P-510: Glycemic control in children and adolescents with type 1 diabetes: impact of disease duration and temporal trends in a resource-limited setting
J Alencar Melo, G Vasconcelos Barros, A Liberal de Matos, M A Ramos Albuquerque, A B Oliveira Barbosa, C Donaire Sousa, P Padilha Ribeiro, B Gomes, A H Ferreira, J Araujo, T Andrade SchulerAbstract
Introduction
In Northeast Brazil, socioeconomic vulnerability and limited access to diabetes resources remain major barriers to optimal T1D care. Pediatric patients with T1D often have inconsistent access to essential supplies and specialized education, which may compromise long-term outcomes.
Objectives
To evaluate the association between disease duration and glycemic control, and to assess 3-year HbA1c trends in a real-world pediatric cohort.
Methods
We retrospectively analyzed children and adolescents with T1D followed at a public tertiary center in Northeast Brazil who attended clinic over a 3-month period (January-April 2026). Glycemic control was assessed using HbA1c values from the previous 3 years. Patients were stratified by disease duration into 2-5 years, 5-10 years, and >10 years. The 3-year mean HbA1c was compared using the Kruskal-Wallis test, and annual HbA1c progression was assessed using the Friedman test.
Results
Ninety-nine patients were included (mean age 14.7 ± 2.9 years, range 6.9-18.7); all performed home capillary glucose monitoring. Overal, 92% were treated with insulin analog-based regimens, and 8% NPH plus regular insulin. The overall mean 3-year HbA1c was 9.60% ± 1.69%. Mean HbA1c increased by 0.74% between the shortest and longest disease-duration groups, although this was not statistically significant (9.13% ± 1.32% for 2-5 years, 9.77% ± 1.84% for 5-10 years, and 9.87% ± 1.74% for >10 years; p=0.28). In contrast, longitudinal analysis showed significant worsening in annual mean HbA1c from 9.16% in 2023 to 9.90% in 2026 (p=0.007).
Conclusions
Youth with T1D in this resource-limited setting had persistently poor glycemic control, with progressive deterioration over time despite home monitoring and specialist follow-up. These findings may reflect the combined effects of puberty, evolving self-management responsibilities, and structural barriers to care, highlighting the need for long-term, context-adapted educational strategies.