P-193: Structural determinants, care gaps, and multidimensional predictors of diabetes complications among children & adolescents with T1DM enrolled in CDiC at KP-Pakistan
A Hussain, I AliAbstract
Introduction
Type 1 diabetes mellitus in LMICs is characterized by a disproportionate burden of complications, driven not only by glycemic dysregulation but also by structural inequities in healthcare access, socioeconomic constraints, and behavioral care deficits.
Objectives
To characterize the frequency of microvascular and macrovascular complications in Pakistan; (2) to quantify care gaps, socioeconomic, geographic, and healthcare access domains; and (3) to identify multivariable predictors of complications
Methods
A cross-sectional analysis was conducted among 312 T1DM patients from KP, Pakistan. Variables included demographics, disease duration, glycemic parameters, socioeconomic indicators, insulin practices, and self-monitoring. Multivariable logistic regression was used to identify independent predictors of any complication, adjusting for background characteristics. X2, Mann-Whitney U, and Kruskal-Wallis tests were used for bivariate comparisons.
Results
Mean age was 22.0 ± 7.7 years; median disease duration was 4.1 years.The mean HbA1c was 8.9 ± 1.4%; only 10.6% achieved the target HbA1c of <7%. Any diabetic complication was present in (n=60, 19.2%): neuropathy 7.1%, retinopathy 7.1%, nephropathy 3.5%, and macrovascular disease 4.5%. Critical care gaps included: no glucometer access (40.7%), insulin interruption (44.6%), no specialist consultation (66.3%), and zero daily self-monitoring (43.3%). In multivariable analysis, disease duration was the sole independent predictor of complications (OR1.13 per year, 95%CI 1.06–1.19, p < 0.001).Care gap burden was significantly higher in rural vs urban patients across multiple domains.
Conclusions
T1DM patients face a high complication burden driven primarily by disease duration. The stark disparity in healthcare access, especially in rural areas. Urgent structural interventions are in great need. Programs like CDiC are essential models of hope, providing a vital framework to bridge these systemic care gaps in underserved populations