Description
Introduction: Type 1 diabetes mellitus (T1D) is an escalating global health concern, with chronic kidney
disease (CKD) representing a major complication. In 2021, CKD-T1D accounted for 94,020 deaths and
3.87 million disability-adjusted life years (DALYs) worldwide, with both incidence and prevalence
increasing since 1990. Sub-Saharan Africa (SSA) bears a disproportionate burden, where 36% of T1D
patients have HbA1c >12.5%, and microvascular complications develop within 6.2 years of diagnosis. In
Kenya, the prevalence of retinopathy and neuropathy among T1D patients is 21.5% and 29.4%,
respectively, while CKD affects over 20% of diabetic populations.
Methods: A cross-sectional analysis was conducted at Kericho County Referral Hospital involving 150
T1D patients. Albuminuria status was assessed, and insulin regimen use, glycemic control (HbA1c), and
blood pressure (BP) were evaluated. The study reviewed primary healthcare (PHC) service utilization,
including annual urinary albumin screening and BP monitoring rates.
Results: Among the 150 T1D patients, 48% had normoalbuminuria, 34% microalbuminuria, and 18%
macroalbuminuria. Although 72% were on basal-bolus insulin, no insulin regimen was significantly
associated with nephropathy. However, HbA1c >7.5% was linked to a 2.3-fold increased risk of
albuminuria, and systolic BP >130 mmHg raised microalbuminuria likelihood by 1.8-fold. PHC gaps were
identified; only 33% received annual urinary albumin screening, and 41% lacked regular BP monitoring.
In SSA, systemic challenges such as insulin shortages, limited glucose monitoring, and delayed
nephropathy detection further exacerbate CKD-T1D risks.
Conclusion: Glycemic control and hypertension management are stronger predictors of CKD, considering
insulin regimens in resource-limited settings. Strengthening PHC integration, with regular
HbA1c/albuminuria testing, standardized CKD screening, improved access to monitoring tools, context-
specific HbA1c targets, patient education, subsidized insulin, and multisectoral strategies, is essential to
mitigate the rising CKD-T1D burden in sub-Saharan Africa.
Key words: Diabetes Mellitus, Chronic Kidney Disease, Glycemic Control
| Country | Kenya |
|---|---|
| Organization | Government of Kenya |
| Position | County NCD Coordinator |
| Received a Grant? | No |
