Akanji A O
Department of Chemical Pathology, University College Hospital, Ibadan, Nigeria.
J Natl Med Assoc. 1996 Feb;88(2):101-5.
Diabetes mellitus presenting in adolescents age 10 to 20 years accounts for less than 5% of all diabetes in tropical African countries. Consequently, inadequate attention is paid to the medical and psychosocial problems attendant on adolescent diabetes in those countries. This article highlights our clinical experience in the management of 30 adolescent diabetic subjects who presented consecutively in the diabetic clinic of a major Nigerian teaching hospital. In these patients, adolescent diabetes appeared heterogeneous, comprising classical insulin-dependent diabetes mellitus (IDDM) in approximately 80%; the remaining fraction (20%) was contributed variably by malnutrition-related diabetes (MRDM) and an "atypical" form of IDDM. The most common medical complications were recurrent hypoglycemia, ketoacidosis, and infections. About 80% of the patients were poor, and up to two thirds had to withdraw from school or trade because of recurrent illness. One third of the girls had a history of unwanted pregnancies. Almost all (93%) had a history of general rebelliousness and clinic truancy. Therefore, the high prevalence of acute metabolic decompensation may be related to the increased frequency of psychosocial problems, especially poverty, in these patients. It is suggested that agencies in tropical Africa increase welfare facilities for adolescent chronic disease, and also establish and encourage clinics dedicated to adolescent diabetes care.
在热带非洲国家，10至20岁青少年患糖尿病的病例占所有糖尿病病例的比例不到5%。因此，这些国家对青少年糖尿病所伴随的医疗和心理社会问题关注不足。本文重点介绍了我们在一家大型尼日利亚教学医院糖尿病门诊连续收治的30例青少年糖尿病患者的管理方面的临床经验。在这些患者中，青少年糖尿病表现出异质性，约80%为典型的胰岛素依赖型糖尿病（IDDM）；其余部分（20%）由营养不良相关糖尿病（MRDM）和“非典型”形式的IDDM构成。最常见的医疗并发症是反复低血糖、酮症酸中毒和感染。约80%的患者家境贫困，多达三分之二的患者因疾病反复发作而不得不辍学或放弃工作。三分之一的女孩有意外怀孕史。几乎所有患者（93%）都有叛逆和逃诊的历史。因此，这些患者中急性代谢失代偿的高发生率可能与心理社会问题尤其是贫困的频繁发生有关。建议热带非洲的相关机构增加针对青少年慢性病的福利设施，并设立和鼓励专门诊治青少年糖尿病的诊所。
