Background  
The discovery of insulin in 1921 changed the lives of people living with diabetes (PLWD). Yet, millions still lack access to insulin. Additionally, an unrecognized number of PLWD cannot access or afford the commodities needed to measure their blood glucose (BG) or safely administer insulin itself. This inconsistent access (further exacerbated by COVID) forces PLWD to ration insulin, test strips, and ration or reuse needles/syringes, leading to increased rates of severe complications, including death. This represents a huge unmet need and a call-to-action for service delivery innovation. 

Aim  
Diabetes CarePak project aims to: 


* develop a human-centered “co-packaging” solution that increases access to the combination of medication and associated supplies needed for safe administration of insulin and self-care to improve quality of life and health outcomes 
* demonstrate health system benefits and preliminary cost savings to the Kenyan government to advocate for broader uptake. 

Method  
We partnered with &gt; 100 individuals, in Kenya, with lived, clinical, or work expertise in diabetes, to actualize the “care package” included in the Kenya Ministry of Health (MOH) 2018 clinical management guidelines. Utilizing human-centered design (HCD), we conducted interviews and focus groups across three counties with PLWD, health care workers (HCW), and MOH officials to co-create the CarePak prototype, and the educational and training materials for PLWD and HCWs. The CarePak prototype, which included items such as a glucometer, test strips, lancets, needles/syringes (if applicable), and educational materials was given to 23 users with Type 1 (T1D) or Type 2 (T2D) diabetes, across five facilities within the three counties, to be used daily, at home, for two months. Nine users had T1D, eight users had T2D and used insulin, and 6 users had T2D and used oral medication. Fourteen users were female and eight were from a rural area. Users completed baseline and end-line questionnaires and pre-/post-HbA1c values were documented. Usability feedback was gathered through home, clinic, and virtual visits.

Results  
Emerging themes included limited diabetes management/self-care knowledge (PLWD were unaware of what type of diabetes they had, incorrect insulin injection techniques were observed), limited access to personal BG monitoring (&gt;70% of the PLWD did not own monitoring equipment), frequent reuse of needles/syringes due to cost or unreliable availability, and frequent visits to multiple facilities to get all supplies due to stockouts. Following use of the CarePak, users reported changes in individual lifestyle management (e.g. increased self-monitoring of BG, changes in diet), clinical management changes (e.g. changes in insulin regimens using BG data over time), and improved clinical outcomes (e.g. fewer sores from needle reuse, an average HbA1C improvement of 2.8% over two months). 

Discussion  
The HCD methodology, with PLWD at the center of the co-creation process, captured key diabetes management challenges, the need for a bundle of commodities, and ensured the CarePak was usable, feasible, and valuable. CarePak iterations continue in Kenya and work is expanding to additional countries in 2022. As COVID-19 continues to stress supply chains and PLWD, we have an obligation to address all aspects of self-care, otherwise we will continue to fail PLWD globally.



Diabetes CarePak: Creating &amp; testing a bundling solution to improve access to safe insulin administration in Kenya

Diabetes CarePak: Creating & testing a bundling solution to improve access to safe insulin administration in Kenya