P-495: Missed monitoring, missed outcomes: the role of smbg and insulin continuity in CDiC-Pakistan T1DM care
A Hussain, I AliAbstract
Introduction
Optimal glycemic control in T1DM depends critically on frequent self-monitoring of blood glucose and appropriate insulin regimen selection. In Pakistan, structural barriers significantly limit access to both, yet their independent effects on glycemic outcomes and complication risk have not been rigorously quantified.
Objectives
(1) To quantify the impact of glucometer access and SMBG frequency on glycemic control in T1DM patients in KP; (2) to assess the independent contributions of insulin regimen type and insulin interruption on glycemic outcomes; and (3) to determine whether monitoring and insulin practices are independently associated with diabetic complications.
Methods
This cross-sectional analysis included 312 T1DM patients from KP, Pakistan. Monitoring practices & insulin regimen type were analyzed against HbA1c and complication status. Linear regression modelled continuous HbA1c predictors; multivariable logistic regression assessed complication risk. Statistical tests included Mann-Whitney U, Kruskal-Wallis, and post-hoc Dunn tests.
Results
Glucometer access was present in 59.3% of patients. Patients without glucometers had significantly higher median HbA1c (p<0.001). Increasing SMBG frequency was independently associated with lower HbA1c (β = −0.424 per test/day, p< 0.001). Analog basal-bolus insulin use was associated with a 0.82% reduction in HbA1c compared to other regimens (β=−0.823, p< 0.001).Insulin interruption was associated with a 0.82% increase in HbA1c (β =0.822, p< 0.001).Good glycemic control was achieved in 16.2% of those with glucometers versus only 2.4% without (p < 0.001).
Conclusions
In Pakistan, SMBG frequency and insulin continuity are the critical drivers of T1DM outcomes. Supply interruptions directly trigger glycemic failure. Prioritizing universal access to monitoring and insulin is the highest-yield strategy to reduce HbA1c and prevent complications. The CDiC project remains an essential lifeline for this vulnerable population