Chronic micro vascular complication of Type 1 Diabetes Mellitus and Its Predictors among Pediatric Patients with Diabetics Attending Haramaya University Hiwot Fana Comprehensive Specialized Hospital ,Harar Town ,Ethiopia : Ambi directional Cohort Study

Abstract

Introduction: Type 1 diabetes (also called insulin-dependent diabetes mellitus) is caused by an absolute insulin deficiency. Poor glycemic control can result in micro vascular complications (retinopathy, neuropathy, and nephropathy) in addition to macro vascular complications. There is no study done in our setting neither about prevalence of pediatric type 1 diabetes mellitus nor chronic microvascualr complication among this patients, which gap this study is expected to fill. Objective: To assess the risk and predictors of chronic microvascualr complication of type 1 diabetes mellitus among pediatric patients attending diabetic clinic at Haramaya University Hiwot Fana compressive specialized hospital from Sep10, 2021 to January 30, 2023. Methods: Hospital based Ambi directional cohort study was conducted at Haramaya university Hiwot Fana compressive specialized hospital, pediatric and child health department diabetic clinic .The patient were subjected to Hemoglobin A1C determination, urine proteins excretion evaluation, blood pressures, serum creatinine, ophthalmologic and neurologic evaluation for 6 month follow up period . Survival data is described by follow up time and Kaplan Meier graph. To determine predictor associated with chronic microvascualr complication we used Poisson regression optimal model selected using information criterion. All associations are tested at 95% confidence level and reported IRR P-value less than 0.05 is declared as a significant association between variables. Result: Total of 124 children with type 1 DM were followed with total 407.5 year risk time. The overall incidence rate of chronic microvascualr complication was 83 per 1000 population per year (95% CI: 59 -116). The common complications incidence rate was 34 for diabetic nephropathy, 24 for neuropath and 29 for retinopathy per 1000 population. The median time for detection of microvascualr complication was 7 year after diagnosis, but 25% of the patients were detected to have microvascualr complication after 5 year. Being male with IRR-1.71 (95% CI :0. .81 - 3.56) ,being at pubertal age IRR-1.91 (95% CI:1.05 - 3.48 ), longer DM duration IRR 1.13( 95% CI :1.07 - 1.28) , and poor glycemic control IRR 1.50(95% CI:0.46 - 4.97 ) were found to be high risk for chronic microvascualr complication of type 1 DM even though longer duration of diagnosis and pubertal age group were statistically significant . Conclusion: There was high incidence of chromic microvascualr complication of DM with poor glycemic control among majority of the patients. Being pubertal age group and more than 3 years duration diagnosis had statistically significantly association with complication