P-436: Utilisation of continuous glucose monitoring and prevalence of microvascular complications in paediatric type 1 diabetes in low- and middle-income countries: a systematic review
C Patel, J AndhogaAbstract
Introduction
Children and adolescents with type 1 diabetes (T1D) in low- and middle-income countries (LMICs) have persistently poor glycaemic control and early onset of microvascular complications. Continuous glucose monitoring (CGM) improves glycaemic outcomes in paediatric populations in high-income settings, but its utilisation and clinical impact in LMICs remain poorly defined.
Objectives
To evaluate CGM utilisation and its association with glycaemic outcomes and early microvascular complications in individuals aged ≤19 years with T1D in LMICs.
Methods
A systematic review was conducted following PRISMA guidelines. PubMed, Embase, and Scopus were searched (2010–2025). Eligible studies included observational and interventional studies reporting CGM use in paediatric T1D populations in LMICs (World Bank classification). Primary outcomes were HbA1c and time in range (TIR, 70–180 mg/dL). Secondary outcomes included microalbuminuria, retinopathy, and neuropathy. Due to heterogeneity, findings were synthesised narratively.
Results
Thirteen studies (n≈1,500) from Africa, South Asia, and Latin America were included. CGM utilisation was low, ranging from <5% in routine care to ∼25% in structured programmes, with predominantly intermittent use. CGM use was associated with improved glycaemic outcomes, including HbA1c reductions of 0.5–1.2% and TIR increases of 8–15%. In contrast, non-CGM cohorts had persistently elevated HbA1c (>9.0%) and higher prevalence of early complications, particularly microalbuminuria (10–25%) and early retinopathy. Structured CGM programmes showed better adherence and sustained improvement.
Conclusions
CGM utilisation in paediatric T1D populations in LMICs remains limited but is associated with clinically meaningful improvements in glycaemic control and lower early complication burden. Expanding equitable access and integrating CGM into structured care pathways are critical to improving long-term outcomes.