P-418: Beyond basal-BOLUS: persistent poor glycemic control in children and adolescents with type 1 diabetes, Kisumu county, Kenya - barriers to improvement
L MutwikaAbstract
Introduction
Type 1 diabetes (T1D) requires lifelong insulin therapy to achieve optimal glycemic control. Despite standard basal-bolus insulin therapy, achieving glycemic targets among children and adolescents with T1D remains a challenge, particularly in developing countries. Beyond pharmacologic treatment, dietary and insulin adherence behaviors play a vital role in glycemic control.
Objectives
This study assessed barriers to achieving optimal glycemic control in children and adolescents with T1D in Kisumu County, Kenya.
Methods
A descriptive cross-sectional study using a census approach was conducted among 58 participants aged 1 – 25 years, attending the Changing Diabetes in Children (CDiC) clinic in Kisumu County Referral Hospital. HbA1C values were extracted from medical records before transitioning participants to basal-bolus insulin (Levemir and Novorapid) and after 6 months. A structured questionnaire was used to collect data on dietary and insulin adherence behaviour. Data were analyzed using descriptive statistics, a paired t-test, and a Chi-square test.
Results
The mean participant age was 16.9 ± 5.3 years, mean years living with T1D 3.5 ± 2.4 years, with 35 (60.3 %) males and 23 (39.7%) females. There was no significant change in mean HbA1C following 6-month basal-bolus insulin therapy (12.5 ± 2.2 vs 12.2 ± 2.5), with a mean difference of 0.37 ± 2.3, 95% CI: - 0.23 – 0.96, p = 0.22. Missing an insulin dose and not calculating the insulin-carbohydrate ratio always before meals were significantly associated with poor glycemic control, p < 0.05.
Conclusions
The findings indicate that missing an insulin dose and not following insulin-carbohydrate counting are significant factors associated with poor glycemic control despite standard basal bolus insulin therapy. Strengthening diabetes education focusing on insulin adherence and insulin-carbohydrate counting may help improve glycemic outcomes among children and adolescents living with T1D.