Pattern of presentation of Type 1 diabetic patients in Kano, Nigeria

Byline: Umar. Umar

Background: Type 1 diabetes is the most common form of diabetes in children; its symptoms may be subtle and frequently misinterpreted. Presentation with diabetic ketoacidosis (DKA) may be associated with significant morbidity and mortality in the paediatric population. Objective: To examine the prevalence of Type 1 diabetes in children at the Aminu Kano Teaching Hospital, Kano. Design: Retrospective study of case files of children with diagnosis of Type 1 diabetes mellitus (T1DM). Patients and Methods: It was a retrospective review of case files of children younger than 18 years with diagnosis of T1DM over 4 years (January 1, 2012,–December 31, 2015). Results: A total of 7929 patients were seen during the study period, out of which 18 were diagnosed with T1DM, giving a case prevalence rate of 2.3/1000. Sixteen (89%) of the 18 patients were first presented with DKA. The mean age at presentation was 8 years, and there were more females 13/18 than males 5/18 among the subjects. The most prevalent presenting symptoms were dehydration 16 (89%), fever 14 (77.8), abdominal pain 12 (66.6%), polyuria and polydipsia 12 (66.6%). Two of the sixteen patients with DKA died with cerebral oedema during admission. Conclusion: DKA is the most common pattern of presentation of T1DM in our environment. This highlights the need for intensified efforts in education of health workers and the populace at large for quick presentation and prompt diagnosis and optimal management of childhood diabetes.

Introduction

Diabetes mellitus (DM) is a group of diseases characterised by high levels of glucose in the blood resulting from defects in insulin production, insulin action or both.[sup][1] Type 1 DM (T1DM) remains the most common form of diabetes in childhood and is caused by insulin deficiency, following autoimmune destruction of the insulin-producing pancreatic beta-cells.[sup][2] Although it commonly presents in childhood, one-fourth of cases are diagnosed in adults.[sup][3],[4],[5] Worldwide, DM is a major health problem and current studies have revealed a definite global increase in the incidence and prevalence of diabetes, with the World Health Organization (WHO) projecting that there will be almost 285 million cases in the year 2025.[sup][6] This increase is expected in both adult and childhood diabetes, including Type 1 and 2 diabetes.[sup][7] The WHO Diabetes Mondiale project group has reported a worldwide increase in the incidence and variation (over 400-fold) of Type 1 diabetes, with the highest occurring in Finland (over 45/100,000 children under the age of 15 years) and the lowest in parts of China and Fiji.[sup][8] In Africa, the incidence rate in children ranges from 1.5/100,000 in Tanzania to 10.1/100,000 in Sudan.[sup][9] However, the incidence and pattern of presentation in Nigeria are poorly documented. Regional variations exist in terms of prevalence and features of DM in children. A hospital prevalence of 1.6/1000 in Port Harcourt, South Nigeria,[sup][10] and 0.1/1000 in Abakaliki, South-east Nigeria,[sup][11] has been reported. In Sokoto, North-west Nigeria, a hospital prevalence rate of 0.33/1000 was reported by Ugege et al .[sup][12]

Childhood diabetes may present with polyuria, polydipsia and polyphagia, along with lassitude,...