Type 1 diabetes patient experiences and management practices during the COVID-19 pandemic in rural Uganda.

Background: The COVID-19 pandemic has impacted various aspects of the lives of persons with chronic diseases, including type 1 diabetes (T1D). However, the diabetes care experiences and practices adopted by persons living with T1D after the declaration of the COVID-19 pandemic in Uganda have not been well documented. Objectives: We investigated diabetes management practices and experiences of persons with T1D during the COVID-19 pandemic lockdown in a rural district of southwestern Uganda. Methods: Using interactive sequential explanatory mixed methods, we conducted a cross-sectional study of persons with T1D aged 18-25 years, their caregivers and health workers. Quantitative data was exclusively collected from patients with T1D using Kobo Toolbox™ and analysed with SPSS™ version 26; qualitative interviews were used to elicit responses from purposively selected patients with T1D, plus caregivers and health workers that were analysed using a thematic framework approach. Results: The study enrolled 51 (24 males) patients with T1D; diabetes duration (mean ± SD) 6.6 ± 5 years. Access to insulin syringes significantly worsened in 19.6% of participants (p = 0.03). Insulin injection frequency (p = 0.01), blood glucose monitoring (p = 0.001) and meal frequency (p = 0.0001) significantly decreased. Qualitative interviews highlighted COVID-19 restriction measures had reduced household income, frequency of clinic visits, and access to food, diabetes support and social services. Conclusions: Experiences and practices were consistent with decisions to prioritise survival, even with known risks around metabolic control. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01222-4.

Body composition of type 2 diabetes patients in Uganda: A case-control study.

Introduction: The prevalence of obesity among people diagnosed with Type 2 Diabetes Mellitus (T2DM) has been widely documented. However, the specific composition of this bodyweight remains largely unknown. The study aimed to understand the body composition of T2DM patients using the bioelectric impedance analysis technique, comparing findings to sex and agematched controls. Materials and Methods: A comparative case-control study was carried out among 139 known cases of Type 2 diabetes aged 18 to 78 years randomly sampled from the diabetic clinic of Mbarara Regional Referral Hospital. We matched them to 139 hospital controls who were healthy non-diabetic attendants. Body composition parameters were computed and summarized as medians and interquartile ranges. Differences in the medians of body composition parameters were further assessed using the Mann- Whitney U test. Fat-free and fat mass indices were derived to offer a precise estimation of body composition parameters adjusted for height differences among study participants. Results: Cases had significantly higher median systolic blood pressure, pulse rate, weight, Body Mass Index (BMI), Waist-Hip Ratio (WHR), total fat percentage, fat mass amount, Fat Mass Index, visceral fat, and metabolic age than their counterparts, whereas controls had significantly higher median total body water percentage versus cases. The highest significant differences occurred in fat percentage composition (Cases: ß: 6.9 (95% C.I: 4.4, 9.4); Controls: Ref) followed by visceral fat (Cases: ß: 3.5 (95% C.I: 2.5, 4.4); controls: Ref) and Fat Mass Index (Cases: 95% C.I: 2.6 (95% C.I: 1.6, 3.7). Cases had significantly higher Fat Mass Index, visceral fat and fat percentage (all p<0.05) than controls. Conclusions: Routine assessment of body composition of T2DM patients needs to be done to assess the amount, type and pattern of weight gain to prevent increases in adiposity.

Contribution of street food to dietary intake of habitual urban consumers: A cross-sectional study in Kampala city, Uganda.

BACKGROUND: Street food has continued to be a popular food source in the urban settings of developing countries and is proving to be a vital urban dietary source. However, its dietary contribution among urban populations is yet to be comprehensively understood. AIM: To assess how street food contributes to the dietary intake of habitual street food consumers. METHODS: We conducted a community-based cross-sectional study among habitual street food consumers in Kampala city. We defined habitual intake as consumption of a serving of any street food for ≥2 days/week regardless of the food group and number of times it was consumed in a particular day. Questionnaires were used to capture quantitative data on sociodemographic characteristics, anthropometry, 24-hour diet intake and 2-month street food consumption frequency. The Nutritics® diet analysis software version 4.3 and STATA version 13.0 were used for nutrient and statistical analyses respectively. RESULTS: Street food contributed considerably to the daily intake of fat (49.1%), sodium (38.4%) and calcium (36.5%) and least towards the daily intake of vitamin A (11.3%). The majority of consumers opted for street food at breakfast (50%) whereas lunch and snacks featured the least for overall street food inclusion (all 20%). Overall, men demonstrated more dietary intake and inclusion at meals from street food than women. CONCLUSIONS: This study indicates a significant contribution of street food for urban consumers but men derive more benefit than women in terms of nutrient intake and inclusion of street food in meals.

Healthcare delivery for paediatric and adolescent diabetes in low resource settings: Type 1 diabetes clinics in Uganda.

The management of type 1 diabetes (T1DM) includes setting up organised follow-up clinics. A programme for establishing such clinics in Uganda commenced in 2009. The clinics were established along the chronic care model and were integrated into the health structure of other chronic diseases. Web-based electronic medical records were utilised to establish a centralised registry. All children with diabetes below 18 years of age were encouraged to enrol into the programme by attending the nearest established T1DM clinic. At the commencement of the programme, there were 178 patients with T1DM receiving care in various health facilities but without organised follow-up T1DM clinics. These patients were subsequently enrolled into the programme and as of June 30, 2018, the programme had a total of 32 clinics with 1187 children; 3 with neonatal diabetes. Challenges encountered included difficulties in timely diagnosis, failure to provide adequate care in the remote rural areas and failure to achieve pre-defined glycated haemoglobin (HbA1c) goals. Despite these challenges, this observational study demonstrates that healthcare delivery for T1DM organised along the chronic care model and supported by web-based electronic medical records is achievable and provides care that is sustainable. Addressing the encountered challenges should result in improved outcomes for T1DM.

Association of dietary intake and BMI among newly diagnosed type 2 diabetes patients attending diabetic clinics in Kampala.

BACKGROUND: Dietary intake is a known determinant of body mass index (BMI) among different populations and is therefore a useful component for BMI control. To our knowledge, no study has investigated the usual dietary intake and its association with BMI in type 2 diabetes patients among the Ugandan population. This study aimed to analyse the usual dietary intake of newly diagnosed type 2 diabetes patients and determine the association between the different dietary nutrients and BMI. METHODS: We conducted a cross sectional study among 200 newly diagnosed type 2 diabetes patients in two major diabetic clinics of Kampala district. Sociodemographic, lifestyle, clinical measurements and dietary intake data were collected using a pretested structured questionnaire and a 24-h dietary recall respectively. Patients were divided according to quintile of nutrient intake. The association between dietary intake and BMI was investigated using multiple linear regression. RESULTS: The average energy intake was 1960.2 ± 594.6 kilocalories/day. Carbohydrate, protein and fat contributed 73, 12.6 and 14.4% of the daily energy consumption respectively. We observed an inverse association between protein intake and BMI. Slopes (95% C.I) of average BMI for patients in the respective quintiles were: 0.0, -2.1 (-4.2, -0.06), -4.4 (-6.9, -1.9), -5.6 (-8.2, -3.0), and -7.3 (-10.6, -4.0); p trend <0.001. In contrast, the findings showed a positive association between carbohydrate intake and BMI. Slopes (95% C.I) of average BMI for patients in the respective quintiles were: 0.0, 3.0 (0.6, 5.4), 3.5 (0.5, 6.4), 5.2 (1.9, 8.6) and 9.7 (5.3, 14.1); p trend <0.001 after adjusting for sociodemographic, clinical and dietary intake variables. We found no significant association between the dietary intake of fibre, fat, saturated fat, polyunsaturated fat and monounsaturated fat with BMI in the final adjusted model. CONCLUSION: Higher intake of carbohydrate was associated with higher BMI while higher intake of protein was associated with lower BMI.