Risk Factors Associated with Type 1 Diabetes Mellitus among Children and Adolescents in Multan Division, Pakistan - A Population-Based Case-Control Study

Abstract

Background: Type 1 diabetes mellitus (T1DM) is a significant public health issue in the global community and its morbidity is growing in children and adolescents. Nonetheless, there is limited epidemiological evidence on risk factors, as well as clinical features of T1DM in developing countries like Pakistan.

Objective: The current study aimed to identify factors related to T1DM in children and adolescents in Multan Division of Pakistan.

Methods: A population-based case-control study was performed on a population of 614 participants [case (n=221) and control (n=393)]. A structured and validated questionnaire was used to collect data related to demographic characteristics, clinical and psychosocial variables. Descriptive statistics was used to summarize characteristics of the participants. Chi-square tests and logistic regression analysis were conducted to assess the association between potential factors and T1DM at p < 0.05 significant level.

Results: The current study revealed that Multan city had a higher rate of T1DM cases (42.9%; 95% CI: 37.7–48.1) compared to Jalalpur Pir Wala (27.4%; 95% CI: 21.0–34.6) and Shujabad (25.9%; 95% CI: 17.4–36.4). there was a significant relationship between age at diagnosis and T1DM with children diagnosed aged below 5 years showing more odds than those diagnosed between 6-10 years (OR = 0.44) and 11-15 years (OR = 0.12). Clinical indicators of the severity of the disease were almost universal insulin dependence (99.5%) and inadequate glycemic control with HbA1c levels between 9–10% (OR = 170.0) and >10% (OR = 29.0). Several diabetes-related complications were also significantly related to T1DM cases such as diabetic ketoacidosis (OR = 219.0), weight loss (OR = 22.6), visual problems (OR = 30.67), and hypoglycemic episodes (OR = 104.14). Children with T1DM had significant psychosocial challenges including social discrimination (OR = 104.14), negative community experiences (OR = 119.67), and substantial impacts on mental health (OR = 39.0).

Conclusion: The current study revealed that several demographic, clinical and psychosocial variables were associated with T1DM in children and adolescents. Therefore, there is need to enhance early detection, diabetes education/awareness programs, and further strengthen healthcare support systems to enhance disease management and patient wellbeing.