Mortality and natural progression of type 1 diabetes patients enrolled in the Rwanda LFAC program from 2004 to 2012

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 th...

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Bibliographic Details
Published in:International journal of diabetes in developing countries 2017-12, Vol.37 (4), p.507-515
Main Authors: Marshall, Sara L., Edidin, Deborah V., Arena, Vincent C., Becker, Dorothy J., Bunker, Clareann H., Gishoma, Crispin, Gishoma, Francois, LaPorte, Ronald E., Kaberuka, Vedaste, Ogle, Graham, Rubanzana, Wilson, Sibomana, Laurien, Orchard, Trevor J.
Format: Article
Language:English
Subjects:
Adolescents
Diabetes
Diabetes mellitus
Diabetes mellitus (insulin dependent)
Diagnosis
Family Medicine
General Practice
Health Administration
Hypertension
Medicine
Medicine & Public Health
Mortality
Original Article
Survival
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Summary: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.
ISSN:0973-3930
1998-3832
DOI:10.1007/s13410-016-0536-z