P-57: High access to insulin analogs in a socioeconomically vulnerable pediatric population within a resource-limited country: data from northeast Brazil
A B Barbosa, A Liberal de Matos, G Vasconcelos Barros, J Alencar Melo, M A Ramos Albuquerque, T Andrade Schuler, A H Ferreira, P Padilha Ribeiro, B Gomes, C Donaire Sousa, J AraujoAbstract
Introduction
Access to insulin analogs remains uneven in resource-limited countries. In Brazil, major regional disparities persist, with the Northeast marked by greater socioeconomic vulnerability. Real-world pediatric data from this setting remain scarce.
Objectives
To describe insulin regimen use in a public pediatric type 1 diabetes cohort and assess its association with glycemic control, measured by mean HbA1c over the last 3 years.
Methods
Cross-sectional study including 100 children and adolescents with type 1 diabetes aged 0-18 years followed at a tertiary public hospital in Northeast Brazil during the most recent 3 months. Regimens were categorized as glargine + rapid-acting analogs (RAA), degludec + RAA, NPH + regular insulin, and glargine + regular insulin. Mean HbA1c over the past 3 years was calculated for each participant. Group comparisons used Kruskal-Wallis and Bonferroni-adjusted Mann-Whitney tests.
Results
Overall, 91% of participants used analog-based regimens (75% glargine + RAA; 16% degludec + RAA), while 8% used NPH + regular insulin and 1% glargine + regular insulin. Mean HbA1c differed across groups (p=0.0008), with lower values in the degludec + RAA (8.53%) and glargine + RAA (9.64%) groups than in the NPH + regular insulin group (11.47%). Differences were significant for glargine + RAA versus NPH + regular (p=0.0066) and degludec + RAA versus NPH + regular (p=0.0003). Mean HbA1c was also lower with degludec + RAA versus glargine + RAA (p=0.0196).
Conclusions
Despite being conducted in a socioeconomically vulnerable region within a resource-limited country, this cohort showed high access to insulin analogs. Analog-based regimens were associated with better glycemic control. These findings support policies to expand equitable access to modern therapies in vulnerable settings.