P-496: From early onset to lifelong burden: age at diagnosis, disease duration, and the temporal architecture of complications in type 1 diabetes: evidence from CDiC Pakistan
I Ali, A HussainAbstract
Introduction
In LMICs, T1DM follows a life-course trajectory shaped by onset timing, cumulative glycemic exposure, and care deficits. In Pakistan, where T1DM commonly presents in childhood and adolescence, the relationship between onset age, disease duration, and complication burden remains poorly defined
Objectives
To describe the distribution of T1DM diagnosis across the life-course spectrum; characterize complication frequency by onset category; examine the duration complication and duration–glycemia relationships; and identify transition care gaps in adolescent patients.
Methods
A cross-sectional analysis on T1DM patients in Khyber Pakhtunkhwa, Pakistan was conducted. Patients were stratified by age at onset (<5, 5–12, 12–18, >18 years) and disease duration (<5, 5–10, >10 years). Early complications were defined as any complication within five years of diagnosis.
Results
Adult onset predominated (>18y; n=128), followed by adolescent (12–18y; n=85), childhood (5–12y; n=68), and early childhood (<5y; n=31). Duration differed across strata (p<0.001). Complications were highest in childhood-onset (26.5%) vs. adult-onset (14.1%; p=0.195). HbA1c varied by onset group (H=8.30, p=0.040). Complication prevalence rose with duration: 13.5% (<5y), 20.3% (5–10y), and 36.4% (>10y). Early complications occurred in 24/174 patients (13.8%). Disease duration was the sole independent predictor (OR=1.14/year; p<0.001). Transition care was critically deficient: 62.4% of adolescents (12–24y) had not consulted an endocrinologist in the prior 12 months.
Conclusions
Disease duration is the primary determinant of diabetic complications in this Pakistani cohort, with prevalence nearly tripling across duration strata; childhood-onset cases carry the highest cumulative risk due to prolonged glycemic exposure. The transition care gap is a critical, modifiable vulnerability in LMICs, and the CDiC program provides a vital lifeline by improving insulin access and supporting disease management education.