiC) were implemented in Tanzania in 2005 to provide diabetes care to children and youth. No evaluation of survival has been done since their implementation. OBJECTIVE To assess the survival of children and youth living with diabetes mellitus (CYLDM) in Tanzania. METHODS A retrospective data collection from 39 clinics of CYLDM was done by extracting data from the diabetes registry between 1991 and 2019. Three cohort were analyzed (1) Cohort 1991-2004 (pre-implementation), (2) Cohort 2005-2010 (during implementation), and (3) 2011-2019 (after the implementation of LFAC/CDiC). Data were analyzed using STATA-version 14. RESULTS A total of 3822 data of CYLDM were extracted, mean age at diagnosis was 13.8 (±5) years. Approximately fifty-one percent (50.8%) were male. The total observation time was 28 years, and the Median duration of diabetes of 5 (IQR2, 8) years. Total death was 95 (3%), with a mean age at death of 17.7 (SD 4.7) years. The last cohort (2011-2019) had more diagnosis 2353 (72.7%), as compared to the <2005 cohort with only 163(5%). The survival improved from 59% before 2005 to 69% in the last cohort (2011-2019). CONCLUSION The implemented programs have facilitated the diagnosis and retention of CYLDM in the health care system. In doing so, it has also increased the survival probability in Tanzania compared to the early 90s.
Collapse
Affiliation(s)
- Edna Siima Majaliwa
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | | | - Sayoki G Mfinanga
- National Institute for Medical Research, Dar es Salaam, Tanzania.,Department of Epidemiology and Statistics, The Muhimbili University of Health and Allied Sciences, School of Public Health, Dar es Salaam, Tanzania.,Alliance for Africa Research and Innovation (A4A), Dar es Salaam, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| |
Collapse
|
7
|
Fantahun B, Leulseged TW. Glycemic control among children with type 1 diabetes mellitus and its determinants in a resource-limited setting. J Pediatr Endocrinol Metab 2022; 35:813-817. [PMID: 35538692 DOI: 10.1515/jpem-2022-0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/22/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Glycemic control is an important parameter that can predict long-term complications of diabetes mellitus. It can be affected by many factors. Hence, identifying those factors for improving disease outcomes is essential. The purpose of this study was to assess glycemic control in children who were treated with a conventional insulin regimen and to identify its associated factors. METHODS A retrospective cohort study was conducted among children with type one diabetes mellitus (T1DM) who had follow-up from November 2015 to November 2020 at the pediatric endocrinology clinic of St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia. Glycemic control was assessed by measuring glycosylated hemoglobin (HbA1C) and children who had HbA1C within three to six months of the data collection were recruited. RESULTS A total of 106 children with TIDM who were on conventional insulin therapy were included in this study. Their median age at diagnosis was nine years, 47.2% were females, and 57.5% were from urban areas. The average HbA1c of the children was 9.7%. The majority (85.2%) of the children had poor glycemic control (>7.5%). Younger age, longer disease duration, and urban residence were found to be significant predictors of good glycemic control. CONCLUSIONS A significant majority of children with T1DM had poor glycemic control. This calls for the need to create access to intensive diabetes care by health authorities and stakeholders to prevent the long-term complications of T1DM.
Collapse
Affiliation(s)
- Bereket Fantahun
- Department of Pediatrics, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tigist W Leulseged
- Department of Pediatrics, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| |
Collapse
|
8
|
Essuman VA, Tagoe NN, Essuman A, Abaidoo B, Akpalu J, Sackey HA, Hayfron-Benjamin CF, Asare G, Amoah AGB, Ndanu TA, Ofori-Adjei IDB, Barnes NA, Appiah-Thompson BL, Amoaku WM. A Cross-Sectional Study of Ocular Changes in Children and Adolescents with Diabetes Mellitus in Selected Health Facilities in Ghana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5295. [PMID: 35564690 PMCID: PMC9104046 DOI: 10.3390/ijerph19095295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The main objective of the study was to determine the prevalence of diabetic retinopathy (DR), other diabetes-related ocular changes (e.g., cataracts, corneal ulceration), and non-diabetic ocular disease in Ghanaian children and adolescents. The second objective was to evaluate the relationship between these conditions and age at diagnosis, current age, diabetes mellitus (DM) duration, and participant's sex. METHODS A cross-sectional study, undertaken by a multidisciplinary team, included a cohort of children and adolescents (4-19 years) with DM recruited from selected health facilities in Ghana, from March 2016 to September 2019, after written informed consent or assent. The cohort will be followed up for 3 years to determine the natural course of the ocular changes, reported later. Participants were examined for all microvascular and macrovascular complications, non-diabetic ocular disease, anthropometric measurements, laboratory characteristics and quality of life issues. Full ocular examination was also undertaken. Statistical Package for Social Sciences (SPSS Version 25.0) was used for the data analysis. Continuous and categorical variables were presented as mean and standard deviation (SD), median (interquartile range) and as percentages (%), respectively. T-test and Mann-Whitney U test were used in establishing associations. RESULTS A total of 58 participants were recruited. DR was detected in only 1 out of 58 (1.7%) participants at baseline. Cataracts were the most common ocular finding, detected in 42 (72%) at baseline. Other anterior segment changes observed included blepharitis 46 (79.3%) and tear film instability 38 (65.5%). There was a significant positive association between duration of the DM and the risk of cataract (p = 0.027). Participants' age at diagnosis was significantly associated with the presence of prominent corneal nerves (p = 0.004). CONCLUSIONS DR was uncommon in this cohort of young persons with DM in Ghana. Cataracts, blepharitis and refractive errors were ocular changes commonly observed. All young persons with diabetes should undergo regular eye examination in all clinics where follow-up care is provided.
Collapse
Affiliation(s)
- Vera A. Essuman
- Ophthalmology Unit, Department of Surgery, University of Ghana Medical School, University of Ghana, Accra P.O. Box GP 4236, Ghana;
- Eye Department, Korle Bu Teaching Hospital, Accra P.O. Box 77, Ghana; (N.N.T.); (I.D.B.O.-A.)
| | - Naa N. Tagoe
- Eye Department, Korle Bu Teaching Hospital, Accra P.O. Box 77, Ghana; (N.N.T.); (I.D.B.O.-A.)
| | - Akye Essuman
- Department of Community Health, University of Ghana Medical School, University of Ghana, Accra P.O. Box GP 4236, Ghana;
| | - Benjamin Abaidoo
- Ophthalmology Unit, Department of Surgery, University of Ghana Medical School, University of Ghana, Accra P.O. Box GP 4236, Ghana;
| | - Josephine Akpalu
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Accra P.O. Box GP 4236, Ghana; (J.A.); (A.G.B.A.)
| | - Harold A. Sackey
- Department of Child Health, University of Ghana Medical School, University of Ghana, Accra P.O. Box GP 4236, Ghana;
| | - Charles F. Hayfron-Benjamin
- Department of Physiology, University of Ghana Medical School, University of Ghana, Accra P.O. Box GP 4236, Ghana;
- Department of Anaesthesia, Korle Bu Teaching Hospital, Korle Bu, Accra P.O. Box GP 4236, Ghana
| | - George Asare
- Chemical Pathology Unit, Department of Medical Laboratory Sciences, University of Ghana School of Basic and Allied Health Sciences, College of Health Sciences, Accra P.O. Box GP 4236, Ghana;
| | - Albert G. B. Amoah
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Accra P.O. Box GP 4236, Ghana; (J.A.); (A.G.B.A.)
- National Diabetes Management and Research Centre (NDMRC), Korle Bu Teaching Hospital, Accra P.O. Box GP 4236, Ghana
| | - Thomas A. Ndanu
- Department of Preventive & Community Dentistry, University of Ghana Dental School, University of Ghana, Accra P.O. Box GP 4236, Ghana;
| | | | - Nana A. Barnes
- Santa Rosa Community Health, Vista Clinic 3569 Round Barn Circle, Santa Rosa, CA 95403, USA;
| | | | - Winfried M. Amoaku
- Ophthalmology and Visual Sciences (DCN), University Hospital, QMC Nottingham, Nottingham NG7 2UH, UK;
| |
Collapse
|
9
|
Fatal cryptococcal meningitis in a non-HIV patient. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns1.6010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cryptococcal infections (Cryptococcosis) are fatal fungal infections typically caused by Cryptococcus neoformans, a saprophyte frequently found in soil contaminated with pigeon droppings and frequently seen in immunocompromised (specifically HIV Positive) individuals. Now a day’s awareness is emerging on cryptococcal disease among non-immunocompromised patients also. We present a case of Cryptococcus meningitis (CM) in a patient with cardiopulmonary arrest. A 55 year old male patient came with history of headache and fever with neck rigidity since last 3 months. The patient was admitted as a case of CM based on clinical findings and radiological features. Investigations were done to rule out other disorders of the immune system. He was treated with Amphotericine B (IV) and Fluconazole orally for 2 weeks. Culture of CSF was done which showed presence of Cryptococcus neoformans. It is concluded from the findings that Cryptococcus may also affect non-HIV patients regardless to their immune system.
Collapse
|
10
|
The effectiveness of an education intervention based on self-care model on diabetes self-management behaviors and glycemic control. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
11
|
Ravi K, Pasi R. Type 1 diabetes mellitus in pediatric age group: A rising endemic. J Family Med Prim Care 2022; 11:27-31. [PMID: 35309606 PMCID: PMC8930152 DOI: 10.4103/jfmpc.jfmpc_975_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 11/04/2022] Open
Abstract
Type 1 Diabetes Mellitus is the most common endocrinological abnormality found in children. The incidence of T1DM has steadily increased in nearly all parts of the world. Both genetic susceptibility and environmental factors contribute to the pathogenesis. It is caused due to either decreased or absent insulin production in the body due to multiple etiologies. We have done a literature review of type 1 DM in children and a clinical audit of point prevalence of type 1 DM cases & its clinical correlates of patients presenting at the tertiary level hospital, AIIMS Rishikesh, over two years six months period (April 2015 to September 2017). We found the prevalence of diabetes mellitus (Type 1) is 2.88%. Among clinical features at presentation, 56.5% presented with polyuria, 34.8% with polydipsia, 21.7% with polyphagia, 39.1% with weight loss. 26.1% of patients had diabetic ketoacidosis at presentation. The majority of children have deranged HbA1C levels (94.4%). It is concluded that children presented with higher HbA1c levels at onset and higher duration of symptoms are at greater risk for the development of complications.
Collapse
|
12
|
Adler AJ, Trujillo C, Schwartz L, Drown L, Pierre J, Noble C, Allison T, Cook R, Randolph C, Bukhman G. Experience of living with type 1 diabetes in a low-income country: a qualitative study from Liberia. BMJ Open 2021; 11:e049738. [PMID: 34667004 PMCID: PMC8527120 DOI: 10.1136/bmjopen-2021-049738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION While epidemiological data for type 1 diabetes (T1D) in low/middle-income countries, and particularly low-income countries (LICs) including Liberia is lacking, prevalence in LICs is thought to be increasing. T1D care in LICs is often impacted by challenges in diagnosis and management. These challenges, including misdiagnosis and access to insulin, can affect T1D outcomes and frequency of severe complications. Despite the severe nature of T1D and growing burden in sub-Saharan Africa, little is currently known about the impact of T1D on patients and caregivers in the region. METHODS We conducted a qualitative study consisting of interviews with patients with T1D, caregivers, providers, civil society members and a policy-maker in Liberia to better understand the psychosocial and economic impact of living with T1D, knowledge of T1D and self-management, and barriers and facilitators for accessing T1D care. RESULTS This study found T1D to have a major psychosocial and economic impact on patients and caregivers, who reported stigma, diabetes distress and food insecurity. Patients, caregivers and providers possessed the knowledge necessary to effectively manage T1D but insufficient community awareness leads to delayed diagnosis, often in an emergency department. Most patients reported receiving free services and materials, though the cost of transportation to clinic visits and recommended foods is a barrier to disease management. Many providers noted the lack of national T1D-specific guidelines and registries. Policy-makers reported a lack of prioritisation of and resources for T1D. These barriers, combined with scarcity and expense of appropriate foods, pose severe barriers for self-management of T1D. CONCLUSION T1D was found to have a significant impact on patients and caregivers, and informants identified several key individual and systems-level barriers to effective T1D care in Liberia. Addressing these concerns is vital for designing sustainable and effective programmes for treating patients living with T1D.
Collapse
Affiliation(s)
- Alma J Adler
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Celina Trujillo
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners in Health, Boston, Massachusetts, USA
| | | | - Laura Drown
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | | | - Christopher Noble
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | | | | | | | - Gene Bukhman
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
- Partners in Health, Boston, Massachusetts, USA
| |
Collapse
|
13
|
Bille N, Byberg S, Gishoma C, Buch Kristensen K, Lund Christensen D. HbA 1c variability and the development of nephropathy in individuals with type 1 diabetes mellitus from Rwanda. Diabetes Res Clin Pract 2021; 178:108929. [PMID: 34216679 DOI: 10.1016/j.diabres.2021.108929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 05/21/2021] [Accepted: 06/28/2021] [Indexed: 11/20/2022]
Abstract
AIM To estimate the incidence and prevalence of nephropathy and investigate whether high and fluctuating HbA1c levels were associated with development of nephropathy among T1 diabetes individuals in Rwanda. METHODS From 2009 to 2018, 471 T1 diabetes individuals from Rwanda were assessed for nephropathy (albumin-creatinine ratio (ACR) ≥ 30 mg/g). We calculated the mean HbA1c (HbA1c-MEAN) and two measures of HbA1c variability, i.e. A): intra-individual standard deviation (HbA1c-SD), adjusted for HbA1c assessments (HbA1c-AdjSD) and coefficient of variation (HbA1c-CV) and B): (number of HbA1c variability measures > 11 mmol/mol between two measures/number of comparisons between measurements)*100. We followed individuals from first ACR-measurement (baseline) until nephropathy, death or last ACR-measurement (end-of-follow-up), and calculated HRs for developing nephropathy using Cox-regression. RESULTS The incidence and prevalence of nephropathy were 25% and 40%, respectively. All HbA1c variability measures were associated with lower HRs of developing nephropathy, i.e. individuals with HbA1c-AdjSD levels of 0.8-1.5%, 1.5-2.1% and > 4.1% had 53% (95 %CI:0.26;0.86), 55% (95 %CI:0.25;0.82) and 53% (95 %CI:0.26;0.84) lower HRs, respectively, of nephropathy compared to individuals with HbA1c-AdjSD < 0.8%. Results did not change after adjustments, though some estimates were no longer significant. Individuals with adjusted HbA1c-MEAN 9.9-11.4% and > 11.4% had HRs of 1.7 (95 %CI: 0.87;3.32) and 1.8 (95 %CI: 0.94;3.50) compared to individuals with HbA1c-MEAN of 4.9-8.5%. CONCLUSION The incidence and prevalence of nephropathy was high. Higher mean HbA1c was associated with higher HRs of developing nephropathy whereas higher HbA1c variability was associated with lower HRs of nephropathy. This indicates that higher HbA1c levels rather than fluctuating HbA1c levels is a risk factor for developing nephropathy.
Collapse
Affiliation(s)
- Nathalie Bille
- World Diabetes Foundation, Department of Advocacy and Partnerships, Bagsvaerd, Denmark; University of Copenhagen, Department of Public Health, Global Health Section, Copenhagen, Denmark.
| | - Stine Byberg
- Steno Diabetes Center Copenhagen, Department of Clinical Epidemiology, Gentofte, Denmark
| | | | - Kirza Buch Kristensen
- World Diabetes Foundation, Department of Advocacy and Partnerships, Bagsvaerd, Denmark
| | - Dirk Lund Christensen
- University of Copenhagen, Department of Public Health, Global Health Section, Copenhagen, Denmark
| |
Collapse
|
14
|
Gomes MB, Calliari LE, Conte D, Correa CL, Drummond KRG, Mallmann F, Pinheiro AA, Muniz LH, Leal FSL, Morales PH, Negrato CA. Diabetes-related chronic complications in Brazilian adolescents with type 1 diabetes. A multicenter cross-sectional study. Diabetes Res Clin Pract 2021; 177:108895. [PMID: 34090967 DOI: 10.1016/j.diabres.2021.108895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/11/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
AIMS To investigate the prevalence of diabetes-related chronic complications (DRCCs) and its associated factors in Brazilian adolescents with type 1 diabetes (T1D). METHODS This nationwide study was conducted in 14 public clinics in 10 cities, with 1,760 patients, 367 adolescents, with 328 eligible for this study. Evaluated DRCCs were retinopathy (DR), chronic kidney disease (CKD), peripheral neuropathy (DPN) and cardiovascular autonomic neuropathy (CAN). RESULTS Among eligible patients, 184 were females (50.1%), age range 13-19 years, HbA1c 9.6% ± 2.4, aged 8.9 ± 4.3 years at diagnosis and diabetes duration of 8.1 ± 4.3 years. 103 (31.4%) patients presented any type of DRCC. CKD was found in 46 (14.0%), CAN in 41(12.5%), DR in 28 (8.5%) and DPN in 16 (4.9%) patients. One, two or three DRCCs were observed in 79 (24.1%), 19 (5.8%) and 5 (1.5%) patients, respectively, and were associated with longer diabetes duration, higher HbA1c and diastolic blood pressure levels (dBP), use of renin angiotensin inhibitors and lower adherence to diet. CONCLUSIONS A high percentage of patients presented some kind of DRCC, associated with diabetes duration, glycemic control, dBP, adherence to diet. Educational programs should start from the diagnosis to avoid DRCCs in this young population.
Collapse
Affiliation(s)
- Marilia Brito Gomes
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Brazil
| | - Luis Eduardo Calliari
- Diabetes Outpatient Clinic, Pediatric Endocrine Unit, Santa Casa School of Medical Sciences, São Paulo, SP, Brazil.
| | - Deborah Conte
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Brazil
| | - Caio Lima Correa
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Brazil
| | | | - Felipe Mallmann
- Department of Ophthalmology, Federal University of Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brazil
| | | | - Luiza Harcar Muniz
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Brazil
| | | | | | - Carlos Antonio Negrato
- Medical Doctor Program, University of São Paulo- School of Dentistry, Bauru, São Paulo, Brazil
| |
Collapse
|
15
|
McLarty RP, Alloyce JP, Chitema GG, Msuya LJ. Glycemic control, associated factors, acute complications of Type 1 Diabetes Mellitus in children, adolescents and young adults in Tanzania. Endocrinol Diabetes Metab 2021; 4:e00200. [PMID: 33855206 PMCID: PMC8029575 DOI: 10.1002/edm2.200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 12/22/2022] Open
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.
Collapse
Affiliation(s)
- Ronald P. McLarty
- Kilimanjaro Christian Medical University CollegeMoshiTanzania
- Kilimanjaro Christian Medical CentreMoshiTanzania
| | | | | | - Levina J. Msuya
- Kilimanjaro Christian Medical University CollegeMoshiTanzania
- Kilimanjaro Christian Medical CentreMoshiTanzania
| |
Collapse
|
16
|
Zabeen B, Khaled MZ, Husain L, Aktar A, Huda K, Kamal YA, Choudhury N, Azad K. Risk factors associated with retinopathy in young people with type 1 diabetes in Bangladesh. Endocrinol Diabetes Metab 2021; 4:e00197. [PMID: 33855204 PMCID: PMC8029569 DOI: 10.1002/edm2.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives Diabetic retinopathy (DR) is the most common microvascular complications seen in children and adolescents with type 1 diabetes. The aim of this study was to evaluate the prevalence of retinopathy and its association with other risk factors in young people with type 1 diabetes. Methods This study was a cross-sectional study, which was done as part of the ongoing complication assessment in the paediatric diabetes clinic in BIRDEM (Bangladesh Institute of Research and Rehabilitation of Diabetes Endocrine and Metabolic Disorders), a tertiary care hospital. Children, adolescents and young adults with type 1 diabetes who were having diabetes duration >2 years were included in this study. Retinopathy was detected using fundal photography, and grading was done by National Screening Committee of UK by trained ophthalmologists. Results Diabetic retinopathy was observed in 44 (6.6%) patients. Majority (95.4%) of them had early diabetic retinopathy in the form of mild NPDR (nonproliferative diabetic retinopathy) (R1). Patients with retinopathy had higher HbA1c 9.6[8.4-12.3] vs 9.1 [7.9-10.8] (P = .013), longer duration of diabetes 7.6 [5.5-10.7] vs 6.0 [4.5-8.2] years (P = .001) and were older 21.5 [18.0-23.0] vs 18 [16.0-21.0] years (P = .0001) compared with those without retinopathy. On multivariate regression analysis, higher age and median HbA1c were significantly associated with DR. Conclusions Higher HbA1c was the only modifiable risk factor for development of DR in our study population. Early detection of DR with improvement of glycaemic control may reduce the risk of progression of severe stages of the disease.
Collapse
Affiliation(s)
- Bedowra Zabeen
- Department of PaediatricsLife for a Child & Changing Diabetes in Children ProgrammeBangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders (BIRDEM)Diabetic Association of BangladeshDhakaBangladesh
| | - Mohammad Zafar Khaled
- Department of OphthalmologyBangobandhu Sheikh Mujib Medical University (BSMMU)DhakaBangladesh
| | - Lutful Husain
- Orbis InternationalBangladesh Country OfficeDhakaBangladesh
| | - Asma Aktar
- National Institute of Ophthalmology (NIO)DhakaBangladesh
| | - Kamrul Huda
- Life for a child (LFAC) and Changing Diabetes in Children (CDiC) ProgrammeBIRDEM 2Diabetic Association of BangladeshDhakaBangladesh
| | - Yeasmin Afroz Kamal
- Department of OphthalmologyBangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders (BIRDEM)DhakaBangladesh
| | - Nujhat Choudhury
- Department of OphthalmologyBangobandhu Sheikh Mujib Medical University (BSMMU)DhakaBangladesh
| | - Kishwar Azad
- Department of PaediatricsPerinatal Care ProjectBangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders (BIRDEM)Diabetic Association of BangladeshDhakaBangladesh
| |
Collapse
|
17
|
Ogugua CF, Chikani UN, Okiche CY, Ibekwe UM. Sociodemographic determinants of glycaemic control among children with type 1 diabetes in South Eastern Nigeria. Pan Afr Med J 2021; 38:250. [PMID: 34104298 PMCID: PMC8164434 DOI: 10.11604/pamj.2021.38.250.19790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 02/12/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION diabetic complications have been identified as the major causes of morbidity and mortality in persons with type 1 diabetes mellitus (T1DM). Lack of appropriate glycaemic control is a significant risk factor for the onset and progression of long term complications of diabetes. Identifying the determinants of good glycaemic control is therefore imperative. METHODS this was a cross-sectional, hospital-based study of children aged 3-18 years with T1DM. Subjects were consecutively enrolled after obtaining consent from their parents and assent from children aged ≥7 years. A questionnaire was completed recording their clinical history and sociodemographic variables. Their HbA1c was estimated and values ≤7.5% was defined as the cut-off for optimal glycaemic control. RESULTS seventy-one children with T1DM were enrolled for the study. Thirty-eight (53.5%) of them were males. Mean age (years) was 13.7±4. Mean age at onset of diabetes was 11.6 years (range: 3-16 years), mean duration of diabetes was 24.4 months (range: 4-84 months), mean HbA1c value was 10.5% (range: 6.4%-14%); a multivariate logistic regression analysis was performed to identify determinants of optimal glycaemic control. Only caregivers' involvement in diabetes management P<0.016, odd ratio 13.03 (95% CI: 1.60-105.95) was identified as determinant of good glycaemic control. CONCLUSION our data suggest that of all the sociodemographic factors studied, caregivers' involvement in diabetes management was the only strong determinant for optimal glycaemic control.
Collapse
Affiliation(s)
- Chinwe Flora Ogugua
- Paediatric Endocrinology Unit, Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Ugo Nnenna Chikani
- Paediatric Endocrinology Unit, Department of Paediatrics, University of Nigeria, Ituku Ozalla Campus, Enugu, Nigeria
| | - Chikosolu Yvonne Okiche
- Paediatric Endocrinology Unit, Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Ugochi Maryann Ibekwe
- Paediatric Endocrinology Unit, Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
- Department of Paediatrics, Ebonyi State University, Abakaliki, Ebonyi, Nigeria
| |
Collapse
|
18
|
Glycemic control and complications of type 1 diabetes among children in Tanzania. J Clin Transl Endocrinol 2021; 23:100245. [PMID: 33365257 PMCID: PMC7749418 DOI: 10.1016/j.jcte.2020.100245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 12/06/2020] [Accepted: 12/06/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Knowledge on Type 1 Diabetes (T1D) in sub-Saharan Africa is scarce. This study aimed at assessing microvascular complications of Type 1 diabetes in young patients. Method A retrospective study based on medical recordings from 2010–2016 was done. 604 children and young adults with T1D were recruited from five hospitals with pediatric diabetes clinics. 559 patients aged 2–35 years with known date of birth were included. Clinical data on retinopathy and neuropathy were analyzed. There was no information on renal function/ nephropathy. Results Most data were missing. There was documentation on HbA1C, plasma glucose and complications in less than half of the patient files. Of those with registered HbA1c values (42.2%), 36% had HbA1c > 12.5%. There was high prevalence of retinopathy (21.5%) and neuropathy (29.4%) in spite of short mean duration of diabetes (6.2 ± 4.1 years). Conclusion Many patients with T1D in Tanzania have poor metabolic control. Microvascular complications are common already after a short duration of diabetes, but the results have to be interpreted with great caution because of study limitations. Better pediatric diabetes care as well as increased awareness of diabetes is needed. Studies in resource-poor countries need careful planning, if possible with prospective design.
Collapse
|
19
|
Ramaphane T, Gezmu AM, Tefera E, Gabaitiri L, Nchingane S, Matsheng-Samuel M, Joel D. Prevalence and Factors Associated with Microalbuminuria in Pediatric Patients with Type 1 Diabetes Mellitus at a Large Tertiary-Level Hospital in Botswana. Diabetes Metab Syndr Obes 2021; 14:4415-4422. [PMID: 34754207 PMCID: PMC8572018 DOI: 10.2147/dmso.s322847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/16/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Microalbuminuria is considered the earliest sign of diabetic nephropathy among patients with type 1 diabetes mellitus (T1DM). The prevalence of microalbuminuria among African children with T1DM is reported to be high, yet its prevalence and population-specific risk factors in Botswana are not known. AIM This study aimed to determine the prevalence of microalbuminuria among children and young adults with T1DM in Botswana and identify factors associated with microalbuminuria in this population. METHODS A retrospective cross-sectional study was conducted on 127 T1DM patients aged <24 years followed at a pediatric endocrinology clinic in Botswana from 2010 to 2017. Clinical, laboratory, and demographic data were collected using chart review and patient surveys. Descriptive statistics were reported as mean and standard deviation for continuous variables, and frequency and percentage for categorical variables. Prevalence of microalbuminuria was calculated as a simple proportion. Group comparison was done using two-sample independent t-test, X 2-test, or Fisher's exact test and logistic regression to assess for associations. Level of significance was set at p<0.05. RESULTS There were a total of 71 (55.9%) females. The mean age was 18.7 (±5) years and mean duration of T1DM was 6.6 (±4.6) years. Most study participants were of African descent. The prevalence of microalbuminuria was 28.3%. Group comparison revealed gender (p= 0.040), duration of diabetes (p= 0.002), systolic blood pressure (p=0.003), baseline glycated hemoglobin (HbA1c) (p=0.009) and Tanner's stage (p=008) to be significantly associated with microalbuminuria. On binary logistic regression, only gender (p=0.039) and baseline HbA1c (p=0.039) were independently associated with the presences of microalbuminuria. CONCLUSION This study identified a high prevalence of microalbuminuria among children and young adults with T1DM in Botswana and reaffirms the importance of early detection, glycemic control, and regular screening to prevent diabetic nephropathy.
Collapse
Affiliation(s)
- Tshireletso Ramaphane
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Alemayehu M Gezmu
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Correspondence: Alemayehu M Gezmu Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Bag UB00713, Gaborone, Botswana Email
| | - Endale Tefera
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Lesego Gabaitiri
- Department of Statistics, Faculty of Social Sciences, University of Botswana, Gaborone, Botswana
| | | | | | - Dipesalema Joel
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| |
Collapse
|
20
|
Tamru K, Aga F, Berhanie E, Aynalem YA, Shiferaw WS. Incidence of diabetic nephropathy in patients with type 2 diabetes mellitus at a tertiary healthcare setting in Ethiopia. Diabetes Metab Syndr 2020; 14:1077-1083. [PMID: 32650279 DOI: 10.1016/j.dsx.2020.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Diabetic nephropathy (DN) is a leading cause of morbidity and mortality in diabetic patients representing a huge health and economic burden. Despite the increasing number of patients with Diabetes Mellitus in Ethiopia, the incidence of diabetic nephropathy in patients with DM has not been well established. Therefore, this study aimed to estimate the incidence and predictors of DN in patients with T2DM at tertiary healthcare setting, Ethiopia. METHODS An institution based retrospective follow study was conducted from March 1 to April 28, 2019. Kaplan-meier survival curve together with log rank test were used. Cox proportional hazard model was used at 5% level of significance to determine the net effect of each explanatory variable on diabetic nephropathy. An assumption was check by schoenfeld residual test. RESULTS The incidence rate of diabetic nephropathy was 3.6% per 100 person-years (95% CI = 2.49-11.47). The median time to develop nephropathy was 100(95% CI, 96.7-107) months. Predictors of diabetic nephropathy were males (AHR: 2.7, 95%CI: 1.39, 5.23), long duration of diabetes (AHR: 1.03, 95%CI: 1.01, 1.06), HbA1c> 7% (AHR: 1.74, 95% CI: 1.67, 3.12), high density lipoprotein (AHR: 0.37, 95% CI: 0.16, 0.83), and mixed anti-diabetic therapy (AHR: 0.07, 95% CI: 0.01, 0.59). CONCLUSION The incidence of diabetic nephropathy among T2DM patients was relatively high. Males, longer duration of diabetes, HbA1c, and fasting blood glucose were increase the risk of diabetic nephropathy.
Collapse
Affiliation(s)
- Kidist Tamru
- Diabetes Center, Tikur Anbessa Hospital, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Fekadu Aga
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Emebet Berhanie
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Yared Asmare Aynalem
- Department of Nursing, College of Health Science, Institute of Medicine and Health Science, Debre Berhan University, Ethiopia
| | - Wondimeneh Shibabaw Shiferaw
- Department of Nursing, College of Health Science, Institute of Medicine and Health Science, Debre Berhan University, Ethiopia.
| |
Collapse
|
21
|
Gregory GA, Guo J, Klatman EL, Ahmadov GA, Besançon S, Gomez ED, Fawwad A, Ramaiya K, Wijesuriya MA, Orchard TJ, Ogle GD. Costs and outcomes of "intermediate" vs "minimal" care for youth-onset type 1 diabetes in six countries. Pediatr Diabetes 2020; 21:628-636. [PMID: 31970828 DOI: 10.1111/pedi.12988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/02/2019] [Accepted: 01/13/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Data are needed to demonstrate that providing an "intermediate" level of type 1 diabetes (T1D) care is cost-effective compared to "minimal" care in less-resourced countries. We studied these care scenarios in six countries. METHODS We modeled the complications/costs/mortality/healthy life years (HLYs) associated with "intermediate" care including two blood glucose tests/day (mean HbA1c 9.0% [75 mmol/mol]) in three lower-gross domestic product (GDP) countries (Mali, Tanzania, Pakistan), or three tests/day (mean HbA1c 8.5% [69 mmol/mol]) in three higher-GDP countries (Bolivia, Sri Lanka, Azerbaijan); and compared findings to "minimal" care (mean HbA1c 12.5% [113 mmol/mol]). A discrete time Markov illness-death model with age and calendar-year-dependent transition probabilities was developed, with inputs of 30 years of complications and Standardized Mortality Rate data from the youth cohort in the Pittsburgh Epidemiology of Diabetes Complications Study, background mortality, and costs determined from international and local prices. RESULTS Cumulative 30 years incidences of complications were much lower for "intermediate care" than "minimal care", for example, for renal failure incidence was 68.1% (HbA1c 12.5%) compared to 3.9% (9%) and 2.4% (8.5%). For Mali, Tanzania, Pakistan, Bolivia, Sri Lanka, and Azerbaijan, 30 years survival was 50.1%/52.7%/76.7%/72.5%/82.8%/89.2% for "intermediate" and 8.5%/10.1%/39.4%/25.8%/45.5%/62.1% for "minimal" care, respectively. The cost of a HLY gained as a % GDP/capita was 141.1%/110.0%/52.3%/41.8%/17.0%/15.6%, respectively. CONCLUSIONS Marked reductions in complications rates and mortality are achievable with "intermediate" T1D care achieving mean clinic HbA1c of 8.5% to 9% (69-75 mmol/mol). This is also "very cost-effective" in four of six countries according to the WHO "Fair Choices" approach which costs HLYs gained against GDP/capita.
Collapse
Affiliation(s)
- Gabriel A Gregory
- Life for a Child Program, Diabetes NSW, Glebe, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Jingchuan Guo
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Emma L Klatman
- Life for a Child Program, Diabetes NSW, Glebe, New South Wales, Australia
| | - Gunduz A Ahmadov
- The Endocrine Center, Baku, Azerbaijan.,Azerbaijan Medical University, Baku, Azerbaijan
| | | | | | - Asher Fawwad
- Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | | | - Mahen A Wijesuriya
- Diabetes Association of Sri Lanka, National Diabetes Centre, Colombo, Sri Lanka
| | - Trevor J Orchard
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Graham D Ogle
- Life for a Child Program, Diabetes NSW, Glebe, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| |
Collapse
|
22
|
Msanga D, Reis K, Kayange N, Bakalemwa R, Kidenya B, Hau D, Mwanansao C, Mahamba D, Ottaru S, Kwiyolecha E, Peck R. Diabetic Microvascular Complications Among Children and Adolescents in Northwestern Tanzania: A Cross-Sectional Study. Ann Glob Health 2020; 86:43. [PMID: 32346524 PMCID: PMC7181947 DOI: 10.5334/aogh.2669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Africa is experiencing a rapid increase in morbidity and mortality related to diabetes mellitus (DM). Contemporary data are needed to guide efforts to improve prevention and treatment for microvascular complications in children and adolescents in Africa. This study was conducted to assess prevalence of diabetic microvascular complications in northwestern Tanzania, including nephropathy, retinopathy, and neuropathy, as well as associated risk factors. Objectives 1) To determine the prevalence of microvascular complications and the overlap of nephropathy, retinopathy and neuropathy and 2) to determine factors associated with the development of microvascular complications. Methods This cross-sectional study included 155 children and adolescents with DM consecutively attending all three health centers providing diabetes care for children in the Mwanza region of Tanzania. Participants were examined for microvascular complications and possible risk factors. Results Fifty-one of 155 participants (age: 5-19 years) had diabetic nephropathy (32.9%), 16 had diabetic retinopathy (10.3%), and 21 had diabetic neuropathy (13.6%). Risk factors for development of a microvascular complication included age, duration of DM, and poor glycemic control. Of the participants, 107 had poor levels of glycemic control (69%) with HbA1C levels >10%. Conclusion The prevalence of microvascular complications, especially that of nephropathy, was disturbingly high. Risk factors for microvascular complications were similar to other studies from Africa and included poor glycemic control, older age, and longer duration of DM. Innovative, locally appropriate systems for optimizing glycemic control are urgently needed.
Collapse
Affiliation(s)
| | - Karl Reis
- Weill Bugando School of Medicine, Mwanza, TZ
- Center for Global Health, Division of Medicine, Weill Cornell Medical College, New York, NY, US
| | | | | | | | - Duncan Hau
- Center for Global Health, Division of Medicine, Weill Cornell Medical College, New York, NY, US
| | | | - Dina Mahamba
- Weill Bugando School of Medicine, Mwanza, TZ
- University of Dodoma, Dodoma, TZ
| | | | | | - Robert Peck
- Weill Bugando School of Medicine, Mwanza, TZ
- University of Dodoma, Dodoma, TZ
| |
Collapse
|
23
|
Ahmed H, Elshaikh T, Abdullah M. Early Diabetic Nephropathy and Retinopathy in Patients with Type 1 Diabetes Mellitus Attending Sudan Childhood Diabetes Centre. J Diabetes Res 2020; 2020:7181383. [PMID: 33299891 PMCID: PMC7708000 DOI: 10.1155/2020/7181383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/08/2020] [Accepted: 11/15/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Data on microvascular complications in children and adolescents with type 1 diabetes mellitus (T1DM) in Sudan are scarce. This study was aimed at determining the prevalence of diabetic nephropathy (DN) and retinopathy (DR) and their relationship to certain risk factors in children with T1DM attending the Sudan Childhood Diabetes Centre. Design and Methods. A clinic-based cross-sectional study of 100 patients with T1DM aged 10-18 years. Patients with disease duration exceeding 5 years if the onset of diabetes was prepubertal and 2 years if it was postpubertal were included. Relevant sociodemographic, clinical, and biochemical information was obtained. Blood pressure was measured. The patients were screened for DN and DR using urinary microalbumin estimation and fundus photography, respectively. RESULTS The frequency of microalbuminuria and diabetic retinopathy was 36% and 33%, respectively. Eleven percent had both retinopathy and microalbuminuria. Seven percent of the patients were found to be hypertensive. Patients with diabetic retinopathy had significantly higher HbA1c levels (p = 0.009) and longer diabetes duration (p = 0.02) than patients without retinopathy. Logistic regression showed that high HbA1c (odds ratio (OR) 0.83, confidence interval (CI) 0.68-1.00, p = 0.04), but not age, duration, ethnic group, BMI, blood pressure, and presence of nephropathy, was an independent risk factor for retinopathy. Likewise, high blood pressure (OR 6.89, CI 1.17-40.52, p = 0.03), but not age, duration, ethnic group, BMI, HbA1c, and presence of retinopathy, was a predictor for nephropathy. CONCLUSION High prevalence of incipient DN and early stages of DR were observed in this study. Longer diabetes duration and higher HbA1c were associated with the presence of diabetic retinopathy. High blood pressure was a risk factor for DN. So regular screening for these complications and optimization of glycemic control are needed.
Collapse
Affiliation(s)
- Hana Ahmed
- Department of Paediatric and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Tayseer Elshaikh
- Department of Ophthalmology, Jabir Abu Eliz Diabetes Centre, Khartoum, Sudan
| | - Mohamed Abdullah
- Department of Paediatric and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| |
Collapse
|
24
|
Agroiya P, Alrawahi AH. Pediatric Diabetic Retinopathy: Experience of a Tertiary Hospital in Oman. Middle East Afr J Ophthalmol 2019; 26:189-195. [PMID: 32153329 PMCID: PMC7034150 DOI: 10.4103/meajo.meajo_208_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/26/2019] [Accepted: 12/24/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study is to describe the prevalence and clinical profile of pediatric diabetic retinopathy (DR) among Omani diabetic children and adolescents attending a tertiary care hospital. METHODS This retrospective cross-sectional study involved the record review of 216 diabetic children attending the diabetes retina clinic of the National Diabetes and Endocrine Centre in the period between June 2015 and November 2018. The retinal evaluation was conducted using direct ophthalmological examination and fundus photography. DR was graded using the Early Treatment DR Study criteria. The statistical analysis was performed using SPSS, version 20. RESULTS The prevalence of DR among the study sample was 3.7% (95% confidence interval: 1.2-6.2). Mild and moderate nonproliferative diabetic retinopathy was seen in 2.8% (6) and 0.9% (2) of patients, respectively. Diabetic maculopathy was observed in 2 (0.9%) cases. Diabetic ketoacidosis was seen in 33.8% of children at presentation. DR was significantly associated with age (P = 0.01), duration (P < 0.001), Type 1 diabetes mellitus (P = 0.01), dyslipidemia (P = 0.005), microalbuminuria (P = 0.001), glycated hemoglobin (P = 0.003), total cholesterol (P = 0.001), high-density lipoproteins (P = 0.001), low-density lipoproteins (P < 0.001), and albumin/creatinine ratio (P < 0.001). CONCLUSIONS This is the first study describing DR among the pediatric age group in Oman. This study reveals a relatively low prevalence of DR and maculopathy among the pediatric diabetic population. However, novel strategies are to be adopted at primary levels to achieve timely screening of diabetic children to enhance the early detection of DR.
Collapse
Affiliation(s)
- Puspalata Agroiya
- National Diabetes and Endocrine Centre, Royal Hospital, Seeb, Muscat, Oman
| | | |
Collapse
|
25
|
Jasem D, Majaliwa ES, Ramaiya K, Najem S, Swai ABM, Ludvigsson J. Incidence, prevalence and clinical manifestations at onset of juvenile diabetes in Tanzania. Diabetes Res Clin Pract 2019; 156:107817. [PMID: 31425767 DOI: 10.1016/j.diabres.2019.107817] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/10/2019] [Accepted: 08/14/2019] [Indexed: 01/04/2023]
Abstract
UNLABELLED Better knowledge on incidence, prevalence and clinical manifestations is needed for planning diabetes care in Sub Saharan Africa. AIMS To find a crude incidence/prevalence of diabetes in children and young adults in a low resource setting, classify the diabetes and audit the health record keeping. METHODS A retrospective observational study based on medical recordings 2010-2016. Target population was children and adolescent registered in Changing Diabetes in Children (CDiC) or Life for a Child (LFAC) programs for children with T1DM and diagnosed at 5 diabetes clinics in three geographical regions of Tanzania. 604 patients' files were available from five hospitals. RESULTS 336/604 files covered patients <15 years of age at diagnosis. The prevalence of diabetes <15 years of age ranged from 10.1 to 11.9 per 100,000 children and the annual incidence 1.8-1.9/100,000 children, with peak incidence at 10-14 years. A lot of data were missing. The great majority of the patients presented with typical signs and symptoms of T1D, 83.7% with plausible ketoacidosis (DKA). CONCLUSIONS Diabetes incidence and prevalence is still low. T1D seems to dominate with very high frequency of DKA at diagnosis. Increased awareness of diabetes both in health care and community is needed.
Collapse
Affiliation(s)
- D Jasem
- Div of Pediatrics, Dept of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - E S Majaliwa
- Department of Paediatric and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - K Ramaiya
- Department of Internal Medicine, Hindu Mandal Hospital, Dar Es Salaam, Tanzania
| | - S Najem
- Div of Pediatrics, Dept of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - A B M Swai
- Tanzania Diabetes Association, Dar es Salaam, Tanzania
| | - J Ludvigsson
- Div of Pediatrics, Dept of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Crown Princess Victoria Children's Hospital, University Hospital, Region Östergötland, Linköping, Sweden.
| |
Collapse
|
26
|
Pirie FJ, Jairam V, Paruk IM, Connolly C, Motala AA. High frequency of hypoglycaemia in patients with type 1 diabetes mellitus attending a tertiary diabetes clinic in Durban, South Africa. Diabetes Res Clin Pract 2019; 155:107783. [PMID: 31325541 DOI: 10.1016/j.diabres.2019.107783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/27/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
AIM The study aimed to assess the prevalence of hypoglycaemia in subjects with type 1 diabetes (T1D) attending a public health tertiary diabetes clinic in Durban, South Africa. METHODS Patients with T1D were enrolled at the time of clinic attendance. Data on hypoglycaemia over the previous 12 weeks were obtained from glucose meter downloads as well as diary records. Each patient completed the Hypoglycaemia Fear Survey questionnaire as well as an in-house questionnaire on hypoglycaemic episodes in the previous 12 months. RESULTS A total of 151 subjects (58% female, 54% black African) were enrolled. "Any" hypoglycaemia occurred in 144 (95.4%) in the 12 months prior to clinic attendance. Of these, "severe" hypoglycaemia occurred in 107 (74.3%) and 22 (20.6%) had five or more severe episodes. The most frequent behavioural change in response to hypoglycaemia was insulin dose self-adjustment and the commonest worry was the possibility of becoming emotionally upset during hypoglycaemia. CONCLUSIONS In a tertiary diabetes clinic in Durban, South Africa, there was a high frequency of hypoglycaemia in patients with T1D and in the majority, at least one severe episode occurred in the 12 months prior to clinic attendance. The results indicate a need for further study and strategies to reduce the frequency and severity of hypoglycaemia.
Collapse
Affiliation(s)
- Fraser J Pirie
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
| | - Vishal Jairam
- Kingsway Hospital, Amanzimtoti, KwaZulu-Natal, South Africa
| | - Imran M Paruk
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Cathy Connolly
- School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
| | - Ayesha A Motala
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| |
Collapse
|
27
|
Hadgu FB, Sibhat GG, Gebretsadik LG. Diabetic ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes in Tigray, Ethiopia: retrospective observational study. Pediatric Health Med Ther 2019; 10:49-55. [PMID: 31191086 PMCID: PMC6536121 DOI: 10.2147/phmt.s207165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/16/2019] [Indexed: 01/15/2023] Open
Abstract
Background: Diabetic ketoacidosis (DKA) is the most severe acute complication of type 1 diabetes mellitus which results in increased risk of morbidity and mortality especially in developing countries. Objective: To assess prevalence and associated factors of diabetic ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes in hospitals of the Tigray region, Ethiopia. Methods: A facility based retrospective observational study design was conducted in newly diagnosed type 1 diabetic children and adolescents up to the age of 18 years who were registered in 13 general and two referral hospitals from January 1, 2013 to December 30, 2017. The diagnosis of diabetic ketoacidosis was made with the criteria below, Children presenting with polysymptoms, weight loss, vomiting, dehydration, and also the indirect signs or effects of acidosis on respiratory and central nervous systems like Kussmaul breathing, lethargy or coma and biochemically random blood sugar level >11 ml/L, glucosuria and urine ketone >+1 and diagnosed with type 1 diabetes for the first time. Descriptive, Mann-Whitney U and logistic regression analysis were carried out to describe and identify the associated factors with diabetic ketoacidosis. Results: More than three-quarters, 258/328 (78.7%) of the newly diagnosed type 1 diabetes patients, presented with diabetic ketoacidosis at initial diagnosis. Median age of diabetic ketoacidosis patients was 11 years. The patients with diabetic ketoacidosis were younger than nondiabetic ketoacidosis patients (11 vs 13 years, P=0.002). The mortality rate of diabetic ketoacidosis was 4.3%. Young age, presence of precipitating factors and symptoms of DKA/diabetes were found to be highly associated with diabetic ketoacidosis at initial diagnosis. Conclusions: The prevalence of diabetic ketoacidosis was alarmingly high. Young age group patients, precipitating factors and the presence of symptoms of diabetes/DKA like excessive drinking, vomiting and fatigue were highly associated with diabetic ketoacidosis.
Collapse
Affiliation(s)
- Fikaden Berhe Hadgu
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Gereziher Gebremedhin Sibhat
- Department of Pharmacognocy, School of Pharmacy, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | | |
Collapse
|
28
|
Owuor OH, Chege P. CRYPTOCOCCAL meningitis in a HIV negative newly diagnosed diabetic patient: a CASE report. BMC Infect Dis 2019; 19:5. [PMID: 30606110 PMCID: PMC6318972 DOI: 10.1186/s12879-018-3625-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 12/17/2018] [Indexed: 12/28/2022] Open
Abstract
Background This case report emphasizes the need to recognize cryptococcus as a possible cause of meningitis in non-HIV patients in Sub-Saharan Africa and to highlight the possibility of grave outcomes due to the paradoxical immune response in diabetic patients with cryptococcus meningitis. It also highlights the need for widespread availability of amphotericin-B and flucytosine in hospitals in Sub-Saharan Africa. Case presentation A 27 year old African lady was admitted with generalized tonic clonic seizures lasting 5 to 10 min. These seizures were preceded by severe frontal headaches radiating to the occiput and neck and associated with chills, photophobia and loss of consciousness. She was tachycardic and had tongue bites on the lateral aspects of her tongue. Kernig’s and Brudzinski’s signs were positive. India ink was positive on two cerebrospinal fluid (CSF) samples. She had hyperglycemia and glucosuria as well. She was diagnosed with cryptococcal meningitis in diabetes and had a remarkable response to fluconazole monotherapy. She went home on maintenance dose of fluconazole having made full recovery. and is currently on prophylactic doses of fluconazole. Conclusions With the rising prevalence of diabetes in Sub-Saharan Africa, coupled with the low levels of adequate glucose control, cryptococcal meningitis should be considered in the differential diagnosis for diabetic patients presenting with chronic headache, fever and neurologic deficits.
Collapse
Affiliation(s)
- Odhiambo Henry Owuor
- School of Medicine, Department of Family Medicine, Moi University, P. O. Box, Eldoret, 3900-30100, Kenya.
| | - Patrick Chege
- School of Medicine, Department of Family Medicine, Moi University, P. O. Box, Eldoret, 3900-30100, Kenya
| |
Collapse
|
29
|
Donaghue KC, Marcovecchio ML, Wadwa RP, Chew EY, Wong TY, Calliari LE, Zabeen B, Salem MA, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2018: Microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes 2018; 19 Suppl 27:262-274. [PMID: 30079595 PMCID: PMC8559793 DOI: 10.1111/pedi.12742] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/27/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Kim C. Donaghue
- The Children’s Hospital at Westmead, Westmead, NSW, Australi a,Discipline of Child and Adolescent Health, University of Sydney, Camperdown, Australia
| | | | - R. P. Wadwa
- University of Colorado School of Medicine, Denver, Colorado
| | - Emily Y. Chew
- Division of Epidemiology and Clinical Applications, the National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Tien Y. Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | | | - Bedowra Zabeen
- Department of Paediatrics and Changing Diabetes in Children Program, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Mona A. Salem
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Maria E. Craig
- The Children’s Hospital at Westmead, Westmead, NSW, Australi a,Discipline of Child and Adolescent Health, University of Sydney, Camperdown, Australia,School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia
| |
Collapse
|
30
|
Wagnew F, Eshetie S, Kibret GD, Zegeye A, Dessie G, Mulugeta H, Alemu A. Diabetic nephropathy and hypertension in diabetes patients of sub-Saharan countries: a systematic review and meta-analysis. BMC Res Notes 2018; 11:565. [PMID: 30081966 PMCID: PMC6080368 DOI: 10.1186/s13104-018-3670-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/01/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE This meta-analysis was undertaken to estimate the prevalence of diabetic nephropathy and its association with hypertension in diabetics of sub-Saharan African countries. RESULTS A total of 27 studies were included for the meta-analysis. The pooled overall prevalence of diabetic nephropathy was 35.3 (95% CI 27.46-43.14). In sub-group analyses by types of diabetes and regions, for instance, the prevalence was 41.4% (95% CI 32.2-50.58%) in type-2 diabetes mellitus and 29.7% (95% CI 14.3-45.1%) in Eastern Africa. Pooled point estimates from included studies revealed an increased risk of diabetic nephropathy with hypertension compared to without hypertension (OR = 1.67, 95% CI 1.31, 2.14). Diabetic nephropathy is a common complication in diabetic patients. Diabetic nephropathy complication is significantly higher in hypertensive patients. A preventive strategy should be adopted or planned to reduce diabetes mellitus and its complication of neuropathy, particularly in hypertensive.
Collapse
Affiliation(s)
- Fasil Wagnew
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
| | - Setegn Eshetie
- College of Health Science, University of Gondar, Gondar, Ethiopia
| | | | - Abriham Zegeye
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Getenet Dessie
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Henok Mulugeta
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Amanuel Alemu
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| |
Collapse
|
31
|
Robinson MÈ, Altenor K, Carpenter C, Bonnell R, Jean-Baptiste E, von Oettingen J. High rates of ocular complications in a cohort of Haitian children and adolescents with diabetes. Pediatr Diabetes 2018; 19:1124-1130. [PMID: 29700918 DOI: 10.1111/pedi.12688] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/06/2018] [Accepted: 04/16/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ophthalmic complications of pediatric diabetes are rare, and rates are unknown in Haitian youth. OBJECTIVES To determine the prevalence and predictors of diabetic retinopathy (DR) and cataracts in a cohort of Haitian youth with insulin-treated diabetes. METHODS We performed a cross-sectional retrospective review of pediatric patients with diabetes from a pediatric chronic disease center in Haiti, from December 1, 2012 to November 1, 2016. Data collection included demographic and anthropometric information, total daily insulin dose and result of eye examination by a local ophthalmologist. RESULTS Of 67 patients (54% female, mean age at diagnosis 14.6 ± 3.9 years, mean diabetes duration 3.3 ± 3.0 years, mean HbA1c 84 ± 22 mmol/mol (9.8% ± 2.0%), mean current insulin requirement 0.49 ± 0.28 IU/kg/day), DR was diagnosed in 10/57 (18%) and cataracts in 10/62 (16%), at a mean age of 19.0 ± 4.3 and 19.1 ± 3.3 years, respectively. Diabetes duration was 4.9 ± 5.4 and 3.0 ± 1.5 years at the time of diagnosis of DR and cataracts, respectively. Age at complication, insulin requirement, sex, body mass index, family history, mean HbA1c and diabetes duration were not significant predictors of an ocular complication. CONCLUSIONS In this cohort of Haitian youth, DR and cataracts occur prematurely. Low-insulin requirements years after diagnosis, possibly allowing for prolonged undetected hyperglycemia prediagnosis, may explain complication risk. The phenotypes of diabetes in pediatric populations of African ancestry may be distinct. Ophthalmologic evaluation should possibly start at diagnosis, and screening guidelines may need to be adapted.
Collapse
Affiliation(s)
- Marie-Ève Robinson
- Department of Pediatrics, Division of Endocrinology, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Ric Bonnell
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Texas at Austin, Austin, Texas, United States of America
| | - Eddy Jean-Baptiste
- Haitian Foundation for Diabetic and Cardiovascular Diseases, Port-au-Prince, Haiti
| | - Julia von Oettingen
- Department of Pediatrics, Division of Endocrinology, McGill University Health Centre, Montreal, QC, Canada
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States of America
| |
Collapse
|
32
|
Mendoza JA, Haaland W, D'Agostino RB, Martini L, Pihoker C, Frongillo EA, Mayer-Davis EJ, Liu LL, Dabelea D, Lawrence JM, Liese AD. Food insecurity is associated with high risk glycemic control and higher health care utilization among youth and young adults with type 1 diabetes. Diabetes Res Clin Pract 2018; 138:128-137. [PMID: 29427695 PMCID: PMC5910177 DOI: 10.1016/j.diabres.2018.01.035] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/13/2018] [Accepted: 01/30/2018] [Indexed: 12/20/2022]
Abstract
AIMS Household food insecurity (FI), i.e., limited availability of nutritionally adequate foods, is associated with poor glycemic control among adults with type 2 diabetes. We evaluated the association of FI among youth and young adults (YYA) with type 1 diabetes to inform recent clinical recommendations from the American Diabetes Association for providers to screen all patients with diabetes for FI. METHODS Using data from the Washington and South Carolina SEARCH for Diabetes in Youth Study sites, we conducted an observational, cross-sectional evaluation of associations between FI and glycemic control, hospitalizations, and emergency department (ED) visits among YYA with type 1 diabetes. FI was assessed using the Household Food Security Survey Module, which queries conditions and behaviors typical of households unable to meet basic food needs. Participants' HbA1c were measured from blood drawn at the research visit; socio-demographics and medical history were collected by survey. RESULTS The prevalence of FI was 19.5%. In adjusted logistic regression analysis, YYAs from food-insecure households had 2.37 higher odds (95% CI: 1.10, 5.09) of high risk glycemic control, i.e., HbA1c >9.0%, vs. peers from food-secure households. In adjusted binomial regression analysis for ED visits, YYAs from food-insecure households had an adjusted prevalence rate that was 2.95 times (95% CI [1.17, 7.45]) as great as those from food secure households. CONCLUSIONS FI was associated with high risk glycemic control and more ED visits. Targeted efforts should be developed and tested to alleviate FI among YYA with type 1 diabetes.
Collapse
Affiliation(s)
- Jason A Mendoza
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA; Health Disparities Research Center, Fred Hutchinson Cancer Research Center/UW Cancer Consortium, Seattle, WA, USA.
| | - Wren Haaland
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Ralph B D'Agostino
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Lauren Martini
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA
| | - Edward A Frongillo
- Health Promotion, Education and Behavior, University of South Carolina, Columbia, SC, USA
| | - Elizabeth J Mayer-Davis
- Departments of Nutrition and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lenna L Liu
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Center, Denver, CO, USA
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA; Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
33
|
Silver B, Ramaiya K, Andrew SB, Fredrick O, Bajaj S, Kalra S, Charlotte BM, Claudine K, Makhoba A. EADSG Guidelines: Insulin Therapy in Diabetes. Diabetes Ther 2018; 9:449-492. [PMID: 29508275 PMCID: PMC6104264 DOI: 10.1007/s13300-018-0384-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Indexed: 01/25/2023] Open
Abstract
A diagnosis of diabetes or hyperglycemia should be confirmed prior to ordering, dispensing, or administering insulin (A). Insulin is the primary treatment in all patients with type 1 diabetes mellitus (T1DM) (A). Typically, patients with T1DM will require initiation with multiple daily injections at the time of diagnosis. This is usually short-acting insulin or rapid-acting insulin analogue given 0 to 15 min before meals together with one or more daily separate injections of intermediate or long-acting insulin. Two or three premixed insulin injections per day may be used (A). The target glycated hemoglobin A1c (HbA1c) for all children with T1DM, including preschool children, is recommended to be < 7.5% (< 58 mmol/mol). The target is chosen aiming at minimizing hyperglycemia, severe hypoglycemia, hypoglycemic unawareness, and reducing the likelihood of development of long-term complications (B). For patients prone to glycemic variability, glycemic control is best evaluated by a combination of results with self-monitoring of blood glucose (SMBG) (B). Indications for exogenous insulin therapy in patients with type 2 diabetes mellitus (T2DM) include acute illness or surgery, pregnancy, glucose toxicity, contraindications to or failure to achieve goals with oral antidiabetic medications, and a need for flexible therapy (B). In T2DM patients, with regards to achieving glycemic goals, insulin is considered alone or in combination with oral agents when HbA1c is ≥ 7.5% (≥ 58 mmol/mol); and is essential for treatment in those with HbA1c ≥ 10% (≥ 86 mmol/mol), when diet, physical activity, and other antihyperglycemic agents have been optimally used (B). The preferred method of insulin initiation in T2DM is to begin by adding a long-acting (basal) insulin or once-daily premixed/co-formulation insulin or twice-daily premixed insulin, alone or in combination with glucagon-like peptide-1 receptor agonist (GLP-1 RA) or in combination with other oral antidiabetic drugs (OADs) (B). If the desired glucose targets are not met, rapid-acting or short-acting (bolus or prandial) insulin can be added at mealtime to control the expected postprandial raise in glucose. An insulin regimen should be adopted and individualized but should, to the extent possible, closely resemble a natural physiologic state and avoid, to the extent possible, wide fluctuating glucose levels (C). Blood glucose monitoring is an integral part of effective insulin therapy and should not be omitted in the patient's care plan. Fasting plasma glucose (FPG) values should be used to titrate basal insulin, whereas both FPG and postprandial glucose (PPG) values should be used to titrate mealtime insulin (B). Metformin combined with insulin is associated with decreased weight gain, lower insulin dose, and less hypoglycemia when compared with insulin alone (C). Oral medications should not be abruptly discontinued when starting insulin therapy because of the risk of rebound hyperglycemia (D). Analogue insulin is as effective as human insulin but is associated with less postprandial hyperglycemia and delayed hypoglycemia (B). The shortest needles (currently the 4-mm pen and 6-mm syringe needles) are safe, effective, and less painful and should be the first-line choice in all patient categories; intramuscular (IM) injections should be avoided, especially with long-acting insulins, because severe hypoglycemia may result; lipohypertrophy is a frequent complication of therapy that distorts insulin absorption, and therefore, injections and infusions should not be given into these lesions and correct site rotation will help prevent them (A). Many patients in East Africa reuse syringes for various reasons, including financial. This is not recommended by the manufacturer and there is an association between needle reuse and lipohypertrophy. However, patients who reuse needles should not be subjected to alarming claims of excessive morbidity from this practice (A). Health care authorities and planners should be alerted to the risks associated with syringe or pen needles 6 mm or longer in children (A).
Collapse
Affiliation(s)
- Bahendeka Silver
- MKPGMS-Uganda Martyrs University | St. Francis Hospital, Nsambya, Kampala, Uganda.
| | - Kaushik Ramaiya
- Shree Hindu Mandal Hospital, Chusi Street, Dar es Salaam, Tanzania
| | - Swai Babu Andrew
- Muhimbili University College of Health Sciences, United Nations Road, Dar es Salaam, Tanzania
| | - Otieno Fredrick
- Department of Clinical Medicine and Therapeutics School of Medicine, College of Health Science, University of Nairobi, Nairobi, Kenya
| | - Sarita Bajaj
- Department of Medicine, MLN Medical College, George Town, Allahabad, India
| | - Sanjay Kalra
- Bharti Research Institute of Diabetes and Endocrinology, Sector 12, PO Box 132001, Karnal, Haryana, India
| | - Bavuma M Charlotte
- University of Rwanda, College of Medicine and Health Science, Kigali University Teaching Hospital, Kigali, Rwanda
| | - Karigire Claudine
- Department of Internal Medicine, Rwanda Military Hospital, Kigali, Rwanda
| | - Anthony Makhoba
- MKPGMS-Uganda Martyrs University | St. Francis Hospital, Nsambya, Kampala, Uganda
| |
Collapse
|
34
|
Ameyaw E, Asafo-Agyei SB, Thavapalan S, Middlehurst AC, Ogle GD. Clinical profile of diabetes at diagnosis among children and adolescents at an endocrine clinic in Ghana. World J Diabetes 2017; 8:429-435. [PMID: 28989569 PMCID: PMC5612833 DOI: 10.4239/wjd.v8.i9.429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/31/2017] [Accepted: 06/20/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To determine the clinical features of diabetes in children and adolescents in Ghana.
METHODS Retrospective review of clinical features of all children and adolescents with new-onset diabetes seen at the paediatric endocrinology clinic of Komfo Anokye Teaching Hospital in Kumasi, from February 2012 to Auguest 2016.
RESULTS One hundred and six subjects presented with diabetes. Ninety (84.9%) were diagnosed by clinical features and family history as type 1, and 16 (15.1%) type 2. For type 1 subjects, age range at diagnosis was 0.9-19.9 year (y), peak age of onset 12-13 year, and 3.3% were < 5 year, 21.1% 5- < 10 year, 45.6% 10- < 15 year and 30.0% 15- < 20 year. Seventy-one point one percent were female. Common clinical features were polyuria (100%), polydipsia (98.9%), and weight loss (82.2%). Mean BMI SD was -0.54, range -3.84 to 2.47. 60.0% presented in diabetic ketoacidosis (DKA). Nine had infections at onset (skin, abscess, leg ulcer). Mean ± SD HbA1c at diagnosis was 12.7% ± 1.9% (115 ± 21 mmol/mol). Four have since died: Hypoglycaemia (2), recurrent DKA (1), osteosarcoma (1). Two other type 1 cases died of DKA at presentation in emergency before being seen by the paediatric endocrinologist. Crude mortality rate including these 2 cases was 32.2/1000 patient years. Type 2 cases were 81% female, age of onset 9-19 year. Mean BMI SD was 1.49, range -0.87 to 2.61. Forty-three point eight percent presented in DKA. All type 2 cases had acanthosis nigricans. Overall, 9.8% did not have home refrigeration, most using clay pot evaporative cooling for insulin storage.
CONCLUSION Type 1 occurs with a female preponderance and high DKA rates. Type 2 also occurs. Typology based on clinical features is difficult. Community and professional awareness is warranted.
Collapse
Affiliation(s)
- Emmanuel Ameyaw
- Department of Child Health, Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana
| | - Serwah B Asafo-Agyei
- Department of Child Health, Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana
| | - Sumithira Thavapalan
- International Diabetes Federation Life for a Child Program, Glebe, NSW 2037, Australia
- Diabetes NSW, Glebe, NSW 2037, Australia
| | - Angela C Middlehurst
- International Diabetes Federation Life for a Child Program, Glebe, NSW 2037, Australia
- Diabetes NSW, Glebe, NSW 2037, Australia
| | - Graham D Ogle
- International Diabetes Federation Life for a Child Program, Glebe, NSW 2037, Australia
- Diabetes NSW, Glebe, NSW 2037, Australia
| |
Collapse
|
35
|
Atun R, Davies JI, Gale EAM, Bärnighausen T, Beran D, Kengne AP, Levitt NS, Mangugu FW, Nyirenda MJ, Ogle GD, Ramaiya K, Sewankambo NK, Sobngwi E, Tesfaye S, Yudkin JS, Basu S, Bommer C, Heesemann E, Manne-Goehler J, Postolovska I, Sagalova V, Vollmer S, Abbas ZG, Ammon B, Angamo MT, Annamreddi A, Awasthi A, Besançon S, Bhadriraju S, Binagwaho A, Burgess PI, Burton MJ, Chai J, Chilunga FP, Chipendo P, Conn A, Joel DR, Eagan AW, Gishoma C, Ho J, Jong S, Kakarmath SS, Khan Y, Kharel R, Kyle MA, Lee SC, Lichtman A, Malm CP, Mbaye MN, Muhimpundu MA, Mwagomba BM, Mwangi KJ, Nair M, Niyonsenga SP, Njuguna B, Okafor OLO, Okunade O, Park PH, Pastakia SD, Pekny C, Reja A, Rotimi CN, Rwunganira S, Sando D, Sarriera G, Sharma A, Sidibe A, Siraj ES, Syed AS, Van Acker K, Werfalli M. Diabetes in sub-Saharan Africa: from clinical care to health policy. Lancet Diabetes Endocrinol 2017; 5:622-667. [PMID: 28688818 DOI: 10.1016/s2213-8587(17)30181-x] [Citation(s) in RCA: 275] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 04/10/2017] [Accepted: 05/02/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Rifat Atun
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.
| | - Justine I Davies
- Centre for Global Health, King's College London, Weston Education Centre, London, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Education Campus, University of Witwatersrand, Parktown, South Africa
| | | | - Till Bärnighausen
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Institute of Public Health, Faculty of Medicine, Heidelberg University, Heidelberg, Germany; Africa Health Research Institute, KwaZulu, South Africa
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Naomi S Levitt
- Division of Diabetic Medicine & Endocrinology, University of Cape Town, Cape Town, South Africa; Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Moffat J Nyirenda
- Department of NCD Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; NCD Theme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Graham D Ogle
- International Diabetes Federation Life for a Child Program, Glebe, NSW, Australia; Diabetes NSW & ACT, Glebe, NSW, Australia
| | | | - Nelson K Sewankambo
- Department of Medicine, and Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Eugene Sobngwi
- University of Newcastle at Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Solomon Tesfaye
- Sheffield Teaching Hospitals and University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
| | - John S Yudkin
- Institute of Cardiovascular Science, Division of Medicine, University College London, London, UK
| | - Sanjay Basu
- Center for Population Health Sciences and Center for Primary Care and Outcomes Research, Department of Medicine and Department of Health Research and Policy, Stanford University, Palo Alto, CA, USA
| | - Christian Bommer
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Esther Heesemann
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Jennifer Manne-Goehler
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Iryna Postolovska
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Vera Sagalova
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Sebastian Vollmer
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Zulfiqarali G Abbas
- Muhimbili University of Health and Allied Sciences, and Abbas Medical Centre, Dar es Salaam, Tanzania
| | - Benjamin Ammon
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Akhila Annamreddi
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ananya Awasthi
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | - Agnes Binagwaho
- Harvard Medical School, Harvard University, Boston, MA, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA; University of Global Health Equity, Kigali, Rwanda
| | | | - Matthew J Burton
- International Centre for Eye Health, Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeanne Chai
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Felix P Chilunga
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | | | - Anna Conn
- The Fletcher School of Law and Diplomacy, Tufts University, Medford, MA, USA
| | - Dipesalema R Joel
- Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana
| | - Arielle W Eagan
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | | | - Julius Ho
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Simcha Jong
- Leiden University, Science Based Business, Leiden, Netherlands
| | - Sujay S Kakarmath
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Ramu Kharel
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael A Kyle
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Seitetz C Lee
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Amos Lichtman
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Maïmouna N Mbaye
- Clinique Médicale II, Centre de diabétologie Marc Sankale, Hôpital Abass Ndao, Dakar, Senegal
| | - Marie A Muhimpundu
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | | | | | - Mohit Nair
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Simon P Niyonsenga
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | | | - Obiageli L O Okafor
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Oluwakemi Okunade
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Paul H Park
- Partners In Health, Rwinkwavu, South Kayonza, Rwanda
| | - Sonak D Pastakia
- Purdue University College of Pharmacy (Purdue Kenya Partnership), Indiana Institute for Global Health, Uasin Gishu, Kenya
| | | | - Ahmed Reja
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charles N Rotimi
- Center for Research on Genomics and Global Health, National Institutes of Health, Bethesda, MD, USA
| | - Samuel Rwunganira
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - David Sando
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Anshuman Sharma
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | - Azhra S Syed
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Kristien Van Acker
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mahmoud Werfalli
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
36
|
Pastakia SD, Pekny CR, Manyara SM, Fischer L. Diabetes in sub-Saharan Africa - from policy to practice to progress: targeting the existing gaps for future care for diabetes. Diabetes Metab Syndr Obes 2017; 10:247-263. [PMID: 28790858 PMCID: PMC5489055 DOI: 10.2147/dmso.s126314] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The global prevalence and impact of diabetes has increased dramatically, particularly in sub-Saharan Africa. This region faces unique challenges in combating the disease including lack of funding for noncommunicable diseases, lack of availability of studies and guidelines specific to the population, lack of availability of medications, differences in urban and rural patients, and inequity between public and private sector health care. Because of these challenges, diabetes has a greater impact on morbidity and mortality related to the disease in sub-Saharan Africa than any other region in the world. In order to address these unacceptably poor trends, contextualized strategies for the prevention, identification, management, and financing of diabetes care within this population must be developed. This narrative review provides insights into the policy landscape, epidemiology, pathophysiology, care protocols, medication availability, and health care systems to give readers a comprehensive summary of many factors in these domains as they pertain to diabetes in sub-Saharan Africa. In addition to providing a review of the current evidence available in these domains, potential solutions to address the major gaps in care will be proposed to reverse the negative trends seen with diabetes in sub-Saharan Africa.
Collapse
Affiliation(s)
- Sonak D Pastakia
- Department of Pharmacy Practice, Purdue University College of Pharmacy, Indianapolis, IN, USA
| | - Chelsea R Pekny
- Department of Pharmacy Practice, Purdue University College of Pharmacy, Indianapolis, IN, USA
| | - Simon M Manyara
- Department of Pharmacy, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Lydia Fischer
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
37
|
Niba LL, Aulinger B, Mbacham WF, Parhofer KG. Predictors of glucose control in children and adolescents with type 1 diabetes: results of a cross-sectional study in Cameroon. BMC Res Notes 2017; 10:207. [PMID: 28606170 PMCID: PMC5469010 DOI: 10.1186/s13104-017-2534-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 06/05/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In 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. METHODS This 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. RESULTS The 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. CONCLUSIONS This 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.
Collapse
Affiliation(s)
- Loveline L. Niba
- CIHLMU Center for International Health at Ludwig-Maximilians-Universität, Munich, Germany
- Department of Biochemistry, Catholic University of Cameroon (CATUC), P.O. Box 782, Bamenda, Cameroon
| | - Benedikt Aulinger
- CIHLMU Center for International Health at Ludwig-Maximilians-Universität, Munich, Germany
- Department of Medicine II-Grosshadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 Munich, Germany
| | - Wilfred F. Mbacham
- Department of Physiology and Biochemistry, Faculty of Medicine, University of Yaoundé I, P.O. Box 8094, Yaoundé, Cameroon
| | - Klaus G. Parhofer
- CIHLMU Center for International Health at Ludwig-Maximilians-Universität, Munich, Germany
- Department of Medicine II-Grosshadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 Munich, Germany
| |
Collapse
|
38
|
Haugvik S, Beran D, Klassen P, Hussain A, Haaland A. "My heart burns" - A qualitative study of perceptions and experiences of type 1 diabetes among children and youths in Tajikistan. Chronic Illn 2017; 13:128-139. [PMID: 27614907 DOI: 10.1177/1742395316668566] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims To explore and describe perceptions and experiences of living with type 1 Diabetes Mellitus among children/youths in Tajikistan. Methods Qualitative methods were employed. Participants were recruited through purposive and snowball samplings. Data were collected using a semi-structured interview guide with children/youths having diabetes, their parents as well as health professionals. Data were analyzed according to Malterud's systematic text condensation. Results Children/youths with diabetes (n = 18), their parents (n = 19) and endocrinologists (n = 4) were interviewed. Families described unique stories in which "emotional stress" and a spiritual "evil eye" were perceived as possible causes of diabetes. Life-threatening complications and maltreatment preceding diagnosis of diabetes were frequent. From manifestation of diabetes onwards, families struggled with systemic and cultural obstacles, causing stigma, discrimination, high school-drop-out rates, diabetic coma, chronic complications or death of the child/youth with diabetes. Conclusions Results of this qualitative study highlight the severity and complexity of challenges families living with a child/youth having diabetes in this low-income country face. Efforts to improve life expectancy and life quality are strongly needed and require addressing both systemic and cultural factors in order to accomplish sustainable impact.
Collapse
Affiliation(s)
- Severina Haugvik
- 1 Department of Community Medicine and Global Health, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - David Beran
- 2 Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University of Geneva and University of Geneva Hospitals, Geneva, Switzerland
| | | | - Akhtar Hussain
- 1 Department of Community Medicine and Global Health, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ane Haaland
- 1 Department of Community Medicine and Global Health, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|
39
|
Ogle GD, Middlehurst AC, Silink M. The IDF Life for a Child Program Index of diabetes care for children and youth. Pediatr Diabetes 2016; 17:374-84. [PMID: 26153340 DOI: 10.1111/pedi.12296] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 06/11/2015] [Accepted: 06/11/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Care for children and youth with diabetes varies markedly around the world. We developed a standardized, reproducible measure that can be used to document and compare critical factors influencing treatment outcomes. METHODS A questionnaire consisting of 36 multiple-choice questions covering major components of care (such as insulin therapy, blood glucose monitoring, etc.) was sent to 75 countries: 43 under-resourced countries where the International Diabetes Federation's Life for a Child Program operates, and 32 others (mainly developed nations). Results for each country were scaled to a score with a range of 0-100. RESULTS Responses were received from 71 countries. Scores varied widely and were highly correlated to per capita gross domestic product (R(2) = 0.72, P < 0.001) and health expenditure (R(2) = 0.77, P < 0.001). For the 37 low- and lower-middle income countries, only two had complete government provision of human insulin and none of blood glucose test strips. Marked differences according to income were also found for access to home refrigeration; usage of insulin pens, multiple daily injections, pumps, glucagon and ketone strips; hemoglobin A1c (HbA1c) testing; and complications screening. CONCLUSIONS The index is a comprehensive, easily administered survey instrument. It demonstrated stark differences in access to numerous components of care necessary in achieving good outcomes for children and youth with diabetes.
Collapse
Affiliation(s)
- Graham D Ogle
- International Diabetes Federation Life for a Child Program, Glebe, New South Wales, Australia.,Diabetes NSW, Sydney, Australia
| | - Angela C Middlehurst
- International Diabetes Federation Life for a Child Program, Glebe, New South Wales, Australia.,Diabetes NSW, Sydney, Australia
| | - Martin Silink
- International Diabetes Federation Life for a Child Program, Glebe, New South Wales, Australia.,Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, Australia
| |
Collapse
|
40
|
Abstract
PURPOSE OF REVIEW This review summarizes the current state of diabetes in African children. RECENT FINDINGS Type 1 diabetes is the most common form of pediatric diabetes in Africa. Significant improvements have been achieved over the last 6 years, including the training of more than 60 pediatric endocrinologists who are now practicing in 14 African nations, greater training of other healthcare providers, increased availability of insulin through the efforts of philanthropic organizations and industry, modestly better availability of testing supplies, and the introduction of patient education materials in native languages. However, there is still a long way to go before the standard-of-care available to children in resource-rich nations is available to children with diabetes in Africa. SUMMARY Here, we review the known epidemiology, pathophysiology, complications, and treatment of diabetes in children in Africa.
Collapse
Affiliation(s)
- Thereza Piloya-Were
- aUniversity of Minnesota Department of Pediatrics, Minneapolis, Minnesota, USA bSchool of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda cInternational Diabetes Federation Life for a Child Program, Glebe, Sydney, Australia
| | | | | | | |
Collapse
|
41
|
Ogle GD, Kim H, Middlehurst AC, Silink M, Jenkins AJ. Financial costs for families of children with Type 1 diabetes in lower-income countries. Diabet Med 2016; 33:820-6. [PMID: 26482333 DOI: 10.1111/dme.12997] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 12/17/2022]
Abstract
AIMS To assess the direct costs of necessary consumables for minimal care of a child with Type 1 diabetes in countries where the public health system does not regularly provide such care. METHODS Supply costs were collected between January 2013 and February 2015 from questionnaires submitted by centres requesting International Diabetes Federation Life for a Child Program support. All 20 centres in 15 countries agreed to the use of their responses. Annual costs for minimal care were estimated for: 18 × 10 ml 100 IU/ml insulin, 1/3 cost of a blood glucose meter, two blood glucose test strips/day, two syringes/week, and four HbA1c tests/year. Costs were expressed in US dollars, and as % of gross national income (purchasing power parity) per capita. RESULTS The ranges (median) for the minimum supply costs through the private system were: insulin 10 ml 100 IU/ml equivalent vial: $5.10-$25 ($8.00); blood glucose meter: $15-$121 ($33.33); test strip: $0.15-$1.20 ($0.50); syringe: $0.10-$0.56 ($0.20); and HbA1c : $4.90-$20 ($9.75). Annual costs ranged from $255 (Pakistan) to $1,185 (Burkina Faso), with a median of $553. Annual % gross national income costs were 12-370% (median 56%). For the lowest 20% income earners the annual cost ranged 20-1535% (median 153%). St Lucia and Mongolia were the only countries whose governments consistently provided insulin. No government provided meters and strips, which were the most expensive supplies (62% of total cost). CONCLUSIONS In less-resourced countries, even minimal care is beyond many families' means. In addition, families face additional costs such as consultations, travel and indirect costs. Action to prevent diabetes-related death and morbidity is needed.
Collapse
Affiliation(s)
- G D Ogle
- International Diabetes Federation Life for a Child Program, Glebe, Sydney, Australia
- Diabetes NSW, Glebe, Sydney, Australia
| | - H Kim
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - A C Middlehurst
- International Diabetes Federation Life for a Child Program, Glebe, Sydney, Australia
- Diabetes NSW, Glebe, Sydney, Australia
| | - M Silink
- International Diabetes Federation Life for a Child Program, Glebe, Sydney, Australia
- Children's Hospital at Westmead, Sydney, Australia
| | - A J Jenkins
- International Diabetes Federation Life for a Child Program, Glebe, Sydney, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
- Insulin for Life Australia and Global, Caulfield, Melbourne, Australia
| |
Collapse
|
42
|
Noorani M, Ramaiya K, Manji K. Glycaemic control in type 1 diabetes mellitus among children and adolescents in a resource limited setting in Dar es Salaam - Tanzania. BMC Endocr Disord 2016; 16:29. [PMID: 27246505 PMCID: PMC4886407 DOI: 10.1186/s12902-016-0113-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/24/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Type 1 Diabetes Mellitus is a rapidly growing problem in Tanzania. Children and adolescents with type 1 diabetes have previously been found to have poor glycaemic control and high prevalence of complications. Strict glycaemic control reduces the incidence and progression of chronic complications. The aim of this study was to identify the factors associated with glycaemic control among children and adolescents. METHODS A cross sectional study was done at the diabetes clinic for children and adolescents. Data on socioeconomic, demographic and diabetes specific variables including adherence, diabetes knowledge, caregivers knowledge and their involvement in the care of the child was obtained. Glycaemic control was assessed by measuring glycosylated hemoglobin. (HbA1C). Linear regression analysis was done to determine factors associated with glycaemic control RESULTS Seventy-five participants were recruited into the study (51 % males). The mean HbA1c was 11.1 ± 2.1 %. Children aged <10 years were found to have a significantly better glycaemic control (9.8 %) as compared to 10-14 year olds (11.5 %) and >14 year olds (11.4 %) (P value = 0.022). Sixty-eight percent of patients had good adherence to insulin while adherence to blood glucose monitoring regimen was 48 % and to diet control was 28 %. Younger age, having the mother as the primary caregiver, better caregiver knowledge of diabetes, better adherence to blood glucose monitoring regimen and diabetes duration of less than 1 year were associated with better glycaemic control. In multivariate analysis, age, adherence to blood glucose monitoring regimen and the mother as the primary caregiver were found to independently predict glycaemic control (R(2) = 0.332, p value = 0.00). CONCLUSIONS Children and adolescents with type 1 diabetes in Dar es Salaam have poor glycaemic control. In order to improve metabolic control, adherence to blood glucose monitoring should be encouraged and caregivers encouraged to participate in care of their children especially the adolescents.
Collapse
Affiliation(s)
- Mariam Noorani
- Aga Khan Hospital, PO Box 2289, Barrack Obama Drive, Dar-es-Salaam, Tanzania.
| | - Kaushik Ramaiya
- Hindu Mandal Hospital, PO Box 581, Chusi Street, Dar-es-Salaam, Tanzania
| | - Karim Manji
- Muhimbili University of Health and Allied Sciences, PO Box 65001, UN Road, Dar-es-Salaam, Tanzania
| |
Collapse
|
43
|
Shibeshi MS, Fantahun B, Kebede T, Tilahun B. Pediatric diabetic retinopathy: experience of a tertiary hospital in Ethiopia. BMC Res Notes 2016; 9:116. [PMID: 26899627 PMCID: PMC4762173 DOI: 10.1186/s13104-016-1941-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 02/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetic retinopathy is one of the micro vascular complications of diabetes mellitus. To date there are no studies that show the magnitude of diabetic retinopathy in the pediatric population of Ethiopia with only very few in Africa. The purpose of this study was to determine the prevalence of diabetic retinopathy in children and adolescents at a tertiary center in Ethiopia. METHODS This cross-sectional hospital based descriptive study included children aged between 9 and 17 years attending the endocrine follow-up clinic of Tikur Anbesa Specialized Hospital. A structured questionnaire was used for evaluating sociodemographic data and information pertinent to diabetes. The prevalence of diabetic retinopathy was determined by fundus photography of each eye. RESULTS A total of 86 patients were examined with a mean age of 13.7 (SD = 1.8) years. At onset of diabetes, 95.6% of children presented with diabetic ketoacidosis(DKA); 22 children (25.6%) had at least two episodes of DKA, and 45 children (52.3%) had poor glycemic control. Background retinopathy was present in four children (4.7%) with a mean age of 14.25 (SD = 1.89) years and two of them also had maculopathy. CONCLUSION Although there are some methodological limitations, this study highlights the difficulties of achieving good glycemic control and the early occurrence of diabetic retinopathy in Ethiopian diabetic children.
Collapse
Affiliation(s)
| | - Bereket Fantahun
- Department of Pediatrics and Child Health, St. Paul Medical College, Addis Ababa, Ethiopia.
| | - Tedla Kebede
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Birkneh Tilahun
- Department of Pediatrics and Child Health, Hawassa University, Awassa, Ethiopia.
| |
Collapse
|
44
|
Ngwiri T, Were F, Predieri B, Ngugi P, Iughetti L. Glycemic Control in Kenyan Children and Adolescents with Type 1 Diabetes Mellitus. Int J Endocrinol 2015; 2015:761759. [PMID: 26494998 PMCID: PMC4606130 DOI: 10.1155/2015/761759] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/14/2015] [Accepted: 06/22/2015] [Indexed: 01/27/2023] Open
Abstract
Background. Type 1 diabetes mellitus (T1DM) is the most common endocrine disorder in children and adolescents worldwide. While data about prevalence, treatment, and complications are recorded in many countries, few data exist for Sub-Saharan Africa. The aim of this study was to determine the degree of control in patients with T1DM aged 1-19 years over a 6-month period in 3 outpatient Kenyan clinics. It also sought to determine how control was influenced by parameters of patient and treatment. Methods. Eighty-two children and adolescents with T1DM were included in the study. Clinical history regarding duration of illness, type and dose of insulin, and recent symptoms of hypoglycemia/hyperglycemia were recorded. Glycaemia, HbA1c, and ketonuria were tested. HbA1c of 8.0% and below was defined as the cut-off for acceptable control. Results. The median HbA1c for the study population was 11.1% (range: 6.3-18.8). Overall, only 28% of patients had reasonable glycemic control as defined in this study. 72% therefore had poor control. It was also found that age above 12 years was significantly associated with poor control. Conclusions. African children and with T1DM are poorly controlled particularly in adolescents. Our data strongly support the necessity of Kenya children to receive more aggressive management and follow-up.
Collapse
Affiliation(s)
- Thomas Ngwiri
- Pediatric Endocrinology Training Center, Gertrude's Hospital, Nairobi, Kenya
| | - Fred Were
- Pediatrics Clinic, Kenyatta National Hospital, Nairobi, Kenya
| | - Barbara Predieri
- Department of Pediatrics, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Paul Ngugi
- Endocrinology Clinic, Kenyatta National Hospital, Nairobi, Kenya
| | - Lorenzo Iughetti
- Department of Pediatrics, University of Modena and Reggio Emilia, 41124 Modena, Italy
| |
Collapse
|
45
|
Abstract
In this article, the author reviews the long-term outcomes and their precursors of type 1 diabetes starting in youth. The author also contrasts the changing incidence of these long-term complications as we have moved from the pre-Diabetes Control and Complications Trial (DCCT) to the post-DCCT standard of care and reviews the emerging data related to complications in youths with type 2 diabetes. Finally, the author reviews the recent understanding related to the effects of diabetes on the brain and cognition.
Collapse
Affiliation(s)
- Neil H White
- Department of Pediatrics, Washington University School of Medicine, 660 South Euclid Avenue, Box 8116, St Louis, MO 63110, USA.
| |
Collapse
|
46
|
Samahy MHE, Elbarbary NS, Elmorsi HM. Current status of diabetes management, glycemic control and complications in children and adolescents with diabetes in Egypt. Where do we stand now? And where do we go from here? Diabetes Res Clin Pract 2015; 107:370-6. [PMID: 25649911 DOI: 10.1016/j.diabres.2015.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 10/31/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
Abstract
THE AIM of this study was to use the Diabetes Registry of the Pediatric Diabetes Clinic, Ain Shams University Hospital to examine risk factors related to poor glycemic control and to provide data to health professionals for planning, evaluation and optimizing diabetes care. SUBJECTS AND METHODS Data from 600 children and adolescents with diabetes with information in the registry provide information on current clinical status, metabolic control, acute and long-term complications, presence of concomitant autoimmune diseases, and psychiatric aspects of patients. RESULTS Mean age of patients was 13.3±5.1 years, mean duration of diabetes was 6.4±3.6 years, mean HbA1c was 8.8±4.6% [73±27 mmol/mol], and 71% had poor glycemic control. Acute complications included ketoacidosis in 19.7% and severe hypoglycemia in 2.8%. Chronic complications including peripheral neuropathy, retinopathy, and persistent microalbuminuria were present in 6.3%, 1.8%, and 6.8%, respectively. The majority (97.2%) were on intensive insulin therapy. Patients with poor glycemic control had higher disease duration, DKA frequency and diabetic microvascular complications. However, regular education lecture attendance and regular SMBG were associated with better glycemic control. CONCLUSIONS These registry data indicate that although the majority of the patients were on intensive insulin therapy, poor glycemic control was common and diabetic microvascular complications were observed. These findings will provide potential avenues to improve quality of care and could be the first step in the development of a national registry for diabetes in Egypt.
Collapse
Affiliation(s)
- Mona Hussein El Samahy
- Department of Pediatrics, Diabetes Unit, Faculty of medicine, Ain shams University, Cairo, Egypt..
| | - Nancy Samir Elbarbary
- Department of Pediatrics, Diabetes Unit, Faculty of medicine, Ain shams University, Cairo, Egypt..
| | - Hala Mohammed Elmorsi
- Department of Pediatrics, Diabetes Unit, Faculty of medicine, Ain shams University, Cairo, Egypt..
| |
Collapse
|
47
|
Steyn NP, Mchiza ZJR, Kengne AP. Future challenges for pediatric diabetes management in developing countries: lessons from Africa. Expert Rev Endocrinol Metab 2015; 10:75-86. [PMID: 30289043 DOI: 10.1586/17446651.2015.968552] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In this review, we describe the epidemiology of diabetes mellitus in children and adolescents in Africa, noting that there is a paucity of data with regard to the burden of disease, prevalence of undiagnosed diabetes, healthcare and acute and chronic complications. Furthermore, access to care remains an issue of great concern. Our view is that in the next 5 years, more research will be undertaken on the burden of the disease and on interventions to provide better access to care. While the majority of African countries still have a low incidence of diabetes in children, it is predicted that the incidence will increase and it is therefore essential that governments develop sustainable policies to deal with such increases.
Collapse
Affiliation(s)
- Nelia P Steyn
- a 1 Division of Nutrition, University of Cape Town, Cape Town, South Africa
| | - Zandile June-Rose Mchiza
- b 2 Non-Communicable Disease Research Unit, South African Medical Research Council, Tygerberg, Cape Town, 7505, South Africa
| | - Andre-Pascal Kengne
- b 2 Non-Communicable Disease Research Unit, South African Medical Research Council, Tygerberg, Cape Town, 7505, South Africa
| |
Collapse
|
48
|
Donaghue KC, Wadwa RP, Dimeglio LA, Wong TY, Chiarelli F, Marcovecchio ML, Salem M, Raza J, Hofman PL, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2014. Microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes 2014; 15 Suppl 20:257-69. [PMID: 25182318 DOI: 10.1111/pedi.12180] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/13/2014] [Indexed: 01/21/2023] Open
Affiliation(s)
- Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
|
50
|
Khadilkar VV, Parthasarathy LS, Mallade BB, Khadilkar AV, Chiplonkar SA, Borade AB. Growth status of children and adolescents with type 1 diabetes mellitus. Indian J Endocrinol Metab 2013; 17:1057-1060. [PMID: 24381884 PMCID: PMC3872685 DOI: 10.4103/2230-8210.122623] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Growth parameters are important indicators of a child's overall health, and they are influenced by factors like blood glucose control in diabetic children. Data on growth parameters of Indian diabetic children is scarce. This retrospective, cross-sectional, case control study was conducted at diabetes clinic for children at a tertiary care center at Pune, to study growth parameters of diabetic children in comparison with age-gender matched healthy controls and evaluate effect of different insulin regimes and age at diagnosis of diabetes on growth. MATERIALS AND METHODS ONE TWENTY FIVE DIABETIC CHILDREN (BOYS: 50) and age gender matched healthy controls were enrolled. All subjects underwent anthropometric measurements (standing height and weight). Mean height (HAZ), weight (WAZ) and body mass index (BAZ) for age Z scores were calculated. Diabetes control was evaluated by measuring glycosylated hemoglobin (HbA1C). Statistical analysis was done by SPSS version 12. RESULTS Mean age of diabetic children and age gender matched controls was 9.7 ± 4.4 years. Diabetic children were shorter (128.3 ± 24.3 cm vs. 133.6 ± 24.7 cm) and lighter (29.2 kg ± 15.3 vs. 31.3 ± 15.4 kg). HAZ (-1.1 ± 1.2 vs. -0.2 ± 0.8) and WAZ (-1.2 ± 1.3 vs. -0.7 ± 1.3) were significantly lower in diabetic children (P < 0.05). Children on both insulin regimes (intensive and conventional) were shorter than controls (HAZ-intensive -1.0 ± 1.0, conventional -1.3 ± 1.3, control -0.2 ± 0.8, P < 0.05). HAZ of children who were diagnosed at <3 years of age was the least (-1.6 ± 1) amongst all diabetic children while those diagnosed after puberty (>14 years) were comparable to healthy controls. CONCLUSIONS Growth was compromised in diabetic children in comparison to controls. Children diagnosed at younger age need more attention to optimize growth.
Collapse
Affiliation(s)
- Vaman V. Khadilkar
- Department of Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Lavanya S. Parthasarathy
- Department of Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Basavraj B. Mallade
- Department of Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Anuradha V. Khadilkar
- Department of Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Shashi A. Chiplonkar
- Department of Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Ashwin B. Borade
- Department of Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| |
Collapse
|