title: Glucose control in Rwandan youth with type 1 diabetes following establishment of systematic, HbA1c based, care and education.
abstract: OBJECTIVE
  To assess change in glycemic control concurrent with increased clinic visits, HbA1c testing, and education. Rates of complications were also examined.
  
  
  METHODS
  A 1-2 year follow-up of 214 members of the Rwanda Life for a Child program (aged <26 years) with a first HbA1c between June 2009 and November 2010 was conducted. Data were analyzed for the entire cohort and by age (<18 years, ≥18 years). Trajectory analysis was performed to identify trends in HbA1c.
  
  
  RESULTS
  Mean overall HbA1c decreased significantly from baseline (11.2 ± 2.7%; 99 ± 30 mmol/mol) to one- (10.2 ± 2.6%; 88 ± 28 mmol/mol) and two- (9.8 ± 26%; 84 ± 25 mmol/mol) year follow up visits. The prevalence of microalbuminuria did not significantly change (21.0%, 18.8%, and 19.6%), nor did nephropathy (4.7%, 7.8%, and 5.4%). However, rates of hypertension (31.8%, 44.9%, and 40.3%) were higher than expected. Five HbA1c groups were identified by trajectory analysis, and those with the worst control monitored their glucose significantly fewer times per week.
  
  
  CONCLUSIONS
  The establishment of regular care, HbA1c testing, and increased education is associated with significant improvements in glycemic control in youth with type 1 diabetes (T1D) in sub-Saharan Africa, but the high prevalence of hypertension is of concern.
authors.affiliation: University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, USA.
authors.forename: Sara L
authors.initials: SL
authors.lastname: Marshall
authors.affiliation: Northwestern University, Feinberg School of Medicine, Pediatrics, Chicago, IL, USA.
authors.forename: Deborah V
authors.initials: DV
authors.lastname: Edidin
authors.affiliation: University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA, USA.
authors.forename: Vincent C
authors.initials: VC
authors.lastname: Arena
authors.affiliation: University of Pittsburgh School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA.
authors.forename: Dorothy J
authors.initials: DJ
authors.lastname: Becker
authors.affiliation: University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, USA.
authors.forename: Clareann H
authors.initials: CH
authors.lastname: Bunker
authors.affiliation: Association Rwandaise des Diabetiques, Kigali, Rwanda.
authors.forename: Crispin
authors.initials: C
authors.lastname: Gishoma
authors.affiliation: Association Rwandaise des Diabetiques, Kigali, Rwanda.
authors.forename: Francois
authors.initials: F
authors.lastname: Gishoma
authors.affiliation: University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, USA.
authors.forename: Ronald E
authors.initials: RE
authors.lastname: LaPorte
authors.affiliation: Association Rwandaise des Diabetiques, Kigali, Rwanda.
authors.forename: Vedaste
authors.initials: V
authors.lastname: Kaberuka
authors.affiliation: International Diabetes Federation Life for a Child Program and Australian Diabetes Council, Sydney, NSW, Australia.
authors.forename: Graham
authors.initials: G
authors.lastname: Ogle
authors.affiliation: University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, USA.
authors.forename: Laurien
authors.initials: L
authors.lastname: Sibomana
authors.affiliation: University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, USA. Electronic address: tjo@pitt.edu.
authors.forename: Trevor J
authors.initials: TJ
authors.lastname: Orchard
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism*; D002648:Child; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis / Q000378:metabolism*; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods*; D012432:Rwanda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Africa; Diabetes; Youth