Type 1 diabetes mellitus (DM) in the developing country remains under diagnosed and poorly managed. There is perennial unavailability of insulin, lack of trained manpower and government support.
To audit the management of Type 1 diabetes in Ebonyi State University Teaching Hospital Abakaliki, South Eastern Nigeria before the advent of established Paediatric diabetic units.
Subjects and Methods:
It was a 9 years (1st January 2001- 31st December 2009) retrospective review of case files of children younger than 20 years with diagnosis of type 1 DM.
A total of 15,996 patients were seen during study period out of which 16 were diagnosed with type 1 DM, giving a case prevalence rate of 0.1/1000. The male to female ratio was 1:1.2. The mean age at presentation was 11.4 years. Average duration of illness before presentation at hospital was 7 weeks. The most prevalent presenting symptoms were dehydration 16 (100%), polyuria 15 (93.8%), and polydipsia 13 (81.3%). Fourteen (88%) patients first presented in the children's emergency room with Diabetic ketoacidosis (DKA), and the average duration of hospital stay when admitted was 43.8 days. Repeated DKA and hypoglycemia was reported in 25% of the patients. Eighteen percent of patients opted for discharge against medical advice (DAMA) while about 70% were lost to follow up.
Diabetic management over the past 10 years in this hospital is suboptimal with very poor outcomes. Lack of trained manpower, poverty and ignorance are significant contributory factors to the poor management outcome and high default rate.