Costs and outcomes of “intermediate” vs “minimal” care for youth‐onset type 1 diabetes in six countries

Gregory, Gabriel A; Guo, Jingchuan; Klatman, Emma L; Ahmadov, Gunduz; Besançon, Stéphane; Gomez, Elizabeth Duarte; Fawwad, Asher; Ramaiya, Kaushik; Wijesuriya, Mahen; Orchard, Trevor J.

doi:10.1111/pedi.12988

Cited by 10 publications

(8 citation statements)

References 25 publications

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“…Interestingly, this result is achieved without the use of all ''intermediate care'' resources, which include multiple daily injections (''basalbolus regimen''). This improvement in glycemic control, if maintained, should lead to a reduction in long-term complications and mortality, as has been shown in some studies [6,15]. In a recent population-based cohort study, Marcus Lind found that HbA1c [ 8.6% ([ 70 mmol/mol) was a risk factor for proliferative retinopathy and macroalbuminuria in 10,398 children and adults with type 1 diabetes [16].…”

Section: Discussionmentioning

confidence: 77%

Efficacy of a New Protocol of Premixed 70/30 Human Insulin in Haitian Youth with Diabetes

Jean-Baptiste¹,

Larco²,

Oettingen

et al. 2021

Diabetes Ther

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Introduction Controlling insulin-treated diabetes is challenging in low-resource settings where only Neutral Protamine Hagedorn (NPH), regular (R) and premixed insulin formulations are available, self-monitoring of blood glucose (SMBG) supplies are scarce and food insecurity is common. We examined the impact of a treatment protocol that includes sliding scale-based 70/30 insulin adjustments in Haiti. Methods Thirty young patients aged 11–28 years with diabetes treated with premixed 70/30 insulin twice daily were included in the study. The participants performed one or two daily self-monitoring of blood glucose (SMBG) tests and attended our diabetes clinic monthly. They were randomized to two treatment groups, with one group remaining on the 70/30 insulin formulation (group 70 [G70]) and the other group switching to self-mixed NPH + R (group NR [GNR]). Sliding scales for insulin correction doses and meal insulin doses were designed based on the total daily insulin dose (TDD), carbohydrate ratio and insulin sensitivity factor. SMBG tests and insulin were administered before the morning and evening meals. The frequency of visits to the diabetes clinic was increased to biweekly during a 14-week follow-up. Results Fifteen patients of each group were included in the analysis. Baseline characteristics, increase in total daily dose and number of missed SMBG tests and skipped meals at 14 weeks did not differ between the two groups. Hemoglobin A1c (HbA1c) decreased from 9.5% (interquartile range [IQR] 8.8, 10.5) (80.3 mmol/mol) to 8.0% (IQR 7.1%, 9.0%) (63.9 mmol/mol) in G70 ( p = 0.01), and from 10.6% (IQR 8.1,% 13.1)% (92.4 mmol/mol) to 9.0% (IQR 7.6%, 9.6%) (74.9 mmol/mol) in GNR ( p = 0.10), with no significant between-group difference in reductions ( p = 0.12). No serious acute complications were reported. Stopping the use of sliding scales and resuming monthly visits increased HbA1c to values not significantly different from baseline in both groups after 15 weeks. Conclusion The use of sliding scales adjusted for missed SMBG tests and skipped meals, and frequent clinic visits that focus on patient self-management education significantly improved glycemic control in the patients with youth-onset diabetes in our study treated with premixed 70/30 human insulin in a low-resource setting.

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Section: Discussionmentioning

confidence: 77%

Efficacy of a New Protocol of Premixed 70/30 Human Insulin in Haitian Youth with Diabetes

Jean-Baptiste¹,

Larco²,

Oettingen

et al. 2021

Diabetes Ther

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“…In the second stage, the proportions of individuals living with specific complications of diabetes are determined using methodology from the childhood-onset cohort of the University of Pittsburgh Epidemiology of Diabetes Complications (EDC) study [ 25 •], followed out to 30 years after diagnosis. This methodology provides estimates of the prevalence of several complications at each duration of diabetes, as a function of mean HbA1c.…”

Section: Further Modelling On Health Life Years and Numbers Receiving...mentioning

confidence: 99%

The T1D Index: Implications of Initial Results, Data Limitations, and Future Development

Ogle,

Gregory,

Wang

et al. 2023

Curr Diab Rep

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Purpose of the Review Current global information on incidence, prevalence, and mortality of type 1 diabetes (T1D) is limited, particularly in low- and middle-income countries. To address this gap in evidence, JDRF, Life for a Child, International Society for Pediatric and Adolescent Diabetes, and International Diabetes Federation have developed the T1D Index, which uses a Markov mathematical model, and machine learning and all available data to provide global estimates of the burden on T1D. This review assesses the methodology, limitations, current findings, and future directions of the Index. Recent Findings Global prevalence was estimated at 8.4 million in 2021, with 1.5 million <20 years (y). T1D prevalence varied from 1.5 to 534 per 100,000, with T1D accounting for <0.1–17.8% of all diabetes in different countries. A total of 35,000 young people <25 y are estimated to have died at clinical onset of T1D from non-diagnosis. An estimated 435,000 people <25 y were receiving “minimal care.” Health-adjusted life years (HALYs) lost for individuals diagnosed with T1D at age 10 y in 2021 ranged from 14 to 55 y. Summary These results show that interventions to reduce deaths from non-diagnosis, and improve access to at least an intermediate care level, are needed to reduce projected life years lost. The results have significant uncertainties due to incomplete data across the required inputs. Obtaining recent incidence, prevalence, and mortality data, as well as addressing data quality issues, misdiagnoses, and the lack of adult data, is essential for maintaining and improving accuracy. The index will be updated regularly as new data become available.

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“…There has been lack of basic need for glycemic control which has been improving progressively. Therefore, more work is needed on managing and taking care of children and youth to be able to manage the glycemia as efforts are being done to improve the supply of insulin and monitoring tools, adherence is part of something to be worked on so more than just these supplies (25,41,42). In most studies the psychological parts of children, youth and parents is an aspect which is missing in the African context.…”

Section: Discussionmentioning

confidence: 99%

Type 1 diabetes in low and middle-income countries - Tanzania a streak of hope

2023

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IntroductionIn several of the Low and Middle Income countries , many patients with Type 1 diabetes (T1D) are most probably not diagnosed at all which may contribute to their low incidence. As an example of a country with low income and poor resources, we have chosen to study T1D in children/young people in Tanzania.MethodsAnalyses of casebooks and statistics at several Tanzanian hospitals treating young patients with insulin dependent diabetes, usually Type 1 diabetes, and collection of information from different organisations such a Tanzanian Diabetes Association, Life for a Child, Changing Diabetes in Children and World Diabetes Foundation.ResultsThe incidence in several areas is low. However, a lot of data are often missing at studied clinics and therefore the incidence might be higher, and with increased awareness in recent years the number of patients has increased many-folds. Most patients present with typical symptoms and signs of T1D, and a high proportion with plausible ketoacidosis , although this proportion has decreased from about 90% to about 40% in recent decades. Many patients have poor blood glucose control, and complications often develop already after short diabetes duration. In recent years resources have increased, awareness has increased and diabetes clinics started where staff has got training.ConclusionsThere are problems with diabetes care in Tanzania but several facts give hope for the future.

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Costs and outcomes of “intermediate” vs “minimal” care for youth‐onset type 1 diabetes in six countries

Cited by 10 publications

References 25 publications

Efficacy of a New Protocol of Premixed 70/30 Human Insulin in Haitian Youth with Diabetes

Efficacy of a New Protocol of Premixed 70/30 Human Insulin in Haitian Youth with Diabetes

The T1D Index: Implications of Initial Results, Data Limitations, and Future Development

Type 1 diabetes in low and middle-income countries - Tanzania a streak of hope

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