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Marshall S.L.,University of Pittsburgh | Edidin D.,Northwestern University | Arena V.C.,University of Pittsburgh | Becker D.J.,University of Pittsburgh | And 8 more authors.
Diabetic Medicine | Year: 2015

Aims: To determine prevalence and incidence estimates for clinically recognized cases of Type 1 diabetes from the Life For a Child Program (LFAC) with onset < 26 years in six representative districts, and the capital, of Rwanda. Methods: Cases were identified from the LFAC registry and visits to district hospitals. Denominators were calculated from district-level population surveys. Period prevalence data were collected from 1 August 2011 to 31 July 2012 and annual incidence rates were calculated, retrospectively, for 2004-2011. Ninety-five per cent confidence intervals (95% CI) were calculated using a Poisson distribution. Results: The prevalence of known Type 1 diabetes in seven districts in Rwanda for ages < 26 years was 16.4 [95% CI 14.6-18.4]/100 000 and for < 15 years was 4.8 [3.5-6.4]/100 000. Prevalence was higher in females (18.5 [15.8-21.4]/100 000) than males (14.1 [11.8-16.7]/100 000; P = 0.01) and rates increased with age. The annual incidence rate for those < 26 years was stable between 2007 and 2011 with a mean incidence over that time of 2.7 [2.0-3.7]/100 000 ( < 15 years = 1.2 [0.5-2.0]/100 000). Incidence rates were higher in females than males and peaked in males at ages 17 and 22 years and in females at age 18 years. Conclusions: Our report of known Type 1 diabetes cases shows lower incidence and prevalence rates in Rwanda than previously reported in the USA and most African countries. Incidence of recognized cases has increased over time, but has recently stabilized. However, the likelihood of missed cases due to death before diagnosis and misdiagnosis is high and therefore more definitive studies are needed. What's new?: This report comprises the first estimation of the prevalence and incidence of Type 1 diabetes in Rwanda, Africa. Because it is important for public health officials to know the burden of disease when allocating resources and effort, we believe these results could have a great impact on diabetes care in this country. Diabetic Medicine. © 2015 Diabetes UK.

Marshall S.L.,University of Pittsburgh | Edidin D.V.,Northwestern University | Arena V.C.,University of Pittsburgh | Becker D.J.,University of Pittsburgh | And 8 more authors.
Diabetes Research and Clinical Practice | Year: 2015

Aims: To assess change in glycemic control concurrent with increased clinic visits, HbA1c testing, and education. Rates of complications were also examined. Methods: A 1-2 year follow-up of 214 members of the Rwanda Life for a Child program (aged <26 years) with a first HbA1c between June 2009 and November 2010 was conducted. Data were analyzed for the entire cohort and by age (<18 years, ≥18 years). Trajectory analysis was performed to identify trends in HbA1c. Results: Mean overall HbA1c decreased significantly from baseline (11.2. ±. 2.7%; 99. ±. 30. mmol/mol) to one- (10.2. ±. 2.6%; 88. ±. 28. mmol/mol) and two- (9.8. ±. 26%; 84. ±. 25. mmol/mol) year follow up visits. The prevalence of microalbuminuria did not significantly change (21.0%, 18.8%, and 19.6%), nor did nephropathy (4.7%, 7.8%, and 5.4%). However, rates of hypertension (31.8%, 44.9%, and 40.3%) were higher than expected. Five HbA1c groups were identified by trajectory analysis, and those with the worst control monitored their glucose significantly fewer times per week. Conclusions: The establishment of regular care, HbA1c testing, and increased education is associated with significant improvements in glycemic control in youth with type 1 diabetes (T1D) in sub-Saharan Africa, but the high prevalence of hypertension is of concern. © 2014 Elsevier Ireland Ltd.

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