Diabetes Mellitus in Childhood and Adolescence:
Analysis of Clinical Data of Patients Seen in a Nigerian Teaching Hospital
Abstract
Background: The clinical profile of African children and adolescents with diabetes mellitus is known to differ from that of their non-African counterparts.
Objective: To present an analysis of the clinical data of children and adolescents with diabetes mellitus seen in a Nigerian teaching hospital between 2005 and 2011 and highlight the management challenges encountered.
Methods: In this retrospective study, the case notes of all children and adolescents with diabetes Mellitus seen in the Paediatric Endocrine-Metabolic Clinic and of those admitted into the paediatric wards of the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria were audited. Information extracted included age, sex, presenting features, educational attainment of parents, occupation of parents, insulin management, complications and outcome of patients. The clinic attendance registers of the Department of Child Health, UBTH was examined to obtain information on total number of patients seen by all the units in the department between 2005 and 2011.
Results: Seventeen (0.2%)of the 8,350 casesseenduringtheperiodunderreviewhaddiabetesmellitus, representing 2 per 1000 cases with a male-to-female ratio of 1: 1.8. The mean age at presentation was 212.8 ±2.9 years for both sexes combined. The mean body mass index (BMI) was 18.6±2.5 kg/m . Diabetic ketoacidosis (DKA) was the initial presentation in 9 (52.9%) of cases. The mean duration of symptoms before presentation was 2.7±1.8 months. Only 10(58.8%) of the 17 patients had glucose meter for self- monitoring of blood glucose at home. Of the 17 patients, 6 (35.3%) had documented evidence of hypoglycaemia. During the period under review, 4 (23.5%) were re-admitted; of which 3 were for DKA. Seven (41.2%) of the parents had difficulty procuring insulin on a regular basis.
Conclusion: In the present study,the unique clinical features observed among children with diabetes mellitus were late presentation, high number of cases presenting with DKA and requiring re-admission. The major management challenges included difficulty procuring insulin on a regular basis and inability to acquire a glucose meter with test strips for self-monitoring of blood glucose at home.
References
Alemzadeh R, Wyatt DT. Diabetes mellitus in children. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics, 18t h ed. Philadelphia, Saunders Elsevier, 2007: 2404- 2431.
Bhatia V. Diabetes mellitus. In: Parthasarathy A, ed. IAP Textbook of Pediatrics, 4th ed. New Delhi, Jaypee Brothers Medical (Publishers) Ltd, 2009: 962-969.
Swai AB, Lutale JL, McLarty DG. Prospective study of incidence of juvenile diabetes mellitus over 10 years in Dares Salaam, Tanzania. BMJ 1993; 306: 1570- 1572.
Vos C, Reeser HM, Hirasing RA, Bruining GJ. Confirmation of high incidence of type 1 (insulin- dependent) diabetes mellitus in Moroccan children in The Netherlands. Diabet Med 1997; 14: 397-400.
Afoke AO, Ejeh NM, Nwonu EN, Okafor CO, Udeh NJ, Ludvigsson J. Prevalence and clinical picture of IDDM in Nigerian Igbo school children. Diabetes Care 1992; 15: 1310-1312.
Elamin A, Omer MI, Zein K, Tuvemo T. Epidemiology of childhood type 1 diabetes in Sudan, 1987-1990.Diabetes Care 1992; 15: 1556-1559.
Kadiki OA, Roacid RB. Incidence of type 1 diabetes in children (0-14 years) in Benghazi, Libya (1991-2000). Diabetes Metab 2002; 28: 463-468.
Bessoud K, Boudraa G, Deschamps I, Hors J, Benbouabdallah M, Touhami M. Epidemiology of juvenile insulin-dependent diabetesin Algeria(WilayaofOran).Rev Epidemiol Sante Publique 1990; 38: 91-99.
Majaliwa ES, Elusiyan BEJ, Adesiyun OO, Laigong P, Adeniran AK, Kandi CM, Yarhere I, Limbe SM, Inghetti L. Type 1 diabetes mellitus in the African population: epidemiology and management challenges. Acta Biomed 2008; 79: 255-259.
Elamin A, Altahir H, Ismail B, Tuvemo T. Clinical pattern of childhood type 1(insulin dependent) diabetes mellitus in the Sudan. Diabetologia 1992; 35: 645-648.
Akanji AO. Clinical experience with adolescent diabetes in a Nigerian teaching hospital. J Natl Med Assoc 1996; 88: 101-105.
Sterky G, Holmgren G, Gustavson KH, Larsson Y, Lundmark KM, Nilsson KO, Samuelson G, Thalme B, Wall S. The incidence of diabetes mellitus in Swedis children 1970-1975. Acta Paediatr Scand 1978; 76: 139-143.
Lester FT. Childhood diabetes mellitus in Ethiopians. Diabet Med 1986; 3(3): 278-280.
Bella AF. A prospective study of insulin- dependent diabetic Nigerian Africans. J Natl Med Assoc 1992; 84: 126-128.
Kadiki OA, Reddy MR, Marzouk AA. Incidence of insulin-dependent diabetes (IDDM) and non-insulin-dependent diabetes (NIDDM) (0-34 years at onset) in Benghazi, Libya. Diabetes Res Clin Pract 1996; 32: 165-173.
Ben Khalifa F, Mekaouar A, Takrak S, et al. A five-year study of incidence of insulin- dependent diabetes mellitus in young Tunisians (preliminary results). Diabetes Metab 1997;23:395-401.
Mongalgi MA, el Bez M, Chakroun D, Jedidi H, Debbabi A. An analytic study of cases of childhood diabetes in a pediatric department in Tunis. Ann Pediatr (Paris). 1991; 38: 623- 626.
Ogunlesi TA, Dedeke IOF, Kuponiyi OT. Socio-economic classification of children attending specialist paediatric centres in Ogun State, Nigeria. Nig Med Pract 2008; 54(1): 21-25.
Ibekwe MU, Ibekwe RC. Pattern of type 1 diabetesmellitus inAbakaliki,Southeastern Nigeria. Paediatric Oncall [serial online] 2011 [ Cited July 1]; 8 Art # 48. Available from: http://www.pediatriconcall.com fordoctor/Medical original article/diabetes.asp.
Adeleke SI, Asain MO, Belonwu RO et al. Childhood diabetes in Kano, Northwest Nigeria. Nig J Med 2010; 19: 145-147.
Kurtz Z, Peekham CS, Ades AE. Changing prevalence of juvenile-onset diabetes
mellitus. Lancet 1988; ii: 88-90.
Oli JM, Bottazo GF, Doniach LB. Islet cell antibodies in Nigerian diabetics. Lancet 1980; 1:1090
Bloch CA, Clemons P, Sperling MA. Puberty decreases insulin sensitivity. J Pediatr 1987; 110: 481.
Rewers M, Laporte RE, King H, Tuomilehto J.Trends in the prevalence and incidence of diabetes: Insulin-dependent diabetes in childhood. World Hlth Statist Quart 1988; 41: 179-189.
Habib HS. Frequency and clinical characteristics of ketoacidosis at onset of childhood type 1 diabetes mellitus in Northwest Saudi Arabia. Saudi Med J 2005; 26(12):1936-1939.
Monabeka HG, Mbika-Cadorlle A, Moyen G. Ketoacidosis in children and teenagers in Congo. Sante 2003; 13: 139-141.
Vaughan VC, Litt IF. Child and adolescent development: Clinical Implications. Philadelphia, WB Saunders Company 1990: 229-291.
Federal Ministry of Health, Abuja,Nigeria. National Health Insurance Handbook. 2nd ed. Abuja, Heritage Press 2002:1-16.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
The data collected from registered and non-registered users of this journal falls within the scope of the standard functioning of peer-reviewed journals. It includes information that makes communication possible for the editorial process; it is used to informs readers about the authorship and editing of content; it enables collecting aggregated data on readership behaviors, as well as tracking geopolitical and social elements of scholarly communication.
This journal’s editorial team uses this data to guide its work in publishing and improving this journal. Data that will assist in developing this publishing platform may be shared with its developer Public Knowledge Project in an anonymized and aggregated form, with appropriate exceptions such as article metrics. The data will not be sold by this journal or PKP nor will it be used for purposes other than those stated here. The authors published in this journal are responsible for the human subject data that figures in the research reported here.
Those involved in editing this journal seek to be compliant with industry standards for data privacy, including the European Union’s General Data Protection Regulation (GDPR) provision for “data subject rights” that include (a) breach notification; (b) right of access; (c) the right to be forgotten; (d) data portability; and (e) privacy by design. The GDPR also allows for the recognition of “the public interest in the availability of the data,” which has a particular saliency for those involved in maintaining, with the greatest integrity possible, the public record of scholarly publishing.
