Management of type 1 diabetes in low‐ and middle‐income countries: Comparative health system assessments in Kyrgyzstan, Mali, Peru and Tanzania

Abraimova, Aida; Besançon, Stéphane; Portocarrero, Jill; Ramaiya, Kaushik; Dunganova, Asel; Ewen, Margaret; Hogerzeil, Hans V; Lazo-Porras, María; Laing, Richard; Lepeska, Molly; Nchimbi, Happy; Sidibé, A.T.; Swai, A. B. M.; Tenorio‐Mucha, Janeth; Yudkin, John; Zafra-Tanaka, Jessica Hanae; Zurdinova, A. A.; Beran, David

doi:10.1111/dme.14891

Cited by 11 publications

(24 citation statements)

References 29 publications

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“…Differences across countries and informant groups are likely driven by varying socioeconomic status, clinical needs, health system access and levels of diabetes knowledge. 3 Indeed, knowledge of some of the currently available NI-MI-GMDs differed across countries, with informants from Kyrgyzstan and Peru providing more detailed user requirement narratives due to greater knowledge of devices accessible in their contexts than their counterparts in Mali and Tanzania. This difference highlights the challenge of designing NI-MI-GMDs for use in LMICs, which vary according to current level of NI-MI-GMD use as well as readiness to adopt or expand NI-MI-GMD use due to differences in infrastructure, technology and expertise.…”

Section: Discussionmentioning

confidence: 99%

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User requirements for non-invasive and minimally invasive glucose self-monitoring devices in low-income and middle-income countries: a qualitative study in Kyrgyzstan, Mali, Peru and Tanzania

Safary,

Beran,

Vetter

et al. 2024

BMJ Open

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AimsDevelopment of non-invasive and minimally invasive glucose monitoring devices (NI-MI-GMDs) generally takes place in high-income countries (HICs), with HIC’s attributes guiding product characteristics. However, people living with diabetes (PLWD) in low-income and middle-income countries (LMICs) encounter different challenges to those in HICs. This study aimed to define requirements for NI-MI-GMDs in LMICs to inform a target product profile to guide development and selection of suitable devices.MethodsThis was a multiple-methods, exploratory, qualitative study conducted in Kyrgyzstan, Mali, Peru and Tanzania. Interviews and group discussions/activities were conducted with healthcare workers (HCWs), adults living with type 1 (PLWD1) or type 2 diabetes (PLWD2), adolescents living with diabetes and caregivers.ResultsAmong 383 informants (90 HCW, 100 PLWD1, 92 PLWD2, 24 adolescents, 77 caregivers), a range of differing user requirements were reported, including preferences for area of glucose measurement, device attachment, data display, alert type and temperature sensitivity. Willingness to pay varied across countries; common requirements included ease of use, a range of guiding functions, the possibility to attach to a body part of choice and a cost lower than or equal to current glucose self-monitoring.ConclusionsEase-of-use and affordability were consistently prioritised, with broad functionality required for alarms, measurements and attachment possibilities. Perspectives of PLWD are crucial in developing a target product profile to inform characteristics of NI-MI-GMDs in LMICs. Stakeholders must consider these requirements to guide development and selection of NI-MI-GMDs at country level, so that devices are fit for purpose and encourage frequent glucose monitoring among PLWD in these settings.

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Section: Discussionmentioning

confidence: 99%

“…7 For all PLWD needing tools to monitor their blood glucose, the lack of access to affordable equipment in LMICs gives rise to low levels of monitoring, contributing to poor glycaemic control and, as a result, poor disease outcomes. 3 7–9 …”

Section: Introductionmentioning

confidence: 99%

User requirements for non-invasive and minimally invasive glucose self-monitoring devices in low-income and middle-income countries: a qualitative study in Kyrgyzstan, Mali, Peru and Tanzania

Safary,

Beran,

Vetter

et al. 2024

BMJ Open

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“…The cost, price, and availability of glucometer strips emerged as significant factors influencing self-monitoring practices, consistent with prior research that highlighted the financial burden and cost limitations associated with blood glucose monitoring ( 10 , 23 - 26 ). The cost of glucometer strips and the price of glucometers in low to middle-income countries can amount to a significant portion of the lowest-paid government workers’ wages, ranging from 4 to 29.9 days, depending on the coverage of T1DM care by the government ( 27 ). This underscores the crucial role of price and availability of glucometers and strips in achieving the standard of care for T1DM patients, as highlighted by the findings of this study.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Self-monitoring of Blood Glucose in Iranian Children and Adolescents with Type 1 Diabetes

Fayyaz,

Khosravi,

Mosallanejad

et al. 2023

Int J Endocrinol Metab

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Background: Type 1 diabetes mellitus (T1DM) is a prevalent chronic disease among children and adolescents, necessitating effective self-monitoring of blood glucose (SMBG) levels. Understanding the determinants and factors influencing SMBG behavior is crucial for optimizing diabetes management in this population. Objectives: This study aimed to investigate the frequency of SMBG and identify the determinants influencing factors in children and adolescents with T1DM. Methods: This cross-sectional study was conducted in Tehran, Iran, and included 275 participants selected through simple random sampling from the Gabric Diabetes Education Association. The inclusion criteria comprised children and adolescents aged 3 - 18 years diagnosed with T1DM for at least 6 months who were using analog or neutral protamine Hagedorn (NPH) and regular insulin subcutaneously. Patients using insulin pumps were excluded. Data collection involved an online questionnaire covering demographic information (e.g., age, gender, educational status, and parental occupations) as well as clinical information (number of hypoglycemic episodes, hemoglobin A1C (HbA1C) levels, diabetes duration, insulin regimen, diabetes complications, glucose monitoring practices, hospitalizations, and behavioral characteristics). Statistical analyses, including descriptive statistics, correlation tests, and Poisson regressions, were performed using SPSS software (version 21). A significance level of P-value < 0.05 was considered statistically significant. Results: The participants had a mean age of 10.00 ± 3.77 years, with 54.2% being males. Most of the participants (87.3%) were students, and the mean age of diagnosis was 6.56 ± 3.73 years, with a mean duration of 44.72 ± 36.32 months. Anthropometric investigations revealed mean height, weight, and body mass index (BMI) values of 136.69 ± 21.11 cm, 37.45 ± 15.51 kg, and 18.31 ± 3.55 kg/m2, respectively. The majority of participants (93.5%) used insulin pens, and the mean daily insulin dosage was 35.34 ± 22.20 IU. Parents reported consistent glucose level monitoring in 64.7% of cases. The mean HbA1c level was 7.91 ± 1.58%. Factors such as the price and availability of glucometer strips influenced glucose level monitoring. In univariate analysis, only age and HbA1C levels showed a negative correlation; however, parents’ consistent checking showed a positive correlation with the frequency of daily, weekly, or monthly glucose checking. Conclusions: This study underscores the significance of SMBG in children and adolescents with T1DM. The findings emphasize the critical role of price and availability of glucometers and strips in achieving standard care for T1DM patients.

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“…1 Current quality of care for type 1 diabetes, as expressed by access to medicines and supplies or specialized care, has been reported to be inadequate in different countries, especially in low-and middle-income countries. 2 Some reasons are the challenges in accessing healthcare and that existing health systems interventions are not necessarily adapted for the complex management of type 1 diabetes. A previous review on health system interventions found that studies mainly focused on delivery of care and failed to assess other types of interventions such as financial arrangements, legal or policy interventions or implementation strategies.…”

Section: Introductionmentioning

confidence: 99%

“…Globally, approximately 9 million people live with type 1 diabetes 1 . Current quality of care for type 1 diabetes, as expressed by access to medicines and supplies or specialized care, has been reported to be inadequate in different countries, especially in low‐ and middle‐income countries 2 . Some reasons are the challenges in accessing healthcare and that existing health systems interventions are not necessarily adapted for the complex management of type 1 diabetes.…”

Section: Introductionmentioning

confidence: 99%

Outcomes measured in studies assessing health systems interventions for type 1 diabetes management: A scoping review

Zafra‐Tanaka,

del Valle,

Bernabé‐Ortiz

et al. 2023

Diabet Med

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AimsDescribe the outcomes reported in research on health systems interventions for type 1 diabetes management in comparison to the outcomes proposed by a core outcome set (COS) for this condition, an essential list of outcomes that studies should measure.MethodsSystematic search of studies published between 2010 and 2021 reporting health systems interventions directed to improve the management of type 1 diabetes using PubMed, EMBASE and CENTRAL. Information on the outcomes was extracted and classified according to a COS: self‐management, level of clinical engagement, perceived control over diabetes, diabetes‐related quality of life, diabetes burden, diabetes ketoacidosis, severe hypoglycemia, and glycated hemoglobin (HbA1C).Results187 studies were included. Most of the studies included either children (n=82/187) or adults (n=82/187) living with type 1 diabetes. The most common outcome measured was HbA1C (n=149/187), followed by self‐management (n=105/187). While the least measured ones were diabetes ketoacidosis (n=15/187), and clinical engagement (n=0/187). None of the studies measured all the outcomes recommended in the COS. Additionally, different tools were found to be used in measuring the same outcome.ConclusionsThis study provides a description of what researchers are measuring when assessing health systems interventions to improve type 1 diabetes management. In contrast to a COS, it was found that there is a predominance of clinical‐based outcomes over patient‐reported outcome measures.

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Management of type 1 diabetes in low‐ and middle‐income countries: Comparative health system assessments in Kyrgyzstan, Mali, Peru and Tanzania

Cited by 11 publications

References 29 publications

User requirements for non-invasive and minimally invasive glucose self-monitoring devices in low-income and middle-income countries: a qualitative study in Kyrgyzstan, Mali, Peru and Tanzania

User requirements for non-invasive and minimally invasive glucose self-monitoring devices in low-income and middle-income countries: a qualitative study in Kyrgyzstan, Mali, Peru and Tanzania

Determinants of Self-monitoring of Blood Glucose in Iranian Children and Adolescents with Type 1 Diabetes

Outcomes measured in studies assessing health systems interventions for type 1 diabetes management: A scoping review

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