肯尼亚一家三级医院儿童和青少年1型糖尿病血糖控制不良的相关因素

Abstract

Type 1 diabetes mellitus (T1DM) remains a growing global health priority, with disproportionate underdiagnosis, delayed diagnosis, and mortality in sub-Saharan Africa. Despite the introduction of the Life for a Child (LFaC) programme in Kenya, which provides free insulin, glucose-monitoring supplies, and specialist education, no published studies have examined the determinants of glycaemic control among Kenyan children and adolescents with T1DM. This study aimed to determine the proportion of children and adolescents achieving good glycaemic control and to identify the socio-demographic and clinical determinants of glycaemic control at a tertiary hospital in Kenya. This cross-sectional study enrolled 160 children and adolescents with T1DM attending the paediatric diabetes clinic at Kenyatta National Hospital, Nairobi, between September 2025 and May 2026. Sociodemographic and clinical data were collected through structured interviews and physical examination. Poor glycaemic control was defined as HbA1c >7.5%. Associations between candidate determinants and glycaemic control were assessed using chi-square or Fisher's exact tests. Variables with p<0.2 on bivariate analysis were entered into a multivariable logistic regression model; Firth's penalized-likelihood method was used given the small number of participants achieving good control. Only 9 participants (5.6%) achieved the target HbA1c of ≤7.5% (mean HbA1c 11.02%, SD ±2.29), and only 5 of 133 patients (3.8%) had ≥70% of glucometer readings within the target blood glucose range (3.9–10.0 mmol/L).On bivariate analysis, household income (p=0.026) and self-monitored blood glucose (SMBG) frequency (p=0.018) were significantly associated with glycaemic control. In an exploratory multivariable regression analysis (Firth penalized logistic regression, given the small number of participants with good control), only SMBG frequency ≥4 tests/day remained independently associated with lower odds of poor control (adjusted OR 0.19, 95% CI 0.04–0.84, p=0.028); the effect of household income was attenuated after adjustment. Glycaemic control remains markedly poor among children and adolescents with T1DM in this Kenyan tertiary hospital setting despite structured programmatic support. Frequency of self-monitoring, rather than household income alone, was the factor most strongly associated with glycaemic control, suggesting that strengthening access to glucose-testing supplies and supporting their consistent use should be prioritised in care, alongside attention to socioeconomic barriers. Longitudinal studies are needed to confirm these associations.

Competing Interest Statement

The authors have declared no competing interest.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study represents a secondary analysis of data collected as part of a larger cross-sectional study “Early Indicators Of Cardiovascular Disease In African Children With T1DM” that received approval by the UoN-KNH Ethics Committee (Approval No. P8/01/2025 approval date: 14/07/2025). No additional participant recruitment or data collection was taken.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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Yes

Data Availability

The data underlying the findings of this study contain potentially identifying and sensitive information relating to a paediatric patient population and cannot be made publicly available due to ethical and privacy restrictions imposed by the UoN-KNH Ethics and Research Committee. De-identified data may be made available to qualified researchers upon reasonable request to the corresponding author (anjumomar2011{at}gmail.com) and with approval from the UoN-KNH Ethics and Research Committee.