Comprehensive diabetes health care for people with type 1 diabetes in a resource constraint society; a three-year follow-up

Bilal Tahir, Muhammad Yakoob Ahmedani, Asher Fawwad, Fariha Shaheen, Abdul Basit

Background
Unfortunately, the majority of people with type1 diabetes, living in developing countries do not have access to the standardized care along with life-saving medicines they need. As a result, many of them die, others develop severe complications. The aim of the study was to observe the effectiveness of standardized and comprehensive care for the non-affording people with type 1 diabetes.
Methodology 
This community based observational study was part of “Insulin my life” a collaborative project of World Diabetes Foundation (WDF), Life for a Child program (LFAC) and Baqai Institute of Diabetology & Endocrinology (BIDE), carried out in the province of Sindh, Pakistan from February 2010 to February 2013. Ethical approval was obtained from Institutional Review Board (IRB) of BIDE. All people with type 1 diabetes who attended the Outpatient department of BIDE were included after obtaining informed consent. Electronic database was designed for demographic, biochemical, anthropometric and medical examination. Monthly consultation with a team of physician, diabetes educator and dietitian along with HbA1c (every 6 month) was part of the standardized health care. All the recruited people with type 1 diabetes were provided insulin, glucometer, glucose measuring strips and advised to monitor their blood glucose at home. Records of self-monitoring of blood glucose (SMBG) and complications like symptomatic hypoglycemia and hyperglycemia was also observed. A website for the project was developed and a 24-hour telephonic helpline service was established for the people with type 1 diabetes. SPSS version 20 was used for data analysis.
Results 
Out of 421 people with type 1 diabetes, 218 (51.8%) were males and 203 (48.2%) were females. Mean age of the participants was 15.96 ± 7.36 years with mean duration of diabetes and mean body mass index (BMI) was 3.35 ± 5.01 years and 18.23 ± 5.56 kg/m2 respectively. Family history of type 2 diabetes was positive 141 (33.5%) participants. Total of 57448 blood glucose readings were obtained during study period. Eight forty five (1.5%) and 11407 (19.6%) blood glucose readings in severe hypoglycemic (< 40 mg/dl) and severe hyperglycemic (> 300 mg/dl) ranges respectively. Blood glucose reading at different meal timings were observed the decreasing trend during the study period (p < 0.05).  Among the participants with 10 years of diabetes, 5.5% had nephropathy, 1.5% had retinopathy and 2.9% had neuropathy at baseline as compared to last visit with 5.6% 2.9% and 1.9% respectively. Mean HbA1c of the participants at baseline was 10.96 ± 2.85% which decreased to 10.12 ± 2.47% after 6 months, 9.75 ± 2.19% after 12 months, 9.84 ± 2.23%, after 18 months, 9.51 ± 2.44% after 24 months, 9.60 ± 2.64% after 30 months and 8.84 ± 2.05% after 36 months (p< 0.05).
Conclusion 
Provision of standardized and comprehensive health care for people with type 1 diabetes along with free accessibility of insulin to non-affording people resulted in improvement of their glycemic control. Increasing awareness regarding type 1 diabetes and health care facilities could be supportive and valuable to decrease the complication rate to achieve healthy life with diabetes.
Acknowledgment
We acknowledge the support of “Insulin my life” (IML) project, a collaborative project of World Diabetes Foundation (WDF), Life for a Child program (LFAC) and Baqai Institute of Diabetology and Endocrinology (BIDE).

Comprehensive health care for people with type 1 diabetes in a resource constraint society: a three year follow-up