In low- and middle-income countries (LMIC), youth with diabetes suffer from poor glycemic control even if free insulin and diabetes care are provided. In Haiti, health-related quality of life (HRQL) among youth with diabetes is low. We validated depression, self-esteem and self-management scales (Table 1) in Haitian youth with diabetes and evaluated them as well as perceived health, subjective and objective social status as determinants of glycemic control and HRQL. In 85 participants (59% female, mean age 17.5±5 years, mean diabetes duration 3.7±3.5 years, mean HbA1c 11.3±2.6%, mean HRQL 61±16 out of 100, mean satisfaction score 64±20 out of 100) mild, moderate and moderately-severe depression rates were 38%, 21% and 7% respectively, self-esteem score was 61±12 on a scale of 0 to 100 and perceived self-management score was 45±17 on a scale of 0 to 100. No measure predicted glycemic control (p>0.05 for all). When adjusted for age, sex and diabetes duration, higher self-esteem (p=0.003), higher subjective SES (p=0.04) and lower depression score (p<0.05) remained significant determinants of HRQL. Higher objective SES (p=0.01) and lower depression score (p=0.04) remained determinants of satisfaction. Depression and objective SES emerge as intervention targets while subjective psychosocial health emerges as a resilience worth nurturing to improve HRQL and life satisfaction. Disclosure R. Vincent: None. Z. Kamal: None. B. Coriolan: None. K. Altenor: None. J.E. von Oettingen: None.
Background: In resource-limited settings, screening for gestational diabetes (GDM) is not routine. Standard commercial glucose preparations are often not available. Objectives: To test a locally accessible, cheaper alternative glucose source (AGS) for GDM screening in Haiti. Methods: Double cross-over trial of 138 pregnant women 24-28 weeks gestational age. Two one-step 75g oral glucose tolerance tests (oGTT) with capillary blood glucose (CBG) obtained at 0, 1 and 2h were performed 3-5 days apart with the standard glucose drink Glucola and with AGS. Each participant served as her own control. Logistic and linear regression were used to assess AGS-CBG as a predictor of GDM and of Glucola-CBG, respectively. Tolerance of AGS was surveyed. Results: Fourteen women (10%) had GDM, and 5, 2, and 7 were diagnosed based on Glucola-CBG of >92, >180, and >163 mg/dl at 0, 1 and 2h, respectively. At 1 and 2h, mean AGS-CBG vs. Glucola-CBG was 107 vs. 126 (p<.0001) and 89 vs. 113 mg/dl (p<.0001), respectively, and they were positively correlated (r=0.65 and r=0.68, p≤0001). The 1h AGS-CBG had an area under the curve of 0.82 (p=0.0002) to predict GDM. A cut-off of ≥120 mg/dl had a sensitivity, specificity, positive and negative predictive value of 100%, 78%, 25% and 100% to predict GDM not diagnosed by a fasting CBG. Conclusion: Using a fasting CBG of >92 mg/dL and a 1h post-AGS CBG of ≥120 mg/dL, AGS can determine the need for a Glucola-based oGTT, avoiding 3 out of 4 Glucola based tests. Women prefer AGS over Glucola. Disclosure L. Ronciere: None. B. Coriolan: None. R. Destine: None. C. Belanger-Bishinga: None. I. Malhame: None. J.E. von Oettingen: None. Funding McGill University
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