P-276: Misdiagnosis, metabolic crises, and missed screenings: assessing gaps in type 1 diabetes care in Kenya
E Onyango, G Gathecha, J Kimetto, N Ngugi, C Karekezi, P Wamalwa, V Nabeta, O Nabeta, M Evelyn, C Lagat, S Marwa, B Muchoki, N H Y JonesAbstract
Introduction
An estimated 20818 people are living with Type 1 Diabetes mellitus (T1DM) in Kenya. T1DM requires lifelong, consistent management to prevent complications and premature deaths. Identifying and closing gaps across the care cascade is key in optimizing health outcomes for people living with diabetes.
Objectives
To describe the diagnostic gaps, metabolic crises, and missed screening opportunities for complications among individuals with Type 1 diabetes in Kenya.
Methods
A facility-based cross-sectional study was carried out in 46 CDiC clinics across 35 counties, involving 3847 participants below 25 years of age. Data was collected using a structured questionnaire. Descriptive analysis was conducted for diabetes care and other support services.
Results
T1DM was misdiagnosed in 31% of the respondents. Only 4% and 6% of the respondents indicated that they had been tested on insulin and c-peptides levels respectively. Approximately 42% had no knowledge of DKA, and 49% were admitted at the initial diagnosis of DKA. Insulin interruption due to stock out in the clinic was reported by 11% of the patients. Close to 39% have been admitted 2-5 times since being diagnosed with T1DM, and the common cause of admission was hyperglycaemia (57%). Only 50% had access to eye review, 33% to foot assessment, 23% to lipid profile tests, 19% to mental assessment, and 51% to urine microalbumin.
Conclusions
The findings demonstrate critical gaps in diagnosis, patient education, access to essential investigations, continuity of insulin supply, and comprehensive diabetes care. Policy action is needed to strengthen early detection, accurate diagnosis and effective management of Type 1 diabetes through improved training of healthcare workers and access to essential diagnostic tools at all levels of care. The Ministry of Health should ensure uninterrupted availability of insulin and essential supplies through strengthened forecasting, procurement, and supply chain systems.