870-P: Patient Factors and Engagement of Care in Type 2 Diabetes in Phnom Penh, Cambodia

Cambodia is developing its response to non-communicable diseases including the increasing prevalence of diabetes. Third party payment for care is limited therefore much of the financial burden is left to the patient. The Community Medical Center (CMC) is an NGO-sponsored outpatient clinic in Phnom Penh which started a diabetes specialty clinic in 2013 in the absence of endocrinologists by relying on a corps of internists. This corps plays a critical role in monitoring and treating patients over time given the chronic nature of the disease. Multiple visits annually are considered standard of care in the developed world. The CMC team launched a database tracking all patients in 2015 and had enrolled 3634 patients with T2DM as of January, 2019. Complete data sets were available for 3570. We performed a fixed effects regression analysis to identify patient characteristics at the initial visit that might impact engagement in care (ENC), defined as fully engaged if patient had at least 2 follow-up visits within the first year of enrollment (FENC), or partially engaged (one f/u visit) PENC. Of the patients enrolled, 2,019 met criteria for FENC, 420 met criteria for PENC, and 1,131 were not engaged. In a fully adjusted model, receiving financial assistance for health expenses had the greatest impact (β = 0.382, p<.001) on ENC. Taking antihypertensive medication was also associated with ENC (β = 0.141, p<.001). BMI > 35 was negatively associated with ENC (β = -0.280, x p<.05). Proximity of residence to CMC, presence of complications, A1C level, and use of insulin were not significantly associated with ENC. This is the first large longitudinal study of its type in Cambodia. Assistance with cost of care to the patient had the strongest positive correlation with ENC. Further research is needed to better understand the factors that lead to ENC in resource challenged environments such as Cambodia as well as guide what modifications can be made to programs.