Improved glycemic control and acute complications among children with type 1 diabetes mellitus in Moshi, Tanzania.
OBJECTIVE
There are an estimated 1000 children with diabetes in Tanzania. Recently, the first two pediatric endocrinologists, trained in the European Society for Paediatric Endocrinology (ESPE)/International Society for Paediatric and Adolescent Diabetes (ISPAD) program in Nairobi, Kenya, entered practice. The purpose of this study was to prospectively assess the impact of a 6-month diabetes management and education program on glycemic control and acute complications in children and adolescents in Tanzania.


METHODS
Eighty-one patients aged 3-19 yr were enrolled. All were on split-dose Insulatard (Neutral Protamine Hagedorn) and Actrapid (soluble, regular) insulin, and were given three glucose test strips per week. Children were seen in clinic an average of six times over 6 months and received 3 h of diabetes education. A structured questionnaire evaluated social demographic data and acute complications.


RESULTS
Despite regular clinic attendance, diabetes education, and provision of insulin, hemoglobin A1c (HbA1c) levels did not improve. Four children (5%) had HbA1c 7.5%, 22 (28%) HbA1c 7.5-10%, 9 (24%) HbA1c 11-12.5%, and 36 (44%) HbA1c >12.5%. There was a substantial reduction in severe hypoglycemia, with 17% of subjects experiencing this acute complication compared to 52% in the 6 months prior to study enrolment. Six children were admitted in diabetic ketoacidosis during the study compared to three during the previous 6 months. Twenty-six children (36%) reported missing >6 doses of insulin (but only two lacked insulin).


CONCLUSIONS
Diabetes education significantly reduced the risk of severe hypoglycemia, but better glycemic control of diabetes was not attained. Further study is needed to explore factors to improve glycemic control including increased testing, or perhaps different insulin regimens.
Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre and Kilimanjaro Christian Medical University College, Moshi, Tanzania. lulengoj@excite.com
Lulengo J
LJ
Mukama
Antoinette
A
Moran
Mramba
M
Nyindo
Rune
R
Philemon
Levina
L
Msuya
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D005190:Family; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000517:prevention & control*; D007003:Hypoglycemia / Q000453:epidemiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D007336:Insulin, Isophane / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D061386:Insulin, Regular, Human / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D061389:Insulin, Regular, Pork / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000068880:Isophane Insulin, Human; D008297:Male; D055118:Medication Adherence; D010044:Outpatient Clinics, Hospital; D010353:Patient Education as Topic; D011446:Prospective Studies; D013636:Tanzania / Q000453:epidemiology
D007004:Hypoglycemic Agents; D061386:Insulin, Regular, Human; D061389:Insulin, Regular, Pork; D000068880:Isophane Insulin, Human; D007336:Insulin, Isophane; C000006:insulin, neutral