Uncontrolled type 1 diabetes among Egyptian adolescents; risk determinants and clinical outcomes

Abstract

BackgroundAdolescents are exposed to multiple psychosocial, cognitive and emotional challenges. Those with type 1 diabetes (T1D) are additionally exposed to diabetes related social, dietary, emotional and clinical stressors. This can impair their glycemic control contributing to the development of diabetes complications. AimTo assess the risk determinants and clinical outcomes of uncontrolled diabetes among Egyptian adolescents with T1D. MethodsSix hundred adolescents with T1D were recruited from the Pediatric and Adolescents Diabetology Clinic, Ain-Shams University. Their mean age was 14.78 years and their mean HbA1C was 8.66% with 200 (33%) having HbA1C (>7%). From the studied cohort, 200 with good glycemic control (≤7%) and 200 with poor control (>7%) were assessed for diabetes-duration, insulin regimen, frequency of diabetic-ketoacidosis, clinically significant hypoglycemia and the Mini-International Neuropsychiatric-Interview for Children and Adolescents. Auxological assessment, fundus and clinical screening for complications were done. Neuropathy was confirmed by nerve conduction velocity. Thyroid profile, anti-tissue transglutaminase-IgG, fasting lipids and urinary albumin/excretion ratio (UAE) were measured. ResultsAdolescents having uncontrolled diabetes have significantly higher diabetes onset age (p = 0.037), diabetes-duration (p = 0.038), eating disorders (p = 0.027), sadness (p = 0.038), depression (p = 0.003), suicidal manifestations (p = 0.001) and anxiety (p<0.001) than the well-controlled group. Furthermore, they had significantly higher LDL(p<0.001), cholesterol(p = 0.002), triglycerides (p = 0.011), UAE (p = 0.007), neuropathy (p<0.001) and school absenteeism (p<0.001). Multivariate-regression showed that HbA1c is independently related to diabetes-duration (p = 0.005), depression (p<0.001), sadness (p = 0.004) and anxiety (p<0.001). ConclusionUncontrolled T1D among adolescents is associated with older age and psychiatric comorbidities. Furthermore, it is linked to school absenteeism, hyperlipidemia, diabetic nephropathy and neuropathy.