Factors associated with poor glycaemic control among children and adolescents with Type 1 Diabetes Mellitus at a tertiary hospital in Kenya
- 1University of Nairobi College of Health Sciences: University of Nairobi Faculty of Health Sciences
Abstract
Type 1 diabetes mellitus (T1DM) remains a growing global health priority, with disproportionate underdiagnosis, delayed diagnosis, and mortality in sub-Saharan Africa. Despite the introduction of the Life for a Child (LFaC) programme in Kenya, which provides free insulin, glucose-monitoring supplies, and specialist education, no published studies have examined the determinants of glycaemic control among Kenyan children and adolescents with T1DM. This study aimed to determine the proportion of children and adolescents achieving good glycaemic control and to identify the socio-demographic and clinical determinants of glycaemic control at a tertiary hospital in Kenya.
This cross-sectional study enrolled 160 children and adolescents with T1DM attending the paediatric diabetes clinic at Kenyatta National Hospital, Nairobi, between September 2025 and May 2026. Sociodemographic and clinical data were collected through structured interviews and physical examination. Poor glycaemic control was defined as HbA1c >7.5%. Associations between candidate determinants and glycaemic control were assessed using chi-square or Fishers exact tests. Variables with p<0.2 on bivariate analysis were entered into a multivariable logistic regression model; Firths penalized-likelihood method was used given the small number of participants achieving good control.
Only 9 participants (5.6%) achieved the target HbA1c of [≤]7.5% (mean HbA1c 11.02%, SD {+/-}2.29), and only 5 of 133 patients (3.8%) had [≥]70% of glucometer readings within the target blood glucose range (3.9-10.0 mmol/L).On bivariate analysis, household income (p=0.026) and self-monitored blood glucose (SMBG) frequency (p=0.018) were significantly associated with glycaemic control. In an exploratory multivariable regression analysis (Firth penalized logistic regression, given the small number of participants with good control), only SMBG frequency [≥]4 tests/day remained independently associated with lower odds of poor control (adjusted OR 0.19, 95% CI 0.04-0.84, p=0.028); the effect of household income was attenuated after adjustment.
Glycaemic control remains markedly poor among children and adolescents with T1DM in this Kenyan tertiary hospital setting despite structured programmatic support. Frequency of self-monitoring, rather than household income alone, was the factor most strongly associated with glycaemic control, suggesting that strengthening access to glucose-testing supplies and supporting their consistent use should be prioritised in care, alongside attention to socioeconomic barriers. Longitudinal studies are needed to confirm these associations.
Related
- Glycaemic outcomes of three months of continuous glucose monitoring in children, adolescents and young adults with type 1 diabetes at a Kenyan tertiary hospital: a single-arm prospective study.
- Female sexual dysfunction in premenopausal women with diabetes mellitus in northern Nigeria: A cross-sectional study from two tertiary hospitals examining associations with glycaemic control and reproductive hormones
- Eating behaviour and glycaemic control: A cross-sectional study in adolescents with diabetes
- Diabetic Ketoacidosis at Diagnosis is Associated With Adverse Long-Term Glycaemic Trajectories and Retinopathy in Adult-Onset Type 1 Diabetes. A Single-Centre Retrospective Cohort Study.
- Appearance Over Health: A Phenomenological Study of Obese Adolescents With a Family History of Type 2 Diabetes Mellitus in a Collectivistic Indonesian Context.
BibTeX
@misc{omar2026factors,
title = {{Factors associated with poor glycaemic control among children and adolescents with Type 1 Diabetes Mellitus at a tertiary hospital in Kenya}},
author = {A. Omar and D. Marangu-Boore and F. Bukachi and F. Were},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.14.26365593},
url = {https://www.medrxiv.org/content/10.64898/2026.10.14.26365593v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Factors associated with poor glycaemic control among children and adolescents with Type 1 Diabetes Mellitus at a tertiary hospital in Kenya
AU - A. Omar
AU - D. Marangu-Boore
AU - F. Bukachi
AU - F. Were
PY - 2026
DA - 2026/10/14
PB - medRxiv
DO - 10.64898/2026.10.14.26365593
UR - https://www.medrxiv.org/content/10.64898/2026.10.14.26365593v1
AB - Type 1 diabetes mellitus (T1DM) remains a growing global health priority, with disproportionate underdiagnosis, delayed diagnosis, and mortality in sub-Saharan Africa. Despite the introduction of the Life for a Child (LFaC) programme in Kenya, which provides free insulin, glucose-monitoring supplies, and specialist education, no published studies have examined the determinants of glycaemic control among Kenyan children and adolescents with T1DM. This study aimed to determine the proportion of children and adolescents achieving good glycaemic control and to identify the socio-demographic and clinical determinants of glycaemic control at a tertiary hospital in Kenya. This cross-sectional study enrolled 160 children and adolescents with T1DM attending the paediatric diabetes clinic at Kenyatta National Hospital, Nairobi, between September 2025 and May 2026. Sociodemographic and clinical data were collected through structured interviews and physical examination. Poor glycaemic control was defined as HbA1c >7.5%. Associations between candidate determinants and glycaemic control were assessed using chi-square or Fishers exact tests. Variables with p<0.2 on bivariate analysis were entered into a multivariable logistic regression model; Firths penalized-likelihood method was used given the small number of participants achieving good control. Only 9 participants (5.6%) achieved the target HbA1c of [≤]7.5% (mean HbA1c 11.02%, SD {+/-}2.29), and only 5 of 133 patients (3.8%) had [≥]70% of glucometer readings within the target blood glucose range (3.9-10.0 mmol/L).On bivariate analysis, household income (p=0.026) and self-monitored blood glucose (SMBG) frequency (p=0.018) were significantly associated with glycaemic control. In an exploratory multivariable regression analysis (Firth penalized logistic regression, given the small number of participants with good control), only SMBG frequency [≥]4 tests/day remained independently associated with lower odds of poor control (adjusted OR 0.19, 95% CI 0.04-0.84, p=0.028); the effect of household income was attenuated after adjustment. Glycaemic control remains markedly poor among children and adolescents with T1DM in this Kenyan tertiary hospital setting despite structured programmatic support. Frequency of self-monitoring, rather than household income alone, was the factor most strongly associated with glycaemic control, suggesting that strengthening access to glucose-testing supplies and supporting their consistent use should be prioritised in care, alongside attention to socioeconomic barriers. Longitudinal studies are needed to confirm these associations.
ER -