Endocrine Abstracts

Introduction: In many low income countries in Southeast Asia, twice daily premix insulin regimen has been the conventional insulin therapy initiated for children and young people (CYP) with type 1 (T1D) diagnosis. In Laos, uni-versal health coverage for diabetes does not include insulin provision and blood glucose testing kits. We aimed to explore, This study aims to explore the views and perceptions of CYP with T1D in Laos on how transitioning from twice daily insulin regimen to a MDI regimen affected their diabetes management and quality of life.

Methods: Data were collected from the medical records of, and through individual semi-structured face to face interviews with, CYP supported by the Action4Diabetes program in Laos. Participants were recruited as they switched from a BD to MDI regimen. Quantitative data were stratified into HbA1c 6 and 12 months before and after the switch, and male vs. female sex; associations were examined using t-tests. Qualitative data were analysed using Gibbs’s framework.

Results: Overall, 24 youth (62.5% female) from across nine provinces transitioned to an MDI regimen. In the 6 and 12-month periods prior to the switch, mean ± SD HbA1cs were 8.8±2.3 and 8.3±2.2% respectively. In the 6 and 12-month periods following the switch, HbA1c had improved to 7.6±2.7 and 7.7±2.1%, respectively. No differences were observed between males and female sexes. Interviews were conducted with 15 CYP (73.3% female). Mean ages at T1D diagnosis was 10.6 years and at the switch time were 14.3 years (range 4-24) respectively. Describing how transitioning to an MDI regimen could and did affect their T1D management and quality of life, three themes emerged: pragmaticism; empowerment and agency; and foundations of success. Prior to transitionning, lack of confidence in carbohydrate counting and injections during school-time were raised as barriers. However, the switch was viewed positively, with cited benefits including increased food flexibility, and improved glucose stability (with less hypoglycaemia), and sense of well-being.

Conclusions: This study provides valuable insights that will guide future work in supporting the switch for youth with T1D from BD to MDI regimens.