Retrospective review of presentation of newly diagnosed children with diabetes mellitus in a Nigerian rural setting

Abstract

Background: Diabetes mellitus (DM) is the common endpoint of a variety of disorders of insulin production and/or insulin action resulting in hyperglycemia with associated abnormalities of carbohydrate, fat, and protein metabolism. Presentation with diabetic ketoacidosis (DKA) may be associated with significant morbidity and mortality in the pediatric population. Objective: The objective of this study was to examine the pattern of presentation of newly diagnosed children with DM in a rural setting. Design: It was a retrospective study of case files of newly diagnosed children with DM. Patients and Methods: It was a retrospective review of case files of children younger than 18 years with diagnosis of DM, over a 2-year period (from November 1, 2015, to October 31, 2017) at Federal Medical Centre Nguru, Yobe State, North-Eastern Nigeria. Results: A total of 3289 patients were seen during the study period, of which 6 were diagnosed with DM, giving a case prevalence rate of 1.8/1000. The mean age at presentation was 11.1 (±0.8) years, and there were four males and two females among the patients. All of the patients presented in DKA, and other prevalent presenting features were polyuria (6, 100%), polydipsia (6, 100%), dehydration (6, 100%), weight loss (100%), fever (83.3%), and weakness (4, 66.7%). Two of the six patients with DKA died from cerebral edema, and one had acute kidney injury during admission. Conclusion: Presentation with DKA is common in this setting despite the glaring symptoms of DM, such as polyuria, polydipsia, and weight loss. This highlights the need for intensified efforts in education of health workers and the populace at large for quick recognition, presentation, and prompt diagnosis for optimal management of childhood DM.