Prevalence, patterns and factors associated with ocular manifestations of type 1 diabetes mellitus among children and adolescents attending Mulago National Referral Hospital

Abstract

Background; Diabetes mellitus is a growing public health challenge in sub-Saharan Africa, Uganda inclusive, with an annual incidence of 6% in the Sub-Saharan Africa region, 3% in many countries and 77% in the European region. Despite the increasing number of children and adolescents being diagnosed with type 1 diabetes mellitus in Uganda, there is no routine screening for ocular manifestations and little is known about the magnitude of ocular manifestations which can lead to blindness among children and adolescents living with type 1 diabetes mellitus in Uganda. Aim; To determine the prevalence, patterns and factors associated with ocular manifestation among children and adolescent patients with type 1 diabetes mellitus attending pediatric diabetes clinic at Mulago National Referral Hospital. Methods and Materials; The study was a cross-sectional study on 118 children and adolescents living with type 1 diabetes mellitus seen at pediatric diabetic clinic at Mulago National Referral Hospital from July to September 2021. Participants who met the inclusion criteria were recruited consecutively until the required sample size was reached. Informed consent was obtained from all the study participants. Details of the history and clinical examinations were recorded using a questionnaire. Data were entered using Epi data version 4.2 and analysed using STATA version 15.0. For continuous variables, means with standard deviations were used and proportions were used to summarize baseline characteristics for categorical variables. Results: A total of 118 participants were recruited with 70(59.3%) females. The mean age was 13.3±4.2SD years. The prevalence of ocular manifestation was 34.8%. The ocular manifestations found were refractive errors 30 (25.4%), non-proliferative diabetic retinopathy 4 (3.4%), ocular hypertension 4 (3.4%), dry eye syndrome 2 (1.7%) and cataracts 1 (0.8%). Age groups of 5-11 years (aPR=0.32, 95%CI 0.19-0.52, p value <0.001),>11-15years (aPR=0.27,95%CI 0.16-0.44,p value <0.001) and >15 years (aPR =0.31,95% CI 0.18-0.53,p value <0.001),BMI in 3rd -85th centiles ( aPR=0.43,95% CI 0.25-0.74,p value =0.003) and premixed type of insulin injection (aPR=0.22 ,95%CI 0.06-0.78,p value =0.019) were less likely to develop ocular manifestation while duration of 10 years or more years with diabetes mellitus (aPR=2.87,95%CI 1.62-5.05,p value <0.001) were more likely to develop ocular manifestation. Conclusion and recommendations: In our study we found high prevalence of ocular manifestations. Age group of >5years, normal BMI for age in percentiles (3rd -85th) and type of insulin injection and duration of diabetes mellitus of 10 or more years were statistically significant associated with ocular manifestation. Annual screening for ocular manifestations especially all children and adolescent with type 1 DM is recommended.