Background
Currently, in India, there are neither reimbursement policies nor government supply of free Insulin Pumps (IP) to T1D children. A good majority of these
children does not have the fortune to live longer like those without the disease. P Kesavadev Trust type 1 diabetes Project (KT1DP) Sweet Stars was
initiated by us with a humanitarian objective to provide a lifesaving technology to economically challenged T1D children by providing free IPs, accessories etc. With the collaboration of various stakeholders, we succeeded in providing IPs and accessories totally free of cost to some of the most deserving T1D candidates attending our diabetes care centre.

Aim
To identify the challenges faced by the diabetes team while implementing a humanitarian project of providing free insulin pumps, accessories, insulin,
glucometers, strips, etc. and to propose possible solutions. Also to assess the effectiveness of IP Therapy (IPT) on achieving glycemic control as well as in improving the quality of life (QoL) of economically challenged children with uncontrolled T1D. 

Method
Economically challenged T1D children who were uncontrolled on MDI were provided with IPs and accessories completely free of cost as a part of our KT1DP initiative. Clinical parameters noted in these individuals (n=4, 2 boys and 2 girls, mean age= 16.3±4.6 years, mean T1D duration= 8±1.73 years, mean time spent on IPT as on the date of data retrieval= 3±2 months) during pre and
post pump sessions were compared. Experiences shared by them were assessed to understand the utility of this technology in improving the overall QoL. Challenges faced by our project team while implementing this selfless initiative was evaluated to come up with possible recommendations.

Results
All of the patients achieved a significant drop in HbA1c as noted from their latest clinical visit after IPT initiation (11.07±0.83% to 9.5±0.83%, p=0.0265).
Patients met with lesser events of hypoglycemia and no events of DKA after shifting to IPT and all of them recounted a positive experience. Challenges
faced by KT1DP team while implementing the project and the possible solutions identified by the team members to address these challenges are provided.

Discussion
Many T1D patients require advanced technologies to lead a normal life. In developing countries where even insulin is not available, IP is definitely a farfetched dream. Our results reinforce that patients who are motivated and take efforts to learn the techniques can undoubtedly reap the benefits of IPT. Costs associated should never be a hindrance towards achieving the best treatment. Government and charity organisations should recognise the significance of such lifesaving modalities and implement appropriate reimbursement policies. Extra time and resources for continuous training and troubleshooting especially for those uneducated parents will remain a major challenge. The project team will have to face an additional risk of bearing the responsibility of mishaps arising due to the inappropriate use of the technology. Such untoward instances can create suspicion about the merits of such technologies. Patients and their caregivers must be educated on the advantage they are at with regard to obtaining such a costly treatment at no cost, which is essentially meant for ‘gifting a life’.

Free insulin pumps to type 1 diabetes children- KT1DP initiative