Background: In non-Caucasian youth residing in low-income settings, risk of mortality and rates of diabetes complications are substantially higher and clinical phenotypes may be distinct.
Objectives: To assess the clinical presentation, glycemic control, and chronic complications of diabetes in Haitian youth residing in Haiti.
Methods: Retrospective review between 01/201303/2018 of youth 0-25 years with diabetes followed at a chronic disease center in Haiti where specialized care, insulin and diabetes supplies are provided free of charge. Symptoms, presence of suspected diabetic ketoacidosis (DKA) and coma at diagnosis, and number of providers consulted before diagnosis were extracted. We documented yearly anthropometric data, total daily insulin dose (TDD), quarterly hemoglobin A1c (A1c), presence of hypertension and chronic complications. We used linear and logistic regression to determine predictors of mean A1c and of presence of chronic complications, respectively.
Results: 91 patients (60% female, mean age at diagnosis 14.1±4.6 years, mean diabetes duration 4.1±3.6 years) were included in the study. DKA and coma at initial presentation were present in 56% and 18%, respectively. 54% consulted at two or more health facilities before being diagnosed. Mean A1c was 10.6±2%. Hypertension was present in 17.8%. In 57 patients with documented evaluation, chronic complications included cataracts (13.9%), retinopathy (15.6%), nephropathy (24.3%), and neuropathy (13.6%). Mean most recent TDD was 0.48±0.29 units/kg per day and remained below 0.5 units/kg per day in a third of patients up to 5 years after diagnosis. Younger age at diagnosis (P=0.004) and longer diabetes duration (P=0.001) predicted a higher mean A1c, while TDD and presence of coma did not. Presence of any complication was predicted by longer diabetes duration (OR 10.3 95%CI 0.0010.6, P=0.004), lower BMI z-score at presentation (OR 0.1, 95%CI 0.010.8, P=0.03), absence of coma at presentation (OR 0.005, 95%CI 0.0010.6, P=0.03) but not TDD, while a higher mean A1c was marginally predictive (OR 2.5, 95%CI 0.996.5, P=0.05).
Conclusions: Haitian youth with diabetes present to care late and frequently experience DKA and coma at diagnosis. Even when a medical home is accessible, glycemic control is suboptimal. Cachexia and absence of coma at presentation in the context of older age at diagnosis and lower insulin requirements compared to Caucasian youth may suggest an attenuated autoimmune process with slower depletion of pancreatic beta cells, resulting in prolonged exposure to hyperglycemia prior to diagnosis and an increased risk of early-onset chronic complications.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology