P-05: Glycemic disparities and inequities in diabetes care across provinces in Pakistan: nationwide CDiC study in children and young people with type 1 diabetes
E Ghafoor, B Tahir, A BasitAbstract
Introduction
There is a critical need to understand provincial disparities in glycemic control and diabetes care among children and young people with type 1 diabetes in Pakistan, where access to insulin, trained HCPs, and structured education varies widely across provinces. These inequities may contribute to differences in glycemic outcomes, acute complications, & long-term health risks.
Objectives
To assess provincial disparities in glycemic control and diabetes care among children and young people with type 1 diabetes in Pakistan.
Methods
A cross-sectional analysis of all registered participants with T1DM was conducted using national-level data from the CDiC program across Pakistan. Youth (≤25 years) were included. Standardized electronic data systems were used to collect demographic characteristics, glycemic status, clinical outcomes, and complications at enrollment.
Results
A total of 4,132 youth with T1DM were included from all provinces of Pakistan. Provincial distribution showed the highest representation from Punjab (n=1,754; 42.4%), followed by Sindh (n=1,346; 32.6%). Male predominance was observed. Mean HbA1c was highest in Balochistan (12.13 ± 1.82%) and lowest in Sindh (10.61 ± 2.71%), indicating significant regional variation in glycaemic control. The prevalence of chronic complications among individuals with ≤5 years versus >5 years duration of diabetes was higher with longer duration, including hypertension (1.0% vs. 3.0%), neuropathy (3.2% vs. 5.8%), retinopathy (1.3% vs. 5.1%), and nephropathy (0.4% vs. 1.6%). The history of hospitalization due to diabetes and/or DKA was highest in Balochistan (85.8%), followed by Punjab (57.1%), highlighting substantial regional disparities.
Conclusions
Substantial provincial disparities exist in glycemic control and diabetes outcomes among youth with type 1 diabetes in Pakistan. These findings highlight inequities in access to timely diagnosis and quality diabetes care, underscoring the need for targeted strategies to improve outcomes in low-resource settings.