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 Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 6  |  Issue : 1  |  Page : 76

Childhood diabetes mellitus in a rural tertiary hospital in North-West Nigeria


Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq

Date of Submission12-May-2018
Date of Decision18-Jun-2018
Date of Acceptance15-Aug-2018
Date of Web Publication14-Feb-2019

Correspondence Address:
Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_64_18

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How to cite this article:
Al-Mendalawi MD. Childhood diabetes mellitus in a rural tertiary hospital in North-West Nigeria. CHRISMED J Health Res 2019;6:76

How to cite this URL:
Al-Mendalawi MD. Childhood diabetes mellitus in a rural tertiary hospital in North-West Nigeria. CHRISMED J Health Res [serial online] 2019 [cited 2019 Mar 23];6:76. Available from: http://www.cjhr.org/text.asp?2019/6/1/76/252295



Sir,

I read with interest the study by Idris published in April 2018 issue of CHRISMED J Health Res.[1] In a 10-year retrospective study of Nigerian children with Type 1 diabetes mellitus (TIDM), the author reported that all the studied children presented with diabetic ketoacidosis (DKA) at the initial diagnosis of T1DM.[1] The author attributed that the variation in the frequency of the reported DKA with that in the developed countries to racial, ethical, genetic, and environmental factors.[1] The author also postulated that socioeconomic status, access to healthcare services, and level of awareness of the population to T1DM might also be contributory.[1] Moreover, the author proposed that DKA at the onset of T1DM might be due to delayed diagnosis or an indication of an aggressive form of the disease.[1] I presume that the following four points might be additionally relevant.

First, the highest frequency of DKA (100%) in Idris's study[1] could coincide with the general trend of rapidly increasing incidence of T1DM among children in developed world, and consequently, DKA has become an increasingly important problem in the pediatric population.[2]

Second, the author did not address the parental education level of the studied TIDM children. I presume that this variable might influence the frequency of DKA in the studied population as it was found that DKA at the diagnosis was associated with low parental education.[3]

Third, although the author mentioned that 11.1% of the studied TIDM children were under the age of 10 years while 88.8% were above 10 years of age,[1] it is noteworthy that difficulties in diagnosing T1DM importantly contribute to DKA development in children with new-onset T1DM and patient's age at presentation represents an important risk factor of delayed diagnosis particularly in young children. Moreover; diabetic children overall were noticed to have more medical encounters before diagnosis than control children and children with DKA were less likely to have had relevant laboratory testing before diagnosis than children with diabetes without DKA.[4]

Fourth, to the best of my knowledge, Nigeria is a multireligious country. The author did not define the religious backgrounds of the studied TIDM population. This point is important to be taken into consideration as it has been noticed that the religious affiliation had an impact on presentation with DKA in TIDM children. For instance, DKA and severe DKA at diabetes diagnosis were found to be more common among religious ultra-orthodox than among secular Jewish children.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Idris UA. Childhood diabetes mellitus in a rural tertiary hospital in North-West Nigeria. CHRISMED J Health Res 2018;5:123-6.  Back to cited text no. 1
  [Full text]  
2.
Wojcik M, Sudacka M, Wasyl B, Ciechanowska M, Nazim J, Stelmach M, et al. Incidence of type 1 diabetes mellitus during 26 years of observation and prevalence of diabetic ketoacidosis in the later years. Eur J Pediatr 2015;174:1319-24.  Back to cited text no. 2
    
3.
Lee HJ, Yu HW, Jung HW, Lee YA, Kim JH, Chung HR, et al. Factors associated with the presence and severity of diabetic ketoacidosis at diagnosis of type 1 diabetes in Korean children and adolescents. J Korean Med Sci 2017;32:303-9.  Back to cited text no. 3
    
4.
Bui H, To T, Stein R, Fung K, Daneman D. Is diabetic ketoacidosis at disease onset a result of missed diagnosis? J Pediatr 2010;156:472-7.  Back to cited text no. 4
    
5.
Gruber N, Reichman B, Lerner-Geva L, Pinhas-Hamiel O. Increased risk of severe diabetic ketoacidosis among Jewish ultra-orthodox children. Acta Diabetol 2015;52:365-71.  Back to cited text no. 5
    




 

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