Glycemic control and complications of type 1 diabetes among children in Tanzania.

INTRODUCTION: Knowledge on Type 1 Diabetes (T1D) in sub-Saharan Africa is scarce. This study aimed at assessing microvascular complications of Type 1 diabetes in young patients. METHOD: A retrospective study based on medical recordings from 2010-2016 was done. 604 children and young adults with T1D were recruited from five hospitals with pediatric diabetes clinics. 559 patients aged 2-35 years with known date of birth were included. Clinical data on retinopathy and neuropathy were analyzed. There was no information on renal function/ nephropathy. RESULTS: Most data were missing. There was documentation on HbA1C, plasma glucose and complications in less than half of the patient files. Of those with registered HbA1c values (42.2%), 36% had HbA1c > 12.5%. There was high prevalence of retinopathy (21.5%) and neuropathy (29.4%) in spite of short mean duration of diabetes (6.2 ± 4.1 years). CONCLUSION: Many patients with T1D in Tanzania have poor metabolic control. Microvascular complications are common already after a short duration of diabetes, but the results have to be interpreted with great caution because of study limitations. Better pediatric diabetes care as well as increased awareness of diabetes is needed. Studies in resource-poor countries need careful planning, if possible with prospective design.

Incidence, prevalence and clinical manifestations at onset of juvenile diabetes in Tanzania.

Better knowledge on incidence, prevalence and clinical manifestations is needed for planning diabetes care in Sub Saharan Africa. AIMS: To find a crude incidence/prevalence of diabetes in children and young adults in a low resource setting, classify the diabetes and audit the health record keeping. METHODS: A retrospective observational study based on medical recordings 2010-2016. Target population was children and adolescent registered in Changing Diabetes in Children (CDiC) or Life for a Child (LFAC) programs for children with T1DM and diagnosed at 5 diabetes clinics in three geographical regions of Tanzania. 604 patients' files were available from five hospitals. RESULTS: 336/604 files covered patients <15 years of age at diagnosis. The prevalence of diabetes <15 years of age ranged from 10.1 to 11.9 per 100,000 children and the annual incidence 1.8-1.9/100,000 children, with peak incidence at 10-14 years. A lot of data were missing. The great majority of the patients presented with typical signs and symptoms of T1D, 83.7% with plausible ketoacidosis (DKA). CONCLUSIONS: Diabetes incidence and prevalence is still low. T1D seems to dominate with very high frequency of DKA at diagnosis. Increased awareness of diabetes both in health care and community is needed.

Management of diabetic ketoacidosis in children and adolescents in sub-Saharan Africa: a review.

BACKGROUND: Diabetic ketoacidosis (DKA) is a complex metabolic state of hyperglycaemia, ketosis, and acidosis. Diabetes in sub-Saharan Africa is, in many patients a serious disease with a poor prognosis. Most deaths, however, are due to preventable causes. OBJECTIVE: To improve knowledge on the management of DKA in sub-Saharan Africa. DATA SOURCES: Literature review from different published sources. DATA SYNTHESIS: Health systems in sub-Saharan Africa are currently organised for the treatment of episodes of illness and not long-term conditions like diabetes. Therefore the high rates of DKA is essentially due to lack of training of health professionals, lack of facilities in most hospitals, lack of public awareness as well as lack of health education to individual patients/families. In addition erratic insulin supply coupling with infections, low parental education, poor insulin storage and lack of facilities for self monitoring of blood glucose. CONCLUSION: A complex unfavourable social and economic environment is the basis of the high prevalence of DKA in sub-Saharan Africa. Several episodes of DKA can be prevented by effective public awareness programmes and education to healthcare providers.

Growth and puberty in children with HIV infection.

Children with perinatal HIV infection may present with clinical features of endocrine dysfunction such as growth failure and pubertal delay. Pediatric care providers and pediatric endocrinologists should implement appropriate preventive, screening, and therapeutic strategies to maximize survival and quality of life in these children. Growth and pubertal delay can be exacerbated by a variety of treatable infectious, endocrine, nutritional, and immunological disorders. Timely diagnosis and appropriate treatment of these conditions may lead to improvement or even normalization of growth and puberty. HIV-infected children with advanced disease should undergo periodic growth evaluation, including GH levels, IGF-I, IGF binding protein 3 and androgens, in order to identify subclinical endocrine dysfunction. However, little is known about the association between HIV infection and endocrine dysfunction in children. Highly active antiretroviral therapy may also be associated with endocrine dysfunction with consequences on growth and puberty. Growth retardation and pubertal delay are always seen in children with advanced HIV infection and are often related to the proinflammatory milieu found in advanced AIDS. Growth and pubertal impairment are markers of advanced disease and require proper evaluation. A dysregulation of the hypothalamic-pituitary axis, toxic or allergic drug reactions may play a role in growth and pubertal delay of HIV-infected children. These dysfunctions require careful monitoring, in order to assess metabolic alterations that may be important in regulation of growth among HIV infected children. Better understanding of the mechanisms leading to impairment of growth and puberty in children with perinatal HIV-1 infection might lead to appropriate treatment when required.