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vol.105 issue5The poor children of the poor: Coping with diabetes control in a resource-poor settingSelf-monitoring of blood glucose measurements and glycaemic control in a managed care paediatric type 1 diabetes practice author indexsubject indexarticles search
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SAMJ: South African Medical Journal

On-line version ISSN 2078-5135
Print version ISSN 0256-9574

Abstract

KALWEIT, K L; BRIERS, N  and  OLORUNJU, S A S. The success of various management techniques used in South African children with type 1 diabetes mellitus. SAMJ, S. Afr. med. j. [online]. 2015, vol.105, n.5, pp.400-404. ISSN 2078-5135.  http://dx.doi.org/10.7196/SAMJ.9334.

BACKGROUND: Despite the availability of international guidelines for the treatment of type 1 diabetes mellitus (T1DM) in children, important aspects of treatment are not accessible to all young patients in South Africa (SA OBJECTIVE: To investigate factors in diabetes management strategies that are associated with poor glycaemic control and decreased quality of life (QoL) in SA children with T1DM METHODS: Eighty children (mean (standard deviation) age 12.9 (2.7) years) with T1DM were asked to answer standardised questionnaires on demographics, management techniques used and perceptions of diabetes. The height and weight of each child was recorded and glycosylated haemoglobin (HbA1c) measured. Informed consent and assent for each participant was obtained before enrolment RESULTS: A total of 51.4% of the participants had poor metabolic control, with an HbA1c level >10.0% (86 mmol/mol). Factors in clinical practice found to have a significant association with decreased HbA1c and/or QoL were healthcare system (p<0.001), insulin administration (p=0.001), correction dose (p=0.002), carbohydrate counting (p<0.001) and number of severe hyperglycaemic events (p=0.048). Regular exercise did not show any association with HbA1c classification or QoL. Children from single-parent households were prone to unsuccessful diabetes management regardless of treatment techniques used (p=0.002 CONCLUSIONS: The use of premixed insulin without access to rapid-acting insulin, absence of correction doses for hyperglycaemia and lack of carbohydrate counting showed significant association with poor diabetes management. Some recommendations regarding the adoption of more effective diabetes management strategies in the public healthcare system are suggested

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