Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Sep 15, 2017; 8(9): 429-435
Published online Sep 15, 2017. doi: 10.4239/wjd.v8.i9.429
Clinical profile of diabetes at diagnosis among children and adolescents at an endocrine clinic in Ghana
Emmanuel Ameyaw, Serwah B Asafo-Agyei, Sumithira Thavapalan, Angela C Middlehurst, Graham D Ogle
Emmanuel Ameyaw, Serwah B Asafo-Agyei, Department of Child Health, Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana
Sumithira Thavapalan, Angela C Middlehurst, Graham D Ogle, International Diabetes Federation Life for a Child Program, Glebe, NSW 2037, Australia
Sumithira Thavapalan, Angela C Middlehurst, Graham D Ogle, Diabetes NSW, Glebe, NSW 2037, Australia
Author contributions: Ameyaw E contributed to study design, conducted the study, and contributed to the manuscript; Asafo-Agyei SB contributed to concept and assisted in conduct of the study; Thavapalan S analysed the data, prepared the figures, and reviewed the manuscript; Middlehurst AC assisted with study design and review of data; Ogle GD designed the study, interpreted the results, and was the lead writer on the manuscript.
Institutional review board statement: The study was reviewed and approved by the Committee on Human Research Publication and Ethics, School of Medical Sciences/Komfo Anokye Teaching Hospital, College of Health Sciences, Kwame Nkrumah University of Science and Technology.
Informed consent statement: All subjects gave informed consent.
Conflict-of-interest statement: None of the authors have any conflicts of interest in regards to this study.
Data sharing statement: Not relevant.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr.Graham D Ogle, International Diabetes Federation Life for a Child Program, 26 Arundel St., Glebe, NSW 2037, Australia. grahamo@diabetesnsw.com.au
Telephone: +61-95-529922
Received: January 25, 2017
Peer-review started: January 28, 2017
First decision: May 11, 2017
Revised: May 31, 2017
Accepted: June 19, 2017
Article in press: June 20, 2017
Published online: September 15, 2017
Abstract
AIM

To determine the clinical features of diabetes in children and adolescents in Ghana.

METHODS

Retrospective review of clinical features of all children and adolescents with new-onset diabetes seen at the paediatric endocrinology clinic of Komfo Anokye Teaching Hospital in Kumasi, from February 2012 to Auguest 2016.

RESULTS

One hundred and six subjects presented with diabetes. Ninety (84.9%) were diagnosed by clinical features and family history as type 1, and 16 (15.1%) type 2. For type 1 subjects, age range at diagnosis was 0.9-19.9 year (y), peak age of onset 12-13 year, and 3.3% were < 5 year, 21.1% 5- < 10 year, 45.6% 10- < 15 year and 30.0% 15- < 20 year. Seventy-one point one percent were female. Common clinical features were polyuria (100%), polydipsia (98.9%), and weight loss (82.2%). Mean BMI SD was -0.54, range -3.84 to 2.47. 60.0% presented in diabetic ketoacidosis (DKA). Nine had infections at onset (skin, abscess, leg ulcer). Mean ± SD HbA1c at diagnosis was 12.7% ± 1.9% (115 ± 21 mmol/mol). Four have since died: Hypoglycaemia (2), recurrent DKA (1), osteosarcoma (1). Two other type 1 cases died of DKA at presentation in emergency before being seen by the paediatric endocrinologist. Crude mortality rate including these 2 cases was 32.2/1000 patient years. Type 2 cases were 81% female, age of onset 9-19 year. Mean BMI SD was 1.49, range -0.87 to 2.61. Forty-three point eight percent presented in DKA. All type 2 cases had acanthosis nigricans. Overall, 9.8% did not have home refrigeration, most using clay pot evaporative cooling for insulin storage.

CONCLUSION

Type 1 occurs with a female preponderance and high DKA rates. Type 2 also occurs. Typology based on clinical features is difficult. Community and professional awareness is warranted.

Keywords: Children, Diabetes, Developing countries, Ghana, Mortality

Core tip: In this study of 106 consecutive new diagnoses of diabetes in young people < 20 years in a tertiary referral centre in Ghana, type 1 predominated (85%) with the remaining cases clinically diagnosed as type 2. Both types had a female preponderance. Type 1 peak age of onset was 12-13 years. All type 2 subjects had acanthosis nigricans. Most presented in ketoacidosis signifying a lack of awareness of presentation features. Clinic numbers quickly rose due to availability of supplies and expertise. Further typology studies are indicated to further define diabetes type.