Title : Young hearts at risk: Hidden cardiovascular damage and the role of social determinants of health among youth with type 1 diabetes in Kenya
Abstract:
Background: Type 1 diabetes (T1D) is rising globally, with a disproportionate burden of complications in developing countries. In such settings, a 10-year-old diagnosed with T1D has an average life expectancy of only 13 years, five times lower than in high-income countries. Adverse social determinants of health (SDOH), including poverty, poor access to care, and limited health literacy, exacerbate poor glycemic control and accelerate cardiovascular risk. We aimed to evaluate cardiovascular risk factors and SDOH amongst youth living with T1D.
Methods: A cross-sectional study among youth aged 18–34 years with T1D was conducted across four hospitals in Kenya. Parameters assessed included HbA1c, lipid profile (LDL/HDL ratio), cardiac troponin-T (cTnT), N-terminal pro–B-type natriuretic peptide (NT-proBNP), urinary albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), body mass index (BMI) and blood pressure (BP).
Results: Among 165 participants (mean age 25 years, female preponderance, mean diabetes duration 7.5 years, BMI 22.1 kg/m²), mean HbA1c, LDL/HDL, cTnT, NT-proBNP and UACR were: 11.4%, 2.54, 11.5 ng/L, 176 pg/mL, and 29.8 mg/mmol respectively.
Dyslipidemia (LDL/HDL > 2) was found in 60% (n=99); 27.8% (n=46) of participants had diabetic nephropathy, UACR > 3 mg/mmol, out of which 28% (n=13) had reduced renal function (eGFR less than 90 mL/min/1.73 m²); 12.7% (n=21) had elevated cTnT > 14 ng/L while 10.3% (n=17) had raised NT-proBNP > 125 pg/mL. Elevated Blood pressure, > 130/80 mmHg, was detected in 33.3% (n=46). Less than 10% used antihypertensives and under 2% were on lipid-lowering drugs. Over 70% reported irregular clinic attendance due to work, transport, or low perceived clinic value.
Conclusion: Youth with T1D in Kenya exhibit high rates of subclinical cardiovascular and renal injury linked to poor glycemic control and adverse SDOH. Integrating multidisciplinary care, implementation of cardiometabolic management guidelines and addressing social barriers are critical to prevent early cardiovascular morbidity and mortality.
