Abstract
Diabetes mellitus presenting in adolescents age 10 to 20 years accounts for less than 5% of all diabetes in tropical African countries. Consequently, inadequate attention is paid to the medical and psychosocial problems attendant on adolescent diabetes in those countries. This article highlights our clinical experience in the management of 30 adolescent diabetic subjects who presented consecutively in the diabetic clinic of a major Nigerian teaching hospital. In these patients, adolescent diabetes appeared heterogeneous, comprising classical insulin-dependent diabetes mellitus (IDDM) in approximately 80%; the remaining fraction (20%) was contributed variably by malnutrition-related diabetes (MRDM) and an "atypical" form of IDDM. The most common medical complications were recurrent hypoglycemia, ketoacidosis, and infections. About 80% of the patients were poor, and up to two thirds had to withdraw from school or trade because of recurrent illness. One third of the girls had a history of unwanted pregnancies. Almost all (93%) had a history of general rebelliousness and clinic truancy. Therefore, the high prevalence of acute metabolic decompensation may be related to the increased frequency of psychosocial problems, especially poverty, in these patients. It is suggested that agencies in tropical Africa increase welfare facilities for adolescent chronic disease, and also establish and encourage clinics dedicated to adolescent diabetes care.
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Selected References
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- Akanji A. O., Bella A. F., Osotimehin B. O. Cheiroarthropathy and long term diabetic complications in Nigerians. Ann Rheum Dis. 1990 Jan;49(1):28–30. doi: 10.1136/ard.49.1.28. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Akanji A. O., Famuyiwa O. O., Adetuyibi A. Factors influencing the outcome of treatment of foot lesions in Nigerian patients with diabetes mellitus. Q J Med. 1989 Nov;73(271):1005–1014. [PubMed] [Google Scholar]
- Akanji A. O. Malnutrition-related diabetes mellitus in young adult diabetic patients attending a Nigerian diabetic clinic. J Trop Med Hyg. 1990 Feb;93(1):35–38. [PubMed] [Google Scholar]
- Bella A. F. A prospective study of insulin-dependent diabetic Nigerian Africans. J Natl Med Assoc. 1992 Feb;84(2):126–128. [PMC free article] [PubMed] [Google Scholar]
- Deeb L. C., Tan M. H., Alberti K. G. Insulin availability among International Diabetes Federation member associations. Report of the Task Force on Insulin Distribution. Diabetes Care. 1994 Mar;17(3):220–223. doi: 10.2337/diacare.17.3.220. [DOI] [PubMed] [Google Scholar]
- KINNEAR T. W. The pattern of diabetes mellitus in a Nigerian teaching hospital. East Afr Med J. 1963 May;40:288–294. [PubMed] [Google Scholar]
- Lester F. T. Childhood diabetes mellitus in Ethiopians. Diabet Med. 1986 May;3(3):278–280. doi: 10.1111/j.1464-5491.1986.tb00763.x. [DOI] [PubMed] [Google Scholar]
- Mohan V., Mohan R., Susheela L., Snehalatha C., Bharani G., Mahajan V. K., Ramachandran A., Viswanathan M., Kohner E. M. Tropical pancreatic diabetes in South India: heterogeneity in clinical and biochemical profile. Diabetologia. 1985 Apr;28(4):229–232. doi: 10.1007/BF00282238. [DOI] [PubMed] [Google Scholar]
- Oli J. M. Diabetes mellitus in Africans. J R Coll Physicians Lond. 1983 Oct;17(4):224–227. [PMC free article] [PubMed] [Google Scholar]
- Osuntokun B. O., Akinkugbe F. M., Francis T. I., Reddy S., Osuntokun O., Taylor G. O. Diabetes mellitus in Nigerians: a study of 832 patients. West Afr Med J Niger Pract. 1971 Oct;20(5):295–312. [PubMed] [Google Scholar]
- Rayfield E. J., Ault M. J., Keusch G. T., Brothers M. J., Nechemias C., Smith H. Infection and diabetes: the case for glucose control. Am J Med. 1982 Mar;72(3):439–450. doi: 10.1016/0002-9343(82)90511-3. [DOI] [PubMed] [Google Scholar]
- Schade D. S., Drumm D. A., Duckworth W. C., Eaton R. P. The etiology of incapacitating, brittle diabetes. Diabetes Care. 1985 Jan-Feb;8(1):12–20. doi: 10.2337/diacare.8.1.12. [DOI] [PubMed] [Google Scholar]
- Serantes N. A. The problem of the diabetic patient in developing countries. Diabetologia. 1985 Aug;28(8):597–601. doi: 10.1007/BF00281994. [DOI] [PubMed] [Google Scholar]
- Tattersall R. Brittle diabetes. Br Med J (Clin Res Ed) 1985 Aug 31;291(6495):555–557. doi: 10.1136/bmj.291.6495.555. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Teuscher T., Baillod P., Rosman J. B., Teuscher A. Absence of diabetes in a rural West African population with a high carbohydrate/cassava diet. Lancet. 1987 Apr 4;1(8536):765–768. doi: 10.1016/s0140-6736(87)92797-8. [DOI] [PubMed] [Google Scholar]
- Wallenburg H. C., Dekker G. A., Makovitz J. W., Rotmans P. Low-dose aspirin prevents pregnancy-induced hypertension and pre-eclampsia in angiotensin-sensitive primigravidae. Lancet. 1986 Jan 4;1(8471):1–3. doi: 10.1016/s0140-6736(86)91891-x. [DOI] [PubMed] [Google Scholar]
- Williams G., Pickup J., Keen H. Psychological factors and metabolic control: time for reappraisal? Diabet Med. 1988 Apr;5(3):211–215. doi: 10.1111/j.1464-5491.1988.tb00972.x. [DOI] [PubMed] [Google Scholar]
