19-OR: Treatment and Outcomes in Paediatric Type 1 Diabetes across Countries with Different Gross Domestic Products—Results from the Sweet Initiative

Introduction and Objective: Treatment choices and outcomes for children with T1D vary by country, but the influence of economic wealth is not well studied. Aim: To evaluate this association using SWEET registry data Methods: A cross-sectional analysis of 54,285 individuals with T1D under 25 years, diagnosed for > 3 months, from 130 SWEET centers (2022-2023). Subjects were stratified by country GDP in four groups. Key variables included HbA1c, BMI, insulin dose, use of CGM, insulin pumps, and AID. Height and BMI z-scores followed WHO references. Regression models adjusted for age, diabetes duration, and sex. Results: Height z-scores were lowest in the low GDP group (-0.44) versus +0.24 to +0.50 in higher GDP groups. BMI z-scores increased from +0.04 in the low GDP group to +0.89 in the high GDP group (p < 0.001). Insulin requirements were highest in the low GDP group (0.93 U/kg) versus 0.75-0.79 U/kg in other groups (p < 0.001). CGM use rose from 36% in the low GDP group to 91% in the high GDP group, insulin pump use from 17% to 70%, and AID systems from 11% to 38% (all p < 0.001). HbA1c was highest in the low GDP group (8.7%) and lowest in the lower-middle group (7.5%), followed by 7.7% (upper-middle) and 8.1% (high GDP). DKA was most frequent in the high GDP group, while severe hypoglycemia was most common in the low GDP group (both p < 0.001). Conclusion: A strong association exists between GDP and nutritional status, technology use, and metabolic outcomes in pediatric T1D. Best metabolic control was in countries with lower-middle or upper-middle income. High-GDP countries showed poorer control, higher BMI, and more frequent DKA. These findings stress the need for better resource allocation in pediatric diabetes care. Disclosure C. Martinez Mateu: Other Relationship; Sanofi-Aventis Argentina. S.S. Gupta: None. R. Duperval: None. R.A. Thabet: None. D. Al-Abdulrazzaq: None. M. Pogajepec: None. O. Kaminska-Jackowiak: None. M.M. Cavalin: None. S. Munoz: None. C. Sanon: None. S. Sap: None. R.W. Holl: None. D. Pacaud: Research Support; Medtronic, Novo Nordisk, Eli Lilly and Company.