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Poor glycemic control and its associated factors among type 1 diabetic children in Ethiopia: a systematic review and
Fentahun Meseret1, Awoke Masrie2, Adisu Birhanu Weldesenbet2
1Department of Pediatrics and Child Health Nursing, School of Nursing, College of Health and Medical Science, Haramaya University, Harar, Ethiopia. mesie1055@gmail.com.
Insights
Poor glycemic control is prevalent in Ethiopian children with type 1 diabetes. Access to a glucometer significantly improves glycemic control, highlighting a key area for intervention.
Area of Science:
- Pediatrics
- Endocrinology
- Public Health
Background:
- Poor glycemic control in children with type 1 diabetes poses significant risks for acute complications and long-term morbidity/mortality.
- Optimal glycemic control is particularly challenging in resource-limited settings.
- Existing studies on poor glycemic control in Ethiopian children with type 1 diabetes have yielded inconsistent findings.
Purpose of the Study:
- To systematically review and meta-analyze the pooled prevalence of poor glycemic control among type 1 diabetic children in Ethiopia.
- To identify factors associated with poor glycemic control in this population.
- To provide evidence-based recommendations for improving diabetes management.
Main Methods:
- A systematic review and meta-analysis of articles published between December 2015 and June 2024 from major scientific databases.
- Data analysis using Stata version 17, including heterogeneity assessment (I2 tests) and subgroup analysis by sample size and publication year.
- Inclusion of studies examining the association between poor glycemic control and glucometer availability.
Main Results:
- The pooled prevalence of poor glycemic control among type 1 diabetic children in Ethiopia was 71% (95% CI: 57-85%), with high heterogeneity (I2=97.57%).
- Children with type 1 diabetes who did not have a glucometer had lower odds of glycemic control (POR: 0.51, 95% CI: 0.08-0.93).
- Subgroup analysis revealed the highest pooled prevalence (76%) in studies with sample sizes under 200.
Conclusions:
- A high pooled prevalence of poor glycemic control exists among type 1 diabetic children in Ethiopia.
- Access to a glucometer is a significant factor associated with improved glycemic control.
- Recommendations include increasing glucometer accessibility for all diabetic children in Ethiopia through the Ministry of Health and stakeholders.
Background:
Poor glycemic control increases the risk of acute metabolic derangements and long-term consequences, which are the main causes of morbidity and mortality. Sustaining optimal glycemic control is challenging for children with diabetes, mainly in resource-limited settings. Numerous factors have identified as being associated with poor glycemic control among type 1 diabetic children. However, studies scrutinizing about the magnitude of poor glycemic control have had inconsistent findings in Ethiopia. This systematic review and meta-analysis is therefore aimed at appraising the pooled prevalence of poor glycemic control and its associated factors among type 1 diabetic children in Ethiopia by combining the studies from the existing literatures.
Methods:
All relevant articles published between December 30, 2015 and June 1, 2024, were systematically retrieved from scientific databases (PubMed, Hinari, Scopus, web of science, Science direct and Google scholar). Stata version 17 was used to analyze data (poor glycemic control and factors associated). From the identified studies, the one that shows the association of poor glycemic control and having glucometer were included. I2 tests were used to assess the heterogeneity of the studies. Subgroup analysis was done based on sample sizes and year of publication to determine how pooled estimates of poor glycemic control vary across the studies events. The pooled estimate of association between poor glycemic control and having glucometer as glucose level monitoring equipment/device was reported.
Results:
The aggregated seven articles revealed a lower odds of glycemic control among type 1 diabetic patients with no having glucometer as glucose level monitoring device than those who had it (POR: 0.51, 95% CI: 0.08, 0.93). The pooled prevalence of poor glycemic control among type 1 diabetic children in Ethiopia was 71% (95%: CI: 57, 85); (I2 = 97:57%, P < 0.01). Subgroup analysis was performed based on sample size, and the highest pooled prevalence (76%) was observed among primary studies with sample sizes less than 200.
Conclusions:
The pooled prevalence of poor glycemic control among type 1 diabetic children was high in Ethiopia. Access of glucometer as glucose monitoring was fond to be the significant factor for glycemic control. Therefore, we recommend ministry of health and other stack holders to increase the accessibility of glucometer for all diabetic children in Ethiopia.
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