Factors associated with glycaemic control in children and adolescents with type 1 diabetes mellitus at Muhimbili National Hospital, Dar Es Salaam

Abstract

ABSTRACT Background: Type 1 Diabetes Mellitus (T1DM) is a rapidly growing problem in Tanzania and Africa as a whole. Its long term complications are devastating for individuals and families and impose a considerable burden to health care systems. Maintaining strict glycaemic control in type 1 diabetics has been shown to greatly reduce the incidence and progression of long term complications. Various risk factors have been found to be associated with poor glycaemic control. Children and adolescents with T1DM in Dar es Salaam have previously been found to have very poor glycaemic control and a high prevalence of chronic complications. Identification of factors associated with poor control in our setting is critical in order to institute appropriate interventions that will result in improved metabolic control and prevent chronic complications. Objectives: To determine the mean glycaemic control and identify factors associated with poor control in children and adolescents with T1DM. Materials and Methods: A cross sectional study was carried out at the diabetes clinic for children and adolescents at Muhimbili National Hospital. Children and adolescents attending the clinic were enrolled into the study after obtaining informed consent from the parent/guardian or assent from the adolescents themselves. A structured questionnaire was used to collect data from participants and parents/guardians. Glycaemic control was assessed by measurement of glycosylated haemoglobin (HbA1c). Data entry and analysis was done using Epi Info software version 3.5.1 and SPSS version 16. Results: 75 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 (9.83%) as compared to 10 – 14 year olds (11.46%) and > 14 year olds (11.39%) (P value = 0.022). Sixty eight percent (68%) of patients had good adherence to insulin while good adherence to blood glucose monitoring regimen (BGM) and diet was 48% and 28% respectively. Younger children had better adherence to all treatment modalities and had optimal caregiver involvement in diabetes related tasks. Adherence to insulin injections was vii better in children who had optimal caregiver involvement in the task of injecting insulin. Younger age, having the mother as the primary caregiver, better caregiver knowledge of T1DM, better adherence to blood glucose monitoring (BGM) regimen and diabetes duration of less than 1 year were associated with better glycaemic control. In multivariate analysis, age of the child, adherence to BGM regimen and the mother as the primary caregiver were found to independently predict glycaemic control.(R2 = 0.332, p value = 0.00). Sixty percent (60%) of children and adolescents reported a negative impact of T1DM on their daily lives. This was not related to glycaemic control. Conclusions and Recommendations: Children and adolescents with T1DM in Dar es Salaam have very poor glycaemic control and poor adherence to treatment. Factors associated with poor control include older age, a caregiver other than the mother and poor adherence to BGM. There is also a high frequency of negative impact of the disease on daily life. In order to improve metabolic control, more frequent BGM should be encouraged. Emphasis needs to be put on adherence counseling and active participation of caregivers in diabetes related tasks of their children. Close follow up of the adolescents is necessary as this group is the most vulnerable to poor control.