MON-213 - Impact of Psychosocial Determinants and the Brazilian Socioeconomic Context on Adherence to Treatment in Type 1 Diabetes Mellitus: A Case Report

Introduction Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease that mainly affects children and adolescents, requiring continuous treatment and strict monitoring. In Brazil, there are an estimated 499,000 cases, approximately 99,000 of which are in people under the age of 19. Despite the provision of insulin and basic supplies by the Unified Health System (SUS), access to technologies remains limited. In adolescence, a phase marked by biopsychological changes and the search for autonomy, psychosocial and socioeconomic factors directly influence treatment adherence and clinical outcomes. Objective To analyze the impact of psychosocial and socioeconomic factors on treatment adherence in an adolescent with T1DM. Methods Case report with a qualitative approach, based on interviews with the patient and his mother, associated with the analysis of medical records and contextualization by national epidemiological data and scientific literature. Results and Discussion K.M.C.T.R., male, 14 years old, Brazilian, diagnosed with T1DM in April 2024, irregular follow-up for seven months, with five previous admissions to the emergency room, including one admission to the ICU. Admitted with complaints of odynophagia, emesis, and abdominal pain for three hours. Prescribed use of NPH 20 IU morning and evening, and regular insulin according to capillary blood glucose, which has not been performed for 7 months due to refusal of glycemic monitoring due to aversion to finger pricking. On physical examination, he was in good general condition, Glasgow 15, with no respiratory or cardiovascular changes, with diffuse abdominal pain. Laboratory tests showed hyperglycemia, metabolic acidosis, and ketonuria, indicating management in the ICU for diabetic ketoacidosis. The anamnesis revealed relevant socioeconomic and psychosocial determinants, including a large family structure, maternal overload, limited income of R$2,600 including salary and pensions, and difficult access to specialized care. On the psychosocial level, there was partial understanding of the disease, incomplete use of insulin therapy, and emotional distress, with conflicts between autonomy and self-care, contributing to avoidable decompensations. Conclusion The case shows that, in addition to the supply of basic inputs, the lack of continuous specialized follow-up, limited access to technologies, and psychosocial distress negatively impact the management of T1DM in adolescence. Integrated strategies, including health education, psychological support, and expanded access to technologies, are essential to improve adherence, reduce decompensations, and prevent recurrent hospitalizations. Educational measures, referral to low-cost specialized care, emotional support, and discussion about the possibility of legal action to obtain access to continuous blood glucose monitoring were recommended.

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