Prevalence of Acute Complications of Type 1 Diabetes in Children and Adolescents in Kenyatta National Hospital

Abstract

Background: Insulin-dependent diabetes mellitus is a frequent long-term endocrine condition in Kenyan kids although it has largely been under-reported. Due to parental/caregiver unawareness or a knowledge gap in the community, many patients are randomly picked at advanced disease stages. T1DM has been linked to major complications e.g., diabetic ketoacidosis (DKA) and hypoglycemia. Prior research has shown the prevalence of DKA to range between 0.2 – 3% while the prevalence of hypoglycemia ranges between 19-37% among children and adolescents. However, in the local context, the magnitude of DKA and hypoglycemia has not been extensively investigated. Objectives: To determine the prevalence of DKA and low blood sugar among children and adolescents in Kenyatta National Hospital (KNH). Methodology: This was a cross-sectional conducted at KNH. Using a consecutive sampling method, 161 kids aged 6 months to 18 years were recruited. Data collection was carried out using a structured questionnaire, capturing information on caregiver characteristics, patient demographics, and acute symptoms. Both descriptive and inferential analyses were performed. Categorical data were summarised using frequencies and percentages, while medians and interquartile ranges were used for continuous variables. The prevalence of acute type 1 diabetes complications (DKA or hypoglycemia) was calculated as a proportion of the total sample and presented with a 95% confidence interval. Relationships between grouped data were examined using Chi-square and Fisher's exact tests. Logistic regression analysis was used to identify independent factors associated with these complications. Analysis was performed in R version 4.1.2. Results: The study involved a total of 161 participants, ranging in age from 6 months to 18 years, all diagnosed with type 1 diabetes. The middle age of the children was 10.1 years, with a 25th quartile of 6.0 and a 75th quartile of 14.0 years. Female participants were the majority, 52.8% (85 out of 161). There were 105 (66%) healthy children, 38 (24%) were overweight and 15 (9.5%) were obese. The rest had severe malnutrition. There were 83 (51.5%) children with DKA alone, 3 (1.9%) with hypoglycaemia alone, and 17 (10.6%) with both DKA and hypoglycaemia combined. The prevalence of acute complications of type 1 DM was 64% (95% CI 54%, 73%). None of the factors assessed were linked to acute complications of type 1DM before adjustment. After adjustment, the age of the children was substantially linked to the development of acute complications of type 1 DM (P value = 0.048). xi Conclusion: Our study revealed a high prevalence of acute complications of T1DM in kids visiting the diabetic clinic at KNH. The age of the children in years was substantially linked to the development of acute complications of type 1 DM after adjusting for sex. Recommendation. More emphasis should be put on type I diabetes in paediatric populations focusing on public education to raise awareness of this complex disease. Special attention should be paid to screening and parental education on the acute complications of type 1 diabetes. Further studies need to be conducted in this area to ascertain the results of this study under a bigger sample and in a greater duration of investigation time