Prevalence and Factors Associated with Microalbuminuria in Pediatric Patients with Type 1 Diabetes Mellitus at a Large Tertiary-Level Hospital in Botswana

Introduction: Microalbuminuria is considered the earliest sign of diabetic nephropathy among patients with type 1 diabetes mellitus (T1DM). The prevalence of microalbuminuria among African children with T1DM is reported to be high, yet its prevalence and population-specific risk factors in Botswana are not known. Aim: This study aimed to determine the prevalence of microalbuminuria among children and young adults with T1DM in Botswana and identify factors associated with microalbuminuria in this population. Methods: A retrospective cross-sectional study was conducted on 127 T1DM patients aged <24 years followed at a pediatric endocrinology clinic in Botswana from 2010 to 2017. Clinical, laboratory, and demographic data were collected using chart review and patient surveys. Descriptive statistics were reported as mean and standard deviation for continuous variables, and frequency and percentage for categorical variables. Prevalence of microalbuminuria was calculated as a simple proportion. Group comparison was done using twosample independent t-test, X-2-test, or Fisher's exact test and logistic regression to assess for associations. Level of significance was set at p<0.05. Results: There were a total of 71 (55.9%) females. The mean age was 18.7 (+/- 5) years and mean duration of T1DM was 6.6 (+/- 4.6) years. Most study participants were of African descent. The prevalence of microalbuminuria was 28.3%. Group comparison revealed gender (p= 0.040), duration of diabetes (p= 0.002), systolic blood pressure (p=0.003), baseline glycated hemoglobin (HbA1c) (p=0.009) and Tanner's stage (p=008) to be significantly associated with microalbuminuria. On binary logistic regression, only gender (p=0.039) and baseline HbA4c (p=0.039) were independently associated with the presences of microalbuminuria. Conclusion: This study identified a high prevalence of microalbuminuria among children and young adults with T1DM in Botswana and reaffirms the importance of early detection, glycemic control, and regular screening to prevent diabetic nephropathy.