Association of limited joint mobility in childhood and adolescent diabetes mellitus patients with HBA1C, microalbuminuria, and retinopathy at Tygerberg Hospital, Western Cape, South Africa

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dc.contributor.advisorZollner, Ekkeharden_ZA
dc.contributor.advisorKruger, Marianaen_ZA
dc.contributor.authorSekgabo, Nightingaleen_ZA
dc.contributor.otherStellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.en_ZA
dc.date.accessioned2020-02-19T11:11:54Zen_ZA
dc.date.accessioned2020-04-28T12:01:28Zen_ZA
dc.date.available2020-02-19T11:11:54Zen_ZA
dc.date.available2020-04-28T12:01:28Zen_ZA
dc.date.issued2020-03en_ZA
dc.descriptionThesis (MMed)--Stellenbosch University, 2020en_ZA
dc.description.abstractENGLISH SUMMARY: BACKGROUND: Limited joint mobility (LJM) is the earliest clinically apparent long-term complication of diabetes mellitus (DM) in children and adolescents. The importance of LJM in young diabetic patients is that it is related to serious microvascular complications, especially retinopathy and nephropathy. OBJECTIVES: The primary objective of this study was to determine the relationship of LJM with blood HbA1c levels, microalbuminuria, and diabetic retinopathy. The secondary objective was to determine the prevalence of LJM in all children with DM. METHODS: This was a retrospective folder review done at the Tygerberg Hospital paediatric diabetes clinic over a10 year period. Pre-pubertal patients were included if they had DM for ≥5 years, and pubertal patients were included if they had DM for ≥2 years. The following data was recorded: Age, sex, type of DM, duration of DM, absence/presence of LJM, HbA1c, insulin regimen, urine albumin/Cr, and absence/presence of retinopathy. RESULTS: Of the 129 patients enrolled in the study, only 74 patients fulfilled the entry criteria. They had Type 1 diabetes (T1DM), with a median age of 8 years (IQR 4- 10.75) at diagnosis. LJM occurred in 60.8% (45/74). Of these, 37 had HbA1c of 8.5% and above, 2 had retinopathy, and a total of 12 patients had microalbuminuria (> 2mg/mmol). There was no statistically significant association between LJM and HbA1c [OR=1.038 (95% CI 0.303 to 3.550)], retinopathy (P value 1.000), and microalbuminuria, (p value 0.594). Sex, the type of insulin regimen, and age at diagnosis also did not influence the outcome [OR=0.988,95% CI (0.365,2.673), p value 0.202,OR=1.063,95% CI (0.877,1,290), respectively)]. A borderline association was observed between LJM and duration on DM (p-value=0.053). This association is not confirmed in the multiple regression model that accounts for the effect of potential confounders [OR=1.215 (95% CI 0.941, 1.569)]. The diagnostic performance of LJM as a screening tool for poor glycaemic control is as follows: Sensitivity = 82.2%, (95% CI 71.1-93.3) %, specificity = 17.24 % (95% CI 3.49-30.99%), Positive Predictive Value=60.66%, 95% (CI 48.4%, 72.91%), and Negative Predictive Value=38.46%, 95% CI (12.02%, 64.91%). ROC model is not better than chance (95% CI 0.413,0.592), and the p value of 0.9534 also confirms this. LJM has a good sensitivity and poor specificity. CONCLUSION: Although most studies describe LJM as a common and early long-term complication in diabetes patients, it is not a useful screening test for poor glycaemic control or microvascular complications. Diabetes duration seems to be an important determinant of LJM. A larger multicentre prospective study to better investigate this relationship should be performed. Knowing that there is an association between LJM and microvascular complications would provide an inexpensive clinical alternative to investigations not readily available in a low resource setting, for the early identification of poor control and increased risk of other microvascular complications.en_ZA
dc.description.abstract"Geen opsomming biskikbaar"af_ZA
dc.description.versionMastersen_ZA
dc.embargo.terms2020-12-31en_ZA
dc.format.extent20 pages : illustrationsen_ZA
dc.identifier.urihttp://hdl.handle.net/10019.1/107740en_ZA
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch Universityen_ZA
dc.rights.holderStellenbosch Universityen_ZA
dc.subjectDiabetesen_ZA
dc.subjectDiabetes mellitusen_ZA
dc.subjectLimited joint mobilityen_ZA
dc.subjectAlbuminuriaen_ZA
dc.subjectMicrocirculation disordersen_ZA
dc.subjectDiabetes in childrenen_ZA
dc.subjectUCTDen_ZA
dc.titleAssociation of limited joint mobility in childhood and adolescent diabetes mellitus patients with HBA1C, microalbuminuria, and retinopathy at Tygerberg Hospital, Western Cape, South Africaen_ZA
dc.typeThesisen_ZA
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