Mortality and natural progression of type 1 diabetes patients enrolled in the Rwanda LFAC program from 2004 to 2012
- 29 Downloads
The natural history and mortality of type 1 diabetes in adolescents in Africa is not well characterized. Our aim is, therefore, to describe these characteristics for cases in the Rwanda Life For a Child (LFAC) program. Participants (≤25 years old) were the first 500 children and youth enrolled in the Rwanda LFAC program from 2004 to 2012. Clinical and demographic data were extracted from LFAC forms, and vital status was evaluated as of November 1, 2011. For the first 500 participants, 5-year survival was 93.8% while crude mortality was 13.9/1000 (95% CI 9.0–20.6/1000) person years of diabetes. However, since vital status is unknown for 134 participants, mortality could be as high as 40.2/1000 person years of diabetes if all missing cases died. Mortality was directly associated with age at diagnosis, and inversely to calendar year of first visit, BMI, and monitoring frequency. Hypertension prevalence reached 46% by 2012. Mortality rates associated with type 1 diabetes in Rwanda are similar to those in other African countries, but higher than rates in developed countries. Delayed diagnosis may contribute to excess mortality risk, but recent improvements in survival suggest that advancements are being made. Hypertension and loss to follow-up need to be addressed.
KeywordsType 1 diabetes Youth Children Natural history Rwanda Africa
- 1.International Diabetes Federation. Diabetes atlas, fourth edition. Brussels, Belgium; 2009.Google Scholar
- 3.Walsh MG, Zgibor J, Borch-Johnsen K, Orchard TJ. A multinational assessment of complications in type 1 diabetes: the DiaMond substudy of complications (DiaComp) level 1. Diabetes & vascular disease research : official journal of the International Society of Diabetes and Vascular Disease. 2006;3(2):80–3.CrossRefGoogle Scholar
- 20.Mayer-Davis EJ, Beyer J, Bell RA, Dabelea D, D’Agostino R, Imperatore G, Lawrence JM, Liese AD, Liu L, Marcovina S, Rodriguez B. Diabetes in African American youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32(Suppl 2):S112–22.CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Marshall SL, Edidin DV, Arena VC, Becker DJ, Bunker CH, Gishoma C, Gishoma F, LaPorte RE, Kaberuka V, Sibomana L, Orchard TJ. Glucose control in Rwandan youth with type 1 diabetes following establishment of systematic, HbA1c based, care and education. Diabetes Res Clin Practice. 2015;107(1):113–22.CrossRefGoogle Scholar