Determinants of glycemic control in children and adolescents with type 1 diabetes (T1D) in three care centers of the changing diabetes in children (CDIC) program in the northern regions of Cameroon.

OBJECTIVE: Aim: Type 1 diabetes mellitus (T1DM) is the most common endocrine disorder affecting children and adolescents worldwide. Glycemic control is the ultimate goal of diabetes management, and poor glycemic control is associated with serious short- and long-term complications. Only a few studies have addressed this problem in Cameroon. This study aimed to identify the determinants of glycemic control of T1DM in children and adolescents living in the three northern regions of Cameroon. PATIENTS AND METHODS: Materials and Methods: This was a descriptive and analytical cross-sectional study conducted on 100 children and adolescents with type 1 diabetes followed up in the three T1DM management centers of the CDiC program in the northern regions of Cameroon, from November 2016 to March 2017. Glycemic control was assessed on the basis of glycosylated hemoglobin (HbA1c) levels, according to the current ADA Standards of Care in Diabetes-2025 and ISPAD Clinical Practice Consensus Guidelines 2022, both of which recommend a universal target of HbA1c ≤7.0% (≤53 mmol/mol) for all children and adolescents with type 1 diabetes, regardless of age group. Data were entered into CDC Epi-info™ version 7.2 software, then exported to IBM SPSS Statistics™ version 20.0 for analysis. Descriptive and inferential statistics were used. Bivariate analysis was followed by binary logistic regression to calculate adjusted odds ratios (AORs) for determinants of glycemic control, and a p-value <0.05 was considered statistically significant. RESULTS: Results: The 100 participants were predominantly male (73%), with a mean age of 16.59 ± 2.54 years. The median HbA1c value was 10.08% [8.7-11.63], reflecting very poor overall glycemic control. Applying the current unified ADA/ISPAD target of ≤7.0% (53 mmol/mol), only 19% of participants achieved their glycemic targets - a proportion markedly lower than figures reported in high-income countries such as the United States (approximately 21-25% in the T1D Exchange Registry). In bivariate analysis, variables significantly associated with glycemic control included: being followed in the Adamaoua region (OR=0.21 [0.07-0.62]; p=0.003), living within 20 km of the diabetes clinic (OR=4.4 [0.94-20.84]; p=0.04), and duration of diabetes less than 2 years (OR=2.90 [1.06-8.30]; p=0.03). In multivariate logistic regression, belonging to the Adamaoua region, a treatment regimen of more than 2 injections per day, living less than 20 km from the management clinic, fewer than three episodes of severe hypoglycemia in the last 6 months, duration of diabetes less than 2 years, and participation in more than three therapeutic education sessions were associated with achieving glycemic targets. CONCLUSION: Conclusions: The majority of children and adolescents with T1DM in the northern regions of Cameroon had poor glycemic control, with only 19% achieving the current unified target of HbA1c ≤7.0% (≤53 mmol/mol). Belonging to the Adamaoua region, intensive insulin therapy (>2 injections/day), proximity to the care center (<20 km), fewer severe hypoglycemic episodes, shorter disease duration (<2 years), and regular therapeutic education were identified as factors associated with good glycemic control. Although global innovations such as hybrid closed-loop insulin delivery systems and teplizumab represent transformative advances in T1D management, these technologies remain inaccessible in the study setting. Intensification of therapeutic education, creation of satellite CDiC centers, and progressive adoption of affordable monitoring technologies are urgently needed.