title: Glycaemic control in type 1 diabetes mellitus among children and adolescents in a resource limited setting in Dar es Salaam - Tanzania.
abstract: BACKGROUND
  Type 1 Diabetes Mellitus is a rapidly growing problem in Tanzania. Children and adolescents with type 1 diabetes have previously been found to have poor glycaemic control and high prevalence of complications. Strict glycaemic control reduces the incidence and progression of chronic complications. The aim of this study was to identify the factors associated with glycaemic control among children and adolescents.
  
  
  METHODS
  A cross sectional study was done at the diabetes clinic for children and adolescents. Data on socioeconomic, demographic and diabetes specific variables including adherence, diabetes knowledge, caregivers knowledge and their involvement in the care of the child was obtained. Glycaemic control was assessed by measuring glycosylated hemoglobin. (HbA1C). Linear regression analysis was done to determine factors associated with glycaemic control
  
  
  RESULTS
  Seventy-five participants were recruited into the study (51 % males). The mean HbA1c was 11.1 ± 2.1 %. Children aged <10 years were found to have a significantly better glycaemic control (9.8 %) as compared to 10-14 year olds (11.5 %) and >14 year olds (11.4 %) (P value = 0.022). Sixty-eight percent of patients had good adherence to insulin while adherence to blood glucose monitoring regimen was 48 % and to diet control was 28 %. Younger age, having the mother as the primary caregiver, better caregiver knowledge of diabetes, better adherence to blood glucose monitoring regimen and diabetes duration of less than 1 year were associated with better glycaemic control. In multivariate analysis, age, adherence to blood glucose monitoring regimen and the mother as the primary caregiver were found to independently predict glycaemic control (R(2) = 0.332, p value = 0.00).
  
  
  CONCLUSIONS
  Children and adolescents with type 1 diabetes in Dar es Salaam have poor glycaemic control. In order to improve metabolic control, adherence to blood glucose monitoring should be encouraged and caregivers encouraged to participate in care of their children especially the adolescents.
authors.affiliation: Aga Khan Hospital, PO Box 2289, Barrack Obama Drive, Dar-es-Salaam, Tanzania. mariamnoorani@yahoo.com.
authors.forename: Mariam
authors.initials: M
authors.lastname: Noorani
authors.affiliation: Hindu Mandal Hospital, PO Box 581, Chusi Street, Dar-es-Salaam, Tanzania.
authors.forename: Kaushik
authors.initials: K
authors.lastname: Ramaiya
authors.affiliation: Muhimbili University of Health and Allied Sciences, PO Box 65001, UN Road, Dar-es-Salaam, Tanzania.
authors.forename: Karim
authors.initials: K
authors.lastname: Manji
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001786:Blood Glucose; D015190:Blood Glucose Self-Monitoring; D002648:Child; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D010349:Patient Compliance; D012307:Risk Factors; D012959:Socioeconomic Factors; D013636:Tanzania
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Adherence; Adolescents; Children; Glycaemic control; Tanzania; Type 1 diabetes mellitus