India faces one of the biggest diabetes burdens in the world. Type 1 diabetes (T1D) is mostly overlooked. Investigation of care models that improve T1D outcomes in India and other resource-constrained settings is critically needed. The All India Institute of Medical Sciences (AIIMS) in Delhi operates a free, weekly multidisciplinary T1D self-management clinic. As a preliminary investigation into the effectiveness of this model and the potential benefit of its dissemination, we examined whether frequency of engagement with T1D care among a 2016 sample of AIIMS patients (n=328) close to the frequency recommended by guidelines (3 visits/yr) was associated with a reduction in the prevalence of poor glycemic control (HbA1c>9%) that is the norm among those with diabetes in India, and whether this differed by gender. With multivariate binomial generalized linear regression, we estimated the difference in prevalence of HbA1c>9% comparing those who attended 0-1 clinic visits in 2016 to those who attended 2-3 visits (ref), and comparing those who attended >3 visits to those who attended 2-3. The final adjustment set of T1D duration and gender was guided by directed acyclic graph and comparison of bias and precision of multiple models. T1D duration was 13.7± 9.0 yrs, mean age was 28.6±12.0 yrs, and HbA1c>9% prevalence was 45.7% (n=150). Prevalence of HbA1c>9% was high among those with 2-3 yearly visits (0.57; 95% CI: 0.43, 0.75). However, prevalence of HbA1c>9% was an absolute 16% higher (95% CI: 0.04, 0.27; p=0.01) among those with 0-1 visits. Estimates of the benefit of >3 visits remain unclear due to limitations including sparse data. We did not observe effect modification by gender (p=0.48). In sum, 2-3 vs. fewer yearly visits with a multidisciplinary outpatient team like the model delivered by AIIMS may help alleviate the high prevalence of HbA1c>9% in India. Further research will identify which care features drive glycemic control improvements and may be feasibly adopted elsewhere.
A. Cristello: None. P.A. Praveen: None. E.J. Mayer-Davis: None. N. Tandon: None.