Glycaemic control and prevalence of microalbuminuria among children with type 1 diabetes mellitus attending Mulago Hospital clinic

Abstract

Background: Uganda has an estimated 900 children under the age of 14 years with TIDM. Currently, there is limited information on burden and complications of diabetes in the country, as it is in sub-Saharan Africa where diagnosis is often missed, monitoring is erratic and availability of insulin is poor. Glycosylated haemoglobin is a reliable indicator of glycaemic control needed to provide protection of body organs. Acute complications of TIDM include DKA, infection, hypoglycaemia, and electrolyte imbalance. Chronic complications of TIDM include neuropathy, nephropathy, retinopathy and neuropsychiatric. Microalbuminuria is a good indicator of early renal damage when treatment with angiotensin converting enzyme inhibitors may reverse the disease. Objective: This study assessed glycaemic control and microalbuminuria in children with type 1 diabetes attending Mulago hospital clinic. Methods: A cross sectional study was conducted at the diabetic clinic in Mulago hospital, after informed consent and assent (when applicable) was obtained. All children were on insulin, either soluble-lente combination or mixtard. Data was collected on socio-demographic, patient's characteristics, insulin usage, duration of disease and factors affecting glycaemic control. It was then exported into EpiData v 3.1. The prevalence of glycaemic control and microalbuminuria was performed using Stata v 10.0 software package. Odds ratio was used to measure factors of association with sub optimal glycaemic control. Statistical significance was considered when P - value was ≤ 0.05. Results: Of the 83 children studied, female to male ratio was 1.2:1, mean ± SD age was 14.2 ± 3.5 years, duration of diabetes was 3.24 ± 2.77. The prevalence of children with sub-optimal glycaemic control was 48 (57.8%) whilst 35 (42.2%) had optimal glycaemic control. Microalbuminuria was present in 52 (62.7%) children, 30 (36.1%) had overt albuminuria and 1.2% had no albuminuria. Among the factors investigated, insulin insecurity through self rationing was the only significant factor associated with sub-optimal glycaemic control. Conclusion: The prevalence of sub-optimal glycaemic control and that of microalbuminuria was high, indicating a very high incidence of poor glycaemic control, and early renal disease among study children. Recommendations: Regular monitoring of glycaemic control and screening for microalbuminuria in Ugandan children with TIDM should start as soon as the diagnosis is made. There is need for adequate stocks of insulin to improve glycaemic control. A longitudinal study should be carried out to monitor and screen for complications that may arise in early adulthood.