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Rochmah N, Soetjipto S, Faizi M, Hisbiyah Y, Perwitasari RK, Fedora K, Rosyidah LN, Endarko E, Kuswanto D, Rini EA. Frequent Self-Monitoring Blood Glucose Correlated to Better Medication Adherence and Glycemic Control in Children with Type 1 Diabetes Mellitus. Diabetes Metab Syndr Obes 2024; 17:2203-2209. [PMID: 38854446 PMCID: PMC11162244 DOI: 10.2147/dmso.s448508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/19/2024] [Indexed: 06/11/2024] Open
Abstract
Background Type 1 diabetes mellitus (T1DM) is the most common chronic disease in children, with several severe short and long-term complications. Glycemic control is an important aspect of diabetes management with the most influential factor being compliance with self-monitoring blood glucose (SMBG). Mostly, in Indonesia, the finger stick devices as a glucose monitoring tool were frequently used. About 20% of children follow the recommendation to measure blood glucose four to six times daily. Methods This is a single center, cross-sectional study that was conducted between July-November 2022. The Population is children with T1DM at the Pediatric Outpatient Clinic of Dr. Soetomo Hospital, Surabaya, Indonesia. Children with T1DM aged 4-18 years were enrolled using consecutive sampling. A compliance questionnaire was used to assess SMBG. Psychosocial conditions were assessed using the Pediatric Symptom Checklist 17, and medication adherence was evaluated using the Adherence to Refills and Medications Scale for Diabetes (ARMS-D). Pearson correlation and linear regression were employed for statistical analyses using Statistical Package for Social Sciences version 21.0, with p < 0.05 indicating statistical significance. Results A total of 36 children were included in this study. SMBG frequency over 4x per day was significantly associated with increased medication adherence as measured by the ARMS-D score (p = 0.012). Higher SMBG frequency was also correlated with decreased HbA1c (p = 0.014, r = 0.406) and nutritional status (p = 0.031, r = 0.360). Less than 50% of the patients in Indonesia adhered to the recommended guidelines for SMBG (ie, ≥4 times per day). Conclusion Higher SMBG frequency was correlated with better glycemic control. This finding suggests the need for further support in conducting SMBG based on the national guideline. However, due to it being conducted in a single center, we suggest increasing the sample size or conducting multi-centre collaborations in future studies. Originality/Value By specifically investigating the relationship between adherence to self-monitoring of blood glucose (SMBG) and glycemic control in children with type 1 diabetes mellitus (T1DM), our study represents a novel contribution to the field of pediatric diabetes management in Indonesia. While previous research has explored similar relationships in other populations, our study focuses exclusively on the unique context of Indonesia, where rates of adherence to SMBG in pediatric patients have not been well studied and are relatively low compared to global standards.
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Affiliation(s)
- Nur Rochmah
- Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Child Health, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | - Soetjipto Soetjipto
- Department of Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Muhammad Faizi
- Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Child Health, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | - Yuni Hisbiyah
- Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Child Health, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | - Rayi Kurnia Perwitasari
- Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Child Health, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | - Katherine Fedora
- Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Child Health, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | | | - Endarko Endarko
- Faculty of Science and Data Analysis, Sepuluh Nopember Institute of Technology, Surabaya, Indonesia
| | - Djoko Kuswanto
- Faculty of Creative Design and Digital Business, Sepuluh Nopember Institute of Technology, Surabaya, Indonesia
| | - Eka Agustia Rini
- Department of Child Health, Faculty of Medicine, Universitas Andalas, Padang, Indonesia
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Eshetu K, Regassa LD, Dehresa M, Genete D. Chronic Microvascular Complication of Type 1 Diabetes Mellitus and Its Predictors Among Children with Type 1 Diabetes Mellitus in Ethiopia; A Single Center Experience: Ambi Directional Cohort Study. Pediatric Health Med Ther 2024; 15:201-212. [PMID: 38808177 PMCID: PMC11130991 DOI: 10.2147/phmt.s456541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024] Open
Abstract
Introduction Type 1 diabetes mellitus is the most common pediatric endocrine disorder. Poor glycemic control in diabetes mellitus can result in microvascular complications (retinopathy, neuropathy, and nephropathy). There is no study done in our setting either about prevalence of pediatric type 1 diabetes mellitus or chronic microvascular complication among these patients, which gap this study is expected to fill. Objective This study aimed to assess the risk and predictors of chronic microvascular complication of type 1 diabetes mellitus among children with diabetes at Haramaya University Hiwot Fana Compressive Specialized Hospital from September 10, 2021 to January 30, 2023. Methods A hospital-based Ambi directional cohort study was conducted. Survival data are described by follow-up time and Kaplan-Meier graph. To determine predictors associated with chronic microvascular complication we used a Poisson regression optimal model selected using the information criterion. All associations are tested at the 95% confidence level and a reported IRR P-value less than 0.05 is declared as a significant association between variables. Results A total of 124 children with type 1 diabetes mellitus were followed with total 407.5 years risk time. The overall incidence rate of chronic microvascular complication was 83 per 1000 population per year (95% CI: 59-116). The median time for detection of microvascular complication was 7 years after diagnosis. Being male with IRR 1.71 (95% CI: 0. 0.81-3.56), being at pubertal age IRR 1.91 (95% CI: 1.05-3.48), longer diabetes mellitus duration IRR 1.13 (95% CI: 1.07-1.28), and poor glycemic control IRR 1.50 (95% CI: 0.46-4.97) were found to be at higher risk for chronic microvascular complication. Conclusion There was high incidence of chronic microvascular complication of diabetes mellitus. Being pubertal age group and more than 3 years duration after diagnosis had statistically significant association with complication.
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Affiliation(s)
- Konjit Eshetu
- Department of Pediatrics and Child Health, School of Medicine, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Lemma Demissie Regassa
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Merga Dehresa
- Department of Maternal and Child Health, School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Desta Genete
- Department of Ophthalmology, School of Medicine, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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3
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Ali L, Alhassan M. Challenges in achieving adequate glycemic control among children with type 1 diabetes mellitus in a resource-limited setting: A cross-sectional study from Sudan. Diabetes Res Clin Pract 2024; 208:111113. [PMID: 38266824 DOI: 10.1016/j.diabres.2024.111113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/11/2024] [Accepted: 01/21/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To assess glycemic control and associated factors in children with type 1 diabetes mellitus (T1DM) attending the pediatric diabetes clinic in Wad-Madani City, Sudan. METHODS This cross-sectional observational study was conducted at a referral center in Sudan. The study population consisted of children aged 1-18 years who had been diagnosed with T1DM for more than 1 year and were under regular follow-up in the clinic. Data on their glycemic control and sociodemographic and clinical characteristics were captured. RESULTS Out of 211 enrolled patients, 120 (56.9 %) were females. The mean age was 11.7 years (SD = 4.0), with the mean age at diagnosis of 6.7 years (SD = 4.0). Only 6.2 % achieved adequate glycemic control. Adolescents had particularly poor control (97.8 %). The mean glycosylated hemoglobin (HBA1c) level was 10.4 % (90 mmol/mol). Inferior glycemic control was associated with advancing age, older age at diagnosis, belonging to single-parent households, less frequent self-monitoring of blood glucose (SMBG), and having a greater number of siblings or household members. A third of patients (33.8 %) had had one or more diabetes ketoacidosis (DKA) episodes in the previous year. There was a high prevalence of lipodystrophy (34.1 %) and arthropathy (25.1 %). CONCLUSIONS An exceptionally low proportion of children with T1DM achieved adequate glycemic control, with adolescents particularly struggling. SMBG frequency and family dynamics emerged as potential factors, highlighting the urgent need for tailored interventions and improved diabetes education in resource-limited settings.
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Affiliation(s)
- Lena Ali
- Family Medicine Board, Sudan Medical Specialization Board, Khartoum, Sudan.
| | - Mohammed Alhassan
- College of Medicine, Department of Pediatrics, Prince Sattam Bin Abdulaziz University, Alkharj, Kingdom of Saudi Arabia.
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Majaliwa ES, Muze K, Godfrey E, Byashalira K, Mmbaga BT, Ramaiya K, Mfinanga SG. Latent tuberculosis in children and youth with type 1 diabetes mellitus in Dar es Salaam, Tanzania: a cross section survey. BMC Infect Dis 2023; 23:740. [PMID: 37904143 PMCID: PMC10614349 DOI: 10.1186/s12879-023-08753-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/25/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Data for latent tuberculosis in patients with type 1 Diabetes in Africa is limited. We assessed the prevalence of latent tuberculosis in youth and children with type 1 Diabetes in Dar es Salaam -Tanzania. METHODS Our cross-sectional study recruited children and youth with T1DM by stage of puberty, glycaemic control, and age at diagnosis from January to December 2021 in Dar es Salaam. Participants were screened for the presence of latent Tuberculosis using the QuantiFERON test. A positive test was considered to have latent TB. RESULTS Of the 281 participants, the mean age was 19 (± 6) years, 51.2% were female, and 80.8% had either a primary or secondary level of education at baseline. The prevalence of latent TB was 14.9% and was slightly higher in females (52.4%) than in males. This difference, however, was insignificant (p > 0.05). On the other hand, the proportion of latent TB was significantly higher in uncontrolled HbA1c levels (76.2%) than in those with controlled HbA1c (23.8%) [p = 0.046]. Duration of diabetes and age at diagnosis did not affect the occurrence of latent Tuberculosis [p > 0.05]. Meanwhile, in the regression model, participants with latent TB were more likely to have uncontrolled HbA1c. [p = 0.045] CONCLUSIONS: Despite the methodological limitations, this survey highlights the high prevalence of latent TB among children and youth with diabetes; shouting for better control. These results clearly show the need to screen for Tuberculosis in children and youth with diabetes and start them on prevention as per protocol, especially in tuberculosis-endemic areas like Tanzania.
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Affiliation(s)
- Edna S Majaliwa
- Kilimanjaro Christian Medical University College, Box 2240, Moshi, Kilimanjaro, United Republic of Tanzania.
- Muhimbili National Hospital, Box 65000, Dar es Salaam, United Republic of Tanzania.
| | - Kandi Muze
- Muhimbili National Hospital, Box 65000, Dar es Salaam, United Republic of Tanzania
| | - Evance Godfrey
- Muhimbili National Hospital, Box 65000, Dar es Salaam, United Republic of Tanzania
| | - Kenneth Byashalira
- Kilimanjaro Christian Medical University College, Box 2240, Moshi, Kilimanjaro, United Republic of Tanzania
- Kibong'oto Infectious Diseases Hospital, Sanya Juu, Siha, United Republic of Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College, Box 2240, Moshi, Kilimanjaro, United Republic of Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Kaushik Ramaiya
- Shree Hindu Mandal Hospital, Dar es Salaam, United Republic of Tanzania
| | - Sayoki G Mfinanga
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
- School of Public Health, Department of Epidemiology and Statistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Alliance for Africa Research and Innovation, Dar es Salaam, United Republic of Tanzania
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Habteyohans BD, Hailu BS, Meseret F, Mohammed A, Berhanu Y, Alemu A, Tolosa G, Keneni M, Desalew A. Poor glycemic control and its associated factors among children with type 1 diabetes mellitus in Harar, eastern Ethiopia: A cross-sectional study. BMC Endocr Disord 2023; 23:208. [PMID: 37759193 PMCID: PMC10538014 DOI: 10.1186/s12902-023-01453-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Poor glycemic control increases the risk of acute metabolic derangements and long-term consequences, which are the main causes of morbidity and mortality. Maintaining adequate glycemic control is challenging for children with diabetes, particularly in resource-limited settings. There is a paucity of data on the magnitude of poor glycemic control and its predisposing factors in Ethiopian particularly in this study setting. Hence, we aimed to assess the magnitude of poor glycemic control and its associated factors among children and adolescents with type 1 diabetic mellitus in Jugol and Hiwot Fana Compressive Specialized University Hospitals in Harar, eastern Ethiopia. METHODS A facility-based cross-sectional study was conducted among 231 children and adolescents with type 1 diabetes mellitus in Jugol and Hiwot Fana Compressive Specialized University Hospitals. Participants were included consecutively in the follow-up clinic from November 15, 2022 to January 15, 2023. Data were collected through an interviewer-administered structured questionnaire and a review of medical records. A binary logistic regression model with an adjusted odds ratio (aOR) and a 95% confidence interval (CI) was used to identify the factors associated with poor glycemic control. Statistical significance was set at p < 0.05. RESULT A total of 231 children and adolescents with type 1 diabetes mellitus were included. The magnitude of poor glycemic control was 166 (71.9%) with 95% CI 66.0-77.7%). In multivariable analysis, the age of the child (aOR = 0.19, 95% CI: 0.05-0.83), education of the caregiver (aOR = 4.13;95% CI: 1.82-9.46), meal frequency less than three (aOR = 3.28; 95% CI: 1.25-8.62), and consumption of forbidden foods (aOR = 3.17; 95% CI: 1.21-8.29) were factors significantly associated with poor glycemic control. CONCLUSION Two-thirds of participants had poor glycemic control. There was a statistically significant association between the age of the child, education of the caregiver, meal frequency, and forbidden foods with poor glycemic control. To improve glycemic control, diabetes education on meal use and selection should be conducted during follow-up along with parent education.
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Affiliation(s)
- Betelhem Demeke Habteyohans
- Department of Pediatrics and Child Health, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Betre Shimelis Hailu
- Department of Pediatrics and Child Health, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fentahun Meseret
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia.
| | - Ahmed Mohammed
- Department of Pediatrics and Child Health, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yeshi Berhanu
- Department of Pediatrics and Child Health, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ayichew Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Gadissa Tolosa
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Mulualem Keneni
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Assefa Desalew
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
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6
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Abrahim AM, Tilahun T, Gelana B. Glycemic Control and Associated Factors Among Children and Adolescents with Type 1 Diabetes Mellitus, Southwest Ethiopia. Diabetes Metab Syndr Obes 2023; 16:2025-2037. [PMID: 37427083 PMCID: PMC10329440 DOI: 10.2147/dmso.s412529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose Type 1 diabetes mellitus is the most common endocrine disorder among children and adolescents worldwide. Glycemic control is the ultimate goal of management of diabetes. Poor glycemic control is shown to be associated with complications of diabetes. Only a few studies have addressed the problem in Ethiopia, and this study aimed to determine the level of glycemic control and factors associated among children and adolescents with type 1 diabetes mellitus on follow up. Methods Institution based cross sectional study design was conducted on a total of 158 children and adolescents with type 1 diabetes on follow up at Jimma Medical Center from July to October 2022. Data were collected using structured questionnaire and entered into Epi Data 3.1 then exported to SPSS for analysis. Glycemic control was assessed based on glycosylated hemoglobin (HbA1c) level. Descriptive and inferential statistics were employed, and a p-value <0.05 was considered to declare statistical significance. Results The mean glycosylated hemoglobin of the participants was 9.67 ± 2.28%. Of the total study participants, 121 (76.6%) had poor glycemic control. In multivariable logistic regression, guardian or father as a primary caregiver [guardian (AOR=4.45, 95%, p=0.045), father (AOR=6.02, 95%, p=0.023)], minimal involvement of caregiver in insulin injection (AOR=5.39, 95%, p=0.002), poor blood glucose monitoring adherence (AOR=4.42, 95%, p=0.026), faced problems at health facility (AOR=4.42, 95%, p=0.018) and being admitted to hospital in the past 6 months (AOR=7.94, 95%, p=0.004) were the variables significantly associated with poor glycemic control. Conclusion Majority of children and adolescents with diabetes had poor glycemic control. Whereas, primary caregiver other than mother, minimal involvement of caregiver in insulin injection, and poor adherence to glucose monitoring were among the contributing factors for poor glycemic control. Therefore, adherence counseling and the participation of caregivers in diabetes management is recommended.
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Affiliation(s)
| | - Tsion Tilahun
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Beshea Gelana
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
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Akpalu J, Essuman VA, Amoaku WM, Abaidoo B, Essuman A, Hayfron-Benjamin C, Barnes NA, Tagoe NN, Asare G, Ndanu TA, Appiah-Thompson B, Ofori-Adjei IDB, Sackey AH. A multi-centre investigation of macrovascular and non-ocular microvascular complications in children and adolescents with diabetes mellitus in southern Ghana. Ghana Med J 2023; 57:87-96. [PMID: 38504754 PMCID: PMC10846650 DOI: 10.4314/gmj.v57i2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Objectives To investigate the prevalence of macrovascular and non-ocular microvascular complications and the associated factors among children and adolescents with diabetes mellitus in selected hospitals in southern Ghana. Design A cross-sectional study. Setting The out-patient clinics of the Departments of Child Health, Medicine and Therapeutics, Family Medicine, Ophthalmology, and the National Diabetes Management and Research Centre, all at the Korle Bu Teaching Hospital, Accra, as well as from Cape-Coast Teaching Hospital in the Central Region of Ghana. Participants Fifty-eight children and adolescents aged 4-19 years who had been diagnosed with diabetes mellitus. Main outcome measures Macrovascular (peripheral artery disease and coronary heart disease) and non-ocular microvascular complications (neuropathy and nephropathy). Results Data from 58 children and adolescents with diabetes were analysed. The mean age of participants was 14.6±2.6 years, and a female preponderance was observed (45, 77.6%). The prevalence of macrovascular and non-ocular microvascular complications was 27.6% and 8.6%, respectively. Long duration of diabetes diagnosis (p=0.044) and low triglycerides (p=0.009) were associated with microvascular complications, while high triglycerides (p=0.032), lower HDL cholesterol (p=0.046), and abnormal body mass index (p=0.020) were associated with macrovascular complications. Conclusions Macrovascular and non-ocular microvascular complications are common among children and adolescents with diabetes in southern Ghana and are associated with a long duration of diabetes diagnosis, abnormal body mass index, low HDL cholesterol, and triglyceride levels. Therefore, the early institution of regular screening for diabetes-related complications to allow early detection and appropriate management is recommended. Funding University of Ghana Research Fund.
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Affiliation(s)
- Josephine Akpalu
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Vera A Essuman
- Ophthalmology Unit, Department of Surgery, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Winfried M Amoaku
- Academic Ophthalmology, MHCN, University of Nottingham, 'B' Floor, Eye & ENT Centre, Nottingham University Hospital, QMC Nottingham, UK
| | - Benjamin Abaidoo
- Ophthalmology Unit, Department of Surgery, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Akye Essuman
- Department of Internal Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Charles Hayfron-Benjamin
- Department of Physiology, University of Ghana Medical School, University of Ghana, Accra, Ghana
- Department of Anaesthesia, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana
| | - Nana A Barnes
- Santa Rosa Community Health, Vista Clinic 3569 Round Barn Circle, Santa Rosa, USA
| | - Naa N Tagoe
- Eye Department, Korle Bu Teaching Hospital, Accra, Ghana
| | - George Asare
- Chemical Pathology Unit, Department of Medical Laboratory Sciences, University of Ghana School of Basic and Allied Health Sciences, College of Health Sciences, Accra, Ghana
| | - Thomas A Ndanu
- Department of Preventive & Community Dentistry, University of Ghana Dental School, University of Ghana, Accra, Ghana
| | | | | | - Adziri H Sackey
- Department of Child Health, University of Ghana Medical School, University of Ghana, Accra, Ghana
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Sagna Y, Bagbila WPAH, Bognounou R, Ilboudo A, Sawadogo N, Kyelem CG, Guira O, Ouedraogo MS, Drabo JY. Comparison of regular with NPH insulin vs. premix insulin in children and adolescents with type 1 diabetes in a resources-limited setting: a retrospective data analysis. J Pediatr Endocrinol Metab 2023; 36:447-450. [PMID: 36913487 DOI: 10.1515/jpem-2022-0637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/20/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVES Few studies addressed the efficacy of human insulin regimens (mostly premix insulin) used in many low-and-middle income countries on glycemic control of children and adolescents with diabetes. The aim of this study was to assess the efficacy of the premix insulin on the glycated hemoglobin (HbA1c) in comparison to the regular with NPH insulin scheme. METHODS A retrospective study was carried out from January 2020 to September 2022 on patients with type 1 diabetes aged below 18 years followed in Burkina Life For A Child program. They were categorized into three groups, on regular with NPH insulin (Group A), on premix insulin (Group B) and on regular with premix insulin (Group C). Outcome was analyzed based on HbA1c level. RESULTS Sixty-eight patients with a mean age of 15.38 ± 2.26 years and the sex ratio (M/W) 0.94 were studied. There were 14 in Group A, 20 in Group B, and 34 patients in Group C. The mean HbA1c value in the corresponding insulin regimen was 12.8 ± 1.39%, 9.87 ± 2.18%, and 10.66 ± 2.1%, respectively. Glycemic control was better in Groups B and C than Group A (p<0.05) but there was no difference between groups B and C. CONCLUSIONS Our results indicate that the use of premix insulin gives a better glycemic control than NPH insulin. However, further prospective study of these insulin regimens with a strengthening education strategy and glycemic control by continuous glucose monitoring and HbA1c is required to corroborate these preliminary findings.
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Affiliation(s)
- Yempabou Sagna
- Service de médecine interne, CHU Sourô Sanou, Bobo Dioulasso, Burkina Faso.,INSSA - Université Nazi BONI, Bobo Dioulasso, Burkina Faso
| | | | - René Bognounou
- Service de médecine interne CHU Yalgado Ouédraogo, Bobo Dioulasso, Burkina Faso.,UFR/SDS - Université Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | | | - Nongoba Sawadogo
- Service de Médecine Interne, CHUR de Ouahigouya, Université de Ouahigouya, Ouahigouya, Burkina Faso
| | - Carole G Kyelem
- Service de médecine interne, CHU Sourô Sanou, Bobo Dioulasso, Burkina Faso.,INSSA - Université Nazi BONI, Bobo Dioulasso, Burkina Faso
| | - Oumar Guira
- Service de médecine interne CHU Yalgado Ouédraogo, Bobo Dioulasso, Burkina Faso.,UFR/SDS - Université Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | - Macaire S Ouedraogo
- Service de médecine interne, CHU Sourô Sanou, Bobo Dioulasso, Burkina Faso.,INSSA - Université Nazi BONI, Bobo Dioulasso, Burkina Faso
| | - Joseph Y Drabo
- Service de médecine interne CHU Yalgado Ouédraogo, Bobo Dioulasso, Burkina Faso.,UFR/SDS - Université Joseph Ki Zerbo, Ouagadougou, Burkina Faso
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9
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Majaliwa ES, Muze KC, Ndayongeje J, Mfinanga SG, Mmbaga BT, Ramaiya K. Correlation of C-Peptide With Complications Observed in Children and Adolescents With Type 1 Diabetes in Tanzania: A Cross-Sectional Survey. Glob Pediatr Health 2023; 10:2333794X231159790. [PMID: 36950323 PMCID: PMC10026112 DOI: 10.1177/2333794x231159790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/25/2023] [Accepted: 02/08/2023] [Indexed: 03/19/2023] Open
Abstract
Type 1 diabetes mellitus (T1DM) complications corelate with C-peptide levels. However, the C-Peptide role has not been explored in resource limited countries. This study explored the relationship between C-peptide and complications. A cross-sectional study involving participants aged 0 to 25 years with T1DM in Dar es salaam Tanzania, between 2021 and 2022 was done. Diabetes nephropathy and retinopathy were assessed. About 281 (92.4%) participants were screened, 144 (51.2%) were females. Mean age was 19 ± 6 years. Majority 175 (62.3%) had poor glycemic control (HbA1c) > 10%, and low C-Peptide level 201 (71.5%). Retinopathy was 11.7% and risk for nephropathy was 41.3%. About 13.4% and 41.8% with low C peptide had Retinopathy and high-risk nephropathy respectively. Age at diagnosis, poor glycemic control, low c peptide and duration of diabetes were associated with complications. Further prospective studies are needed to capture when complications set in, so to have better strategies to prevent complications.
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Affiliation(s)
- Edna Siima Majaliwa
- Kilimanjaro Christian Medical
University College, Moshi, United Republic of Tanzania
- Muhimbili National Hospital, Dar es
Salaam, United Republic of Tanzania
- Edna Siima Majaliwa, Kilimanjaro Christian
Medical University College, Box, Moshi 255, United Republic of Tanzania.
| | | | - Joel Ndayongeje
- Global Programmes Tanzania, Dar es
salaam, United Republic of Tanzania
| | | | | | - Kaushik Ramaiya
- Shree Hindu Mandal Hospital, Dar es
salaam, United Republic of Tanzania
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Senbanjo IO, Akinola IJ, Umar UI, Anyabolu CH, Abolurin OO, Adekoya AO, Adeniyi OF, Adepoju AA, Salisu MA, Gwarzo GD, Olorunmoteni OE, Ugowe OJ, Suwaid S, Ashubu OO, Fetuga MB, Oduwole AO. Children and adolescents with type 1 diabetes mellitus in Nigeria: clinical characteristics and compliance with care. J Pediatr Endocrinol Metab 2022; 35:1377-1384. [PMID: 36148598 DOI: 10.1515/jpem-2022-0290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/01/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The prevalence of type 1 diabetes mellitus (T1DM) is increasing in most developed and developing countries. This study described the clinical characteristics and compliance with care among Nigerian children and adolescents with T1DM. METHODS This was a cross-sectional descriptive multi-center study of children seen at the paediatric endocrinology clinic of seven selected tertiary health facilities in Nigeria. Information was collected on socio-demographics, clinical characteristics and compliance of the children with dietary recommendations and insulin therapy. Compliance with dietary recommendations and insulin therapy was graded as either good or poor based on defined criteria. RESULTS The mean age of children was 13.1 ± 4.7 years. The mean age of children at the diagnosis of T1DM was 9.9 ± 4.2 years. Sixty-nine (60%) children were female while about half (47.8%) of the children were from the lower socioeconomic class. Compliance with insulin administration was good in 39.1% of the children and was significantly associated with the father's (p=0.001) and mother's educational status (p=0.024) while compliance with dietary recommendations was good in 20.0% of the children and was significantly associated with mother's educational status (p=0.034) and family socioeconomic class (p=0.010). Only the mother's level of education was independently and significantly associated with compliance to recommendations on insulin therapy (OR 4.2, 95% CI=1.5-11.6, p=0.007). CONCLUSIONS The compliance of children with dietary recommendations and insulin therapy was poor. Efforts should be strengthened at all healthcare facilities to educate parents on the need for compliance with management guidelines.
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Affiliation(s)
- Idowu O Senbanjo
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Ibironke J Akinola
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Umar I Umar
- Department of Paediatrics, Aminu Kano University Teaching Hospital, Kano, Nigeria
| | - Chineme H Anyabolu
- Department of Paediatrics, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | - Adesola O Adekoya
- Department of Paediatrics, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
| | - Olufunmilayo F Adeniyi
- Department of Paediatrics, College of Medicine, University of Lagos, Akoka, Lagos, Nigeria
| | - Akinlolu A Adepoju
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mohammad A Salisu
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Garba D Gwarzo
- Department of Paediatrics, Aminu Kano University Teaching Hospital, Kano, Nigeria
| | | | - Osagie J Ugowe
- Department of Paediatrics, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Salma Suwaid
- Department of Paediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Oluwakemi O Ashubu
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Musili B Fetuga
- Departments of Paediatrics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, Nigeria
| | - Abiola O Oduwole
- Department of Paediatrics, College of Medicine, University of Lagos, Akoka, Lagos, Nigeria
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Ibrahim SA, El Hajj MS, Owusu YB, Al-Khaja M, Khalifa A, Ahmed D, Awaisu A. Adherence as a Predictor of Glycemic Control Among Adolescents With Type 1 Diabetes: A Retrospective Study Using Real-World Evidence. Clin Ther 2022; 44:1380-1392. [PMID: 36192263 DOI: 10.1016/j.clinthera.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 08/14/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Metabolic control among adolescents with type 1 diabetes mellitus (T1DM) is generally poor. Nonadherence is a contributor to this poor glycemic control, leading to adverse outcomes. The findings of studies reporting the association between adherence and glycemic control are conflicting. This study aimed to assess the level of adherence among adolescents with T1DM and its relationship with glycemic control. METHODS This was a retrospective, cross-sectional study that was conducted at Sidra Medicine, a state-of-the-art tertiary health care facility for women and children in Qatar. Mean blood or interstitial glucose monitoring frequency (BGMF) was used to assess adherence level among adolescents with T1DM, whereas glycemic control was assessed via documented glycated hemoglobin A1c (HbA1c). Adolescents who had a mean BGMF of ≥4 checks per day were considered adherent, and those who had an HbA1c level of <7% were considered as having controlled diabetes. Correlational and logistic regression analyses were performed to assess the relationship between adherence and glycemic control, incorporating other covariates into the model. FINDINGS The rate of adherence among adolescents with T1DM in Qatar was 40.9%. Adherent adolescents had significantly lower median HbA1c levels compared with nonadherent adolescents (9.0% vs. 9.7%; P = 0.002). A significant negative correlation was found between BGMF and HbA1c level (correlation coefficient rs = -0.325; P < .001). Approximately 97% of nonadherent adolescents compared with 87% of adherent adolescents had suboptimal diabetes control (HbA1c ≥7%) (P = .016). Furthermore, nonadherent adolescents were 78% less likely to have controlled diabetes compared with adherent adolescents (adjusted odds ratio = 0.221; 95% CI, 0.063-0.778; P = 0.019). The combined effect of the determinants of glycemic control among adolescents with T1DM that were included in the multiple regression model was able to explain approximately 9% of the variances in glycemic control (Cox and Snell R2 = 0.092). IMPLICATIONS The current findings suggest that nonadherence was highly prevalent among adolescents with T1DM and was a significant independent predictor of glycemic control, explaining 9% of the variability. This finding warrants further exploration of other possible predictors of poor glycemic control among the adolescent population. Comprehensive interventions, including educational, technological, and health service delivery aspects, aimed at improving adherence and ultimately optimizing glycemic control are warranted in adolescents with T1DM.
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Affiliation(s)
| | | | - Yaw B Owusu
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | | | | | | | - Ahmed Awaisu
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
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Meseret F, Belachew A, Tesfa G, Mengesha T, Embiale T, Alemu A, Dagne M. Time to first optimal glycemic control and its predictors among type 1 diabetic children in Bahir Dar city public referral hospitals, North West Ethiopia: a retrospective follow up study. BMC Pediatr 2022; 22:563. [PMID: 36153485 PMCID: PMC9508760 DOI: 10.1186/s12887-022-03604-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 09/05/2022] [Indexed: 11/21/2022] Open
Abstract
Background Recognizing the level of glycemic control of a client is an important measure/tool to prevent acquiring complications and risk of death from diabetes. However, the other most important variable, which is the time that the patient stayed in that poor glycemic level before reaching optimal glycemic control, has not been studied so far. Therefore, this study aim to estimate time to first optimal glycemic control and identify predictors among type 1 diabetic children in Bahir Dar city public referral hospitals, Northwest, Ethiopia, 2021. Methods A Retrospective cohort study was conducted at Bahir Dar city public referral hospitals among a randomly selected sample of 385 patients with type 1 diabetes who were on follow up from January 1, 2016 to February30, 2021.Data were collected by using a data abstraction tool and then entered into Epi-data version 4.6 and exported into STATA 14.0 statistical software. Descriptive statistics, Kaplan Meier plots and median survival times, Log-rank test and Cox-proportional hazard regression were used for reporting the findings of this study. After performing Cox-proportional hazard regression, model goodness-of-fit and assumptions were checked. Finally, the association between independent variables and time to first optimal glycemic control in months was assessed using the multivariable Cox Proportional Hazard model and variables with a p-value < 0.05 were considered as statistically significant. Results Median survival time to first optimal glycemic control among type 1 diabetic clients was 8 months (95%CI: 6.9–8.9). The first optimal glycemic achievement rate was 8.2 (95%CI: 7.2–9.2) per 100 person/month observation. Factors that affect time to first optimal glycemic control were age > 10–14 years (AHR = 0.32;95%CI = 0.19–0.55), increased weight (AHR = 0.96;95%CI = 0.94–0.99), having primary care giver (AHR = 2.09;95%CI = 1.39–3.13), insulin dose (AHR = 1.05;95%CI = 1.03–1.08), duration of diabetes ≥4 years (AHR = 0.64;95%CI = 0.44–0.94), adherence to diabetic care (AHR = 9.72;95%CI = 6.09–15.51), carbohydrate counting (AHR = 2.43;95%CI = 1.12–5.26), and comorbidity (AHR = 0.72;95%CI = 0.53–0.98). Conclusion The median survival time to first optimal glycemic control in this study was long. Age, weight, primary care giver, insulin dose, duration of diabetes, adherence, and carbohydrate counting, including history of comorbidity were determinant factors. Giving attention for overweight and comorbid illness prevention, increasing either the dose or frequency of insulin during initial treatment; counseling parent (for both the mother and father) about adherence to diabetic care focusing on insulin drugs and how to audit their children’s diet as prescription helps to reduce the length of glycemic control.
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13
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Fantahun B, Leulseged TW. Glycemic control among children with type 1 diabetes mellitus and its determinants in a resource-limited setting. J Pediatr Endocrinol Metab 2022; 35:813-817. [PMID: 35538692 DOI: 10.1515/jpem-2022-0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/22/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Glycemic control is an important parameter that can predict long-term complications of diabetes mellitus. It can be affected by many factors. Hence, identifying those factors for improving disease outcomes is essential. The purpose of this study was to assess glycemic control in children who were treated with a conventional insulin regimen and to identify its associated factors. METHODS A retrospective cohort study was conducted among children with type one diabetes mellitus (T1DM) who had follow-up from November 2015 to November 2020 at the pediatric endocrinology clinic of St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia. Glycemic control was assessed by measuring glycosylated hemoglobin (HbA1C) and children who had HbA1C within three to six months of the data collection were recruited. RESULTS A total of 106 children with TIDM who were on conventional insulin therapy were included in this study. Their median age at diagnosis was nine years, 47.2% were females, and 57.5% were from urban areas. The average HbA1c of the children was 9.7%. The majority (85.2%) of the children had poor glycemic control (>7.5%). Younger age, longer disease duration, and urban residence were found to be significant predictors of good glycemic control. CONCLUSIONS A significant majority of children with T1DM had poor glycemic control. This calls for the need to create access to intensive diabetes care by health authorities and stakeholders to prevent the long-term complications of T1DM.
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Affiliation(s)
- Bereket Fantahun
- Department of Pediatrics, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tigist W Leulseged
- Department of Pediatrics, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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14
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Shibeshi MS, Daba AK, Meiso KM, Tadesse BT. Glycemic control among children and adolescents with diabetes in Southern Ethiopia: a cross-sectional study. BMC Endocr Disord 2022; 22:161. [PMID: 35705956 PMCID: PMC9202171 DOI: 10.1186/s12902-022-01070-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/31/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Glycemic control is an important part of diabetes management. Strict glycemic control has been shown to reduce the long-term complications of diabetes. However, achieving good glycemic control is challenging for people with diabetes especially in resource limited settings. The aim of this study was to assess glycemic control and identify its determinants among children and adolescents with diabetes. METHODS A cross-sectional study among 116 children and adolescents with diabetes was done at a pediatric endocrine clinic in southern Ethiopia. Data on socioeconomic, demographic, nutrition, and diabetes related variables were collected. Glycemic control was assessed based on glycosylated hemoglobin level. Logistic regression analysis was used to identify predictors of glycemic control. RESULTS The mean glycated hemoglobin (HbA1c) of the participants was 9.6 ± 2.4% (81 ± 3 mmol/mol). Ninety seven (83.6%) of the study participants had poor glycemic control [HbA1c ≥7.5% (58 mmol/mol)]. The presence of lipodystrophic change at injection sites (p =0.028) and being from a family that cannot afford for insulin when there is no free supply (p =0.009) were associated with poor glycemic control. CONCLUSIONS The majority of children and adolescents with diabetes had poor glycemic control. Stakeholders shall focus on identifying strategies to improve the magnitude of poor glycemic control. More research is warranted to exhaustively list out factors contributing to poor glycemic control.
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Affiliation(s)
| | | | - Kebede Mola Meiso
- Department of Pediatrics and Child Health, Alatyon General Hospital, Hawassa, Ethiopia
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15
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Geneti Y, Wondwossen K, Adimasu M, Deressa D, Aga F, Lami M, Abdisa L, Abebe S, Dinku H. Adherence to Diabetes Self-Management and Its Associated Factors Among Adolescents Living with Type 1 Diabetes at Public Hospitals in Addis Ababa, Ethiopia: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2022; 15:659-670. [PMID: 35256847 PMCID: PMC8898021 DOI: 10.2147/dmso.s350168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/16/2022] [Indexed: 11/30/2022] Open
Abstract
Objective The purpose of this study was to determine the level of adherence to diabetes self-management and associated factors among adolescents living with type 1 diabetes at Public Hospitals in Addis Ababa, Ethiopia. Methods An institutional-based cross-sectional study was carried out among 422 adolescents with type 1 diabetes attending outpatient diabetic clinics at public hospitals in Addis Ababa. The adolescents were interviewed using pretested questionnaires to give information on adherence to diabetes self-management. A variable that has a P-value of <0.2 in bi-variable logistic regression analysis was subjected to multivariable logistic regression analysis to control the confounding factors. The level of significance was pronounced at P-value <0.05. Results In this study, a total of 414 adolescents living with type 1 diabetes were interviewed making a 98.1% response rate. About 218 participants (52.7%) had poor adherence to overall diabetes self-management. Self-efficacy (AOR=8.7, 95% CI:1.9-14.1, P=0.005), social support (AOR=4.6, 95% CI:1.5-13.5, P=0.006), age (AOR=0.2, 95% CI:0.1-0.4, P=0.001), good knowledge of the disease (AOR=9.046, 95% CI:3.83-13.5, P=0.000), moderate knowledge (AOR=6.763, 95% CI:2.18-12.921, P=0.001), and time since diagnosis of type 1 diabetes (AOR=0.1, 95% CI:0.02-0.2, P=0.005) were significantly associated with adherence to diabetes self-management. Conclusions and Recommendations More than half of this population had poor adherence to diabetes self-management. The finding suggested that implementing a comprehensive guideline of adherence and expanding the recurrence of follow-up visits could be important for this population.
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Affiliation(s)
- Yomilan Geneti
- Department of Nursing and Midwifery, Dire Dawa University, Dire Dawa, Ethiopia
| | - Kalkidan Wondwossen
- Department of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mekonen Adimasu
- Department of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dereje Deressa
- Department of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fekadu Aga
- Department of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Magarsa Lami
- Department of Nursing and Midwifery, Haramaya University, Harar, Ethiopia
| | - Lemesa Abdisa
- Department of Nursing and Midwifery, Haramaya University, Harar, Ethiopia
| | - Seboka Abebe
- Department of Nursing and Midwifery, Wolkite University, Wolkite, Ethiopia
| | - Hirut Dinku
- Department of Nursing and Midwifery, Wolkite University, Wolkite, Ethiopia
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Dayal D, Yadav J, Kumar R, Gupta S, Yadav A, Nanda PM. Glycaemic control and factors affecting it in type 1 diabetes in children: experience from a tertiary care centre in India. Pediatr Endocrinol Diabetes Metab 2022; 28:281-286. [PMID: 35942831 PMCID: PMC10214966 DOI: 10.5114/pedm.2022.118326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/22/2022] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Optimal glycaemic control is essential for the prevention of future micro- and macrovascular complications in type 1 diabetes (T1D). The type of insulin, the type of insulin delivery device, the caregiver's knowledge, the patient's age, duration of diabetes, and self-monitoring of blood glucose affect glycaemic control in type 1 diabetes. In the present study, we analysed glycaemic control and factors affecting it at a tertiary care centre in northern India. MATERIAL AND METHODS A retrospective review of records of patients registered between 2015 and 2018 was done. The data on demographic and disease-related factors were collected from the records. The different groups were compared with the t-test, one-way ANOVA, or Kruskal-Wallis test. RESULTS The mean age at the time of evaluation was 10.43 ±4.04 years (2-21 years), and the mean disease duration was 46.61 ±28.49 months (16-141 months). Most of the patients were prepubertal and using a basal-bolus regimen. The mean glycated haemoglobin (HbA1c ) was 7.96 ±1.46%, but only 24% had HbA1c below the International Society of Paediatric and Adolescent Diabetes (ISPAD) recommended desirable level of below 7%. Forty-six patients suffered one or more micro-macrovascular complications, and dyslipidaemia was the most common complication. Children with a longer duration of disease (8.39 ±1.42% vs. 7.59 ±1.65%), an episode of DKA (diabetes ketoacidosis) within a year of evaluation (9.19 ±2.54% vs. 7.93 ±1.39%), lower maternal (8.22 ±1.37% vs. 7.56 ±1.45%) and paternal education (8.26 ±1.67% vs. 7.78 ±1.30%), and hyperthyroid state (9.43 ±2.28% vs. 7.91 ±1.45%) had higher HbA1c. CONCLUSIONS Better diabetes education focusing on parents with lower education strata and children with longer disease duration and poor compliance can help improve glycaemic control in developing countries like India.
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Affiliation(s)
| | - Jaivinder Yadav
- Jaivinder Yadav Department of Pediatrics Postgraduate Institute of Medical Education and Research Chandigarh, India e-mail:
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Khadilkar A, Oza C. Glycaemic Control in Youth and Young Adults: Challenges and Solutions. Diabetes Metab Syndr Obes 2022; 15:121-129. [PMID: 35046683 PMCID: PMC8759988 DOI: 10.2147/dmso.s304347] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/22/2021] [Indexed: 04/20/2023] Open
Abstract
Diabetes is the third most prevalent severe chronic disease of youth. Management of any chronic condition like type-1 diabetes (T1D) during adolescence, a time of rapid growth and physiological changes accompanied by important individuation and socialization processes, constitutes a major challenge for the youth, their family and the health-care team. The increasing prevalence of T1D in the adolescent age group and deteriorating glycaemic control from childhood to adolescence and youth, as well as the secular trend of worsening glycaemic control in youth and young adults with T1D, are a matter of real concern. Lack of monitoring, insufficient self-control, psychosocial factors, lack of family support and parental supervision, inadequate adherence to treatment, pubertal increase in insulin resistance and incompetent transition from paediatric to adult care are likely causes of deteriorating glycaemic control in youth. Efforts to improve insulin sensitivity by using pharmacological agents such as metformin are insufficient in resolving this problem. Interventions such as structured intervention, motivational interviews, development of youth friendly services and organization of diabetes camps for peer support can improve adherence in these individuals. Innovative technologies such as continuous subcutaneous insulin infusion and continuous glucose monitoring, comprehensive multidisciplinary teams with effective communication, parental support and supervision with planned transition from paediatric to adult care will not only reduce the risk of micro- and macrovascular complications in young adults with T1D but will also cause significant improvement in their quality of life.
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Affiliation(s)
- Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411 001, India
- Correspondence: Anuradha Khadilkar Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement Jehangir Hospital, 32 Sassoon Road, Pune, 411001, IndiaTel +91 206057004 Email
| | - Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411 001, India
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Adler AJ, Trujillo C, Schwartz L, Drown L, Pierre J, Noble C, Allison T, Cook R, Randolph C, Bukhman G. Experience of living with type 1 diabetes in a low-income country: a qualitative study from Liberia. BMJ Open 2021; 11:e049738. [PMID: 34667004 PMCID: PMC8527120 DOI: 10.1136/bmjopen-2021-049738] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION While epidemiological data for type 1 diabetes (T1D) in low/middle-income countries, and particularly low-income countries (LICs) including Liberia is lacking, prevalence in LICs is thought to be increasing. T1D care in LICs is often impacted by challenges in diagnosis and management. These challenges, including misdiagnosis and access to insulin, can affect T1D outcomes and frequency of severe complications. Despite the severe nature of T1D and growing burden in sub-Saharan Africa, little is currently known about the impact of T1D on patients and caregivers in the region. METHODS We conducted a qualitative study consisting of interviews with patients with T1D, caregivers, providers, civil society members and a policy-maker in Liberia to better understand the psychosocial and economic impact of living with T1D, knowledge of T1D and self-management, and barriers and facilitators for accessing T1D care. RESULTS This study found T1D to have a major psychosocial and economic impact on patients and caregivers, who reported stigma, diabetes distress and food insecurity. Patients, caregivers and providers possessed the knowledge necessary to effectively manage T1D but insufficient community awareness leads to delayed diagnosis, often in an emergency department. Most patients reported receiving free services and materials, though the cost of transportation to clinic visits and recommended foods is a barrier to disease management. Many providers noted the lack of national T1D-specific guidelines and registries. Policy-makers reported a lack of prioritisation of and resources for T1D. These barriers, combined with scarcity and expense of appropriate foods, pose severe barriers for self-management of T1D. CONCLUSION T1D was found to have a significant impact on patients and caregivers, and informants identified several key individual and systems-level barriers to effective T1D care in Liberia. Addressing these concerns is vital for designing sustainable and effective programmes for treating patients living with T1D.
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Affiliation(s)
- Alma J Adler
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Celina Trujillo
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners in Health, Boston, Massachusetts, USA
| | | | - Laura Drown
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | | | - Christopher Noble
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | | | | | | | - Gene Bukhman
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
- Partners in Health, Boston, Massachusetts, USA
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Bille N, Byberg S, Gishoma C, Buch Kristensen K, Lund Christensen D. HbA 1c variability and the development of nephropathy in individuals with type 1 diabetes mellitus from Rwanda. Diabetes Res Clin Pract 2021; 178:108929. [PMID: 34216679 DOI: 10.1016/j.diabres.2021.108929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 05/21/2021] [Accepted: 06/28/2021] [Indexed: 11/20/2022]
Abstract
AIM To estimate the incidence and prevalence of nephropathy and investigate whether high and fluctuating HbA1c levels were associated with development of nephropathy among T1 diabetes individuals in Rwanda. METHODS From 2009 to 2018, 471 T1 diabetes individuals from Rwanda were assessed for nephropathy (albumin-creatinine ratio (ACR) ≥ 30 mg/g). We calculated the mean HbA1c (HbA1c-MEAN) and two measures of HbA1c variability, i.e. A): intra-individual standard deviation (HbA1c-SD), adjusted for HbA1c assessments (HbA1c-AdjSD) and coefficient of variation (HbA1c-CV) and B): (number of HbA1c variability measures > 11 mmol/mol between two measures/number of comparisons between measurements)*100. We followed individuals from first ACR-measurement (baseline) until nephropathy, death or last ACR-measurement (end-of-follow-up), and calculated HRs for developing nephropathy using Cox-regression. RESULTS The incidence and prevalence of nephropathy were 25% and 40%, respectively. All HbA1c variability measures were associated with lower HRs of developing nephropathy, i.e. individuals with HbA1c-AdjSD levels of 0.8-1.5%, 1.5-2.1% and > 4.1% had 53% (95 %CI:0.26;0.86), 55% (95 %CI:0.25;0.82) and 53% (95 %CI:0.26;0.84) lower HRs, respectively, of nephropathy compared to individuals with HbA1c-AdjSD < 0.8%. Results did not change after adjustments, though some estimates were no longer significant. Individuals with adjusted HbA1c-MEAN 9.9-11.4% and > 11.4% had HRs of 1.7 (95 %CI: 0.87;3.32) and 1.8 (95 %CI: 0.94;3.50) compared to individuals with HbA1c-MEAN of 4.9-8.5%. CONCLUSION The incidence and prevalence of nephropathy was high. Higher mean HbA1c was associated with higher HRs of developing nephropathy whereas higher HbA1c variability was associated with lower HRs of nephropathy. This indicates that higher HbA1c levels rather than fluctuating HbA1c levels is a risk factor for developing nephropathy.
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Affiliation(s)
- Nathalie Bille
- World Diabetes Foundation, Department of Advocacy and Partnerships, Bagsvaerd, Denmark; University of Copenhagen, Department of Public Health, Global Health Section, Copenhagen, Denmark.
| | - Stine Byberg
- Steno Diabetes Center Copenhagen, Department of Clinical Epidemiology, Gentofte, Denmark
| | | | - Kirza Buch Kristensen
- World Diabetes Foundation, Department of Advocacy and Partnerships, Bagsvaerd, Denmark
| | - Dirk Lund Christensen
- University of Copenhagen, Department of Public Health, Global Health Section, Copenhagen, Denmark
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Missambou Mandilou SV, Atipo-Ibara Ollandzobo LC, Kitemo Mpolo FLG, Ngoulou BPS, Elenga Bongo CL, Bouénizabila E, Mabiala Babela JR. Psychosocial functioning and health related quality of life in children, adolescents and young adults with type 1 diabetes mellitus in Congo. Pediatr Diabetes 2021; 22:675-682. [PMID: 33528086 DOI: 10.1111/pedi.13187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/15/2020] [Accepted: 01/29/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To describe the psychosocial functioning and assess the quality of life of children, adolescents and young adults with T1DM; and to identify the risk factors associated with the psychosocial experience and quality of life of these patients. MATERIAL AND METHODS A cross-sectional, descriptive study of children, adolescents and young adults with type 1 diabetes. Symptoms of anxiety and depression, and the quality of life were assessed using the Beck's Anxiety and Depression Scales and the pedsQL diabetes module score respectively. RESULTS A total of 74 patients were recruited. The mean age was 18 ± 4.1 years. Minimal symptoms of anxiety were noted in 51 (69%) patients, 23 (31%) had non-minimal symptoms of anxiety (mild:14, moderate: 5, severe: 4). Symptoms of depression were absent in 43 (58.1%) patients and present in 31 (41.9%) patients (mild: 19, moderate: 12). The patients total score of quality of life was 65.4. Higher socioeconomic status (p = 0.03) was a protective factor against Symptoms of anxiety, while the age above 14 years (p = 0.01) was a risk factor for symptoms of depression. The quality of life was lower in patients from low socio-economic status (p = 0.01), those with poor glycemic control (p = 0.03), and when symptoms of depression were present (p = 0.02). CONCLUSIONS Patients with type 1 diabetes in Congo experienced a significant elevated symptoms of anxiety and depression, and a fairly good quality of life. These findings support recommendations for integrating psychosocial aspects in the management of these patients.
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Affiliation(s)
- Steve Vassili Missambou Mandilou
- Department of Pediatrics, Teaching Hospital of Brazzaville, Brazzaville, Congo.,Institut du Diabète Maison Bleue of Brazzaville, Brazzaville, Congo
| | - Lucie Charlotte Atipo-Ibara Ollandzobo
- Department of Pediatrics, Teaching Hospital of Brazzaville, Brazzaville, Congo.,Department of Medicine, Health Sciences Faculty, Marien Ngouabi University, Brazzaville, Congo
| | | | | | - Charley Loumade Elenga Bongo
- Department of Medicine, Health Sciences Faculty, Marien Ngouabi University, Brazzaville, Congo.,Department of Metabolic and Endocrine Diseases, General Hospital Adolph Sicé, Pointe-Noire, Congo
| | - Evariste Bouénizabila
- Institut du Diabète Maison Bleue of Brazzaville, Brazzaville, Congo.,Department of Medicine, Health Sciences Faculty, Marien Ngouabi University, Brazzaville, Congo.,Department of Metabolic and Endocrine Diseases, Teaching Hospital of Brazzaville, Brazzaville, Congo
| | - Jean Robert Mabiala Babela
- Department of Pediatrics, Teaching Hospital of Brazzaville, Brazzaville, Congo.,Department of Medicine, Health Sciences Faculty, Marien Ngouabi University, Brazzaville, Congo
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21
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Ndahura NB, Munga J, Kimiywe J, Mupere E. Effectiveness of a Structured Nutrition Education Course for Caregivers of Children and Adolescents with Type 1 Diabetes in Improving Glycemic and Dietary Outcomes: A Cluster-Randomized Controlled Trial Protocol. OPEN ACCESS JOURNAL OF CLINICAL TRIALS 2021. [DOI: 10.2147/oajct.s304290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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22
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Ndahura NB, Munga J, Kimiywe J, Mupere E. Caregivers' Nutrition Knowledge and Dietary Intake of Type 1 Diabetic Children Aged 3-14 Years in Uganda. Diabetes Metab Syndr Obes 2021; 14:127-137. [PMID: 33469330 PMCID: PMC7813451 DOI: 10.2147/dmso.s285979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/07/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE This study aimed to assess the association between caregiver's level of type 1 diabetes (T1D) nutrition knowledge with children's dietary diversity score (DDS), mean intake of macronutrients, nutrient adequacy ratios (NARs) and mean adequacy ratio (MAR). RESEARCH DESIGN AND METHODS A cross-sectional analytical study design was used. The study was conducted at 6 diabetes clinics in Uganda among 59 caregivers and 61 children. T1D nutrition knowledge survey (NKS) was used to assess the caregiver's nutrition knowledge, and the 24-hour dietary recall and dietary diversity score (DDS) questionnaires were used to collect data on the child's dietary intake. RESULTS Majority (93.2%) of the caregivers had low T1D nutrition knowledge. Carbohydrate counting was the least performed nutrition knowledge domain. The children's mean DDS, calorie intake and MAR were 5.7 ± 1.6, 666.7 ± 639.8 kcal and 0.7 ± 0.3, respectively. The mean NARs of carbohydrate, protein, and fat were 0.9 ± 0.3, 0.9 ± 0.4, 0.5 ± 0.5, respectively. There was a significant association between DDS with NARs of carbohydrate, protein, fat, vitamins A, B2, B3, B5, B12, folic acid, zinc and MAR. No formal education was significantly associated with a lower mean NKS score among caregivers (p = 0.039). Caregivers' T1D nutrition knowledge, age and family size explained 14% of variation in the child's dietary diversity (p = 0.041). CONCLUSION Despite poor nutrition knowledge among caregivers especially on carbohydrate counting, dietary diversity among children with T1D remained favorable. Excess carbohydrate intake was observed with inadequate intake of proteins, fats and micronutrients (vitamin A, B vitamins and calcium). Caregivers with low education were more likely to register poor nutrition knowledge; therefore, there is need to develop and tailor nutrition education programmes to enhance comprehensive learning among caregivers for improved outcomes.
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Affiliation(s)
- Nicholas Bari Ndahura
- Department of Human Nutrition and Home Economics, Kyambogo University, Kampala, Uganda
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
- Correspondence: Nicholas Bari Ndahura Department of Human Nutrition and Home Economics, P.O Box 1 Kyambogo, Kampala, UgandaTel +256772636271 Email
| | - Judith Munga
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Judith Kimiywe
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Ezekiel Mupere
- Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda
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23
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Begum M, Chittleborough C, Pilkington R, Mittinty M, Lynch J, Penno M, Smithers L. Educational outcomes among children with type 1 diabetes: Whole-of-population linked-data study. Pediatr Diabetes 2020; 21:1353-1361. [PMID: 32833299 DOI: 10.1111/pedi.13107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 07/08/2020] [Accepted: 08/17/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Challenges with type 1 diabetes (T1D) blood glucose management and illness-related school absences potentially influence children's educational outcomes. However, evidence about the impact of T1D on children's education is mixed. The objectives were to estimate the effects of T1D on children's educational outcomes, and compare time since T1D diagnosis (recent diagnosis [≤2 years] and 3 to 10 years long exposure) on educational outcomes. METHODS This whole-of-population study used de-identified, administrative linked-data from the South Australian Early Childhood Data Project. T1D was identified from hospital ICD-10-AM diagnosis codes (E10, ranging E101 to E109), from 2001 to 2014. Educational outcomes were measured in grade 5 by the National Assessment Program-Literacy and Numeracy (NAPLAN, 2008-2015) for children born from 1999 to 2005. Analyses were conducted using augmented inverse probability of treatment weighting. Multiple imputations was used to impute missing data. RESULTS Among 61 445 children born in South Australia who had undertaken NAPLAN assessments, 162 had T1D. There were negligible differences in the educational outcomes of children with and without T1D, and between recently diagnosed and those with longer exposure. For example, the mean reading score was 482.8 ± 78.9 for children with T1D and 475.5 ± 74.3 for other children. The average treatment effect of 6.8 (95% CI - 6.3-19.9) reflected one-tenth of a SD difference in the mean reading score of children with and without T1D. CONCLUSION Children with T1D performed similarly on literacy and numeracy in grade 5 (age ~ 10-years) compared to children without T1D. This could be due to effective T1D management.
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Affiliation(s)
- Mumtaz Begum
- School of Public Health, The University of Adelaide, Adelaide, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, Australia.,Department of Food and Nutrition, College of Home Economics, University of Peshawar, Peshawar, Pakistan
| | - Catherine Chittleborough
- School of Public Health, The University of Adelaide, Adelaide, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Rhiannon Pilkington
- School of Public Health, The University of Adelaide, Adelaide, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Murthy Mittinty
- School of Public Health, The University of Adelaide, Adelaide, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - John Lynch
- School of Public Health, The University of Adelaide, Adelaide, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, Australia.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Megan Penno
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia.,School of Medicine, University of Adelaide, Adelaide, Australia
| | - Lisa Smithers
- School of Public Health, The University of Adelaide, Adelaide, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, Australia
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24
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Yang J, Yang H, Wang Z, Wang X, Wang Y, Yu X, Liu L. Self-management among type 2 diabetes patients via the WeChat application: A systematic review and meta-analysis. J Clin Pharm Ther 2020; 46:4-16. [PMID: 33085789 DOI: 10.1111/jcpt.13264] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The incidence of diabetes has been rising worldwide and is expected to increase to affect 591.9 million people by 2035 in China. Strict control of blood glucose can significantly reduce the risk of diabetic complications, but traditional interventions lack continuity, timeliness and teleonomy. The development of mobile health management has become a hot topic, as a very popular app in China, WeChat platform, has a large number of users every day. Many studies show the health management of patients with diabetes through WeChat can achieve the ideal effect. This study aims to evaluate the application of WeChat based on clinical research data, provide clinical evidence for medical staff and promote the self-management of patients with diabetes. METHODS The PubMed, EMBASE, Cochrane Library, CNKI and Wanfang database were searched to identify related reports that were published up to 9 March 2020. The quality of included studies was assessed by Cochrane Collaboration risk assessment tool. Measures of interest were mean difference (MD) and 95% confidence interval (CI). Random-effect model was used according to the absence or presence of significant heterogeneity. Heterogeneity among trials was evaluated by I2 test. Publication bias was assessed by funnel plots. RESULTS AND DISCUSSION Thirty-eight articles involved 2,709 controls and 2,709 patients who used WeChat were identified. Relative to the traditional group, WeChat group had a lower level in fasting plasma glucose (FPG in mmol/L; MD: 1.36, 95% CI 1.10-1.62, P < .00001), so did 2hPG (MD: 1.91, 95% CI 1.48-2.35, P < .00001) and HbA1C (MD: 1.07, 95% CI 0.86-1.27, P < .00001). Self-efficacy scale improved significantly, including diet score (MD: -1.31, 95% CI -1.77 to -0.86, P < .00001), exercise score (MD: -1.92, 95% CI -2.44 to -1.40, P < .00001), medication taking score (MD: -1.45, 95% CI: -1.94 to -0.97, P < .00001), monitoring of blood glucose score (MD: -1.17, 95% CI -1.83--0.51, P = .0005) and foot care score (MD: -1.71, 95% CI -2.08 to -1.34, P < .00001). Patients' understanding of the disease and satisfaction with follow-up increased significantly, whereas the incidence of adverse reactions and complications decreased. WHAT IS NEW AND CONCLUSION WeChat follow-up appears to be helpful to improve the level of blood glucose and self-management, reduce the incidence of adverse reactions and complications, and improve the satisfaction rate of patients with type 2 diabetes. It should be noted that this meta-analysis has limitations, such as small sample sizes and the low quality of included literature, as well as the lack of research in Western countries. Therefore, more high-quality studies with larger samples are needed in the future to verify our results.
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Affiliation(s)
- Jing Yang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hui Yang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zihui Wang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xin Wang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yingkai Wang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaojia Yu
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lihong Liu
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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25
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McClure Yauch L, Velazquez E, Piloya‐Were T, Wainaina Mungai L, Omar A, Moran A. Continuous glucose monitoring assessment of metabolic control in east African children and young adults with type 1 diabetes: A pilot and feasibility study. Endocrinol Diabetes Metab 2020; 3:e00135. [PMID: 32704558 PMCID: PMC7375091 DOI: 10.1002/edm2.135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/16/2020] [Accepted: 03/22/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND For individuals with type 1 diabetes (T1D) in East Africa and other low-income regions, the last decade has seen substantial gains in access to insulin and trained healthcare providers, yet metabolic control remains poor. METHODS The objective was to determine the feasibility of continuous glucose monitoring (CGM) and to gather baseline metabolic data for future power analysis in Ugandan and Kenyan youth with T1D using a Freestyle Libre Pro blinded CGM. RESULTS Of 78 participants recruited, four sensors fell off and six patients did not return, leaving 68 evaluable subjects. Average age was 16 ± 5 (range 4-26) years, 43% female. Average diabetes duration was 7 ± 5 years, insulin dose 0.9 ± 0.3 U/kg/d, and number of fingerstick glucose levels per day 2.1 ± 1.1. All were on human insulin. Point-of-care HbA1c was 10.9 ± 2.7% (96 ± 30 mmol/mol). Mean number of sensor days was 13 ± 3; >90% wore the sensor for ≥10 days. Mean glucose was 231 ± 86 mg/dL (12.8 ± 4.8 mmol/L). Only 30 ± 19% of time was spent in the target range (70-180 mg/dL; 3.9-10 mmol/L), and 7 ± 8% of time was spent in hypoglycaemia (glucose <55 mg/dL, 3.0 mmol/L). Hypoglycaemia occurred in 81% of participants, averaging five events/wk with an average duration of 140 ± 79 minutes/event. CONCLUSIONS Despite significant diabetes care improvements, East African youth with T1D have poor metabolic control with chronic hyper- and hypoglycaemia, placing them at high risk for serious acute and chronic complications. This study demonstrates the feasibility of CGM use in this population and provides baseline metabolic data that will be used to inform a future intervention study.
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Affiliation(s)
| | - Eric Velazquez
- Department of PediatricsUniversity of MinnesotaMinneapolisMNUSA
| | - Thereza Piloya‐Were
- Department of PediatricsMakerere University College of Health SciencesKampalaUganda
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26
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The impact of limited and strategic blood glucose monitoring on metabolic control in a type 1 diabetes clinic in Central India. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00817-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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27
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Bahendeka S, Mutungi G, Tugumisirize F, Kamugisha A, Nyangabyaki C, Wesonga R, Sseguya W, Mubangizi D, Nalunkuma C, Were TP. Healthcare delivery for paediatric and adolescent diabetes in low resource settings: Type 1 diabetes clinics in Uganda. Glob Public Health 2019; 14:1869-1883. [PMID: 31042454 DOI: 10.1080/17441692.2019.1611897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The management of type 1 diabetes (T1DM) includes setting up organised follow-up clinics. A programme for establishing such clinics in Uganda commenced in 2009. The clinics were established along the chronic care model and were integrated into the health structure of other chronic diseases. Web-based electronic medical records were utilised to establish a centralised registry. All children with diabetes below 18 years of age were encouraged to enrol into the programme by attending the nearest established T1DM clinic. At the commencement of the programme, there were 178 patients with T1DM receiving care in various health facilities but without organised follow-up T1DM clinics. These patients were subsequently enrolled into the programme and as of June 30, 2018, the programme had a total of 32 clinics with 1187 children; 3 with neonatal diabetes. Challenges encountered included difficulties in timely diagnosis, failure to provide adequate care in the remote rural areas and failure to achieve pre-defined glycated haemoglobin (HbA1c) goals. Despite these challenges, this observational study demonstrates that healthcare delivery for T1DM organised along the chronic care model and supported by web-based electronic medical records is achievable and provides care that is sustainable. Addressing the encountered challenges should result in improved outcomes for T1DM.
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Affiliation(s)
- Silver Bahendeka
- Mother Kevin Post Graduate Medical School (MKPGMS), Uganda Martyrs University , Kampala , Uganda.,The Diabetes Centre, St. Francis Hospital , Kampala , Uganda
| | - Gerald Mutungi
- Non-Communicable Disease Desk, Ministry of Health , Kampala , Uganda
| | - Florence Tugumisirize
- Department of Paediatrics, Fort-Portal Regional Referral Hospital , Fort-Portal , Uganda
| | - Albert Kamugisha
- Department of Paediatrics, Masaka Regional Referral Hospital , Masaka , Uganda
| | - Catherine Nyangabyaki
- Mother Kevin Post Graduate Medical School (MKPGMS), Uganda Martyrs University , Kampala , Uganda.,The Diabetes Centre, St. Francis Hospital , Kampala , Uganda
| | - Ronald Wesonga
- School of Statistics and Planning, Makerere University , Kampala , Uganda.,Department of Statistics, Sultan Qaboos University , Muscat , Oman
| | | | - Denis Mubangizi
- The Diabetes Centre, St. Francis Hospital , Kampala , Uganda
| | - Cissy Nalunkuma
- Department of Paediatrics, Uganda Martyrs Hospital Lubaga , Kampala , Uganda
| | - Thereza Piloya Were
- School of Medicine, College of Health Sciences, Makerere University Kampala , Kampala , Uganda
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28
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Klatman EL, Jenkins AJ, Ahmedani MY, Ogle GD. Blood glucose meters and test strips: global market and challenges to access in low-resource settings. Lancet Diabetes Endocrinol 2019; 7:150-160. [PMID: 30072234 DOI: 10.1016/s2213-8587(18)30074-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 12/23/2022]
Abstract
Blood glucose meters and test strips for self-monitoring of blood glucose (SMBG) are often inaccessible to, and infrequently used by, people with diabetes in countries with limited resources for health care. Supplies for measuring blood glucose can also be scarce in health facilities, despite being needed in a myriad of clinical settings at all levels of the health system. Numerous studies and international guidelines emphasise the value of SMBG in diabetes care, particularly in people with type 1 diabetes. In this Review, we assess global access to blood glucose meters and test strips, collating published information on cost, availability, system accuracy, competitive bidding, technological trends, and non-financial barriers. We also provide new information on global market share data and prices, taxes and tariffs, and product availability. Blood glucose meters and test strips should be viewed similarly to essential medicines, with issues of access prioritised by relevant international agencies. Efforts are needed to reduce tariffs and taxes and to create unified global system accuracy requirements and accountable post-marketing evaluations. Preferential pricing arrangements, pooled procurement, and best-purchasing practices could help to lower direct costs. SMBG supplies should also be included in national health insurance schemes. Enhanced diabetes education of health professionals and patients is crucial to ensure effective use of SMBG. Finally, as technology advances for people who can afford new interstitial fluid glucose monitoring systems, blood glucose meters and test strips must remain available and become more affordable in low-resource settings.
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Affiliation(s)
- Emma Louise Klatman
- International Diabetes Federation Life for a Child Program, Sydney, NSW, Australia.
| | | | | | - Graham David Ogle
- International Diabetes Federation Life for a Child Program, Sydney, NSW, Australia; Diabetes NSW and ACT, Sydney, NSW, Australia
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29
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Taha Z, Eltoum Z, Washi S. Predictors of Glucose Control in Children and Adolescents with Type 1 Diabetes: Results of a Cross-Sectional Study in Khartoum, Sudan. Open Access Maced J Med Sci 2018; 6:2035-2039. [PMID: 30559856 PMCID: PMC6290430 DOI: 10.3889/oamjms.2018.423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/09/2018] [Accepted: 10/11/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: Type 1 diabetes mellitus (T1DM) is a rapidly growing problem in Sudan as well as other African countries. Children and adolescents with type 1 diabetes have previously been found to have poor glycemic control. Strict glycemic control reduces the incidence and progression of chronic complications. AIM: This study aimed to identify the factors associated with glycemic control among children and adolescents. METHODS: The study was a health-centre based descriptive cross-sectional study. Data on socioeconomic, demographic, disease history, and diabetes-specific variables was obtained. Glycemic control was assessed by measuring glycosylated haemoglobin (HbA1C). Linear regression analysis was done to determine factors associated with glycemic control. RESULTS: One hundred Sudanese children with T1DM aged from (1-18) years were recruited for the study (63 % females). Most of the study children (80%) had high random blood glucose levels. Less than half (40%) suffered from the presence of glucose in their urine and one-quarter of them have urine ketones. Also, Glycosylated haemoglobin (HbA1c) level of the study children showed that more than three-quarters (76%) had poor glycemic control. It was found that there is no relationship between nutritional status and glycemic control. However, there is a relationship between socioeconomic status and glycemic control (P = 0.025) CONCLUSION: To improve metabolic control, more frequent BGM should be encouraged among children and adolescents with T1DM. Emphasis needs to be put on providing families with children with diabetes with the medical, financial and social support for better control of their diabetes.
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Affiliation(s)
- Zainab Taha
- Department of Health Sciences, Zayed University, Abu Dhabi, United Arab Emirates
| | - Zeinab Eltoum
- School of Health Sciences, Ahfad University for Women, Omdurman, Sudan
| | - Sidiga Washi
- School of Health Sciences, Ahfad University for Women, Omdurman, Sudan
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30
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Kyokunzire C, Matovu N. Factors associated with adherence to diabetes care recommendations among children and adolescents with type 1 diabetes: a facility-based study in two urban diabetes clinics in Uganda. Diabetes Metab Syndr Obes 2018; 11:93-104. [PMID: 29636626 PMCID: PMC5880187 DOI: 10.2147/dmso.s156858] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the level of adherence and the factors associated with adherence to diabetes care recommendations among type 1 diabetic children and adolescents at two urban diabetes clinics in Kampala, Uganda. RESEARCH DESIGN AND METHODS A facility-based cross-sectional study was carried out among 200 children and adolescents with type 1 diabetes at two major diabetes clinics in Kampala. Caretakers of the children and adolescents were interviewed using pretested questionnaires to provide information on sociodemographic characteristics, diabetes care, knowledge, attitudes, and adherence to diabetes care recommendations in type 1 diabetes. Prevalence rate ratios (PRRs) at the 95% confidence interval (CI) were used to establish the factors associated with adherence using modified Poisson regression, with robust standard errors. The data were analyzed by using STATA Version 13.0. RESULTS The overall prevalence of adherence to diabetes care recommendations was at 37%. However, evaluating adherence to specific treatment parameters showed that 52%, 76.5%, and 29.5% of the children and adolescents adhered to insulin, blood glucose monitoring, and dietary recommendations, respectively. In the final adjusted model, active diet monitoring (adjusted PRR [APRR]: 1.95; 95% CI: 1.01, 3.78), being under care of a sibling (APRR: 1.66; 95% CI: 1.61, 1.71), being under care of a married caretaker (APRR: 1.10; 95% CI: 1.05, 1.14) and a separated or divorced caretaker (APRR: 1.60; 95% CI: 1.12, 2.27), taking three or less tests of blood glucose per day (APRR: 0.63; 95% CI: 0.42, 0.95), and having a caretaker with poor knowledge about diabetes (APRR: 0.49; 95% CI: 0.43, 0.57) and who is inactive in supervision of insulin injections (APRR: 0.58; 95% CI: 0.56, 0.60) were associated with adherence to type 1 diabetes care recommendations. CONCLUSION Adherence to type 1 diabetes care recommendations is still low among this population. The results suggest that reinforcing caretaker involvement could be vital in improving adherence to diabetes care recommendations in this population.
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Affiliation(s)
- Catherine Kyokunzire
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nicholas Matovu
- Department of Community Health, Division of Noncommunicable Diseases, Ministry of Health – Uganda, Kampala, Uganda
- Global Health Corps Fellowship Program 2017/2018, New York, NY, USA
- Correspondence: Nicholas Matovu, Department of Community Health, Division of Noncommunicable Diseases, Ministry of Health-Uganda, P.O. Box 7272, Kampala, Uganda, Tel +256 775 600 637, Email
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Jin M, An Q, Wang L. Chronic conditions in adolescents. Exp Ther Med 2017; 14:478-482. [PMID: 28672956 PMCID: PMC5488599 DOI: 10.3892/etm.2017.4526] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/22/2017] [Indexed: 12/20/2022] Open
Abstract
The health problems related to the nervous system are on rise in young infants leading to high mortality amongst this age group. A chronic medical condition (CC) is present in this age group to the tune of 10–20%. We searched the electronic database PubMed for pre-clinical as well as clinical controlled trials reporting variable chronic conditions especially in pediatric patients. Most of these reports revealed that type 1 diabetes mellitus is the most common CC in young infants. In female patients, metabolic control is often disturbed during CC in this age group. Poor metabolism regulation often results in long-term complications, including cognitive disorders. In cognitive disorders, memory loss and learning problems are the most among adolescents. Executive problems are observed to be associated with low physical activities. The review article concludes that knowledge about factors influencing treatment adherence is crucial in chronically ill infants. Further, we should focus on protective factors in order to prevent health risk behavior.
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Affiliation(s)
- Mingwei Jin
- Department of Pediatric Internal Medicine, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Qi An
- Department of Pediatric Internal Medicine, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Lei Wang
- Department of Pediatric Internal Medicine, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
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