Mortality and natural progression of type 1 diabetes patients enrolled in the Rwanda LFAC program from 2004 to 2012

  • Sara L. Marshall
  • Deborah V. Edidin
  • Vincent C. Arena
  • Dorothy J. Becker
  • Clareann H. Bunker
  • Crispin Gishoma
  • Francois Gishoma
  • Ronald E. LaPorte
  • Vedaste Kaberuka
  • Graham Ogle
  • Wilson Rubanzana
  • Laurien Sibomana
  • Trevor J. Orchard
Original Article
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Abstract

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.

Keywords

Type 1 diabetes Youth Children Natural history Rwanda Africa 

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Copyright information

© Research Society for Study of Diabetes in India 2016

Authors and Affiliations

  • Sara L. Marshall
    • 1
  • Deborah V. Edidin
    • 2
  • Vincent C. Arena
    • 1
  • Dorothy J. Becker
    • 3
  • Clareann H. Bunker
    • 1
  • Crispin Gishoma
    • 4
  • Francois Gishoma
    • 4
  • Ronald E. LaPorte
    • 1
  • Vedaste Kaberuka
    • 4
  • Graham Ogle
    • 5
  • Wilson Rubanzana
    • 6
  • Laurien Sibomana
    • 1
  • Trevor J. Orchard
    • 1
  1. 1.University of Pittsburgh Graduate School of Public HealthPittsburghUSA
  2. 2.Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  3. 3.University of Pittsburgh School of MedicinePittsburghUSA
  4. 4.Association Rwandaise des DiabetiquesKigaliRwanda
  5. 5.International Diabetes Federation Life for a Child Program and Australian Diabetes CouncilSydneyAustralia
  6. 6.National University of RwandaKigaliRwanda

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