Endocrine Abstracts

Background: Type 1 diabetes mellitus is the most common chronic illness in childhood. His treatment involves a multifaceted regimen that includes daily blood glucose monitoring, insulin injections, a dietary plan, and regular exercise. Patients, especially during adolescence, do not fully adhere to the diabetes treatment and, as a result, they appear to be at risk for serious medical complications, including hyperglycemic episodes, Ketoacidosis and microvascular complications such as retinopathy, nephropathy and neuropathy.

Aims: To assess adherence to treatment in a group of Tunisian adolescents with type 1 diabetes and study the consequences on the balance of diabetes

Methods: Cross sectional study concerning 102 adolescents with type 1 diabetes hospitalized or followed at the consultation of diabetology of the Institute of Nutrition in Tunis over a one-year period between January 2017 and January 2018. To assess adherence to treatment, we used the validated version in Arabic of the self-questionnaire derived from the Medication Adherence Questionnaire (MAQR) from Morisky-Green. This questionnaire contains 6 yes/no items. It targets memory and attention, as well as knowledge and opinion. It allows you to define three grip profiles:

– Good adherence if the answer is ‘no’ for the 6 items

– Moderate adherence if 1 or 2 ‘yes’ answers

– Poor adherence if 3 or more ‘yes’ answers

Results: The study population consisted of 102 adolescents with type1 diabetes and 51% were female. The mean duration of diabetes was 7.1 ± 4.3 years. The daily average of insulin dose was 1 ± 0.4 u/kg/ day. The average number of injections per day was 3.4 ± 1 with extremes ranging from 2 to 5 injections per day. Adherence to treatment was good in 12.8% of patients, moderate in 57,8% and poor in 29,4%. Insulin omission was present in 7.8%. The average rate of HbA1c was 10.6 ± 2.2% with extremes ranging from 5.8 to 16.8%. Diabetic retinopathy, nephropathy, and neuropathy were found respectively in 3.9%, 5.9%, and 5.9%. The average number of ketosis or Ketoacidosis in the last year was 3,6 ± 6,3 per year. severe hypoglycemia rate in the past 3 months was 1.8 ± 7,9 per month.

Conclusion: Child routines and the complexity of diabetes treatment may influence behaviorally problematic youths ’risk for poor adherence to T1DM treatment. Clinicians and parents are encouraged to cultivate child routines early in development because it may reduce the risk for parent – child conflicts in adolescence, which can compromise the adherence to treatment.