Clinical profile of diabetes at diagnosis among children and adolescents at an endocrine clinic in Ghana

AIM To determine the clinical features of diabetes in children and adolescents in Ghana.METHODS Retrospective review of clinical features of all children and adolescents with new-onset diabetes seen at the paediatric endocrinology clinic of Komfo Anokye Teaching Hospital in Kumasi, from February 2012 to Auguest 2016. RESULTS One hundred and six subjects presented with diabetes. Ninety(84.9%) were diagnosed by clinical features and family history as type 1, and 16(15.1%) type 2. For type 1 subjects, age range at diagnosis was 0.9-19.9 year(y), peak age of onset 12-13 year, and 3.3% were < 5 year, 21.1% 5-< 10 year, 45.6% 10-< 15 year and 30.0% 15-< 20 year. Seventy-one point one percent were female. Common clinical features were polyuria(100%), polydipsia(98.9%), and weight loss(82.2%). Mean BMI SD was -0.54, range -3.84 to 2.47. 60.0% presented in diabetic ketoacidosis(DKA). Nine had infections at onset(skin, abscess, leg ulcer). Mean± SD HbA 1c at diagnosis was 12.7% ± 1.9%(115±21 mmol/mol). Four have since died: Hypoglycaemia(2), recurrent DKA(1), osteosarcoma(1). Two other type 1 cases died of DKA at presentation in emergency before being seen by the paediatric endocrinologist. Crude mortality rate including these 2 cases was 32.2/1000 patient years. Type 2 cases were 81% female, age of onset 9-19 year. Mean BMI SD was 1.49, range -0.87 to 2.61. Forty-three point eight percent presented in DKA. All type 2 cases had acanthosis nigricans. Overall, 9.8% did not have home refrigeration, most using clay pot evaporative cooling for insulin storage. CONCLUSION Type 1 occurs with a female preponderance and high DKA rates. Type 2 also occurs. Typology based on clinical features is difficult. Community and professional awareness is warranted.