P-477: Relationship between insulin dose, regimen, and glycemic control in pediatric type 1 diabetes in a resource-limited setting
G Vasconcelos Barros, J Alencar Melo, A B Barbosa, A Liberal de Matos, M A Ramos Albuquerque, T Andrade Schuler, A H Ferreira, B Gomes, C Donaire Souza, J Araujo, P Padilha RibeiroAbstract
Introduction
In low-resource settings, access to insulin analogs remains limited, and relationships between insulin dose, regimen, and glycemic control in pediatric type 1 diabetes are poorly characterized.
Objectives
To describe correlations between insulin dose/kg, regimens, and HbA1c in Northeast Brazil, a region marked by socioeconomic vulnerability.
Methods
This retrospective analysis included 100 individuals aged 0-18 years followed at a public tertiary center in Northeast Brazil during a 3-month period (January-April 2026). Regimens included degludec + rapid-acting analog (RAA), glargine + RAA, NPH + regular, and glargine + regular. HbA1c in the last year and mean HbA1c over the last 3 years were compared using Kruskal-Wallis and Mann-Whitney tests. Spearman correlations and regression analyses assessed insulin dose-HbA1c relationships.
Results
Overall, 91% used analogs (75% glargine + RAA, 16% degludec + RAA), while 8% used NPH + regular insulin and 1% glargine + regular insulin. Mean HbA1c over the last 3 years differed significantly across regimens: degludec + RAA 8.53%, glargine + RAA 9.64%, and NPH + regular 11.47% (p=0.0008). HbA1c in the last year also differed significantly (p=0.0023). Insulin dose/kg was positively correlated with HbA1c in the last year (Spearman r=0.24, p=0.021) and mean HbA1c over 3 years (r=0.29, p=0.006), persisting among analog-only users (r=0.28, p=0.011). Multiple linear regression confirmed that insulin dose was independently associated with higher mean 3-year HbA1c (β=1.23, p=0.044).
Conclusions
In this Brazilian cohort, higher insulin doses were associated with poorer glycemic control, suggesting structural, behavioral, or physiological barriers that dose escalation alone cannot overcome. Analog regimens were associated with lower HbA1c compared with NPH. These findings highlight both progress in analog access and persistent challenges in achieving glycemic targets in vulnerable pediatric populations.