Glycaemic control in type 1 diabetes mellitus among children and adolescents in a resource limited setting in Dar es Salaam - Tanzania

Noorani, Mariam; Ramaiya, Kaushik; Manji, Karim

doi:10.1186/s12902-016-0113-y

Cited by 46 publications

(78 citation statements)

References 17 publications

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“…Sample size was calculated based on Daniel’s formula for a finite population. 16 Using a standard normal value corresponding to a 95% confidence interval (CI), assuming a margin of error of 5% and a prevalence of the outcome of 28% 8 (based on the least expected adherence levels), a sample size of 192 children and adolescents with type 1 diabetes was obtained from a finite population of 500 patients who regularly attended both clinics based on details from the clinic registers. With a 5% rate to account for nonresponse, the overall sample size required for the study was 202 respondents.…”

Section: Methodsmentioning

confidence: 99%

“… 7 Certainly, the consequences due to nonadherence to recommendations in type 1 diabetes are concerning and can be potentially life threatening. However, given that some of the previous studies have consistently shown an association between poor adherence and worsening glycemic control, 8 there is a critical need to improve adherence to therapy in children and adolescents with type 1 diabetes.…”

Section: Introductionmentioning

confidence: 99%

“…Studies elsewhere that have assessed adherence to single treatment parameter found suboptimal adherence rates, with the proportions of adherence ranging from 39% to 44% for blood glucose monitoring 10 , 14 and between 7.2% and 28% for diet adherence. 8 , 15 A study that assessed adherence to recommendations on three treatment parameters such as insulin, blood glucose monitoring, and diet in Tanzanian type 1 diabetes children and adolescents also found somewhat unsatisfactory adherence levels – with only 68%, 48%, and 28% of them adhering to those recommendations, respectively. 8 In Uganda, however, no study has been conducted to ascertain the level of adherence to diabetes care recommendations – especially incorporating these three treatment parameters (blood glucose monitoring, insulin regimen, and diet) among children and adolescents with type 1 diabetes, and therefore, this creates a critical knowledge gap.…”

Section: Introductionmentioning

confidence: 99%

“… 8 , 15 A study that assessed adherence to recommendations on three treatment parameters such as insulin, blood glucose monitoring, and diet in Tanzanian type 1 diabetes children and adolescents also found somewhat unsatisfactory adherence levels – with only 68%, 48%, and 28% of them adhering to those recommendations, respectively. 8 In Uganda, however, no study has been conducted to ascertain the level of adherence to diabetes care recommendations – especially incorporating these three treatment parameters (blood glucose monitoring, insulin regimen, and diet) among children and adolescents with type 1 diabetes, and therefore, this creates a critical knowledge gap. The aims of this study were therefore to establish the level of adherence to type 1 diabetes care recommendations among children and adolescents and to establish the factors associated with adherence to such recommendations in two urban diabetes clinics in Uganda.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with adherence to diabetes care recommendations among children and adolescents with type 1 diabetes: a facility-based study in two urban diabetes clinics in Uganda

Kyokunzire

Matovu

2018

DMSO

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PurposeThe purpose of this study was to determine the level of adherence and the factors associated with adherence to diabetes care recommendations among type 1 diabetic children and adolescents at two urban diabetes clinics in Kampala, Uganda.Research design and methodsA facility-based cross-sectional study was carried out among 200 children and adolescents with type 1 diabetes at two major diabetes clinics in Kampala. Caretakers of the children and adolescents were interviewed using pretested questionnaires to provide information on sociodemographic characteristics, diabetes care, knowledge, attitudes, and adherence to diabetes care recommendations in type 1 diabetes. Prevalence rate ratios (PRRs) at the 95% confidence interval (CI) were used to establish the factors associated with adherence using modified Poisson regression, with robust standard errors. The data were analyzed by using STATA Version 13.0.ResultsThe overall prevalence of adherence to diabetes care recommendations was at 37%. However, evaluating adherence to specific treatment parameters showed that 52%, 76.5%, and 29.5% of the children and adolescents adhered to insulin, blood glucose monitoring, and dietary recommendations, respectively. In the final adjusted model, active diet monitoring (adjusted PRR [APRR]: 1.95; 95% CI: 1.01, 3.78), being under care of a sibling (APRR: 1.66; 95% CI: 1.61, 1.71), being under care of a married caretaker (APRR: 1.10; 95% CI: 1.05, 1.14) and a separated or divorced caretaker (APRR: 1.60; 95% CI: 1.12, 2.27), taking three or less tests of blood glucose per day (APRR: 0.63; 95% CI: 0.42, 0.95), and having a caretaker with poor knowledge about diabetes (APRR: 0.49; 95% CI: 0.43, 0.57) and who is inactive in supervision of insulin injections (APRR: 0.58; 95% CI: 0.56, 0.60) were associated with adherence to type 1 diabetes care recommendations.ConclusionAdherence to type 1 diabetes care recommendations is still low among this population. The results suggest that reinforcing caretaker involvement could be vital in improving adherence to diabetes care recommendations in this population.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Factors associated with adherence to diabetes care recommendations among children and adolescents with type 1 diabetes: a facility-based study in two urban diabetes clinics in Uganda

Kyokunzire

Matovu

2018

DMSO

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“…Among patients with type 1 diabetes in Brazil, women demonstrated poorer QoL perceptions whereas younger patients demonstrated poor QoL perception, suggesting that glycaemic control can impact on QoL [14]. A study carried out in Dar es Salaam -Tanzania, revealed that being of younger age, having the mother as the primary caregiver, caregiver knowledge of diabetes, adherence to blood glucose monitoring regimen and diabetes duration of less than 1 year were associated with better glycaemic control [15]. A systematic review found that there was a significant relationship between some health-related quality of life scales and blood glucose profiles and higher quality of life may be associated with better control of blood glucose in diabetics [16].…”

Section: Introductionmentioning

confidence: 99%

Quality of life and Associated Factors among Children aged 5 to 18 years with Diabetes Mellitus at St. Francis Hospital Nsambya and Mulago National Referral Hospital

2019

IJDMD

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Background: This study aimed to determine the quality of life and describe associated factors among children aged 5-18 years with diabetes Mellitus at St. Francis Hospital Nsambya and Mulago National Referral Hospital. Methods: An explanatory sequential study design was used between November 2018 and March 2019. Univariate analysis together with bivariate logistic regression analysis was used to determine quality of life and identify association between the quality of life at a p-value ˂ 0.05 respectively. Factors found to have a p-value ˂ 0.25 were included in the Multivariate logistic regression. A backward method was then applied to determine the best model that predicts quality of life among children. Data was analysed using STATA version 14. Data on the perception of quality of life of children with diabetes mellitus from the perspective of the children, caregivers and health workers was used to obtain qualitative results. Results: 115 children were recruited from the paediatric diabetic clinics. A low quality of life with a mean score of 77 ±15.58 was reported with a mean age of 13 ± 3.9. Factors associated with quality of life included: age groups of 8-12 and 13-18 years, primary education, secondary education, tertiary education, a single parent, living with relatives and primary care giver being a relative other than the biological parents. Conclusion: A sub-optimal quality of life was observed among children with type 1 diabetes mellitus. The factors associated with good quality of life included; age between 5- 7 years, a child living with biological parents, a child being in primary school and higher parental level of education. Recommendation: Community health education and sensitization should be more focused towards the adolescent patients, single mothers, guardians and benefactors of children with diabetes mellitus. There is greater need for healthcare support in schools to mitigate the stigma experienced by these children.

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Continuous glucose monitoring assessment of metabolic control in east African children and young adults with type 1 diabetes: A pilot and feasibility study

Yauch

Velazquez

Piloya

et al. 2020

Endocrino Diabet & Metabol

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Background For individuals with type 1 diabetes (T1D) in East Africa and other low‐income regions, the last decade has seen substantial gains in access to insulin and trained healthcare providers, yet metabolic control remains poor. Methods The objective was to determine the feasibility of continuous glucose monitoring (CGM) and to gather baseline metabolic data for future power analysis in Ugandan and Kenyan youth with T1D using a Freestyle Libre Pro blinded CGM. Results Of 78 participants recruited, four sensors fell off and six patients did not return, leaving 68 evaluable subjects. Average age was 16 ± 5 (range 4‐26) years, 43% female. Average diabetes duration was 7 ± 5 years, insulin dose 0.9 ± 0.3 U/kg/d, and number of fingerstick glucose levels per day 2.1 ± 1.1. All were on human insulin. Point‐of‐care HbA1c was 10.9 ± 2.7% (96 ± 30 mmol/mol). Mean number of sensor days was 13 ± 3; >90% wore the sensor for ≥10 days. Mean glucose was 231 ± 86 mg/dL (12.8 ± 4.8 mmol/L). Only 30 ± 19% of time was spent in the target range (70‐180 mg/dL; 3.9‐10 mmol/L), and 7 ± 8% of time was spent in hypoglycaemia (glucose <55 mg/dL, 3.0 mmol/L). Hypoglycaemia occurred in 81% of participants, averaging five events/wk with an average duration of 140 ± 79 minutes/event. Conclusions Despite significant diabetes care improvements, East African youth with T1D have poor metabolic control with chronic hyper‐ and hypoglycaemia, placing them at high risk for serious acute and chronic complications. This study demonstrates the feasibility of CGM use in this population and provides baseline metabolic data that will be used to inform a future intervention study.

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Glycaemic control in type 1 diabetes mellitus among children and adolescents in a resource limited setting in Dar es Salaam - Tanzania

Cited by 46 publications

References 17 publications

Factors associated with adherence to diabetes care recommendations among children and adolescents with type 1 diabetes: a facility-based study in two urban diabetes clinics in Uganda

Factors associated with adherence to diabetes care recommendations among children and adolescents with type 1 diabetes: a facility-based study in two urban diabetes clinics in Uganda

Quality of life and Associated Factors among Children aged 5 to 18 years with Diabetes Mellitus at St. Francis Hospital Nsambya and Mulago National Referral Hospital

Continuous glucose monitoring assessment of metabolic control in east African children and young adults with type 1 diabetes: A pilot and feasibility study

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