ESPEYB17 13. Global Health for the Paediatric Endocrinologist Diabetes (3 abstracts)
13.8. Diabetic microvascular complications among children and adolescents in northwestern Tanzania: A cross-sectional study
Msanga D , Reis K , Kayange N , Bakalemwa R , Kidenya B , Hau D , Mwanansao C , Mahamba D , Ottaru S , Kwiyolecha E & Peck R
To read the full abstract: Annals of Global Health. 2020; 86(1): 43, 1–8. doi: https://doi.org/10.5334/aogh.2669
• The authors assessed the prevalence of diabetic microvascular complications in 155 children and adolescents with Type 1 diabetes in northwestern Tanzania.• They observed poor diabetes control in 69% of the patients and a high rate of diabetic nephropathy (32.9%), retinopathy (10.3%) and neuropathy (13.6%).• Innovative initiatives are needed to optimize glycemic control.
Over the last 10–20 years there has been a marked increase in capacity in pediatric endocrinology in sub-Saharan Africa. This has led to the understanding that, like other parts of the world, Type 1 diabetes is not uncommon in African children and adolescents. Unfortunately, microvascular complications appear early in a high percentage of patients. Not surprisingly, in their study, prevalence of microvascular complications was significantly associated with older age (adolescence), poor glycemic control (HbA1c >12.5%) and longer duration of diabetes (>5 years), although the latter association was only statistically significant in univariate analysis. While a genetic predisposition of African patients cannot be ruled out, it is likely that the high rate of early microvascular complications is due to a combination of environmental factors such as insufficient number of trained allied health professionals, lack of access to insulin (although organisations such as Changing Diabetes in Children and Life for a Child support access to insulin and supplies for children with Type 1 diabetes in Tanzania and elsewhere) or high price of glucose strips resulting in poor blood glucose monitoring. These aspects of diabetes care are unfortunately not discussed by the authors. The authors also make the interesting point that pre-existing renal disease (such as renal disease secondary to schistosomiasis) may contribute to the high rate of nephropathy, highlighting the need for guidelines that meet the specific needs of a population. To my knowledge, such guidelines are not commonly available for children and adolescents with diabetes living in low resource settings.
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ESPE Yearbook of Paediatric Endocrinology
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