Challenges in achieving adequate glycemic control among children with type 1 diabetes mellitus in a resource-limited setting: A cross-sectional study from Sudan

Objective: To assess glycemic control and associated factors in children with type 1 diabetes mellitus (T1DM) attending the pediatric diabetes clinic in Wad-Madani City, Sudan. Methods: This cross-sectional observational study was conducted at a referral center in Sudan. The study population consisted of children aged 1–18 years who had been diagnosed with T1DM for more than 1 year and were under regular follow-up in the clinic. Data on their glycemic control and sociodemographic and clinical characteristics were captured. Results: Out of 211 enrolled patients, 120 (56.9 %) were females. The mean age was 11.7 years (SD = 4.0), with the mean age at diagnosis of 6.7 years (SD = 4.0). Only 6.2 % achieved adequate glycemic control. Adolescents had particularly poor control (97.8 %). The mean glycosylated hemoglobin (HBA1c) level was 10.4 % (90 mmol/mol). Inferior glycemic control was associated with advancing age, older age at diagnosis, belonging to single-parent households, less frequent self-monitoring of blood glucose (SMBG), and having a greater number of siblings or household members. A third of patients (33.8 %) had had one or more diabetes ketoacidosis (DKA) episodes in the previous year. There was a high prevalence of lipodystrophy (34.1 %) and arthropathy (25.1 %). Conclusions: An exceptionally low proportion of children with T1DM achieved adequate glycemic control, with adolescents particularly struggling. SMBG frequency and family dynamics emerged as potential factors, highlighting the urgent need for tailored interventions and improved diabetes education in resource-limited settings.