Early Diabetic Nephropathy and Retinopathy in Patients with Type 1 Diabetes Mellitus Attending Sudan Childhood Diabetes Centre

Hana Ahmed, Tayseer Elshaikh, Mohamed Abdullah, Hana Ahmed, Tayseer Elshaikh, Mohamed Abdullah

Abstract

Objective: Data on microvascular complications in children and adolescents with type 1 diabetes mellitus (T1DM) in Sudan are scarce. This study was aimed at determining the prevalence of diabetic nephropathy (DN) and retinopathy (DR) and their relationship to certain risk factors in children with T1DM attending the Sudan Childhood Diabetes Centre. Design and Methods. A clinic-based cross-sectional study of 100 patients with T1DM aged 10-18 years. Patients with disease duration exceeding 5 years if the onset of diabetes was prepubertal and 2 years if it was postpubertal were included. Relevant sociodemographic, clinical, and biochemical information was obtained. Blood pressure was measured. The patients were screened for DN and DR using urinary microalbumin estimation and fundus photography, respectively.

Results: The frequency of microalbuminuria and diabetic retinopathy was 36% and 33%, respectively. Eleven percent had both retinopathy and microalbuminuria. Seven percent of the patients were found to be hypertensive. Patients with diabetic retinopathy had significantly higher HbA1c levels (p = 0.009) and longer diabetes duration (p = 0.02) than patients without retinopathy. Logistic regression showed that high HbA1c (odds ratio (OR) 0.83, confidence interval (CI) 0.68-1.00, p = 0.04), but not age, duration, ethnic group, BMI, blood pressure, and presence of nephropathy, was an independent risk factor for retinopathy. Likewise, high blood pressure (OR 6.89, CI 1.17-40.52, p = 0.03), but not age, duration, ethnic group, BMI, HbA1c, and presence of retinopathy, was a predictor for nephropathy.

Conclusion: High prevalence of incipient DN and early stages of DR were observed in this study. Longer diabetes duration and higher HbA1c were associated with the presence of diabetic retinopathy. High blood pressure was a risk factor for DN. So regular screening for these complications and optimization of glycemic control are needed.

Conflict of interest statement

The authors declare that there is no conflict of interest regarding the publication of this paper.

Copyright © 2020 Hana Ahmed et al.

References

    1. Demirel F., Tepe D., Kara Ö., Esen İ. Microvascular complications in adolescents with type 1 diabetes mellitus. Journal of Clinical Research in Pediatric Endocrinology. 2013;5(3):145–149. doi: 10.4274/Jcrpe.994.
    1. Donaghue K. C., Wadwa R. P., Dimeglio L. A., et al. Microvascular and macrovascular complications in children and adolescents. Pediatric Diabetes. 2014;15(Suppl 20):257–269. doi: 10.1111/pedi.12180.
    1. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The New England Journal of Medicine. 1993;329(14):977–986. doi: 10.1056/nejm199309303291401.
    1. Goldschmid M. G., Domin W. S., Ziemer D. C., Gallina D. L., Phillips L. S. Diabetes in urban African-Americans: II. High prevalence of microalbuminuria and nephropathy in African-Americans with diabetes. Diabetes Care. 1995;18(7):955–961. doi: 10.2337/diacare.18.7.955.
    1. and the WHO Multinational Study Group, Keen H., Lee E. T., et al. The appearance of retinopathy and progression to proliferative retinopathy: the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia. 2001;44(S2):S22–S30. doi: 10.1007/PL00002935.
    1. Lutale J. J. K., Thordarson H., Abbas Z. G., Vetvik K. Microalbuminuria among type 1 and type 2 diabetic patients of African origin in Dar Es Salaam, Tanzania. BMC Nephrology. 2007;8(1) doi: 10.1186/1471-2369-8-2.
    1. Vladu M., Clenciu D., Efrem I. C., et al. Insulin resistance and chronic kidney disease in patients with type 1 diabetes mellitus. Journal of Nutrition and Metabolism. 2017;2017:5. doi: 10.1155/2017/6425359.6425359
    1. Downie E., Craig M. E., Hing S., Cusumano J., Chan A. K., Donaghue K. C. Continued reduction in the prevalence of retinopathy in adolescents with type 1 diabetes: role of insulin therapy and glycemic control. Diabetes Care. 2011;34(11):2368–2373. doi: 10.2337/dc11-0102.
    1. Svensson M., Eriksson J. W., Dahlquist G. Early glycemic control, age at onset, and development of microvascular complications in childhood-onset type 1 diabetes: a population-based study in northern Sweden. Diabetes Care. 2004;27(4):955–962. doi: 10.2337/diacare.27.4.955.
    1. Mohsin F., Craig M. E., Cusumano J., et al. Discordant trends in microvascular complications in adolescents with type 1 diabetes from 1990 to 2002. Diabetes Care. 2005;28(8):1974–1980. doi: 10.2337/diacare.28.8.1974.
    1. Donaghue K., Craig M., Chan A., et al. Prevalence of diabetes complications 6 years after diagnosis in an incident cohort of childhood diabetes. Diabetic Medicine. 2005;22(6):711–718. doi: 10.1111/j.1464-5491.2005.01527.x.
    1. Gallego P. H., Craig M. E., Hing S., Donaghue K. C. Role of blood pressure in development of early retinopathy in adolescents with type 1 diabetes: prospective cohort study. BMJ. 2008;337(aug26 1):p. a918. doi: 10.1136/bmj.a918.
    1. Rodrigues T. C., Pecis M., Canani L. H., et al. Characterization of patients with type 1 diabetes mellitus in southern Brazil: chronic complications and associated factors. Revista da Associação Médica Brasileira. 2010;56(1):67–73. doi: 10.1590/S0104-42302010000100019.
    1. Borchers A. T., Uibo R., Gershwin M. The geoepidemiology of type 1 diabetes. Autoimmunity Reviews. 2010;9(5):A355–A365. doi: 10.1016/j.autrev.2009.12.003.
    1. Ogugua C. F., Chikani U. N., Ibekwe M. U., Ngwieri T., Allen H. Early signs of microvascular complications in pediatric patients with short duration of type 1 diabetes mellitus seen in Southeast Nigeria. Annals of African Medicine. 2019;18(4):200–205. doi: 10.4103/aam.aam_5_19.
    1. Majaliwa E. S., Munubhi E., Ramaiya K., et al. Survey on acute and chronic complications in children and adolescents with type 1 diabetes at Muhimbili National Hospital in Dar es Salaam, Tanzania. Diabetes Care. 2007;30(9):2187–2192. doi: 10.2337/dc07-0594.
    1. Marshall S. L., Edidin D. V., Arena V. C., et al. Glucose control in Rwandan youth with type 1 diabetes following establishment of systematic, HbA1c based, care and education. Diabetes Research and Clinical Practice. 2015;107(1):113–122. doi: 10.1016/j.diabres.2014.09.045.
    1. Sahar Mohammed Mirgani K. J. R., Abdullah M. A. Prevalence and Predictors for Development of Microalbuminuria in a Subset of Sudanese Children with Type 1 Diabetes Mellitus. 2012.
    1. Hassan H. Y., Underhill P. A., Cavalli-Sforza L. L., Ibrahim M. E. Y-chromosome variation among Sudanese: restricted gene flow, concordance with language, geography, and history. American Journal of Physical Anthropology. 2008;137(3):316–323. doi: 10.1002/ajpa.20876.
    1. National High Blood Pressure Education Program. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2):555–576. doi: 10.1542/peds.114.2.s2.555.
    1. Ogden C. L. Defining overweight in children using growth charts. Maryland medicine: MM: a publication of MEDCHI, the Maryland State Medical Society. 2004;5(3):19–21.
    1. Marshall W. A., Tanner J. M. Variations in pattern of pubertal changes in girls. Archives of Disease in Childhood. 1969;44(235):291–303. doi: 10.1136/adc.44.235.291.
    1. DiMeglio L. A., Acerini C. L., Codner E., et al. ISPAD Clinical Practice Consensus Guidelines 2018: glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatric Diabetes. 2018;19(S27):105–114. doi: 10.1111/pedi.12737.
    1. Donaghue K. C., Marcovecchio L., Wadwa R. P., et al. ISPAD Clinical Practice Consensus Guidelines 2018 microvascular and macrovascular complications in children and adolescents. Pediatric Diabetes. 2018;19:262–274. doi: 10.1111/pedi.12742.
    1. Early Treatment Diabetic Retinopathy Study Research Group. Early Treatment Diabetic Retinopathy Study design and baseline patient characteristics. Ophthalmology. 1991;98(5):741–756. doi: 10.1016/s0161-6420(13)38009-9.
    1. Elamin A., Ghalib M., Eltayeb B., Tuvemo T. High incidence of type I diabetes mellitus in Sudanese children, 1991-1995. Annals of Saudi Medicine. 1997;17(4):478–480. doi: 10.5144/0256-4947.1997.478.
    1. Mohammed Abdullah F. M. Sudan: 2015. Incidence and prevalence of type 1 diabetes mellitus in children and adolescents aged 0-19 years in Khartoum state.
    1. Tesfaye S., Gill G. Chronic diabetic complications in Africa. African Journal of Diabetes Medicine. 2011;19(1):4–8.
    1. Mukama L. J., Moran A., Nyindo M., Philemon R., Msuya L. Improved glycemic control and acute complications among children with type 1 diabetes mellitus in Moshi, Tanzania. Pediatric Diabetes. 2013;14(3):211–216. doi: 10.1111/pedi.12005.
    1. Ngwiri T., Were F., Predieri B., Ngugi P., Iughetti L. Glycemic control in Kenyan children and adolescents with type 1 diabetes mellitus. International Journal of Endocrinology. 2015;2015:7. doi: 10.1155/2015/761759.761759
    1. Davey B., Segal D. G. Self-monitoring of blood glucose measurements and glycaemic control in a managed care paediatric type 1 diabetes practice. South African Medical Journal. 2015;105(5):405–407. doi: 10.7196/SAMJ.7686.
    1. Ogle G. D., Middlehurst A. C., Silink M. The IDF Life for a Child Program Index of diabetes care for children and youth. Pediatric Diabetes. 2016;17(5):374–384. doi: 10.1111/pedi.12296.
    1. Ogbera A. O., Kuku S. F. Insulin use, prescription patterns, regimens and costs-a narrative from a developing country. Diabetology & Metabolic Syndrome. 2012;4(1) doi: 10.1186/1758-5996-4-50.
    1. Viswanathan V. Preventing microvascular complications in type 1 diabetes mellitus. Indian Journal of Endocrinology and Metabolism. 2015;19(7):p. 36. doi: 10.4103/2230-8210.155382.
    1. El Samahy M. H., Elbarbary N. S., Elmorsi H. M. Current status of diabetes management, glycemic control and complications in children and adolescents with diabetes in Egypt. Where do we stand now? And where do we go from here? Diabetes Research and Clinical Practice. 2015;107(3):370–376. doi: 10.1016/j.diabres.2015.01.004.
    1. Cho Y. H., Craig M. E., Hing S., et al. Microvascular complications assessment in adolescents with 2- to 5-yr duration of type 1 diabetes from 1990 to 2006. Pediatric Diabetes. 2011;12(8):682–689. doi: 10.1111/j.1399-5448.2011.00762.x.
    1. Eppens M. C., Craig M. E., Cusumano J., et al. Prevalence of diabetes complications in adolescents with type 2 compared with type 1 diabetes. Diabetes Care. 2006;29(6):1300–1306. doi: 10.2337/dc05-2470.
    1. Raile K., Galler A., Hofer S., et al. Diabetic nephropathy in 27,805 children, adolescents, and adults with type 1 diabetes: effect of diabetes duration, A1C, hypertension, dyslipidemia, diabetes onset, and sex. Diabetes Care. 2007;30(10):2523–2528. doi: 10.2337/dc07-0282.
    1. Rossing P., Hougaard P., Parving H.-H. Risk factors for development of incipient and overt diabetic nephropathy in type 1 diabetic patients: a 10-year prospective observational study. Diabetes Care. 2002;25(5):859–864. doi: 10.2337/diacare.25.5.859.
    1. Salman Z., Kirk G. D., DeBoer M. D. High rate of obesity-associated hypertension among primary schoolchildren in Sudan. International Journal of Hypertension. 2011;2011:5. doi: 10.4061/2011/629492.629492
    1. Schwab K. O., Doerfer J., Hecker W., et al. Spectrum and prevalence of atherogenic risk factors in 27, 358 children, adolescents, and young adults with type 1 diabetes: cross-sectional data from the German diabetes documentation and quality management system (DPV) Diabetes Care. 2006;29(2):218–225. doi: 10.2337/diacare.29.02.06.dc05-0724.
    1. Kumar P., Krishna P., Reddy S. C., Gurappa M., Aravind S., Munichoodappa C. Incidence of type 1 diabetes mellitus and associated complications among children and young adults: results from Karnataka Diabetes Registry 1995-2008. Journal of the Indian Medical Association. 2008;106(11):708–711.
    1. Cobas R., Santos B., Braga L., Cunha E. F., Gomes M. B. Evolução para hipertensão arterial em pacientes com diabetes tipo 1. Arquivos Brasileiros de Endocrinologia e Metabologia. 2008;52(4):628–634. doi: 10.1590/S0004-27302008000400008.
    1. Sobngwi E., Mbanya J.-C., Nyolo Moukouri E., Blackett Ngu K. Microalbuminuria and retinopathy in a diabetic population of Cameroon. Diabetes Research and Clinical Practice. 1999;44(3):191–196. doi: 10.1016/S0168-8227(99)00052-2.
    1. Gross J. L., De Azevedo M. J., Silveiro S. P., Canani L. H., Caramori M. L., Zelmanovitz T. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care. 2004;28(1):164–176. doi: 10.2337/diacare.28.1.164.
    1. Cooke D. W., Plotnick L. Type 1 diabetes mellitus in pediatrics. Pediatrics in Review. 2008;29(11):374–385. doi: 10.1542/pir.29-11-374.
    1. de Block C. E. M., de Leeuw I. H., van Gaal L. F. Impact of overweight on chronic microvascular complications in type 1 diabetic patients. Diabetes Care. 2005;28(7):1649–1655. doi: 10.2337/diacare.28.7.1649.
    1. Motala A. A., Pirie F. J., Gouws E., Amod A., Omar M. A. Microvascular complications in South African patients with long-duration diabetes mellitus. South African Medical Journal. 2001;91(11):987–992.
    1. Sidibe E., editor. Main complications of diabetes mellitus in Africa. Annales de Medecine Interne. 2000;151(8):624–628.
    1. Kalk W. J., Joannou J., Ntsepo S., Mahomed I., Mahanlal P., Becker P. J. Ethnic differences in the clinical and laboratory associations with retinopathy in adult onset diabetes: studies in patients of African, European and Indian origins. Journal of Internal Medicine. 2003;241(1):31–37. doi: 10.1046/j.1365-2796.1997.70892000.x.
    1. Schultz C. J., Konopelska-Bahu T., Dalton R. N., et al. Microalbuminuria prevalence varies with age, sex, and puberty in children with type 1 diabetes followed from diagnosis in a longitudinal study. Oxford Regional Prospective Study Group. Diabetes Care. 1999;22(3):495–502. doi: 10.2337/diacare.22.3.495.
    1. Holl R. W., Grabert M., Thon A., Heinze E. Urinary excretion of albumin in adolescents with type 1 diabetes: persistent versus intermittent microalbuminuria and relationship to duration of diabetes, sex, and metabolic control. Diabetes Care. 1999;22(9):1555–1560. doi: 10.2337/diacare.22.9.1555.
    1. Craig M. E., Jones T. W., Silink M., Ping Y. J. Diabetes care, glycemic control, and complications in children with type 1 diabetes from Asia and the Western Pacific Region. Journal of Diabetes and its Complications. 2007;21(5):280–287. doi: 10.1016/j.jdiacomp.2006.04.005.
    1. Kofoed-Enevoldsen A., Borch-Johnsen K., Kreiner S., Nerup J., Deckert T. Declining incidence of persistent proteinuria in type I (insulin-dependent) diabetic patients in Denmark. Diabetes. 1987;36(2):205–209. doi: 10.2337/diab.36.2.205.
    1. The Diabetes Control and Complications Trial Research Group. The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the diabetes control and complications trial. Diabetes. 1995;44(8):968–983. doi: 10.2337/diab.44.8.968.
    1. Mbanya J.-C., Sobngwi E. Diabetes in Africa. Diabetes microvascular and macrovascular disease in Africa. Journal of Cardiovascular Risk. 2003;10(2):97–102. doi: 10.1097/01.hjr.0000060842.48106.78.
    1. Wanjohi F., Otieno F., Ogola E., Amayo E. Nephropathy in patients with recently diagnosed type 2 diabetes mellitus in black Africans. East African Medical Journal. 2002;79(8):399–404. doi: 10.4314/eamj.v79i8.8824.
    1. Kordonouri O., Danne T., Hopfenmüller W., Enders I., Hövener G., Weber B. Lipid profiles and blood pressure: are they risk factors for the development of early background retinopathy and incipient nephropathy in children with insulin-dependent diabetes mellitus? Acta Paediatrica. 1996;85(1):43–48. doi: 10.1111/j.1651-2227.1996.tb13888.x.

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