Microalbuminuria among children with diabetes mellitus attending outpatient clinic at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Type1 Diabetes Mellitus (DM), is caused by insulin deficiency. Microalbuminuria is a serious complication of diabetes. Sustained hyperglycemia and hypertension are known causes of microalbuminuria. In Tanzania, the prevalence of microalbuminuria was 12% in type 1 DM. Recommended time for screening for microalbuminuria in children with diabetes is 5 years after diagnosis.Microalbuminuria has been mistaken to be a condition of adults.Screening needs to be done early enough to prevent rapid progression of the disease. Objective: To determine the prevalence of microalbuminuria among children with diabetes mellitus seen at the outpatient clinic at Moi Teaching and Referral Hospital(MTRH), Eldoret-Kenya. Methods: A cross sectional study design was used. Data was collected from 80 participants attending the diabetic outpatient clinic at MTRH using a questionnaire. Blood pressure, height and weightwere measured and spot urine sample were collected to measure urinary albumin to creatinine ratio. The most recent HbA1c level and other clinical information were recorded from the file. Data was analyzed using SAS version 9.3 at 95% confidence level. The demographic and clinical characteristics were summarized using descriptive statistics. Categorical variables were summarized using frequencies with respective percentages and their associations were assessed using Fisher's exact test. Mean with standard deviation (SD) were used for continuous variables. Results: Out of the 80 participants, 48% were female, 52% were aged 10-15 years. The median age at diagnosis of diabetes was 6.5 years (IQR 4-10) while the median duration with diabetes was 4 years (IQR 2-6).Eighty percent of the children were underweight and younger participants are more likely to be underweight (p=0.015) The prevalence of microalbuminuria was (n=6) 7.5% while that of macroalbuminuria was 1% (n=1). The prevalence of hypertension was 6% (n=5) and none of those with hypertension had microalbuminuria. The mean age of duration of diabetes for children with microalbuminuria was 4.3 years (95% CI 3.5-4.9)as compared to 4.2 years for those with normolbuminuria (SD 3.0, p value= 0.929).The relative risk of developing microalbuminuria at less than 5 years of duration of DM is 1.56 but is not statistically significant.Children with diabetes residing in an urban area is associated with developing microalbuminuria(p=0.04). Almost all children had poor glycemic control in the past with a mean glycated heamoglobin of 11.3%. Children with an older age at diagnosis of DM was associated with developing microalbuminuria(p=0.042) Conclusion: The prevalence of microalbuminuria in children with diabetes at MTRH is 7.5%. Older age at diagnosis and urban residence is associated with developing microalbuminuria. Recommendation:Further longitudinal studies of a larger sample size needs to be done to assess risk factors for developing microalbuminuria in this population.