Growth Impairment and Nutritional Status among Children with Type 1 Diabetes at Edduiem Teaching Hospital, White Nile State, Sudan: A Cross-Sectional Study, 2024

Author

Howida Mohammed Ibrahim, Mohammed Amer Ahmed, Weaam Elamin Dafa Alla

Abstract

 The study aimed to assess growth and nutritional status among children and adolescents with type 1 diabetes mellitus (T1DM) attending the pediatric diabetes clinic at Edduiem Teaching Hospital, and to examine associations with glycemic control parameters, duration of diabetes, sex, and number of daily meals: A descriptive cross-sectional study (January to December 2024). A simple random sample of 76 Sudanese children with T1DM was selected. Data were collected using a questionnaire alongside anthropometric measurements. Weight, height, and body mass index (BMI) were evaluated and converted to age- and sex-specific Z-scores according to World Health Organization (WHO) growth standards. Glycated hemoglobin (HbA1c) was measured using a FinecareTM fluorescence immunochromatography system. The chi-square test (Chi2) was used to evaluate statistical associations, with (P < 0.05) considered statistically significant. The study reached that  the mean age was  12.16 years, and females accounted for 63.2% of participants. The mean age at diagnosis was 7.50 pm 4.14 years. Mean HbA1c was 10.30pm 2.58%;59 out of 76 children (77.6%) had uncontrolled glycemic levels, whereas 17 children (22.4%) had controlled glycemic levels according to the study criteria, mild underweight was observed in17.1%, moderate in15.8%, and severe in 13.2%, mild stunting was present in 14.5\%, moderate in 13.2\%, and severe in 15.8%, 31.6% were classified as underweight, 6.6\% as overweight, and 3.9% as obese, nutritional status was significantly associated with glycemic control across all metrics: weight-for-age (P = 0.017), height-for-age (P = 0.014), and BMI-for-age (P = 0.021). The detailed duration-of-diabetes table also showed statistically significant associations for weight-for-age (P = 0.027), height-for-age (P = 0.031), and BMI-for-age (P = 0.025), although the original narrative conclusion of the thesis described no overall significant differences between short- and long-duration groups and consuming one to two meals per day was associated with weight-for-age (P = 0.016) and height-for-age (P = 0.024), but not with BMI-for-age (P = 0.062). Severe underweight and severe stunting were significantly more frequent among males than females (P < 0.05), while age showed no statistically significant association with nutritional status.

Keywords

Type 1 diabetes mellitus; child growth; nutritional status; underweight; White Nile State; Sudan.

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References

Magliano DJ, Boyko EJ; IDF Diabetes Atlas 10th edition scientific committee. IDF Diabetes Atlas. 10th ed. Brussels: International Diabetes Federation; 2021.

Tuomilehto J, Ogle GD, Lund-Blix N, Stene LC. Epidemiology of childhood type 1 diabetes. Pediatr Endocrinol Rev. 2020;17(Suppl 1):198–209.

Manne-Goehler J, Geldsetzer P, Agoudavi K, et al. Health system performance for people with diabetes in 28 low- and middle-income countries: a cross-sectional study of nationally representative surveys. PLoS Med. 2019;16:e1002751.

Elamin A, Omer MI, Zein K, Tuvemo T. Epidemiology of childhood type 1 diabetes in Sudan 1978–1990. Diabetes Care. 1992;15:1558–1559.

Elamin A, Ghalib M, Eltayeb BTT. High incidence of type I diabetes mellitus in Sudanese children. Ann Saudi Med. 1997;17(4):478–480.

Saad FM, Mahmoud LA, Ali AMM, Omer IM, Abdullah MA. Incidence and prevalence of type 1 diabetes mellitus in children and adolescents aged 6 months–19 years in Khartoum State, Sudan. Sudan J Paediatr. 2020;20(2):163–169.

Sundberg F, de Beaufort C, Krogvold L, et al. ISPAD Clinical Practice Consensus Guidelines 2022: managing diabetes in preschoolers. Pediatr Diabetes. 2022;23:1496–1511.

Dinleyici M, Çarman KB, Özdemir C, et al. Quality-of-life evaluation of healthy siblings of children with chronic illness. Balkan Med J. 2019;37:34–42.

Hu K, Staiano AE. Trends in obesity prevalence among children and adolescents aged 2 to 19 years in the US from 2011 to 2020. JAMA Pediatr. 2022;176(10):1037–1039.

Buzzetti R, Zampetti S, Pozzilli P. Impact of obesity on the increasing incidence of type 1 diabetes. Diabetes Obes Metab. 2020;22(7):1009–1013.

de Ferranti SD, de Boer IH, Fonseca V, et al. Type 1 diabetes mellitus and cardiovascular disease: a scientific statement from the American Heart Association and American Diabetes Association. Circulation. 2014;130(13):1110–1130.

 Maffeis C, Birkebaek NH, Konstantinova M, et al. Prevalence of underweight, overweight, and obesity in children and adolescents with type 1 diabetes: data from the international SWEET registry. Pediatr Diabetes. 2018;19(7):1211–1220.

Chiang JL, Maahs DM, Garvey KC, et al. Type 1 diabetes in children and adolescents: a position statement by the American Diabetes Association. Diabetes Care. 2018;41(9):2026–2044.

 Los E, Wilt AS. Type 1 Diabetes in Children. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2025.

American Diabetes Association. Children and adolescents: Standards of Medical Care in Diabetes—2019. Diabetes Care. 2019;42(Suppl 1):S148–S164.

Wolfsdorf JI, Glaser N, Agus M, et al. ISPAD Clinical Practice Consensus Guidelines 2018: diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes. 2018;19(Suppl 27):155–177.

Triolo TM, Fouts A, Pyle L, et al.; Type 1 Diabetes TrialNet Study Group. Identical and nonidentical twins: risk and factors involved in development of islet autoimmunity and type 1 diabetes. Diabetes Care. 2019;42(2):192–199.

Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study Research Group. Intensive diabetes treatment and cardiovascular outcomes in type 1 diabetes: the DCCT/EDIC study 30-year follow-up. Diabetes Care. 2016;39(5):686–693.

Libman I. ISPAD Clinical Practice Consensus Guidelines: definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. 2022;23(8):1160–1174.

Mehta NM. Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. J Parent Enteral Nutr. 2023;37(4):460–481.

Uwaezuoke SN. Childhood diabetes mellitus and the double burden of malnutrition: an emerging public health challenge in developing countries. J Diabetes Metab. 2015;6:597.

Baseer KA, Mohammed AE, Elwafa AM, Sakhr HM. Prevalence of celiac-related antibodies and its impact on metabolic control in Egyptian children with type 1 diabetes mellitus. BMC Pediatr. 2024;24:99.

Bene J, Hadzsiev K, Melegh B. Role of carnitine and its derivatives in the development and management of type 2 diabetes. Nutr Diabetes. 2018;8:8.

Bahendeka SK. Diabetes in sub-Saharan Africa: let us not forget type 1. Lancet Diabetes Endocrinol. 2017;5:575–577. Sandovici I, Smith NH, Nitert MD, et al. Maternal diet and aging alter the epigenetic control of a promoter-enhancer interaction at the Hnf4a gene in rat pancreatic islets. Proc Natl Acad Sci U S A. 2021;108(13):5449–5454.

Park JH, Stoffers DA, Nicholls RD, Simmons RA. Development of type 2 diabetes following intrauterine growth retardation in rats is associated with progressive epigenetic silencing of Pdx1. J Clin Invest. 2018;118(6):2316–2324. Yajnik CS. Transmission of obesity-adiposity and related disorders from the mother to the baby. Ann Nutr Metab. 2014;64(Suppl 1):8–17.

Braziuniene I, et al. Effect of insulin with oral nutrients on whole-body protein metabolism in growing pubertal children with type 1 diabetes. Pediatr Res. 2019;65(1):109–112.

Elamin A, Hussein O, Tuvemo T. Growth, puberty, and final height in children with type 1 diabetes. J Diabetes Complications. 2006;20(4):252–256.

Ali MOE, Abdullah MA. Growth and nutritional assessment of children with type 1 diabetes mellitus in Wadmedani Teaching Hospital, Gezira State. Thesis. Sudan Medical Specialization Board; 2018.

Taha Z, Eltoum Z, Washi S. Predictors of glucose control in children and adolescents with type 1 diabetes: results of a cross-sectional study in Khartoum, Sudan. Maced J Med Sci. 2018;6(11):2035–2039.

Gabri MF, Abdshaheed TS, Zaki EH, ElNakeeb IF, Aly HM. Growth disorders in children with type 1 diabetes in Aswan, Egypt. Egypt J Hosp Med. 2020;81(4):1726–1731.

Sakhr HM, Hassan M, Ahmed AEA, et al. Nutritional status and extended metabolic screening in Egyptian children with uncomplicated type 1 diabetes. Sci Rep. 2024;14:21055.

Al-Bahnasawy A-EF, El-Mougy MT, Farag IM, Yadak SES. Assessment of the nutritional status of children and adolescents with type 1 diabetes mellitus. Al-Azhar Journal of Pediatrics. 2023;26(3):3483–3498.

Sherif EM, Adel Thabet R, Mahmoud RA, Abd El-aal AMA, et al. Assessment of anthropometric and pubertal growth of children and adolescents with type 1 diabetes mellitus. QJM. 2024;117(Suppl 1):070.519.

Aljuhani FM, Al-Agha AE, Almunami BA, et al. Growth status of children and adolescents with type 1 diabetes mellitus in Jeddah, Saudi Arabia: a cross-sectional study. Curr Pediatr Res. 2018;22(3):249–254.

Qadir KJ. Growth status of adolescents with diabetic type 1 and its associated factors. Medical Research Archives. 2023;11(7).

Mousa WLA, Aitte SA, Qasim AK. Nutritional status of pediatric patients with type 1 diabetes mellitus in DhiQar Governorate. Ann RSCB. 2021;25(7):370–375.

Hussein SA, Ibrahim BA, Abdullah WH. Nutritional status of children and adolescents with type 1 diabetes mellitus in Baghdad: a case-control study. J Med Life. 2023;16(2):254–260.

Dohan BR, Habeeb SI, Abed Khazaal A. Nutritional status of children and adolescents with type 1 diabetes mellitus in Basrah. Med J Basrah Univ. 2021;39(1):54–60.

Jumaan ZA. Nutritional status of children and adolescents with type one diabetes mellitus attending three diabetic clinics in Dar es Salaam, Tanzania. HKMU. 2021;4(7):12–17.

Kayirangwa A, Rutagarama F, Stafford D, McCal N. Assessment of growth among children with type 1 diabetes mellitus: a cross-sectional study of factors contributing to stunting. J Diabetes Metab. 2018;9:793.

Jadhav I, Chakole S. Effects of type 1 diabetes mellitus on linear growth: a comprehensive review. Cureus. 2023;15(9):e45428.

Mynepally M, Yadav BR, Mythili A, Vivekananda B, Subrahmanyam KA. Study of growth parameters in children and adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Diabetes. 2023;3:58–62.

Pavadigoudra MK, Sajjanar SB, Uday K, Ushakiran CB. Assessment of growth among children with type 1 diabetes mellitus. Int J Contemp Pediatr. 2024;11:1057–1060.

Demir K, Altıncık A, Abacı A, Büyükgebiz A, Böber E. Growth of children with type 1 diabetes mellitus. J Clin Res Pediatr Endocrinol. 2019;2(2):72–77.

Kim MS, Quintos JB. Mauriac syndrome: growth failure and type 1 diabetes mellitus. Pediatr Endocrinol Rev. 2019;5(Suppl 4):989–993.

Lebl J, Schober E, Zidek T, et al. Growth data in large series of 587 children and adolescents with type 1 diabetes mellitus. Endocr Regul. 2021;37(3):153–161.

Meira SO, Morcillo AM, Lemos-Marini SHV, et al. Pubertal growth and final height in 40 patients with type 1 diabetes mellitus. Arq Bras Endocrinol Metabol. 2019;49(3):396–402.

Salerno M, Argenziano A, Di Maio S, et al. Pubertal growth, sexual maturation, and final height in children with IDDM: effects of age at onset and metabolic control. Diabetes Care. 2018;20(5):721–724.

Choudhury S, Stutchfield P. Linear growth and weight gain in diabetic children: a cross-sectional and longitudinal evaluation. J Pediatr Endocrinol Metab. 2018;13(5):537–544.

Kanumakala S, Dabadghao P, Carlin JB, Vidmar S, Cameron FJ. Linear growth and height outcomes in children with early onset type 1 diabetes mellitus—a 10-yr longitudinal study. Pediatr Diabetes. 2002;3:189–193.

World Health Organization. WHO Child Growth Standards: Training Course on Child Growth Assessment. Geneva: WHO; 2008.

American Diabetes Association. Standards of Care in Diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S1–S321.

Mustafa IO, Tanko Y, Yusuf R, Musa SA. The use of glycated haemoglobin (HbA1C) in determining glycemic control (and relevance of BMI) in diabetic patients in Ahmadu Bello University Teaching Hospital Zaria, Nigeria. Diabetes Metab Syndr. 2019;13(5):2967–2972.

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