Endocrine Abstracts

JOINT916

Background: The global incidence of pediatric diabetes, including type 1 (T1D) and type 2 (T2D) diabetes, has been rising. Modern diabetes therapies have become widely accessible in the past decade, supported by Universal Coverage (UC) policies aimed at improving treatment outcomes.

Objective: To evaluate the clinical outcomes and complication screening trends in childhood-onset diabetes following the implementation of modern therapies.

Methods: A retrospective review was conducted using medical records from pediatric-onset diabetes patients (diagnosed before age 18) treated between 2018 and 2024 at King Chulalongkorn Memorial Hospital in Bangkok, Thailand.

Results: A total of 141 patients were analyzed in 2024, comprising 115 with T1D (81.5%), 11 with T2D (7.8%), and 15 with other types (10.6%). Intensive insulin therapy adoption in T1D reached 100% by 2024. Self-monitoring of blood glucose (SMBG) adherence remained at 56.52%, while the use of continuous glucose monitoring (CGM), reimbursable under UC since August 2023, rose from 8 users in 2022 (5.7%) to 20 users in 2024 (14.2%), marking a 150% increase. The proportion of T1D patients achieving HbA1c levels below 7% has shown a gradual increase, rising from 18.8% in 2018 to 29.1% in 2024. However, this remains below the expected target. The mean HbA1c levels in 2024 were 9% in T1D and 8.13% in T2D. Complication screenings revealed gaps: diabetic retinopathy was screened in 39.7% of patients, diabetic nephropathy using urine albumin-to-creatinine ratio in 59.6%, and serum creatinine in 60.9%. While dyslipidemia screening via LDL measurement was completed for all patients, only 19.9% had LDL levels below 100 mg/dL, suggesting treatment inertia in pediatric patients.

Conclusion: Despite improvements in therapy adoption, including intensive insulin therapy and DSMES programs, glycemic control in pediatric diabetes remains suboptimal. The significant increase in CGM users and the rising trend of T1D patients achieving targeted HbA1c levels indicate progress, yet further adoption of CGM and insulin pump technologies is needed. The shortage of diabetes educators continues to hinder effective management. Strengthening screening strategy and integrating educators into care teams is vital for better outcomes.