Time to first optimal glycemic control and its predictors among type 1 diabetes children and adolescents follow-up at public hospitals in Borena zone, Oromia, southern Ethiopia, 2025: retrospective cohort study

Background Glycemic control refers to the regulation level of blood sugar in diabetes patients. Recognizing a patient's level of glycemic control is an important measure to avoid complications and the risk of death from diabetes. However, the other most important variable, which is the time that the patient stayed at that suboptimal glycemic level before reaching optimal glycemic control (OGC), has not been studied so far, including both children and adolescents globally, as author searches. Aims to determine the time to first OGC and its predictors among type 1 diabetes children and adolescents follow-up at public hospitals in Borena zone, Ethiopia, 2025. Methods A hospital-based retrospective cohort study was conducted from February 1 to 28, 2025, among 383 type 1 diabetes children and adolescents attending at public hospitals in the Borena zone, Ethiopia. A simple random sampling technique was used to select two hospitals. Then data was collected from patients' cards registered from January 1st, 2020, to January 31st, 2025, by using a simple random sampling method with a pretested checklist in each selected hospital. Data was collected using a data extraction checklist, then entered into Epi-data 4.6 and analyzed using Stata version 15. The Kaplan-Meier survival curve, along with log-rank tests, was used to estimate and compare survival times. Multivariable Cox regression was used to identify predictors of time to first OGC. The adjusted hazards ratio with a 95% confidence interval and a p-value < 0.05 was used to determine statistical significance. Results The Median survival time to first OGC among type 1 diabetic patients was 14.3 months (95%CI:13–17). The first optimal glycemic achievement rate was 4.42 (95%CI:3.8–5.1) per 100-person-month observation. Factors that affect time to first OGC were the absence of health insurance (AHR: 0.566, 95%CI:0.356-0.90), comorbidity (AHR:0.654, 95%CI:0.45–0.94), type of current insulin regimen (AHR:3.76, 95%CI: 1.48–9.56), ≤ 4 follow-ups (AHR:0.63, 95%CI:0.42–0.95), and DKA (AHR:0.53, 95%CI:0.37–0.78). Conclusion Median survival time to first OGC among type 1 diabetic patients was much longer. Which indicates that patients are being unprotected for complications. Absence of health insurance, DKA, type of current insulin regimen, ≤ 4 follow-up frequency, and comorbidity were independent predictors of time to OGC. Therefore, diabetic care should be strengthened to shorten time to first OGC of identified predictors.