Mortality and natural progression of type 1 diabetes patients enrolled in the Rwanda LFAC program from 2004 to 2012
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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
We would like to thank the staff of the ARD in Kigali for all of the help and support they have given to us throughout this project. We also thank the Ministry of Health and Rwanda Biomedical Center for their assistance and guidance. We would also like to acknowledge the LFAC program for providing us with the opportunity to work with them and the ARD. Finally, we thank the wonderful children and youth with diabetes and their caregivers for their willing acceptance of help and the dignity and courage they show in coping with diabetes in the most difficult circumstances.
Compliance with ethical standards
No funding was received for this study. Insulin, syringes, glucose meters, and strips were received free from the LFAC program. DCA machines, HbA1C, and A/C reagents were provided by the University of Pittsburgh.
Conflict of interest
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, and Laurien Sibomana have no conflict-of- interest to declare. Dr. Trevor Orchard serves on Eli Lilly and Company Advisory Panel.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Marshall SL designed the study, performed research and analysis and wrote the paper; Orchard TJ designed the study, reviewed analysis, revised the manuscript; Edidin DV, Gishoma C, Gishoma F, Kaberuka V, Sibomana L, and Rubanzana W performed research, collected data, and revised the manuscript; Arena VC reviewed analysis and revised the manuscript; Becker DJ, Bunker CH, Ogle G, and LaPorte RE provided oversight and revised the manuscript.
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