Growth and type 1 diabetes in Rwanda

OBJECTIVE: To describe the growth status of children and youth (<27 yr) with type 1 diabetes (T1D) in the Rwanda Life For A Child (LFAC) program, to compare growth to other standard populations, and to identify factors that affect growth in order to improve growth outcomes. This paper will impact global public health by increasing knowledge on non-communicable diseases, specifically diabetes, in resource poor settings. \ud RESEARCH DESIGN AND METHODS: Data on height, weight, and HbA1c were collected from 747 individuals from June 2009 to March 2013 for the LFAC program in Rwanda. WHO definitions for growth standards were applied to this population and compared with world and non-diabetic Rwandan populations. Cross-sectional analysis was used to evaluate the most significant correlates of growth at first visit as determined by percentages stunted, thin, and underweight. \ud RESULTS: At first visit (n=747), 24.18% of the study population was found to be stunted, 31.86% thin, and 29.01% underweight. Rwandan children fare significantly worse (p<.0001) than their diabetic counter-parts around the world and also have lower body mass index and higher percentages of females under 145 cm than non-diabetic Rwandans. After controlling for other variables, the most important influences on stunting are sex (p<.0006), age at visit (p<.03), and weight (p<.0001). Significant correlates of thinness are sex (p<.0007) and HbA1c (p<.02). Important variables for determining the underweight are sex (p<.008), age at visit (p<.0001), and HbA1c (p<.0001). \ud CONCLUSIONS: T1D children in Rwanda suffer from impaired growth, likely related to poor glycemic control, failure to gain weight, and environmental factors. Further research specifically oriented towards growth needs to occur in order to better understand how to achieve normal growth, specifically looking at nutrition and access to food and diabetes supplies