P-498: Glycemic control patterns among children and adolescents with type 1 diabetes enrolled in a multi-site digital care program in Kenya
S Marwa, M TonuiAbstract
Introduction
Achieving optimal glycemic control in children and adolescents with type 1 diabetes remains challenging in many low- and middle-income countries due to limited access to diagnostics, fragmented follow-up systems, and constrained specialist care. In Kenya, despite growing service delivery efforts, evidence on glycemic outcomes remains limited. We assessed glycemic control patterns among T1D patients enrolled in a multi-site pilot digital healthcare model in Kenya.
Objectives
To describe recent HbA1c monitoring coverage and glycemic control among children and adolescents with type 1 diabetes receiving care in selected Kenyan facilities.
Methods
We conducted a cross-sectional analysis of routinely collected program data from six health facilities using a standardized digital platform. Included patients were aged below 25 years enrolled in care. Variables analyzed were documented HbA1c testing within the previous 90 days and glycemic control categories defined as controlled (<7%), moderate (7–9%), and poor (>9%). Descriptive statistics were used to summarize outcomes and facility-level variation.
Results
A total of 923 patients were enrolled in care, of whom 349 (37.8%) had documented HbA1c results within the previous 90 days. Among those tested, 35 (10.0%) had HbA1c <7%, 101 (29.0%) had HbA1c 7–9%, and 214 (61.0%) had HbA1c >9%. Marked inter-facility variation was observed. One facility reported all tested patients with HbA1c >9%, while another achieved 15% with HbA1c <7%. Overall, 574 patients (62.2%) lacked recent HbA1c monitoring.
Conclusions
Glycemic control among type 1 diabetes patients was suboptimal, with most tested patients having HbA1c >9% and many lacking recent monitoring. Practical priorities include expanding routine HbA1c access, strengthening insulin dose adjustment at clinic visits, improving adherence and self-management education for patients and caregivers and using routine digital data for continuous quality improvement across facilities.