Glycaemic Control (Serum HbA1c level) and its Associated Factors in Children with Type 1 Diabetes Mellitus Treated in Jimma University Specialized Hospital; Oromia, South-West Ethiopia

Abstract

Background: Long term complications of type 1 diabetes mellitus are devastating for individuals and families and impose a considerable burden to health care systems. Maintaining strict glycaemic control in type 1 diabetics has been shown to greatly reduce the incidence and progression of long term complications. Various risk factors have been found to be associated with poor glycaemic control. Identification of factors associated with poor control in our setting is critical in order to institute appropriate interventions that will result in improved metabolic control and prevent chronic complications. Objective: To assessing glycemic control using serum level of glycosylated hemoglobin (HbA1c) and its associated factors in children with Type 1 diabetes mellitus(T1DM) at Jimma University Specialized Hospital (JUSH) Ethiopia. Methods: A cross-sectional descriptive study was carried out among children and adolescents being treated at the diabetes clinic of JUSH. A structured questionnaire was used to collect sociodemographic, diabetic related knowledge and practice of the participants and parents/guardians. The weight and the height of the patients were measured. Fasting blood sugar was also recorded .Glycemic control was assessed by measurement of serum HbA1c% by using in2itA1c Analyzer. Data was entered using Epidata version 3.1 and exported to SPSS 16 for analysis. Mean, standard deviation (SD), analysis, bivariate and multivariable linear regression analyses were conducted to identify independent predictors of serum HbA1c.The study was conducted from April 1 to May 30, 2006 E.C. Results: We studied 60 children 0.25-18 years of age of which 33(55%) were males with a mean age of 11.81±3.5 yrs. The mean ± SD HbA1c was 10.4±2.6% .Thirty four (56.7%) of them had poor glycemic control (HbA1c ≥10.0 %), 16(26.7 %) of them had fair glycemic control (8-9.9%) and only 10(16.7%) of them had good glycemic control (HbA1c<7.9%). The mean % ± SD of diabetic knowledge of the adolescents and caregivers were 65.79±1.11 and 64.00 ± 1.16 respectively. Fifty one (85%) of patients had good adherence to insulin (did not miss dose in the past three months prior to data collection) while good adherence to blood glucose monitoring (BGM) at home and diet was 20 (33.3%) and 4(6.7%) respectively. Meal adherence scored out of ii 8points from meal content and meal frequency each having 4 points. Maximum score is 8.those who scores < 4(poor), 4-6(average), and > 6 (good). The BGM adherence was scored as good if 3 or more times tests a week; average if 1 – 2 times a week; poor if none. On bivariate analysis none educated care givers (b=2.10, 95%CI=0.23, 3.92, p value=0.028), and rural residence (b=1.40, 95%CI=0.08, 2.68, p values=0.038) have positive correlation with serum HbA1c level. Those who missed1-3 insulin doses in the preceding three months prior to data collection were also associated with increased HbA1c level(b=2.1, 95%CI=0.28,3.9,p values=0.024).Fifty (83.3%) of the study participants were wasted(BMI<18.5). Conclusions: Most of the Children and adolescents with T1DM in Jimma university teaching hospital have poor glycemic control and poor adherence to blood glucose monitoring (BGM) and diet. Both the caregivers and adolescents have low diabetic knowledge. Regularly diabetic education should be given on regular base to improve the diabetic knowledge of the patients and the caregivers, and adherence to BGM at home, which then may improve the glycemic control. Emphasis needs to be put on dietary knowledge and adherence counseling