Abstract
Background: The prevalence of diabetes in the Middle East is amongst the highest worldwide, Bahrain ranks amongst the top 10 countries. In particular, increasing number of children are being diagnosed with type 1 diabetes mellitus (T1DM) posing a significant public health concern. Objective: The aim of this thesis was to characterize the population by exploring lifestyle, dietary and health risk factors associated with pediatric T1DM and to undertake a local needs assessment to inform the development of management strategies. Methodology: An observational case-control study of children with T1DM and healthy controls (n=59 and 53; mean age 9.66±1.72 and 9.02±1.88 years respectively) was conducted to ascertain baseline characteristics of children with T1DM as compared to healthy children with a subsequent more detailed prospective investigation (n=20) of the T1DM population, which included a focus on vitamin D intake and status. A systematic review of the effectiveness of interventions that seek to improve the management of children and adolescents with T1DM and a qualitative study using focus groups with service-users and healthcare workers were undertaken to inform the development of a specific educational package targeting the needs of Bahraini children with diabetes and their families. The findings of all phases were amalgamated to inform the design of an education package and associated feasibility study. Results: Children with T1DM appeared to be more likely to have suffered from an illness before diagnosis of T1DM than their healthy counterparts. Dietary inadequacies were common in Bahraini children irrespective of diabetes diagnosis, particularly excessive sodium intakes, whilst children with T1DM consumed significantly more calories than controls and more protein relative to their RDA. Serum vitamin D as measured by CLIA assay method (standard practice) and by UPLC/MSMS (gold standard) classified 72% and 50% respectively of the children as having suboptimal vitamin D levels. It appears that dietary intake, sunlight exposure and physical activity may to some extent impact the vitamin D status of children with T1DM. The systematic review identified facilitators of successful interventions aimed at children and adolescents with T1DM such as theoretical based interventions. It also highlighted barriers to the real-life integration of such interventions. These factors and the themes identified by the focus groups such as a need to focus on adolescents prior to transitioning were incorporated into the educational package. Conclusion: Children with diabetes do appear to differ from age matched controls with respect to health factors and socio-demographic characteristics. Larger confirmatory studies are urgently needed. The feasibility and acceptability testing of the proposed educational package is currently ongoing with a planned pilot test of the program within the coming year.