P-160: Differential impact of continuous glucose monitoring on glycemic control in pediatric T1D in Nepal: a sweet-based telehealth-supported care model
S Pokhrel, T von Loh, S Biester, I Deneke, P Battharai, R Ghimire Chhetri, S Koirala, O Kordonouri, S Lanzinger, S Neupane, B Parajuli, A Pragya, H Saßmann, M Witsch, F Reschke, , SWEET InitiativeAbstract
Introduction
Access to continuous glucose monitoring (CGM) remains limited in low-resource settings for individuals with type 1 diabetes (T1D). Evidence on its clinical effectiveness under constrained therapeutic conditions, particularly using human insulin, is scarce
Objectives
To evaluate the feasibility and clinical impact of CGM on glycemic control in children and adolescents with T1D in Nepal.
Methods
A prospective cohort study was conducted in a pediatric T1D center in Butwal, Nepal. Fifty-one individuals with T1D (median age 15 years, range 7–25; 45% male) were initiated on CGM while treated with human insulin. Paired HbA1c measurements (pre- and post-CGM initiation) were available for 40 participantsChanges in HbA1c were analyzed overall and stratified by baseline HbA1c tertiles. Patient-reported outcomes (n=30) and feasibility parameters were assessed descriptively. Clinical management was supported by structured telehealth consultations from a SWEET center.
Results
Overall HbA1c decreased modestly from 9.4 ± 1.9% to 8.9 ± 2.0% (p=0.67), with pronounced interindividual variability. HbA1c decreased in 20/40 (50%) participants, while 17/40 (43%) showed an increase and 3/40 (7%) remained stable. Patients with poor baseline control (HbA1c >9.9%) demonstrated the greatest improvement, with HbA1c increases predominantly observed in individuals with lower baseline HbA1c. A significant inverse association between baseline HbA1c and HbA1c change was observed (r = -0.48, p = 0.002). Patient-reported outcomes indicated high acceptance, with 100% recommending CGM and 97% reporting improved self-management.
Conclusions
CGM use in pediatric T1D in a low-resource setting is feasible and associated with clinically relevant improvements, particularly in individuals with poor baseline glycemic control. These findings support a targeted benefit of CGM in individuals with poor glycemic control in resource-limited settings.
Acknowledgement
SWEET e.V. and Alexander Zverev Foundation