Glycemic control, factors associated and quality of life among children and adolescents with type 1 diabetes mellitus at pediatrics follow up clinic, jimma medical center, Ethiopia

Abstract

Background: Type 1 diabetes mellitus is the most common endocrine disorder in children and adolescents worldwide. Glycemic control is the ultimate goal of management of diabetes. Poor glycemic control is shown to be associated with long-term complications of diabetes. Quality of life is a key outcome when treating patients with diabetes. Measuring the quality of life and factors affecting it is important in patients with diabetes for evaluating treatment outcomes and decision making. However, there is paucity of studies on this topic in our setup. Thus, this study aimed to determine the level of glycemic control, factors associated and quality of life among children and adolescents with diabetes. Objective: This study aimed to assess the glycemic control, quality of life and factors associated among children and adolescents with type 1 diabetes mellitus Methods: An institution based cross-sectional study was done from July 10 to October 10, 2022 at pediatrics follow up clinic, Jimma Medical Center. Totally 158 children and adolescents with diabetes were recruited during the study period. Convinience sampling technique was employed. HbA1c measuremts were done for all study participants at the time of data collection. Both health related quality of life (HRQoL) and diabetes related quality of life (DRQoL) were measured using PedsQL™ 4.0 Generic Core Scales and PedsQL™ 3.0 Diabetes Module instruments respectively. Data was entered into Epi-data version 3.1 and exported to SPSS version 25 for analysis. Descriptive analysis was used to identify the level of glycemic control and quality of life. Binary logistic regression was used to identify predictor variables; at p-value < 0.05 with 95% CI of AOR. Results: The mean glycated hemoglobin (HbA1c) of the participants was 9.67 ± 2.28%. Poor glycemic control (HbA1c ≥7.5%) was reported by 121 (76.6%) of study participant. A caregiver other than the mother [guardian(AOR=7.11 95% CI 1.43-35.33, p=0.017), father(AOR=8.08 95% CI 2.05-31.89, p=0.003)], minimal caregiver involvement in insulin injection supervision(AOR=4.01, 95% CI 1.35-11.86, p=0.012), faced problems at health facility (AOR=3.66, 95% CI 1.1.26-10.65, p=0.017), being admitted to hospital in the past 6 months (AOR=7.94 1.91-32.95, P=0.004) and poor DRQoL(AOR=4.43, 95% CI 1.46-13.38, P=0.008) were associated with poor glycemic control. The mean score for total HRQoL of children and adolescents were 79.76±14.14 reported by children and adolescents and 78.78±14.30 reported caregivers/parents. The mean score for total DRQoL of children and adolescents were 68.35±13.22 reported by children and adolescents and 68.33±13.93 reported by caregivers/parents. Poor glycemic control (AOR =4.52 95% CI 1.84-11.09, P=0. 001) and being in secondary school (AOR=18.74 95% CI 2.70-129.74, p=0.003) were associated with poor diabetes related quality of life of children and adolescents with type 1 diabetes. Conclusions and Recommendations: The majority of children and adolescents with diabetes had poor glycemic control which implies they are at risk of long term complications. The quality of life scores for children and adolescents with diabetes were not sufficiently good. This study recommends that encouraging caregiver involvement in diabetes management tasks, regular monitoring of glycemic control and assessment of quality of life after diagnosis of diabetes should be strengthened to detect the problems early and plan intervention