Use of a 24-hour telephone support service for patients with diabetes in a resource constrained society. 

Farrukh Ahmed, Awn Bin Zafar, Rubina Hakeem, Musarrat Riaz, Bilal Tahir, Abdul Basit

Background: Self-management of diabetes is important for optimal control of blood glucose levels.Station based24 hours helpline support for the people with diabetes is a unique concept in developing countries.

Aims: To observe the effectiveness ofa stationed based 24 hours telephonic helpline service in people with diabetes. 

Methodology:The study was conducted at Baqai Institute of Diabetology & Endocrinology, a tertiary care diabetes center inKarachi, Pakistan. People with diabetes attending the outpatient department from January 2013 to January 2017 were included in the study. After providing diabetes education, a telephonic helpline number was also provided for emergency situations and insulin dose adjustments. Telephone calls of registered patients were received by trained diabetes educators stationed at the center 24 hours a day, 7days a week. Data was collected through specially designed interface; Health management system (HMS) in which the current diabetes related health issues of the callers wereaddressed by the diabetes educators. Statistical Package for the Social Sciences (SPSS) version 20 was used.

Result:During this study a total number of 12997calls were received, 1867 calls were made bytype 1diabetes patients and 11045 calls were by type2 diabetes patients. The average age of patients was 49.3 years. The frequent calls were regarding queries about blood glucose targets, medication regimens, gestational diabetes, insulin handling during traveling, hypoglycemia, hyperglycemia and insulin dose adjustment. Estimated calls concerning about hypoglycemia (72-80mg/dl) were 833 (6.4%) and concerning hyperglycemia (>200 mg/dl) were 438(11.1%).Insulin dose was adjusted on 2868 (22.1%) calls while 284 (2.2%) were specifically for dose adjustment during Ramadan. Calls received regarding insulin handling during traveling were 438 (3.4%). Subjects with co morbidities called in emergency situation were447(3.4%) and were advised by diabetes educator to come to emergency department as early as possible. Around 3488 (26.8%) calls have been facilitated for the electronic record keeping of blood glucose levels with help of designated diabetes educator. 

Conclusion: Station based 24-hours telephonic helpline service is an effective tool for providing continuous support to people with diabetes and their families, for the self management of diabetes. It can help in the management of various acute complication of diabetes and emergency situations, thereby preventing unnecessary hospital visits and admissions.