Endocrine Abstracts

Background: Type 1 diabetes mellitus (T1DM) is the commonest paediatric endocrine disorder in Malawi. Chronic diseases such as diabetes are frequently neglected in resource limited settings. The life expectancy from diagnosis of T1DM has been reported to be as low as 1 year in parts of Sub-Saharan Africa. The true incidence of T1DM in Malawi is unknown, however diabetic-ketoacidosis (DKA) is thought to be an overlooked child killer due to misdiagnosis. Lack of investigations, insulin supply, and education are all barriers. There are currently no studies in Malawi which look at glycaemic control or outcomes in this population.

Aim: This retrospective study aims to assess glycaemic control, complications and correlate with availability and type of insulin, patient factors and socio-economic status in Malawi’s only paediatric diabetes clinic.

Methods: Records of all fifty-four children and adolescents with T1DM attending the Diabetes clinic were reviewed. Clinical details including duration of illness, type and dose of insulin, availability of glucometer, symptoms of hypoglycaemia/hyperglycaemia and complications were recorded. Socio-economic details such as educational status, access to a fridge, and mobile phone were also documented.

Results: There were 31 males and 23 females ranging from 4–20 years. The median age of diagnosis was 10 years. Twenty five percent did not have access to a glucometer. The median HbA1c for the study population was 11.4%. Overall only 16% of patients had reasonable control (defined as an HbAlc between 6–8%). There were 7 admissions with DKA over this period. One patient came in twice. Two were new diagnoses of T1DM. There was one 1 death from DKA thought to be due to out of date insulin. Forty five percent of patients had access to a fridge to store insulin, and there was no significant difference in HbAlc (P=0.68) between children with a fridge and those without.

Conclusion: The management of T1DM can be challenging in resource-limited settings as it requires life long follow up and a multi-disciplinary team approach. The median HbAlc is comparable to other studies in low resource settings. This audit highlights additional resources are needed to continue to improve glycaemic control in this population.