Economic disparities and gender differences in pediatric diabetes Care: the SWEET international Registry

Martinez Mateu Carolina; Suzanne Sap; Regina Duperval; Sunil Gupta; Catherine Sanon; Dalia Al-Abdulrazzaq; Šepec Marija Požgaj; Olga Kaminska-Jackowiak; Thabet Rasha; Silvia Munoz; Cavalin Marina; Reinhard Holl; Daniele Pacaud

doi:10.1530/endoabs.110.OC8.1

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Endocrine Abstracts (2025) 110 OC8.1 | DOI: 10.1530/endoabs.110.OC8.1

ECEESPE2025 Oral Communications Oral Communications 8: Diabetes and Insulin Part 2 (6 abstracts)

Economic disparities and gender differences in pediatric diabetes Care: the SWEET international Registry

Martinez Mateu Carolina ^1,2 , Suzanne Sap ³ , Regina Duperval ⁴ , Sunil Gupta ⁵ , Catherine Sanon ⁶ , Dalia Al-Abdulrazzaq ⁷ , Marija Požgaj Šepec ^8,9 , Olga Kaminska-Jackowiak ¹⁰ , Thabet Rasha ¹¹ , Silvia Munoz ¹² , Cavalin Marina ¹³ , Reinhard Holl ¹⁴ & Daniele Pacaud ¹⁵

Author affiliations

¹The University of Buenos Aires, Buenos Aires, Argentina; ²Hospital J.P. Garrahan, Buenos Aires, Argentina; ³University of Ebolowa, Peadiatrics, Mother and Child Center, Yaounde, Cameroon; ⁴Mc Gill University, Montrouis, Haiti; ⁵Sunil’s Diabetes Care n’ Research Centre, Diabetes care foundation of India, Nagpur, India; ⁶The University of Montrouis, Montrouis, Haiti; ⁷Dasma Institute, Kuwait City, Kuwait; ⁸Sestre milosrdnice University Hospital Center, University Department of Pediatrics, Zagreb, Croatia; ⁹University of Zagreb School of Dental Medicine, Zagreb, Croatia; ¹⁰The University of Opole, Opole, Poland; ¹¹Ain Shams University, Cairo, Egypt; ¹²The University of Cochabamba, Cochabamba, Bolivia; ¹³The University of Curitiba - Parana, Curitiba - Parana, Brazil; ¹⁴Universitaet Ulm, Institut für Epidemiologie und medizinische Biometrie, Ulm, Germany; ¹⁵Cumming School of Medicine, University of Calgary, Alberta Childrens Hospital, Department of Pediatrics, Calgary, Canada

JOINT1533

Introduction and objective: Treatment strategies for pediatric Type 1 Diabetes (T1D) show substantial variation across countries. However, the role of national economic wealth interacting with gender differences on the outcome of care remains poorly defined. This study aims to assess these disparities using data from the worldwide SWEET registry.

Methods: We analyzed data from 54,285 pediatric patients with T1D (<25 years of age, diagnosed for >3 months) treated in 2022-2023. Participants (median age: 14.5 years; 52% male) were categorized into four groups based on their countries’ GDP: low, lower-middle, upper-middle, and high income. Z-scores for height and BMI were calculated using the WHO reference standards. We performed linear and logistic regression analyses, adjusted for age, diabetes duration, and sex, to compare the outcomes across GDP groups. Gender-specific analyses were also conducted.

Results: Males consistently had higher height SDS across all income groups (P<0.0001). In contrast, females had higher BMI SDS, with the largest gender differences observed in the low-income groups (P<0.0001). HbA1c levels were highest in the low GDP group (8.7%) and lowest in the lower- and upper middle groups (7.5%). Overall, females had higher HbA1c levels (P<0.0001), with notable gender disparities in lower GDP quartiles (+0.07 to +0.15%), but no significant differences in the highest quartile. DKA episodes were most frequent in the high GDP group, and these were significantly more common in females (P<0.001). Females in the lower GDP quartiles had higher rates of severe hypoglycemia compared to males (0.10 vs. 0.07; P<0.001), with no gender differences in the highest GDP quartile. Insulin doses were found to be significantly higher in females (P<0.001). The use of diabetes technologies increased with GDP: insulin pump use ranged from 17% in low-GDP countries to 70% in high-GDP countries, CGM use from 36% to 91%, and AID systems from 11% to 38% (all P<0.0001). Females showed slightly higher adoption rates for both CGM and AID systems compared to males.

Conclusion: Females with T1D presented with shorter stature, higher BMI, and elevated HbA1c compared to males, particularly in lower-income settings. While they showed higher adoption rates of diabetes technologies, these advances did not fully close the gender gap, highlighting the need for targeted interventions addressing both gender and socioeconomic factors to ensure equitable outcomes in pediatric diabetes care.