Glycemic control and its association with diabetic retinopathy in children and adolescents with type 1 Diabetes Mellitus at Kenyatta National Hospital

Abstract

Introduction: Type 1 diabetes, a common metabolic disorder caused by autoimmune destruction of pancreatic 13 cells, accounts for approximately 10% of all diabetes episodes. The disease is predominantly seen in children and young adults and has recently shown an increasing incidence in this age group. Good control of blood glucose has been reported to reduce the risk of most diabetes complications but the impact of glycemic control on prevention of retinopathy has showed varied results in different studies. Objective: The purpose of the study was to determine glycemic control and to relate it to diabetic.'reti~opathy'among children and adolescents who have type 1 diabetes mellitus. . Study design: Hospit.ai based cross sectional 'study and retrospective study; Study population and setting: The study included. all pediatric patients aged 1-18 years who were on treatment for type 1 diabetes in Kenyatta National Hospital. Subjects: The study included 80 children attending Kenyatta National hospital diabetic outpatient clinic in Nairobi between July 2011 and January 2012. Research Methods: A structured questionnaire was used to obtain information and to evaluate socio demographic data. Blood samples were collected and analyzed for HBA 1 c using the Hemoglobin Al c Immunoturbidimetric test and were compared with previous HBA 1 c documented in patient's historic data. Presence of retinopathy was assessed by the primary researcher together with a trained ophthalmologist using mydriatic opthalmoscopy. Other information obtained included age, gender, duration of diabetes, body mass index, blood pressure, history of previous eye exam, economic status, and level of education of patient or caregiver. Results: 80 children participated in the study. Mean age of the participants was 11.3 years (SD 4.5). The mean duration of diabetes was 2.9 years (SD 2.5). Male to female ratio was approximately 1: 1. Half of the children were in primary school. 25% of the participants had been admitted within three months prior to the study and the reason for admission for most was hyperglycemia. The children with persistent poor control were on average older than the well controlled children, had a higher BMI and had been diabetic for a shorter mean duration. 90% patients had poor glycemic control with HBAlc levels persistently above 8%. None of the patients had diabetic retinopathy. Conclusion: Diabetic retinopathy was not detected in the study subjects despite the high prevalence of poor glycemic control.