P-40: Structural and social determinants of glycemic outcomes among children and young adults with type 1 diabetes in Kenya
C Lagat, J Kimetto, E Omondi, G Gathecha, N Ngugi, B Muchoki, O Nabeta, P Wamalwa, E Onyango, C K Karekezi, V Nabeta, N H Yayah JonesAbstract
Introduction
Glycemic outcomes in children and young adults with type 1 diabetes in sub-Saharan Africa is shaped by clinical, social and health system factors, but the relative contribution of these determinants remains poorly characterized at scale.
Objectives
To identify independent predictors of glycemic outcomes among children and young adults with type 1 diabetes in a nationally distributed cohort in Kenya.
Methods
A cross-sectional analysis was conducted across 46 clinics in 35 counties in Kenya, including 3,847 participants aged 6 months to 25 years. Multivariable linear regression was used to evaluate associations between HbA1c and age, gender, diabetes duration, food insecurity, caregiver education, access to a diabetes educator, and distance to clinic from home.
Results
Participants were 49.7% female, with a mean age of 17.0 years (SD 5.47) and a median age of 17 years (IQR 13–21). Median diabetes duration was 5.0 years (IQR 2.6–8.1). Mean HbA1c was 11.14%, median 11.30% (IQR 9.10–14.00). 92.7% exceeded the target (>7%). High food insecurity was associated with higher HbA1c (β=0.53, 95% CI 0.08–0.98, p=0.049). Access to a diabetes educator was associated with lower HbA1c (β=−0.62, 95% CI −1.10 to −0.11, p=0.013). Greater distance to clinic was associated with higher HbA1c (β=0.08 per 10 km, 95% CI 0.01–0.14, p=0.013). Compared with secondary caregiver education, primary education was associated with higher HbA1c (β=0.39, 95% CI 0.08–0.70, p=0.010), while university education was associated with lower HbA1c (β=−0.64, 95% CI −1.20 to −0.06, p=0.018).
Conclusions
Glycemic control in children and young adults with type 1 diabetes in Kenya is shaped by determinants across social, educational, and access domains. Food insecurity, geographic access, and access to diabetes education were independently associated with glycemic outcomes, while higher caregiver education was protective.