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G319(P) The highs and the lows: a clinic audit of the management of type 1 diabetes in malawi
  1. S Blackstock1,
  2. M Kasiya1,2,
  3. G Mang’anda1,
  4. E Mgawana1,
  5. E Chimwala1,
  6. Q Dube1,2
  1. Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
  2. College of Medicine, University of Malawi, Blantyre, Malawi

Abstract

The incidence of Type 1 diabetes (T1DM) in Malawian children is unknown, however as healthcare improves the burden of non-communicable diseases such as diabetes is rapidly increasing. It has been widely believed that diabetic-ketoacidosis (DKA) is an overlooked cause of child mortality due to misdiagnosis and death prior to hospital. The Glycaemic control of Malawian children and adolescents with T1DM has never been evaluated. To improve services for diabetic patients, it is important to audit current practice and outcomes to support quality improvement.

This audit aims to assess care processes, access to insulin and current regime, glycaemic control, complications of diabetes, patient factors and socio-economic status. These were audited against the IDF resource limited setting guidelines.

A retrospective review of patient notes and diabetic register of the 57 registered patients from 2015–2016. There were 34 males and 23 females ranging from 4–20 years. The median age of diagnosis was 10 years..

Ninety five percent of patients had a HBAlc in the last year. Seventy four percent had had a urine dipstick. Thirty five percent had had an ophthalmology review. Twenty eight percent had had a blood pressure. The median HbA1c for the study population was 11.4%. Overall only 16% of patients had reasonable control. One out of 20 5% had evidence of eye changes related to diabetes. Fifty one percent had microalbuminuria on urine dipstick, 28% had macroalbuminuria. Two patients had neurological complications. The median BMI was 17.6. There were 11 hospital admissions with DKA, four of these were new diagnoses. There was one 1 death due to DKA thought to be due to out of date insulin. There was no significant difference in HBA1c related to economic status. Surprisingly those with higher parental education had worse HBAlc (12 vs 10.9). Patients with access to a fridge also had worse glycaemic control (12 vs 10.6). Children living in rural areas had better HBAlc than those living in urban areas. Glycaemic control was better in children who had the diagnosis of diabetes longer.

Conclusion The management of T1DM can be challenging in resource-limited settings. The median HbAlc is comparable to other studies in low resource settings.

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