Translate this page into:
Determinants of adherence to home management of type 1 diabetes mellitus among children in Kenya: A hospital-based cross-sectional study
-
Received: ,
Accepted: ,
How to cite this article: Okello S, Okusa JM, Ezatiru L, Akello S, Aiko SN. Determinants of adherence to home management of type 1 diabetes mellitus among children in Kenya: A hospital-based cross-sectional study. J Pediatr Endocrinol Diabetes. doi: 10.25259/JPED_38_2025
Abstract
Objectives:
Type 1 diabetes mellitus (T1DM) is a chronic condition and the most common endocrine disorder in children. Effective home management of T1DM requires adherence to insulin therapy, blood glucose (BG) monitoring, dietary regulation, and physical activity. However, adherence to these practices is often suboptimal. This study aimed to assess the level of adherence and identify family psychosocial and facility-related factors influencing adherence to T1DM home management among children in a hospital.
Material and Methods:
A cross-sectional study was conducted among 91 caregivers of children with T1DM, selected through simple random sampling. Data were collected through structured interviewer-administered questionnaires [Supplementary Material], with informed consent obtained from caregivers and assent from children above 8 years. Descriptive statistics and binary logistic regression were used to identify factors associated with adherence.
Results:
The study observed that only 39.6% of the children adhered to the full home management regimen for T1DM. Family psychosocial factors that significantly influenced adherence included support from family members and siblings (adjusted OR = 1.45, P = 0.041), good communication and reminders to the child (adjusted OR = 1.72, P = 0.028), perceived helpfulness of treatment (adjusted OR = 1.89, P = 0.014), and the affordability of resources and treatment (adjusted OR = 2.05, P = 0.002). Facility-related factors positively associated with adherence included support from healthcare workers (adjusted OR = 1.60, P = 0.008), necessary follow-up by healthcare workers (adjusted OR = 1.50, P = 0.01), treatment availability in health facilities (adjusted OR = 2.13, P < 0.001), healthcare providers’ positive attitude and willingness to help (adjusted OR = 1.56, P = 0.011), appropriate health education offered to caregivers (adjusted OR = 1.84, P < 0.001), and offering adequate time by healthcare providers (adjusted OR = 1.62, P = 0.001).
Conclusion:
Adherence to T1DM home management is suboptimal, particularly in diet, physical exercise, and BG monitoring. The study highlights that family psychosocial factors, such as support and communication, along with facility-related factors such as healthcare worker support, treatment availability, and health education, significantly influence adherence. Interventions should focus on improving family support systems, enhancing healthcare provider engagement, ensuring the availability and affordability of treatment, and providing adequate health education to caregivers. These findings are essential for informing policy and practice aimed at improving diabetes management and health outcomes for children with T1DM.
Keywords
Adherence to home management of type 1 diabetes mellitus
Diabetic ketoacidosis
Type 1 diabetes mellitus in children
INTRODUCTION
Type 1 diabetes mellitus (T1DM) is the most common endocrine disorder affecting children globally, with an annual increase of approximately 3% and a high incidence-to-prevalence ratio of 7%.[1] T1DM is a chronic condition resulting in hyperglycemia due to the inability of the pancreas to produce insulin or impaired insulin action, or both. It is characterized by insulin deficiency primarily caused by the autoimmune destruction of pancreatic beta cells (type 1a) or of unknown origin (type 1b).[2] Clinical manifestations of T1DM in children include polyphagia, polyuria, polydipsia, weight loss, vision changes, and fatigue.[3]
The complications of T1DM are severe and include hyperglycemia, diabetic ketoacidosis (DKA), macrovascular diseases, microvascular diseases (nephropathy, neuropathy, and retinopathy), cognitive dysfunction, stunted growth, delayed puberty, and infections.[4] DKA, a life-threatening complication, occurs due to poor adherence to home management of T1DM and contributes to 3.4–13.4% mortality rates in children, especially in developing countries.[5] Approximately 20–30% of newly diagnosed T1DM cases in developed countries present with DKA. Almost all newly diagnosed cases in children in Africa present with DKA due to limited diagnostic capacity and inadequate diagnostic equipment at lower healthcare facilities.[6,7]
Globally, about 3.4 million people die annually due to high blood glucose (BG), with 80% of these deaths occurring in developing countries.[8] In 2019, there were approximately 601,000 children aged 0–14 years with T1DM worldwide, with 98,000 new diagnoses annually.[9] Within the African region, close to 7,600 new cases of T1DM among children are reported each year.[10]
Home management of T1DM is essential in preventing complications associated with the condition. Recommended strategies include adherence to insulin therapy, dietary management, physical exercise, BG monitoring (at least 4 times daily), and regular follow-up medical appointments.[11] The target level for hemoglobin A1c (HbA1c) should be ≤7.5% for children and adolescents.[12,13]
Despite these guidelines, adherence to T1DM home management remains low, especially in developing countries. Studies have reported adherence rates as low as 21% for overall home management, with specific adherence rates of 33% for BG monitoring, 52% for insulin therapy, and 29.5% for dietary management.[14] Poor adherence has been linked to complications occurring at rates of 21–52%.[15] The lack of adherence can result in severe complications, including recurrent DKA, which remains a significant cause of morbidity and mortality in children with T1DM in developing countries.[16]
In Kenya, limited information exists regarding adherence to T1DM home management among children. Addressing family psychosocial and facility-related determinants is crucial since they play a key role in determining adherence levels. Family support, affordability of treatment, perceived helpfulness of treatment, healthcare worker support, and availability of treatment at health facilities are among the factors influencing adherence.
This study aimed to establish the family psychosocial and facility-related determinants influencing adherence to home management of T1DM among children attending diabetes clinics at Kenyatta National Hospital (KNH). Findings from this study may provide valuable insights for developing effective strategies to improve adherence, reduce complications, and enhance health outcomes among children with T1DM.
MATERIAL AND METHODS
This study employed a cross-sectional study design with a quantitative approach. Data were collected at a single point in time to determine adherence levels and assess family, psychosocial, and facility-related determinants of adherence to T1DM home management among children attending the pediatric diabetes clinic at KNH.
The study was conducted at the pediatric diabetes clinic of KNH in Nairobi, the capital city of Kenya. KNH, the largest public teaching and referral hospital in the region, has a bed capacity of approximately 2,000 and offers specialized services, including pediatrics, endocrinology, and intensive care. It also serves as a training center for medical students from the University of Nairobi’s Faculty of Health Sciences. The pediatric diabetes clinic was chosen because it exclusively manages children with T1DM, providing specialized care, nutritional counseling, and psychosocial support. As a referral center, it is involved in the management of children with diabetes-related complications from across Kenya. The clinic operates once a week, attending to about 120 patients monthly. The study was conducted between July and September 2022. The multidisciplinary team included pediatric endocrinologists, resident and fellowship doctors, nurses, counselors, and dietitians.
The study population consisted of caregivers of children aged 0–18 years with T1DM who were receiving follow-up care at the KNH pediatric diabetes clinic between the months of July and September 2022. These caregivers were responsible for administering or supervising the child’s diabetes management at home. Only caregivers whose children had attended at least one prior follow-up visit were included in the study.
Inclusion criteria
Caregivers were eligible to participate in the study if they were aged 18 years or older, provided informed consent, had been caring for a child with T1DM for at least one month, and their child had attended at least one prior follow-up visit at the clinic. In addition, caregivers of children aged 8 years and above, whose children had provided assent, were also included in the study.
Exclusion criteria
Caregivers of children who had critically sick children and required immediate medical attention were excluded.
The sample size was determined using the Kish and Leslie (1965) formula, which is widely used for estimating sample sizes in prevalence studies. The formula is given as:
where:
d is the tolerable sampling error (precision) set at 5%
p is the prevalence of adherence from previous studies at 37%[16]
t is the standard normal value corresponding to set 95% level of confidence (t = 1.96).
The sample size was adjusted as follows:
The investigators selected 91 participants as the sample from these computations.
Sampling procedure
Simple random sampling was used to select participants from caregivers attending the pediatric diabetes clinic on Tuesdays. Eligible caregivers were informed about the study, provided written consent, and then randomly selected through a lottery method. Those who picked designated numbers were included in the study. Recruitment, consenting, and sampling were conducted on the same day to ensure efficiency and minimize bias.
Research instruments
A structured interviewer-administered questionnaire was used to collect data. The questionnaire was adapted from existing validated tools, including the modified Morisky Medication Adherence Scale for adherence assessment[17] and was supplemented with questions based on the World Health Organization (WHO), American Diabetes Association (ADA), and Ministry of Health guidelines.[18] Additional questions on family psychosocial and facility-related determinants of adherence were developed from previous studies.[14,17,19] The questionnaire was developed by the research team and was reviewed by supervisors [Supplementary Material 1]. Written permission was sought for the use of the Morisky Medication Adherence tool. To ensure validity and reliability, the questionnaire was pretested among 10 caregivers at the KNH pediatric endocrinology unit who were not included in the study, and underwent forward and back translation between English and Kiswahili by professional translators to maintain accuracy. The final version was interviewer-administered, with structured closed-ended questions to ensure consistency in data collection.
Study variables
Dependent variable (outcome) – Adherence to T1DM home management
This was measured dichotomously in children ≥3 years as either adherent or non-adherent based on the child’s observance of four key components of the child’s compliance with diabetes management: insulin therapy, diet, physical exercise, and BG monitoring. A score of 80% or above across all components indicates adherence. This is in line with the Morisky Adherence Score and consistent with studies done in other settings.[17]
Independent variables (predictors)
Family psychosocial factors: These included support from family and siblings, good communication and reminders to the child, perceived helpfulness of the treatment, living without conflict in the family, perception of the disease as serious, affordability of necessary resources, and treatment.
Facility-related factors: These included support from healthcare workers, follow-up by healthcare workers, availability of treatment in the facility, healthcare providers’ positive attitude, health education offered to caregivers, and adequate time provided by healthcare workers.
Data collection
Data were collected over 2 months on clinic days (Tuesdays) from 8 am to 2 pm using an interviewer-administered questionnaire [Supplementary Material]. The investigator, along with two research assistants, sampled 12 participants each week for the first 7 weeks and 7 participants in the final week, totaling 91 participants. Each interview lasted about 15 min. The investigator ensured informed consent was obtained and supervised the data collection process to ensure accuracy and adherence to ethical principles.
Data analysis
Data were analyzed using the Statistical Package for the Social Sciences V28. Descriptive statistics, including means and standard deviations (SD) for continuous variables and frequencies and percentages for categorical variables, were used to assess the demographic characteristics of the children and their caregivers.
To assess the association between demographic variables and adherence, binary logistic regression was applied. Adherence to T1DM home management was measured by combining adherence across four key components: BG monitoring, dietary prescriptions, insulin therapy, and physical exercise. Since adherence to home management required following all these aspects, a composite adherence measure was created.
Bivariate analysis with P < 0.2 was used to identify potential factors associated with adherence, while multivariate logistic regression analysis was employed to adjust for confounding variables, with a significance level set at P < 0.05. Odds ratios (OR) were used as the measure of association in the regression models, representing the strength and direction of the relationship between each predictor and adherence to T1DM home management. Both unadjusted and adjusted OR were used to assess the influence of family psychosocial and facility-related determinants on adherence, allowing for accurate identification of key predictors.
RESULTS
Sociodemographic characteristics of children and caregivers
Of the 91 children, 46 were boys and 45 girls, 38 (41.8%) were aged 11 to 17 years, and 47 (51.6%) had primary education. Of the 91 caregivers, 53 (58.2%) were aged 36 years and above, and 68 (68.1%) were married, while 84 (92.3%) were Christians [Table 1].
| Characteristics of the child | Frequency (n=91) | Percentage |
|---|---|---|
| Gender | ||
| Male | 46 | 50.5 |
| Female | 45 | 49.5 |
| Age | ||
| 0–5 years | 20 | 22.0 |
| 6–10 years | 33 | 36.3 |
| 11–17 years | 38 | 41.8 |
| Education level | ||
| Pre-primary | 20 | 22.0 |
| Primary | 47 | 51.6 |
| Secondary | 15 | 16.5 |
| Not yet started | 9 | 9.9 |
| Duration lived with T1DM | ||
| 0–1 year | 23 | 25.3 |
| 2–3 years | 22 | 24.2 |
| 4–5 years | 24 | 26.4 |
| More than 5 years | 22 | 24.2 |
| Characteristics of caregivers | ||
| Age | ||
| 18–23 years | 3 | 3.3 |
| 24–29 years | 18 | 19.8 |
| 30–35 years | 38 | 18.7 |
| 36 years and above | 53 | 58.2 |
| Marital status | ||
| Married | 62 | 68.1 |
| Single | 19 | 20.9 |
| Separated | 10 | 11.0 |
| Employment status | ||
| Formal employment | 29 | 31.9 |
| Self-employed | 37 | 40.7 |
| Not employed | 25 | 27.5 |
| Education level | ||
| Primary | 17 | 18.7 |
| Secondary | 34 | 37.4 |
| Tertiary | 37 | 40.7 |
| Never attended | 3 | 3.3 |
| Religion | ||
| Christian | 84 | 92.3 |
| Muslim | 6 | 6.6 |
| Others | 1 | 1.1 |
Level of adherence to T1DM home management
A total of 39.6% (n = 36) of the children with T1DM at KNH were found to be adherent to home management guidelines, while 60.4% (n = 55) were non-adherent. The adherence rates for individual components of T1DM home management are shown in Table 2.
| T1DM care components | Adherent | Non-adherent | ||
|---|---|---|---|---|
| Frequency (n) | Percentage | Frequency (n) | Percentage | |
| Insulin therapy | 69 | 75.8 | 22 | 24.2 |
| Diet | 34 | 37.4 | 57 | 62.6 |
| Physical exercise (for only ≥3 years old, n=82) | 27 | 32.9 | 55 | 67.1 |
| Blood glucose monitoring | 25 | 27.5 | 66 | 72.5 |
| Aggregate rates | 36 | 39.6 | 55 | 60.4 |
Bivariate analysis for family psychosocial and facility-related factors with adherence to home management of T1DM among children
Bivariate logistic regression analysis revealed several significant family psychosocial and healthcare-related factors associated with adherence to T1DM home management among children at KNH, as listed below:
Family psychosocial factors
Support from family members and siblings was associated with higher odds of adherence (OR = 1.63, 95% CI: 1.07–2.77, P = 0.023). Good communication and reminders to the child also increased the likelihood of adherence (OR = 1.88, 95% CI: 1.09–3.24, P = 0.012). Perceived helpfulness of treatment showed a significant positive association with adherence (OR = 1.98, 95% CI: 1.31–3.55, P = 0.009), as did living in a family without conflict (OR = 1.52, 95% CI: 1.02–2.89, P = 0.034). The affordability of necessary resources and treatment by the family exhibited the strongest association with adherence, with an OR of 2.18 (95% CI: 1.55–4.02, P < 0.001).
Facility-related factors
Support from healthcare workers was significantly associated with higher adherence (OR = 1.97, 95% CI: 1.30–12.95, P = 0.005). The necessity of follow-up by healthcare workers also showed a positive relationship with adherence (OR = 1.66, 95% CI: 1.42–1.95, P = 0.036). Treatment availability in the health facility was strongly associated with adherence (OR = 2.44, 95% CI: 1.80–3.31, P < 0.001), as was the positive attitude and willingness to help of healthcare providers (OR = 1.77, 95% CI: 1.15–2.72, P = 0.024). Offering appropriate health education to caregivers was another important factor associated with adherence (OR = 2.08, 95% CI: 1.72–2.51, P < 0.001), along with being provided adequate time by healthcare providers (OR = 1.86, 95% CI: 1.46–2.39, P = 0.017) [Table 3].
| Variables | Crude OR | 95% Confidence interval (CI) | P-value |
|---|---|---|---|
| Support from the family members and siblings | 1.63 | 1.07– 2.77 | 0.023 |
| Good communication and reminders to child | 1.88 | 1.09–3.24 | 0.012 |
| Perceived helpfulness of the treatment | 1.98 | 1.31–3.55 | 0.009 |
| Living together in family without conflict | 1.52 | 1.02–2.89 | 0.034 |
| Perceiving the disease as serious | 1.24 | 0.78–2.03 | 0.275 |
| Affordability of resources and treatment by family | 2.18 | 1.55–4.02 | <0.001 |
| Support from healthcare workers | 1.97 | 1.30–12.95 | 0.005 |
| Necessary follow-up by healthcare workers | 1.66 | 1.42– 1.95 | 0.036 |
| Treatment availability in the health facility | 2.44 | 1.80–3.31 | <0.001 |
| HCPs positive attitude and willingness to help | 1.77 | 1.15–2.72 | 0.024 |
| Appropriate health education offered to the caregivers | 2.08 | 1.72–2.51 | <0.001 |
| Being offered adequate time by the HCPs | 1.86 | 1.46–2.39 | 0.017 |
HCP: Healthcare provider, Bivariate logistic regression analysis with a P-value of <0.2 was used to identify potential factors associated with adherence.
Multivariate analysis for family psychosocial and facility-related factors with adherence to home management of T1DM among children
In the multivariate analysis, key factors associated with adherence to T1DM home management included family support, communication, and perceived treatment helpfulness. Family members’ support (adjusted OR = 1.45, P = 0.041) and good communication with reminders (adjusted OR = 1.72, P = 0.028) positively impacted adherence. In addition, the perceived helpfulness of treatment (adjusted OR = 1.89, P = 0.014) and affordability of resources (adjusted OR = 2.05, P = 0.002) were significant contributors to adherence.
Healthcare-related factors also played a significant role, including support from healthcare workers (adjusted OR = 1.60, P = 0.008), necessary follow-up (adjusted OR = 1.50, P = 0.01), and treatment availability (adjusted OR = 2.13, P <0.001). Furthermore, healthcare providers’ positive attitudes (adjusted OR = 1.56, P = 0.011), health education for caregivers (adjusted OR = 1.84, P <0.001), and adequate time provided (adjusted OR = 1.62, P = 0.001) all contributed to improved adherence [Table 4].
| Variables | Adjusted OR | 95% Confidence interval (CI) | P-value |
|---|---|---|---|
| Support from the family members and siblings | 1.45 | 1.02–2.48 | 0.041 |
| Good communication and reminders to child | 1.72 | 1.05–3.10 | 0.028 |
| Perceived helpfulness of the treatment | 1.89 | 1.22–3.40 | 0.014 |
| Affordability of resources and treatment by family | 2.05 | 1.41–3.87 | 0.002 |
| Support from healthcare workers | 1.6 | 1.13–2.27 | 0.008 |
| Necessary follow-up by healthcare workers | 1.5 | 1.11–2.02 | 0.01 |
| Treatment availability in the health facility | 2.13 | 1.51–3.01 | <0.001 |
| HCPs positive attitude and willingness to help | 1.56 | 1.11–2.19 | 0.011 |
| Appropriate health education offered to caregivers | 1.84 | 1.49–2.30 | <0.001 |
| Being offered adequate time by HCPs | 1.62 | 1.21–2.16 | 0.001 |
HCP: Healthcare provider, Multivariate logistic regression analysis was employed to adjust for confounding variables, with a significance level set at P < 0.05.
DISCUSSION
This study examined adherence to home management of T1DM among children at KNH and identified key determinants of adherence. The findings reveal significant gaps in adherence to dietary recommendations, physical exercise, and BG monitoring, with an overall adherence rate of only 39.6%. While insulin therapy adherence was relatively high (75.8%), this still fell short of the recommended target of 80%. These gaps highlight the need to better understand the factors influencing adherence and to address barriers to achieving optimal management.
The results point to family psychosocial and healthcare facility-related factors as key determinants of adherence. Family support, effective communication, and the perceived helpfulness and affordability of treatment were positively associated with adherence. This aligns with prior research indicating that family involvement and emotional support are essential for managing chronic conditions like T1DM.[20,21] Moreover, facility-related factors such as the availability of treatment, healthcare worker support, and appropriate health education also played a critical role. This reinforces the need for a holistic approach that integrates both family and healthcare provider support to improve adherence to T1DM management.[21,22]
The limitations of this study are as follows:
Self-reported adherence
The study relied on caregiver’s self-reports to assess adherence to the home management regimen of T1DM. This could have introduced bias due to caregivers’ recall errors or social desirability bias, where they may have over-reported their adherence to prescribed recommendations. Adherence was also not measured using standard investigations like the HbA1c.
Cross-sectional design
The study’s cross-sectional design limits its ability to establish causality between the identified determinants and adherence behaviors. It only provides a snapshot of adherence at a specific point in time without tracking changes over a longer period.
Sample size and generalizability
The study was conducted at a single hospital (KNH), which may limit the generalizability of the findings to other healthcare settings or regions. A larger, multi-center study would provide a more comprehensive view of adherence across different demographics.
Data collection method
The study depended on caregiver reports of adherence, which might not have fully captured all dimensions of adherence, particularly in areas such as physical exercise or BG monitoring, where adherence can be difficult to assess without direct observation or medical records. Furthermore, details pertaining to glycemic control (HbA1c) and type of insulin used are not being presented due to non-availability.
Timeframe
The study was conducted over a limited timeframe, which may not have fully captured seasonal variations in adherence or the long-term impacts of family psychosocial and healthcare facility-related factors. Future research could extend the observation period to gain deeper insights into adherence over time.
The delimitations of the study included the following:
Study population
The study specifically focused on children with T1DM attending KNH, which was chosen due to the hospital’s status as a leading healthcare provider in Kenya. This focus was intended to explore the adherence patterns within this specific population, particularly in an urban hospital setting.
Focus on home management
The study was restricted to examining home management practices, excluding hospital-based interventions and the direct influence of in-patient care. This was done to focus on the real-world management of T1DM outside the clinical setting, which is crucial for long-term disease control.
Adherence metrics
The study defined adherence in terms of four key components: insulin therapy, diet, physical exercise, and BG monitoring. While this provides a comprehensive view of the core aspects of diabetes management, other factors such as emotional well-being or access to other healthcare services were outside the scope of the study.
CONCLUSION
The study found suboptimal adherence to home management of T1DM among children at KNH, with particularly low adherence to diet, physical exercise, and BG monitoring. Family psychosocial factors and healthcare facility-related factors were key determinants of adherence. These findings underscore the importance of addressing these factors to improve overall management of T1DM in the home setting.
Recommendations
To enhance adherence to T1DM home management, the study recommends the following strategies:
Health education: Provide individualized health education to caregivers and children, focusing on the critical role of comprehensive diabetes management, including diet, exercise, and BG monitoring.
Family support: Strengthen family involvement in care through targeted support programs and home visits, fostering better communication and monitoring at the household level.
Healthcare worker support: Improve healthcare worker engagement with caregivers by providing continuous support and ensuring caregivers have the knowledge and resources needed for effective management.
Resource availability: Address barriers to accessing treatment, such as the availability and affordability of necessary resources such as insulin, glucose monitors, and dietary supplements.
Suggestions for future research
Future research should explore the specific barriers to adherence among different socio-economic groups and evaluate the impact of targeted interventions (such as family counseling and healthcare worker training) on adherence rates. Furthermore, examining the long-term outcomes of children who adhere versus those who do not adhere to T1DM home management would provide valuable insights into the effectiveness of current management strategies.
Consent for publication:
The authors declare that consent for publication was obtained from all participants or their legal guardians, as appropriate, before the commencement of the study. All identifying information has been anonymized in accordance with ethical guidelines to protect the privacy of participants.
Availability of data and materials:
All data supporting the findings of this study are available within the paper and its supplementary information. The datasets generated and analyzed during the current study are publicly available at the following link: https://erepository.uonbi.ac.ke/bitstream/handle/11295/162410/Okello%20Samuel-%20Dissertation.pdf?sequence=1
Funding:
The study had no funding. Thus, all participants participated in the survey on a voluntary basis and were not provided any monetary benefit for their participation.
Ethical considerations:
The study was reviewed and approved by the KNH University of Nairobi Ethics and Research Committee (KNH-UON ERC), application approval number: P211/03/2022, and the National Commission for Science, Technology and Innovation (NACOSTI) under License No: NACOSTI/P/22/22410. Upon approval, a letter was presented to the KNH administration to authorize data collection. Participants were informed about the purpose, objectives, and expectations of the study. Informed consent was obtained from each participant. Confidentiality was ensured using codes instead of names on the questionnaires. Privacy was maintained by conducting interviews in a private room. Completed questionnaires were securely stored under lock and key, and data were stored on a password-protected computer.
Acknowledgments:
We would like to express our sincere gratitude to the caregivers and children who participated in the study. We also extend our thanks to the healthcare workers at KNH for their support and cooperation throughout the research process. Special thanks to Dr. Angeline Chepchirchir Kirui and Dr. Joyce Jebet Cheptum whose guidance and support were invaluable to the completion of this study. My special thanks goes to Sheila Nyabisi Aiko for continuous support.
Author contributions:
SO: conceptualized the study, designed the research methodology, conducted data collection and analysis, and wrote the manuscript. JMO: contributed in conducting data collection and analysis, and reviewed the manuscript. SNA: assisted with data collection and provided valuable insights into the interpretation of findings. LE: assisted in data analysis, provided critical feedback on the manuscript, and contributed to the final review. SA: provided critical feedback on the manuscript, and contributed to the final review.
Ethical approval:
The research/study approved by the Institutional Review Board at Kenyatta National Hospital University of Nairobi Ethics and Research Committee (KNH-UON ERC), approval number P211, dated 12th March 2022.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
References
- Diabetes. 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes [Last accessed on 2025 Jun 21]
- [Google Scholar]
- Definition, classification, diagnosis and differential diagnosis of diabetes mellitus: Update 2023. Exp Clin Endocrinol Diabetes. 2024;132:112-24.
- [CrossRef] [PubMed] [Google Scholar]
- Prevalence of acute complications of type 1 diabetes in children and adolescents in Kenyatta national hospital Kenya: University of Nairobi; 2024.
- [Google Scholar]
- Incidence and predictors of mortality in children with diabetic ketoacidosis in the comprehensive specialized referral hospitals of West Amhara Region, Northwest Ethiopia: A retrospective follow-up study. Front Clin Diabetes Healthc. 2023;4:1204133. Available from:
- [CrossRef] [PubMed] [Google Scholar]
- Diabetic microvascular complications among children and adolescents in northwestern Tanzania: A cross-sectional study. Ann Glob Health. 2020;86:43.
- [CrossRef] [PubMed] [Google Scholar]
- Cataract as early ocular complication in children and adolescents with type 1 diabetes mellitus. Inter J Endocrinol. 2018;2018:6763586.
- [CrossRef] [PubMed] [Google Scholar]
- Risk factors of cardio vascular disease among diabetic patients. J Clin Lab Res. 2024;7:2768-0487. Article 151
- [CrossRef] [Google Scholar]
- Type 1 diabetes mellitus in children: Experience in Indonesia. Clin Pediatr Endocrinol. 2021;30:11-8.
- [CrossRef] [PubMed] [Google Scholar]
- Clinical characteristics and management of type 1 diabetes in Spain. SED1 Study. Endocrinol Diabetes Nutr (Engl Ed). 2021;68:642-53.
- [CrossRef] [PubMed] [Google Scholar]
- Diabetes technology: Improving care, improving patient-reported outcomes and preventing complications in young people with type 1 diabetes. Diabet Med. 2018;35:419-29.
- [CrossRef] [PubMed] [Google Scholar]
- Diabetes and the WHO model list of essential medicines. Lancet Diabetes Endocrinol. 2022;10:19-20.
- [CrossRef] [PubMed] [Google Scholar]
- Adherence of self-monitoring of blood glucose in persons with type 1 diabetes in Sweden. BMJ Open Diabetes Res Care. 2017;5:e000342.
- [CrossRef] [PubMed] [Google Scholar]
- Diabetes. 2024. Available from: https://www.who.int/health-topics/diabetes/diabetes [Last accessed on 2025 Jun 21]
- [Google Scholar]
- Factors associated with poor glycemic control and acute complications among children and adolescents with type 1 diabetes mellitus attending clinic at Dodoma and iringa regional referral hospital. 2021. Tanzania: University of Dodoma; (Master's thesis, University of Dodoma, Tanzania). Available from: https://repository.udom.ac.tz/handle/20.500.12661 [Last accessed on 2025 Jun 21]
- [Google Scholar]
- Handbook of diabetes. 2021 Available from: https://doi.org/10.1002/9781118976074 [Last accessed on 2025 Jun 21]
- [CrossRef] [Google Scholar]
- The type 1 diabetes self-care manual. 2018. United States: American Diabetes Association; Available from: https://professional.diabetes.org/content-page/the-type-1-diabetes-self-care-manual [Last accessed on 2025 Jun 21]
- [Google Scholar]
- Medication adherence and factors associated with poor adherence among type 2 diabetes mellitus patients on follow-up at Kenyatta National Hospital, Kenya. Pan Afr Med J. 2018;29:82.
- [CrossRef] [PubMed] [Google Scholar]
- The structure of parental involvement and relations to disease management for youth with type 1 diabetes. J Pediatr Psychol. 2011;36:596-605.
- [CrossRef] [PubMed] [Google Scholar]
- Prevalence of and disparities in barriers to care experienced by youth with type 1 diabetes. J Pediatr. 2014;164:1369-75.e1.
- [CrossRef] [PubMed] [Google Scholar]
- Improved A1C levels in type 1 diabetes with smartphone app use. Can J Diabetes. 2017;41:33-40.
- [CrossRef] [PubMed] [Google Scholar]