Financial costs for families of children with Type 1 diabetes in lower‐income countries

Ogle, Graham D; Kim, H.; Middlehurst, Angela C; Silink, Martin; Jenkins, Alicia J.

doi:10.1111/dme.12997

Cited by 47 publications

(55 citation statements)

References 23 publications

(63 reference statements)

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“…However, this is not the case in many middle‐income or low‐income countries. Insulin, blood glucose tests strips, and other components of care are often unavailable or remain inaccessible, as they must be purchased out‐of‐pocket by families . Access to physicians and nurses skilled in T1D management and diabetes education is also very frequently limited …”

Section: Introductionmentioning

confidence: 99%

“…Health facilities frequently lack any capacity to measure blood glucose . Self‐monitoring of blood glucose (SMBG) is rarely carried out because of financial barriers, indeed, the cost of two test strips per day is generally higher than the cost of insulin . Therefore, blood glucose tests are almost always exclusively carried out during clinic visits, if the measurement is available.…”

Section: Introductionmentioning

confidence: 99%

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Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

et al. 2018

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Optimal care for children and adolescents with type 1 diabetes is well described in guidelines, such as those of the International Society for Pediatric and Adolescent Diabetes. High‐income countries can usually provide this, but the cost of this care is generally prohibitive for lower‐income countries. Indeed, in most of these countries, very little care is provided by government health systems, resulting in high mortality, and high complications rates in those who do survive. As lower‐income countries work toward establishing guidelines‐based care, it is helpful to describe the levels of care that are potentially affordable, cost‐effective, and result in substantially improved clinical outcomes. We have developed a levels of care concept with three tiers: “minimal care,” “intermediate care,” and “comprehensive (guidelines‐based) care.” Each tier contains levels, which describe insulin and blood glucose monitoring regimens, requirements for hemoglobin A1c (HbA1c) testing, complications screening, diabetes education, and multidisciplinary care. The literature provides various examples at each tier, including from countries where the life for a child and the changing diabetes in children programs have assisted local diabetes centres to introduce intermediate care. Intra‐clinic mean HbA1c levels range from 12.0% to 14.0% (108‐130 mmol/mol) for the most basic level of minimal care, 8.0% to 9.5% (64‐80 mmol/mol) for intermediate care, and 6.9% to 8.5% (52‐69 mmol/mol) for comprehensive care. Countries with sufficient resources should provide comprehensive care, working to ensure that it is accessible by all in need, and that resulting HbA1c levels correspond with international recommendations. All other countries should provide Intermediate care, while working toward the provision of comprehensive care.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

et al. 2018

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“…The emerging literature on pediatric T1D management in developing country settings does not focus on parental involvement . Yet, more than half of the world's children (0‐14 years old) with T1D live in developing countries .…”

Section: Introductionmentioning

confidence: 99%

Caregiving for children with type 1 diabetes and clinical outcomes in central India: The IDREAM study

et al. 2017

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“…Nevertheless, with the increase in capacity in pediatric endocrinology in sub-Saharan Africa, there are now thousands of children and adolescents in need of a global management approach for type 1 diabetes, including access to insulin and glucagon. It is important to emphasize that for diabetes, in particular, access to medicines is only one aspect of disease management [3, 49, 50]. …”

Section: Discussionmentioning

confidence: 99%

Insights from the WHO and National Lists of Essential Medicines: Focus on Pediatric Diabetes Care in Africa

Rowlands

Ameyaw²,

Rutagarama

et al. 2018

Horm Res Paediatr

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Background: Access to essential medicines in pediatric endocrinology and diabetes is limited in resource-limited countries. The World Health Organization (WHO) maintains two non-binding lists of essential medicines (EMLs) which are often used as a template for developing national EMLs. Methods: We compared a previously published master list of medicines for pediatric endocrinology and diabetes with the WHO EMLs and national EMLs for countries within the WHO African region. To better understand actual access to medicines by patients, we focused on diabetes and surveyed pediatric endocrinologists from 5 countries and assessed availability and true cost for insulin and glucagon. Results: Most medicines that are essential in pediatric endocrinology and diabetes were included in the national EMLs. However, essential medicines, such as fludrocortisone, were present in less than 30% of the national EMLs despite being recommended by the WHO. Pediatric endocrinologists from the 5 focus countries reported significant variation in terms of availability and public access to insulin, as well as differences between urban and rural areas. Except for Botswana, glucagon was rarely available. There was no significant relationship between Gross National Income and the number of medicines included in the national EMLs. Conclusions: Governments in resource-limited countries could take further steps to improve EMLs and access to medicines such as improved collaboration between health authorities, the pharmaceutical industry, patient groups, health professionals, and capacity-building programs such as Paediatric Endocrinology Training Centres for Africa.

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Financial costs for families of children with Type 1 diabetes in lower‐income countries

Abstract: In less-resourced countries, even minimal care is beyond many families' means. In addition, families face additional costs such as consultations, travel and indirect costs. Action to prevent diabetes-related death and morbidity is needed.

Cited by 47 publications

References 23 publications

Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

Caregiving for children with type 1 diabetes and clinical outcomes in central India: The IDREAM study

Insights from the WHO and National Lists of Essential Medicines: Focus on Pediatric Diabetes Care in Africa

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