P-493: Impact of comprehensive diabetes care on glycemic outcomes in children with type 1 diabetes in a resource-limited setting
J NyangenaAbstract
Introduction
Optimal management of type 1 diabetes (T1D) in children requires a comprehensive care approach that integrates insulin therapy, structured education, nutritional support, and psychosocial care. In resource-limited settings, access to such holistic services remains inconsistent, contributing to poor glycemic outcomes and increased risk of acute complications.
Objectives
To evaluate the impact of a comprehensive diabetes care model on glycemic control and self-management among children and adolescents with T1D at the Kenya Diabetes Management and Information Centre (DMI Centre).
Methods
A program-based observational study was conducted at the DMI Centre between 2022 and 2024. Children and adolescents with T1D enrolled in the program received integrated care including insulin management, carbohydrate counting education, routine follow-up, caregiver training, and peer support. Clinical and program data were reviewed to assess changes in glycemic control (HbA1c), adherence to treatment, and frequency of acute complications.
Results
Implementation of the comprehensive care model was associated with improved glycemic outcomes, with a notable reduction in mean HbA1c levels over the study period. Participants demonstrated improved insulin adherence, increased uptake of carbohydrate counting practices, and enhanced caregiver involvement. Additionally, a reduction in reported episodes of severe hypoglycemia and diabetic ketoacidosis was observed. Structured education and continuous follow-up were key contributors to improved self-management.
Conclusions
A holistic, patient-centered approach to diabetes care can significantly improve glycemic control and reduce acute complications among children with T1D in resource-limited settings. The DMI Centre model highlights the importance of integrating education, clinical care, and psychosocial support to achieve sustainable outcomes. Scaling such models could strengthen pediatric diabetes care in similar contexts.