EFFECT OF TYPE 1 DIABETES ON HEALTH-RELATED QUALITY OF LIFE AND ACADEMIC PERFORMANCE AMONG CHILDREN AND ADOLESCENTS IN TWO HOSPITALS IN YAOUNDE

Abstract

Background: Type 1 diabetes mellitus (T1DM) is a chronic disease associated with many challenges that may negatively affect the physical, emotional, social, and academic well-being of children and adolescents. In addition to metabolic disturbances, children with T1DM may experience difficulties in daily disease management, potentially impairing their health-related quality of life and academic performance. Data on these outcomes remain limited in Cameroon. Objective: We aimed to evaluate the effect of T1DM on health-related quality of life (HRQOL) and academic performance among children and adolescents in two hospitals in Yaoundé. Methods: A case control study was conducted among children and adolescents including 82 diabetic children and 168 non-diabetic controls (matched according to age, sex, school type, level of education, parent’s sector of activity) recruited in two hospitals and secondary schools in Yaoundé. Sociodemographic and clinical data were collected using structured questionnaire. HRQOL was assessed using the PedsQL™ Generic Core 4.0 Scale and the PedsQL™ 3.2 Diabetes Module. Academic performance was evaluated using school absenteeism during first term/days and first term averages/20 scores. Descriptive and comparative analyses were performed, followed by bivariate analyses to determine the association between glycated hemoglobin (HbA1c) and diabetes-specific HRQOL, and academic performance. Statistical significance was set at p < 0.05. Results: the median age for both groups was 15 years old [IQR: 14-17] years. Poor glycemic control (HbA1c >7%) was observed in 90.2% of patients, with a mean HbA1c of 10.51% ± 2.47%. Hyperglycemic counts (>180 mg/dl) were reported by 97.6% of patients, with a median of 10 [6–13] counts per week, while hypoglycemic counts (<70 mg/dl) occurred in 76.5%, with a median of 3 [2–4] counts per week. Most diabetic children reported delayed insulin injection and missed glucose monitoring at school due to school hours and injection-related embarrassment. The total score of the PedsQL Diabetes Module was 58.84, with the worry domain being the most affected (33.33). Compared with controls, diabetic participants had significantly lower HRQOL scores across all PedsQL Generic Core domains, including total score (64.13 vs 82.61) with the most affected domain being school functioning followed by emotional functioning. Median first term average was also significantly lower in diabetic patients (10.98 vs 11.5, p = 0.002), with higher absenteeism (4.0 vs 2.0 p < 0.001), mainly due to routine visits. HbA1c was negatively correlated with total diabetes HRQOL (= -0.249, p =

0.024), and first term average (r=-0.376, p<0.001), and was positively associated to absenteeism (=0.338, p=0.0059) in bivariate analysis. Conclusion: Children and adolescents with T1DM in Yaoundé exhibited poor glycemic control, impaired health-related quality of life, and poorer academic performance compared with non-diabetic peers. These findings highlight the importance of diabetes care integrating affordable self-monitoring supplies, psychosocial support and structured diabetes education programs for children, and their caregivers, Establish a supportive school environment.