Achievement of Glycaemic Targetsin Ethiopian Children and Adolescents with Type 1 Diabetes: A Multi-Indicator Assessment

Introduction: Maintaining blood glucose within recommended ranges is essential for preventing complications and improving health outcomes in children and adolescents with Type 1 diabetes. However, evidence on glycaemic target achievement in sub-Saharan Africa is limited. This study, therefore, assessed glycaemic target achievement using multiple indicators and examined factors associated with optimal achievement.

Methods:  A multicentre study combining secondary document review and a participant survey was conducted among 405 children and adolescents with type 1 diabetes mellitus across five hospitals in Ethiopia. Glycaemic status was assessed using HbA1c (target ≤7.0% [53 mmol/mol], applied to all participants) and one-week-averaged fasting (target 80-144 mg/dl) and random blood glucose (target 70-180 mg/dl). One-week average glucose values were calculated from all available fasting and random glucose measurements recorded during the seven days preceding data collection. Potential determinants were selected using the socioecological and health service frameworks. Multivariable logistic regression was used to identify factors associated with HbA1c target achievement, with p < 0.05 as the significance threshold.

Results: Of the 405 participants, only 54 (13.33%) achieved the HbA1c target (≤7.0% [53 mmol/mol]). Among 368 participants with available fasting glucose records, 141 (38.3%) achieved the fasting glucose target (80–144 mg/dl), while among 379 participants with available random glucose records, 161 (42.5%) achieved the random glucose target (70–180 mg/dl). Hypoglycaemia was the most frequent acute complication (29.9%), while diabetic ketoacidosis occurred in 19.7% of participants. Better glycaemic status was associated with male sex (AOR 2.15; 95% CI 1.14–4.03), shorter diabetes duration (AOR 0.47 per year; 95% CI 0.31–0.71), no recent hospitalisation (AOR 2.93; 95% CI 1.01–8.46), and attending diabetes education (AOR 2.73; 95% CI 1.25–5.96). Lower HRQoL was associated with glycaemic levels above the target.

Conclusion: Glycaemic target achievement across multiple indicators remains suboptimal among children and adolescents with T1DM in Ethiopia, alongside a high burden of acute complications. Glycaemic outcomes were influenced by demographic, clinical and psychosocial factors. These findings highlight the need to strengthen diabetes education, improve continuity of care, address challenges associated with longer diabetes duration, and integrate psychosocial support into routine diabetes services in resource-limited settings.