Glycemic Control, Compliance and Adverse Effects Related to Subcutaneous Insulin in Pediatric Age Group (1–18 Years): A Single-Centre Observational Study in Chevella, Telangana

Abstract

Background: Optimal glycemic control remains the cornerstone of management in children and adolescents with type 1 diabetes mellitus (T1DM). Poor adherence to insulin therapy increases the risk of acute and chronic complications, while treatment-related adverse effects may further compromise long-term disease management. Limited prospective data are available from India regarding factors influencing glycemic control and insulin adherence in pediatric patients.

Objective: To evaluate glycemic control, adherence to subcutaneous insulin therapy, and insulin-related adverse effects among children and adolescents with T1DM and to identify factors associated with poor glycemic control.

Methods: A prospective single-centre observational study was conducted among 41 children aged 1–18 years with T1DM at PMR Medical College and Research Institute, Chevella, Ranga Reddy, Telangana. Glycemic control was assessed using glycated hemoglobin (HbA1c) and random blood glucose (RBS) measurements. Treatment adherence was evaluated using the Adherence in Diabetes Questionnaire (ADQ). Demographic characteristics, disease-related variables, caregiver characteristics, physical activity, routine glucose monitoring, and insulin-related complications were recorded. Statistical analyses included descriptive statistics, paired t-test, and Chi-square test, with p<0.05 considered statistically significant.

Results: The mean age of participants was 12.02±3.70 years, and 53.7% were males. Poor glycemic control was observed in 56.1% of patients despite a significant reduction in mean HbA1c during follow-up (11.96±1.92 vs. 10.03±2.75; p=0.001). Better glycemic control was significantly associated with educated caregivers (p=0.013), female primary caregivers (p=0.047), higher ADQ adherence scores (p=0.001), and caregiver relationship (p=0.027). Lipohypertrophy occurred in 34.1% of patients, while pain at the injection site was reported by 48.8%.

Conclusion: More than half of pediatric patients demonstrated suboptimal glycemic control despite insulin therapy. Caregiver education, treatment adherence, and family involvement were important determinants of metabolic control. Structured diabetes education targeting both patients and caregivers may improve adherence and long-term glycemic outcomes.