Predictors of Glucose Control in Children and Adolescents with Type 1 Diabetes: Results of a Cross-sectional Study in Cameroon

Background: In sub-Saharan Africa the prognosis of children with type 1 diabetes is poor. Many are not diagnosed and those diagnosed have a dramatically reduced life expectancy (less than one year). The purpose of this study was to identify the predictors of glucose control in children and adolescents with type 1 diabetes.

Methods: This hospital based cross-sectional study involved 76 children/adolescents (35 boys and 41 girls, mean age of 15.1 ± 3.1 years) with type 1 diabetes included in the "Changing Diabetes in Children" (CDiC) program and attending the clinics for children living with type 1 diabetes in the North West Region of Cameroon. Data on glycosylated haemoglobin (HbA1c) was obtained from hospital records of participants. Information on socio-demographic characteristics and diabetes related practices were obtained from participants using a structured questionnaire. Odds ratios (OR) were calculated using logistic regression models to assess the association between determinants and good glyceamic control.

Results: The study population had a mean HbA1c of 10.3 ± 2.9%. Bivariate analysis indicated that having a mother as the primary caregiver (OR 0.07, 95% CI 0.02-0.2), being on 2 daily insulin injections (OR 0.2, 95% CI 0.1-0.5) and good blood glucose monitoring (BGM) adherence (OR 0.1, 95% CI 0.04-0.3) were significantly (p < 0.001) associated with better HbA1c. Minimal/moderate caregiver involvement in BGM (OR 7.7, 95% CI 2.7-22.0) and insulin injection (OR 14.9, 95% CI 4.8-46.5) were significantly (p < 0.001) associated with poor outcome. Multivariate analysis showed that having a mother as the primary caregiver (OR 0.02, 95% CI 0.002-0.189) was an independent predictor of good glucose control.

Conclusions: This study has shown that the mother's involvement in the diabetes management of their children and minimal/moderate caregiver involvement in the task of insulin injection are the most important determinants for good and poor glucose control respectively. It is currently unclear whether the direct involvement of the mother is causal or whether "mother as a primary caregiver" is just an indicator for a setting in which good diabetes treatment is possible.