Glucose control in Rwandan youth with type 1 diabetes following establishment of systematic, HbA1c based, care and education

Diabetes Res Clin Pract. 2015 Jan;107(1):113-22. doi: 10.1016/j.diabres.2014.09.045. Epub 2014 Oct 7.

Abstract

Aims: To assess change in glycemic control concurrent with increased clinic visits, HbA1c testing, and education. Rates of complications were also examined.

Methods: A 1-2 year follow-up of 214 members of the Rwanda Life for a Child program (aged <26 years) with a first HbA1c between June 2009 and November 2010 was conducted. Data were analyzed for the entire cohort and by age (<18 years, ≥18 years). Trajectory analysis was performed to identify trends in HbA1c.

Results: Mean overall HbA1c decreased significantly from baseline (11.2 ± 2.7%; 99 ± 30 mmol/mol) to one- (10.2 ± 2.6%; 88 ± 28 mmol/mol) and two- (9.8 ± 26%; 84 ± 25 mmol/mol) year follow up visits. The prevalence of microalbuminuria did not significantly change (21.0%, 18.8%, and 19.6%), nor did nephropathy (4.7%, 7.8%, and 5.4%). However, rates of hypertension (31.8%, 44.9%, and 40.3%) were higher than expected. Five HbA1c groups were identified by trajectory analysis, and those with the worst control monitored their glucose significantly fewer times per week.

Conclusions: The establishment of regular care, HbA1c testing, and increased education is associated with significant improvements in glycemic control in youth with type 1 diabetes (T1D) in sub-Saharan Africa, but the high prevalence of hypertension is of concern.

Keywords: Africa; Diabetes; Youth.

MeSH terms

  • Adolescent
  • Adult
  • Blood Glucose / analysis
  • Blood Glucose / metabolism*
  • Child
  • Cohort Studies
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / therapy*
  • Female
  • Glycated Hemoglobin A / analysis
  • Glycated Hemoglobin A / metabolism*
  • Humans
  • Hypertension / complications
  • Male
  • Patient Education as Topic / methods*
  • Prevalence
  • Primary Health Care / methods*
  • Rwanda / epidemiology
  • Young Adult

Substances

  • Blood Glucose
  • Glycated Hemoglobin A