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

Abstract

Background: Adolescents 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. Aim: To assess the risk determinants and clinical outcomes of uncontrolled diabetes among Egyptian adolescents with T1D. Methods: Six 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. Results: Adolescents 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). Conclusion: Uncontrolled T1D among adolescents is associated with older age and psychiatric comorbidities. Furthermore, it is linked to school absenteeism, hyperlipidemia, diabetic nephropathy and neuropathy.