Assessment of Growth among Children with Type 1 Diabetes Mellitus: A Cross-Sectional Study of Factors Contributing to Stunting

Introduction: Diabetes is a worldwide health challenge. Research done among diabetic children concluded that the abnormalities in growth associated with diabetes are due to reduced insulin use and are reversible with adequate insulin therapy. A diabetic child who is on appropriate treatment should have no impairment of growth. In this study, we assessed the prevalence of stunting among a population of pediatric patients with diabetes. Methods: It is a descriptive cross-sectional study done from September to December 2015 in Rwanda. 136 children from 23 districts were included. Patients aged 1 to 18 years old were enrolled. Weight, height and Glycated hemoglobin were our study parameters. Stunting was defined as height for age below -2SD. Previous HbA1c readings were obtained from patient files. Interviews were used to code demographic, socio-economic factors, access to and affordability of food and clinical data information. Data entry was done in Epidata and analyzed by Stata 13. Result: 136 children were enrolled, aged 2 to 18 years with a mean age of 15.5. 39.7% were male and 60.3% were female. The prevalence of stunting was 30.9%. The mean HbA1c was 9.7%; 28% were well controlled with an HBA1c <7.5, whereas 41.2% had a poor glycemic control with HbA1c of 10% or above. Those with lower socioeconomic status were better controlled. The mean daily Insulin dose was 0.8 IU/kg/day. Regarding availability of meals, 4.4% reported to have only one meal per day. 34.6% admitted their nutrition was inadequate. No secondary school education for parents was associated with stunting. Districts Huye and Rusizi were the most affected with stunting. Insufficiently fed children were likely to be stunted. Conclusion: The prevalence of stunting among children with diabetes was high. There was no association between stunting and glycemic control, but there was an association between stunting and poor socio-economic condition.