Factors influencing Glycemic control of adolescents (10 -19 years) with type 1 diabetes mellitus attending Kenyatta National Hospital

Abstract

Background: Diabetes is a worldwide silent epidemic that claims as many lives each year as Human Immunodeficiency Virus (HIV/AIDS). Much attention is focused on infectious diseases such as malaria, tuberculosis and HIV/AIDS in Africa. However evidence indicates a high prevalence of non-infectious diseases such as diabetes and hypertension in many parts of the continent without the same kind of focus. Type 1 diabetes is on the rise in Kenya, especially in urban areas. In Kenyatta National (KNH) Hospital, 58% of the medical wards are occupied by diabetic patients. In KNH, children with type I diabetes are usually counseled according to WHO expectations to administer insulin injections at the age of 10-12 years, monitor blood glucose at the age of 8-10 years and comply with meal plans at the age of 12-14 years and do all the selfcare regimen at the age of 14 years and above. They are also given patient education on glycemic control. However, in Kenyatta National Hospital diabetic clinic, 72% of children and adolescents are unable to control their blood sugars. The purpose: The study aimed at determining the factors influencing diabetic control among adolescents aged 10-19 years with Type 1 diabetes attending KNH. Design and Methods: This was descriptive cross sectional study conducted at KNH. The study population was adolescents aged 10-19 years attending KNH pediatric endocrinology clinic. Purposive sampling was used in selection of the location. Forty seven adolescents aged 10-19 years were conveniently sampled as they came. A pre-tested structured questionnaire focused on social demographic factors of the parent/caregiver of the study adolescents, self-care factors, psycho- sociological factors, growth factors and food frequency intake. Among adolescent, blood was taken for Random blood sugar and glycated hemoglobin (HbA1C) using semi automated method. The anthropometric measurements of the adolescent were taken using a Standiometer and Salter weighing scale. Nutritional status (growth) was assessed using anthropometric indicators of body mass index (BMI for age), weight-for-age (wt/age), and height-for-age (htJage), according to WHO 2005 standards. Data Analysis: The data was entered and analyzed by use ofEPI info version 3.4.3 2007 Nutristat packages, STATA version 10 and SPSS version 15. Descriptive statistics were applied. The chi square test of significance, t - test, Odds Ratio and Confidence Interval, p-value of < 0.05 and 95% confidence limits were used to test the hypotheses. Results: The questionnaires were completed by 47 adolescents of which 23 were boys and 24 were girls. 35 parents/guardians had accompanied the adolescents to the clinic. The mean age was 10 years, mean HbA1c was 8.5% and mean random blood Sugar 12.6 mmol/L. 76.4% of the adolescents had poor glycemic control (HbA1c > 7%) and 23.4% had good control (HbA1c < 7%). There was no difference in gender but older adolescents tended to have poor glycemic control. Results of the statistical analysis (bivariate analysis) showed that many variables like income of parents, clinic attendance, insulin storage, foot care, encouragement by the peer group and teacher in diabetic management, fostering independence by family members, teacher and peer to the adolescent in diabetic management and random blood sugar were found to be statistically significant but after subjecting the data to logistic regression analysis for multiple analysis and to eliminate confounding factors, it was found that encouragement in diabetic management to the adolescents by teachers (p = 0.0001), foot care (p = 0.033), and random blood sugar (p = 0.05) were found to influence glycemic control of the adolescent with type 1 diabetes. Conclusion and Recommendation: The adolescents have poor glycemic control and from the study findings, the study recommends that efforts directed towards the foot care, teachers to support and encourage students with Type 1 diabetes and control of random blood sugar would have a positive impact on the glycemic control of adolescent with type 1 diabetes. The findings will be used in management of adolescent with Type 1 diabetes attending KNH.