P-350: Implementation of flash glucose monitoring in children and adolescents with type 1 diabetes through a Brazilian municipal public health program: a 12-month prospective study
A H De Castro, E RodriguesAbstract
Introduction
Continuous glucose monitoring (CGM) remains inaccessible for many children with type 1 diabetes (T1D) in low- and middle-income countries despite international recommendations. Real-world evidence on publicly funded pediatric CGM programs is limited.
Objectives
To evaluate glycemic outcomes following the implementation of a municipal flash glucose monitoring program in the Brazilian public healthcare system
Methods
This prospective observational study included 19 children and adolescents (<16 years) with T1D followed at a specialized public diabetes clinic from March 2025 to March 2026. Participants had diabetes duration >2 years, used multiple daily insulin injections, initiated FreeStyle Libre® through a municipal program, and received multidisciplinary follow-up. HbA1c, glucose management indicator (GMI), time in range (TIR, 70–180 mg/dL), hyperglycemia, and hypoglycemia were assessed at baseline and after 3, 6, 9, and 12 months using sensor-derived data. Changes over time were analyzed by repeated-measures ANOVA.
Results
Nineteen participants (mean age 12.2 ± 2.6 years; 53% male) completed 12 months of follow-up. Mean HbA1c decreased from 8.44 ± 2.05% to 7.46 ± 0.96% (−0.98 percentage points). Mean TIR increased from 49.7% to 57.6%, while severe hyperglycemia decreased from 25.2% to 17.4%. Hypoglycemia remained low despite improved glycemic control. Sensor use exceeded 85% throughout follow-up, indicating high adherence. Although longitudinal analyses did not reach statistical significance, likely due to the small sample and interindividual variability, all major glycemic metrics improved consistently.
Conclusions
Flash glucose monitoring provided through a municipal public health program was associated with clinically meaningful improvements in glycemic control in children and adolescents with T1D. These findings support integrating CGM into publicly funded pediatric diabetes programs in middle-income settings and expanding equitable access to diabetes technology.