P-35: A silent crisis in type 1 diabetes: near-universal glycemic failure and structural care gaps in a real-world pediatric registry from CDiC-Pakistan
I Ali, A HussainAbstract
Introduction
Type 1 diabetes mellitus in low-resource settings is marked by persistently poor glycemic control and a rising complication burden driven by glycemic, behavioral, and structural factors, with limited data from Pakistan on the roles of monitoring access, insulin practices, and sociodemographic determinants in clinical outcomes.
Objectives
To assess glycemic control, complication burden, and healthcare access gaps, and to determine predictors of adverse outcomes among children and adolescents with T1DM diabetes in Khyber Pakhtunkhwa, Pakistan
Methods
This cross-sectional study included 442 T1DM patients from multiple diabetes centers in KP. Glycemic control was defined by HbA1c, categorized as controlled (<7.5%), suboptimal (7.5–9%), poor (9–11%), and very poor (>11%). Outcomes included HbA1c levels, poor control (HbA1c ≥7.5%), and presence of any diabetes-related complication. Statistical methods included Mann-Whitney U, Kruskal-Wallis, X2 tests, multivariable linear regression, and binary logistic regression, adjusting for confounding variables.
Results
Mean HbA1c was 11.65±2.72% (median 11.9%), with 92.8% ≥7.5%;72.8% lacked glucometers. Complications occurred in 10.2%, rising with ≥6 years’ duration (24.8% vs. 5.6%, p<0.001); retinopathy increased from 1.2% to 19.0% (p<0.001). Newly diagnosed patients had higher HbA1c (13.4 vs.11.2%, p<0.001). Male sex, family history, and new diagnosis independently predicted HbA1c. New diagnosis and family history predicted poor control, while age, disease duration, and hospitalization predicted complications.
Conclusions
T1DM in Pakistan is characterized by profoundly poor glycemic control and a complication burden rising sharply with disease duration. The near-universal lack of glucometer access and broader structural care limitations underscore the urgent need for targeted interventions, such as CDiC, focusing on improved access to monitoring technologies, patient education at diagnosis, and enhanced complication surveillance in individuals with longer disease duration.