Clinical Presentation of type 1 Diabetes mellitus and Factors Associated with Diabetic Ketoacidosis (DKA) in Children and Adolescents at David Bernardino National Pediatric Hospital- Luanda Angola

Introduction: Type 1 (T1DM) is caused by an absolute deficiency of insulin due to the progressive destruction of the beta cells of the pancreas. The incidence of T1DM varies sharply across countries and age groups; with the highest incidence observed in children between 10 and 14 years old. The diagnosis of Diabetes is made in a symptomatic individual presenting with polydipsia, polyuria, polyphagia, weight loss and a fasting blood glucose concentration > 126 mg/dl (7 mmol/l), a random blood glucose level > 200 mg/dl (11.1 mmol/l) or glycosylated haemoglobin (Hb A1C) > 6.5%. The diagnosis of diabetic ketoacidosis (DKA) should be considered in any patient presenting with (glycaemia > 200 mg/dl), arterial pH <7.3 or bicarbonate level < 15 mmol/l and ketonemia (ketonuria). DKA as the first clinical presentation of T1DM is persistently frequent in Africa. Objective: To describe the clinical presentation of T1DM and factors associated with DKA in children and adolescents aged 6 months to 19 years, followed up in the Endocrinology clinic at Paediatric Hospital David Bernardino (HPDB) in Luanda Angola. Methodology: A cross-sectional, hospital-based study was carried out in children and adolescents at David Bernardino paediatric Hospital – Luanda, Angola Results: Of the 80 patients studied, 43 (53.5%) were female and 37 (46.5%) were male. The median age of the studied participants was 11.9±4.1 years (minimum of 7 months and a maximum of 18 years); while the median age at diagnosis was 9.3± 4.1 years (minimum of 6 months and maximum of 16 years). The classic signs of presentation of diabetes were: polyuria in 97.5%, polydipsia in 87.5% and loss of weight in 82,5%. Of the subjects studied, 52.5% had DKA at the time of T1DM1 diagnosis. After successful iterations at the multivariable modelling, the significant predictors for DKA at diagnosis of T1DM were: Absence of family member with diabetes, especially aunt with diabetes (p=0.035), no family member on insulin therapy (p=0.031), and caregiver's level of education (p=0.058). Conclusion: Very high number of patient present with DKA at the time of diagnosis. Significant predictors for DKA at diagnosis of TIDM in children seen in the endocrinology clinic at HPDB were: Age at diagnosis, absence of family member with diabetes, especially aunt with diabetes, none family member on insulin therapy, and caregiver's level of education.