Prevalence and factors associated with microalbuminuria in children and adolescents with Type 1 Diabetes in Mulago and Nsambya Hospitals in Uganda.

Abstract

Background: Type 1 Diabetes mellitus (T1D) causes profound impact on children and families worldwide. There’s a risk of poor growth, development, and macrovascular and microvascular complications among long term survivors. Over the last decade there has been a rise in T1D in Africa due to improvements in the rates of detection, reporting and survival of these patients. Diabetic nephropathy is common complication of T1D and more so in the developing world due to delayed diagnosis, poor control of blood sugar and inadequate treatment at an early stage. Microalbuminuria in persons with T1D indicates a potentially treatable and reversible stage of nephropathy. Study Objectives: To determine the prevalence and the factors associated with microalbuminuria among children and adolescents with Type 1 diabetes mellitus attending Nsambya Hospital and Mulago hospital diabetic clinics. Methods: This was a cross-sectional quantitative study conducted at Nsambya hospital and Mulago National Referral Hospital pediatric diabetic clinics in Kampala, Uganda. All patients aged between 18 months to 19 years with T1D were screened for eligibility and offered enrolment into the study. The following laboratory tests were done; urine albumin and urine creatinine measurement, random blood glucose, HbA1c, serum urea, serum creatinine. All tests were conducted during routine outpatient visits. Microalbuminuria was confirmed with elevated Albumin Creatinine Ratio (ACR) 30 to 300 mg/g in males and 42 to 300 mg/g in females in a 2 spot urine samples taken within 3 months. Data was collected with the aid of structured questionnaires and analyzed using STATA version 14. Bivariate analysis was used to test the association between microalbuminuria and independent variables; and then multivariable logistic regression models of odds ratios were used to determine the factors associated with microalbuminuria at 95% Confidence interval and p< 0.05 level of significance. Results: A total of 153 children and adolescents were enrolled into the study. The median age of participants at the time of study was 8.4 years (6.12 to 12.09 years) and 83 (54.2%) of them were male. The median duration of T1D was 4.35 years with a high mean HbA1c of 11.2 ± 2.5%. The prevalence of microalbuminuria was 13.7% [95% CI: 9.1 – 20.2%] and the factors independently associated with microalbuminuria were duration of T1D less than 5 years (aOR 27.44, 95% CI (3.32,226.77)), hospitalization in the previous year (aOR 5.39, 95% CI (1.21-23.94)), hypertension (aOR 19.12, 95% CI (3.39,107.83)) and HbA1c (aOR 1.41, 95% CI (1.12-1.783)). Conclusion: The prevalence of microalbuminuria at 13.7% is relatively high. Duration of diabetes for less than 5 years, hypertension, elevated HbA1c and history of hospitalization in the previous year are factors that influence the development of microalbuminuria in T1D patients in our setting. Despite ISPAD guidelines, early and more frequent screening for microalbuminuria irrespective of age or duration of the disease may be warranted in children in our setting. Furthermore, emphasis on aggressive glycemic control even early after diagnosis is crucial and cannot be overstated.