P-328: Caregiver-reported glucose sensor use and acute outcomes in Brazilian youth with type 1 diabetes

Abstract

Children and adolescents with type 1 diabetes require intensive glucose monitoring to reach glycemic targets while avoiding severe hypoglycemia and acute care use. Glucose sensors can support real-time decisions, but in middle-income settings access may depend on family income, public provision or litigation. To evaluate caregiver-reported sensor use, access pathways and clinical outcomes among youth with type 1 diabetes in Brazil. A national cross-sectional online survey was conducted with respondents who identified as caregivers of a child or adolescent with diabetes. Current sensor users were compared with former or never users. Outcomes included HbA1c ≥7%, severe hypoglycemia, emergency/hospital care for dysglycemia and hospitalization in the previous 12 months. Associations were estimated using robust Poisson regression adjusted for sex, health insurance, household income and diabetes duration. Among 440 caregivers, current sensor use was reported by 238 (54.1%), while 179 were former or never users. Compared with non-current users, current users had lower HbA1c ≥7% (61.5% vs 82.3%), severe hypoglycemia (46.6% vs 64.0%), emergency/hospital care (24.8% vs 43.0%) and hospitalization (18.5% vs 29.1%). After adjustment, sensor use remained associated with lower prevalence of HbA1c ≥7% (aPR 0.77, 95%CI 0.67–0.89), severe hypoglycemia (aPR 0.73, 95%CI 0.60–0.89) and emergency/hospital care (aPR 0.70, 95%CI 0.53–0.93). Among current users, 182/238 (76.5%) accessed sensors through out-of-pocket payment or legal action, including 77 (32.4%) via legal action; only 33 (13.9%) reported public provision. Current sensor use was associated with better glycemic and acute outcomes. Dependence on private payment or litigation highlights major inequities and supports structured sensor provision and primary health care investment within the Brazilian Unified Health System.