Factors associated with adherence to diabetes care recommendations among children and adolescents with type 1 diabetes: a facility-based study in two urban diabetes clinics in Uganda

Figures & data

Table 1 Background characteristics of the participants

Parameters	Overall	Boys	Girls	p-value
n (%)	200	96 (48.0%)	104 (52.0%)
Age of the participants, years (mean±SD)	15.3±4.2	15.7±4.3	15.0±4.1	0.058
HbA1c, % (mean±SD)	9.7±2.39	9.7±2.3	9.6±2.4	0.945
Age at diagnosis of T1DM, years (mean±SD)	10.5±4.3	11.2±4.4	10.0±4.1	0.040*
Age group of participants, n (%)
≤13 years	52 (26.0)	22 (22.9)	30 (28.8)	0.420
>13 years	148 (74.0)	74 (77.1)	74 (71.2)
HbA1c status, n (%)				0.722
High (>7.5%)	161 (80.5)	76 (79.2)	85 (81.7)
Normal (≤7.5%)	39 (19.5)	20 (20.8)	19 (18.3)
Schooling level, n (%)				0.139
Preprimary	7 (3.50)	5 (5.2)	2 (1.9)
Primary	51 (25.5)	18 (18.8)	33 (31.7)
Secondary	66 (33.0)	33 (34.4)	33 (31.7)
University/tertiary	24 (12.0)	15 (15.6)	9 (8.7)
Not in school	52 (26.0)	25 (26.0)	27 (26.0)
Household SES tertile, n (%)				0.209
Lowest	84 (42.0)	37 (38.5)	47 (45.2)
Medium	57 (28.5)	33 (34.4)	24 (23.1)
Highest	59 (29.5)	26 (27.1)	33 (31.7)
Family history of type 1 diabetes, n (%)				1.000
Yes	114 (57.0)	55 (57.3)	59 (56.7)
No	86 (43.0)	41 (42.7)	45 (43.3)

Notes: Data are presented as mean±SD unless specified otherwise; p-values were obtained by Mann–Whitney U test for comparison between continuous variables and by Fischer’s exact tests for categorical variables;

* significant association.

Abbreviations: HbA1c, glycated hemoglobin; SD, standard deviation; SES, socioeconomic status; T1DM, type 1 diabetes mellitus.

Figure 1 Level of adherence to diabetes care recommendations among children and adolescents with type 1 diabetes.

Abbreviations: BG, blood glucose; CI, confidence interval.

Table 2 Child/adolescent factors associated with adherence to type 1 diabetes care recommendations

Child/adolescent factors	n	Patients adhering to recommendations (%)	Unadjusted PRR (95% CI)	p-value
Age group
≤13 years	52	46.2	1
>13 years	148	33.8	0.73 (0.50, 1.06)	0.099
Schooling level
Preprimary	7	42.7	1
Primary	51	47.1	1.09 (0.44, 2.71)	0.840
Secondary	66	40.9	0.95 (0.38, 2.36)	0.920
University/tertiary	24	33.3	0.77 (0.27, 2.17)	0.632
Not in school	52	23.1	0.53 (0.19, 1.45)	0.221
Sex of child
Male	96	35.4	1
Female	104	38.5	1.08 (0.75, 1.56)	0.657
Household SES tertile
Lowest	84	28.6	1
Medium	57	45.6	1.59 (1.02, 2.48)	0.038*
Highest	59	40.7	1.42 (0.90, 2.25)	0.131
Frequency of visits in the last 6 months
>5	118	43.2	1
≤5	82	28.1	0.64 (0.43, 0.97)	0.036*
Number of BG tests per day
>3	22	59.1	1
≤3	178	34.3	0.57 (0.38, 0.86)	0.008*
Number of injections per day
≥3	120	40.0	1
<3	80	32.5	0.81 (0.55, 1.19)	0.291
Alternative medicine use
Yes	29	24.1	1
No	168	39.3	1.62 (0.83, 3.19)	0.157
Another source of insulin/syringe other than treatment facility
Yes	18	16.7	1
No	182	39.0	2.34 (0.81, 6.69)	0.113
Frequency of missed facility visits
More than once	57	26.3	1
Once and less	143	41.3	1.56 (0.97, 2.52)	0.065
Frequency of drug stock-out
None	127	35.4	1
Once or more times	73	39.7	1.12 (0.77, 1.62)	0.543

Note:

* Significant association.

Abbreviations: BG, blood glucose; CI, confidence interval; PRR, prevalence rate ratio; SES, socioeconomic status.

Table 3 Caretaker factors associated with adherence to type 1 diabetes care recommendations

Caretaker factors	n	Patients adhering to recommendations (%)	Unadjusted PRR (95% CI)	p-value
Age group (caretaker)
>40 years	92	34.78	1
≤40 years	108	38.89	1.11 (0.77, 1.61)	0.551
Sex of caretaker
Male	41	26.83	1
Female	159	39.62	1.47 (0.85, 2.53)	0.159
Education level
Primary	35	25.71	1
Secondary	85	40.00	1.55 (0.83, 2.89)	0.164
Tertiary	18	50.00	1.94 (0.93, 4.03)	0.074
University graduate	54	37.04	1.44 (0.74, 2.79)	0.281
No formal education	8	25.00	0.97 (0.25, 3.67)	0.967
Caretaker category
Mother	125	36.80	1
Father	32	28.13	0.76 (0.41, 1.39)	0.381
Sibling	20	55.00	1.49 (0.94, 2.36)	0.086
Other	23	34.78	0.94 (0.51, 1.73)	0.855
Marital status
Never married	35	31.43	1
Married	131	35.11	1.11 (0.64, 1.92)	0.689
Separated/divorced	27	59.26	1.88 (1.05, 3.37)	0.033*
Widowed	7	14.29	0.45 (0.06, 2.99)	0.412
Knowledge of child caretakers/adolescents
Good	61	62.30	1
Medium	75	30.67	0.49 (0.33, 0.72)	<0.001*
Poor	64	20.31	0.32 (0.19, 0.55)	<0.001*
Attitude of child caretakers/adolescents about diabetes
Good	32	50.00	1
Medium	129	34.11	0.68 (0.44, 1.04)	0.076
Poor	39	35.90	0.71 (0.41, 1.23)	0.234
Friend and family support
Poor	59	32.20	1
Good	141	39.01	1.21 (0.79, 1.85)	0.377
Caretaker involvement in diet monitoring
Inactive	83	18.07	1
Active	117	50.43	2.79 (1.70, 4.56)	<0.001*
Caretaker involvement in insulin injection supervision
Very active	83	54.22	1
Slightly active	45	22.22	0.41 (0.22, 0.73)	0.003*
Not active	72	26.39	0.48 (0.31, 0.75)	0.001*

Note:

* Significant association.

Abbreviations: CI, confidence interval; PRR, prevalence rate ratio.

Table 4 Factors independently associated with adherence to type 1 diabetes care recommendations

Factors	n	Patients adhering to recommendations (%)	Unadjusted PRR (95% CI)	Adjusted PRR (95% CI)	p-value
Age group (child)
≤13 years	52	46.2	1	1
>13 years	148	33.8	0.73 (0.50, 1.06)	1.08 (0.97, 1.19)	0.131
Caretaker category
Mother	125	36.80	1	1
Father	32	28.13	0.76 (0.41, 1.39)	1.05 (0.93, 1.18)	0.405
Sibling	20	55.00	1.49 (0.94, 2.36)	1.66 (1.61, 1.71)	<0.001*
Other	23	34.78	1.09 (0.51, 1.73)	1.13 (0.63, 1.88)	0.743
Household SES tertile
Lowest	84	28.6	1	1
Medium	57	45.6	1.59 (1.02, 2.48)	1.10 (0.87, 1.39)	0.870
Highest	59	40.7	1.42 (0.90, 2.25)	1.08 (0.89, 1.31)	0.893
Caretaker’s marital status
Never married	35	31.43	1	1
Married	131	35.11	1.11 (0.64, 1.92)	1.10 (1.05, 1.14)	<0.001*
Separated/divorced	27	59.26	1.88 (1.05, 3.37)	1.60 (1.12, 2.27)	0.008*
Widowed	7	14.29	0.45 (0.06, 2.99)	0.63 (0.33, 1.19)	0.162
Number of tests per day
>3	22	59.1	1	1
≤3	178	34.3	0.57 (0.38, 0.86)	0.63 (0.42, 0.95)	0.029*
Frequency of visits in the last 6 months
>5	118	43.2	1	1
≤5	82	28.1	0.64 (0.43, 0.97)	0.64 (0.42, 0.98)	0.044*
Knowledge of caretakers/adolescents
Good	61	62.30	1	1
Medium	75	30.67	0.49 (0.33, 0.72)	0.83 (0.48, 1.44)	0.525
Poor	64	20.31	0.32 (0.19, 0.55)	0.49 (0.43, 0.57)	<0.001*
Caretaker involvement in diet monitoring
Inactive	83	18.07	1	1
Active	117	50.43	2.79 (1.70, 4.56)	1.95 (1.01, 3.78)	0.047*
Caretaker involvement in insulin injection supervision
Very active	83	54.22	1	1
Slightly active	45	22.22	0.41 (0.22, 0.73)	0.49 (0.20, 1.23)	0.132
Not active	72	26.39	0.48 (0.31, 0.75)	0.58 (0.56, 0.60)	<0.001*

Note:

* Significant association.

Abbreviations: CI, confidence interval; PRR, prevalence rate ratio; SES, socioeconomic status.