Risk factors for macro vascular diseases in relation to glycemic control among type 1 diabetic children and adolescents attending diabetic clinic at Muhimbili national hospital, Dar es salaam

Abstract

Background Type 1 Diabetes Mellitus (T1DM) is the most common endocrine-metabolic disorder of childhood and adolescence. It has important physical and emotional development consequences. Individuals with T1DM confront serious lifestyle alterations. These include an absolute daily requirement for exogenous insulin, the need to monitor glucose level, and pay attention to dietary intake. Hyperglycemia is the primary mediator of atherosclerosis in T1DM. Serum lipid abnormalities are prevalent in children and adolescents with T1DM. An association between elevated hemoglobin A1C (HbA1c) and serum lipid levels exists. Its association with atherosclerosis requires early intervention, therapeutic and preventive measures. Children with diabetes are already at an increased risk of early CVD, since diabetes is now recognized as an independent risk factor for future cardiovascular events. Currently available evidence suggests that lipid and lipoprotein abnormalities are more prevalent in children with T1DM compared to their non diabetic counterparts Objective To determine the risk factors for macro vascular disease in relation to glycemic control among type 1 diabetic children and adolescents attending diabetic clinic at Muhimbili National Hospital (MNH). Methodology A hospital based descriptive cross sectional study was done. All children and adolescents aged 2 to 19 years attending diabetic clinic at MNH who met the needed criterion were enrolled in the study. Bio-data such as age, sex, weight, etc was collected using a structured questionnaire designed for the purpose of the study. Venous blood was taken from the anterior cubital fossa of each child for determination of glycosylated hemoglobin (Hba1c) and lipid profile. Abdominal ultrasound was done to 85 study participants for fatty liver assessment. SPSS version 17 was used for data entry and analysis. P - value of less than 0.05 (p <0.05) was considered statistically significant. Ethical clearance to carry out the study was sought from MUHAS higher degree research and publication committee and MNH respectively. vii Results Ninety eight (98) participants were recruited into the study, 51% were females. Dyslipidemia was found in 73.5%.The main abnormality was high low density lipoprotein cholesterol (LDL – C) found in 29.6% patients. Other abnormalities were high TC in 25/98 (25.5%), low HDL cholesterol in 13/98 (13.3%) and high triglycerides in 5/98 (5.1%) patients. It was found that high LDL and TC increased with age. Poor and very poor glycemic control, duration of diabetes and overweight was associated with high LDL and total cholesterol. Among the 85 children and adolescents who had liver ultrasound done 15.3% were found to have mild fatty liver. Among those with mild fatty liver 46.2% had high LDL – C, 38.5% had high TC and15.4% had low HDL- C. Conclusion and Recommendation Children and adolescents with T1DM at MNH had high proportions of abnormal lipid profile. The commonest abnormal lipid profile found was high LDL – C followed by high TC. Abnormal lipid profile becomes prevalent as the glycemic control worsens. These results highlight on the importance of glycemic control in children and adolescents with T1DM. There is an intense need of early screening for dyslipidemia and early treatment so as to prevent cardiovascular disease in high risk diabetic patients.