Optimized health care for subjects with type 1 diabetes in a resource constraint society: A three-year follow-up study from Pakistan
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摘要
BACKGROUND Inadequate health infrastructure and poverty especially in rural areas are the main hindrance in the optimal management of subjects with type 1 diabetes(T1 D) in Pakistan.AIM To observe effectiveness of diabetes care through development of model clinics for subjects with T1 D in the province of Sindh Pakistan.METHODS A welfare project with name of "Insulin My Life", was started in province of Sindh, Pakistan. This was collaborative work of Baqai Institute of Diabetology and Endocrinology, World Diabetes Foundation and Baqai Medical University between February 2010 to February 2013. Under this project thirty-four T1 D clinics were established. Electronic database was designed for demographic,biochemical, anthropometric and medical examination. Monthly consultation was part of the standardized diabetes care. All the recruited subjects with T1 D were provided free insulins and related materials.RESULTS Out of 1428 subjects, 795(55.7%) were males and 633(44.3%) were females.Subjects were categorized into ≤ 5 years of age 103(7.2%), between 6-12 years 323(22.6%), between 13–18 years 428(29.7%) and ≥ 19 years of age 574(40.2%)groups. Glycemic control as assessed by HbA1 c was significantly improved(P <0.0001) at three years follow up as compared to baseline in all age groups.Decreasing trends of mean self-monitoring blood glucose were observed at different meal timings in all age groups. No significant change was found in the frequency of neuropathy, nephropathy and retinopathy during the study period(P > 0.05).CONCLUSION This study gives us long-term longitudinal data of people with T1 D in a resource constraint society. With provision of standardized and comprehensive care significant improvement in glycemic control without any change in the frequency of microvascular complications was observed over 3 years.
BACKGROUND Inadequate health infrastructure and poverty especially in rural areas are the main hindrance in the optimal management of subjects with type 1 diabetes(T1 D) in Pakistan.AIM To observe effectiveness of diabetes care through development of model clinics for subjects with T1 D in the province of Sindh Pakistan.METHODS A welfare project with name of "Insulin My Life", was started in province of Sindh, Pakistan. This was collaborative work of Baqai Institute of Diabetology and Endocrinology, World Diabetes Foundation and Baqai Medical University between February 2010 to February 2013. Under this project thirty-four T1 D clinics were established. Electronic database was designed for demographic,biochemical, anthropometric and medical examination. Monthly consultation was part of the standardized diabetes care. All the recruited subjects with T1 D were provided free insulins and related materials.RESULTS Out of 1428 subjects, 795(55.7%) were males and 633(44.3%) were females.Subjects were categorized into ≤ 5 years of age 103(7.2%), between 6-12 years 323(22.6%), between 13–18 years 428(29.7%) and ≥ 19 years of age 574(40.2%)groups. Glycemic control as assessed by HbA1 c was significantly improved(P <0.0001) at three years follow up as compared to baseline in all age groups.Decreasing trends of mean self-monitoring blood glucose were observed at different meal timings in all age groups. No significant change was found in the frequency of neuropathy, nephropathy and retinopathy during the study period(P > 0.05).CONCLUSION This study gives us long-term longitudinal data of people with T1 D in a resource constraint society. With provision of standardized and comprehensive care significant improvement in glycemic control without any change in the frequency of microvascular complications was observed over 3 years.
BACKGROUND Inadequate health infrastructure and poverty especially in rural areas are the main hindrance in the optimal management of subjects with type 1 diabetes(T1 D) in Pakistan.AIM To observe effectiveness of diabetes care through development of model clinics for subjects with T1 D in the province of Sindh Pakistan.METHODS A welfare project with name of "Insulin My Life", was started in province of Sindh, Pakistan. This was collaborative work of Baqai Institute of Diabetology and Endocrinology, World Diabetes Foundation and Baqai Medical University between February 2010 to February 2013. Under this project thirty-four T1 D clinics were established. Electronic database was designed for demographic,biochemical, anthropometric and medical examination. Monthly consultation was part of the standardized diabetes care. All the recruited subjects with T1 D were provided free insulins and related materials.RESULTS Out of 1428 subjects, 795(55.7%) were males and 633(44.3%) were females.Subjects were categorized into ≤ 5 years of age 103(7.2%), between 6-12 years 323(22.6%), between 13–18 years 428(29.7%) and ≥ 19 years of age 574(40.2%)groups. Glycemic control as assessed by HbA1 c was significantly improved(P <0.0001) at three years follow up as compared to baseline in all age groups.Decreasing trends of mean self-monitoring blood glucose were observed at different meal timings in all age groups. No significant change was found in the frequency of neuropathy, nephropathy and retinopathy during the study period(P > 0.05).CONCLUSION This study gives us long-term longitudinal data of people with T1 D in a resource constraint society. With provision of standardized and comprehensive care significant improvement in glycemic control without any change in the frequency of microvascular complications was observed over 3 years.
引文
1 International Diabetes Federation.IDF diabetes atlas-8th Edition.Atlas.2017;Available from:http://diabetesatlas.org/resources/2017-atlas.html
2 Patterson C,Guariguata L,Dahlquist G,Soltész G,Ogle G,Silink M.Diabetes in the young-a global view and worldwide estimates of numbers of children with type 1 diabetes.Diabetes Res Clin Pract 2014;103:161-175[PMID:24331235 DOI:10.1016/j.diabres.2013.11.005]
3 International Diabetes Federation,Pakistan.Available from:https://www.idf.org/our-network/regions-members
4 DIAMOND Project Group.Incidence and trends of childhood Type 1 diabetes worldwide 1990-1999.Diabet Med 2006;23:857-866[PMID:16911623 DOI:10.1111/j.1464-5491.2006.01925.x]
5 Basit A,Khan A,Khan RA.BRIGHT Guidelines on Self-Monitoring of Blood Glucose.Pak J Med Sci2014;30:1150-1155[PMID:25225546 DOI:10.12669/pjms.305.6006]
6 World Health Organization.Global Report on Diabetes,2016.Available from:http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf
7 Fawwad A,Ahmedani MY,Basit A.Integrated and comprehensive care of subjects with type 1 diabetes in a resource poor environment-“insulin my life(IML)”project.Int J Adv Res 2017;5:1339-1342[DOI:10.21474/IJAR01/3952]
8 Rashid MO,Sheikh A,Salam A,Farooq S,Kiran Z,Islam N.Diabetic ketoacidosis characteristics and differences In type 1 versus type 2 diabetes patients.J Ayub Med Coll Abbottabad 2017;29:398-402[PMID:29076669]
9 Shera AS,Miyan Z,Basit A,Maqsood A,Ahmadani MY,Fawwad A,Riaz M.Trends of type 1 diabetes in Karachi,Pakistan.Pediatr Diabetes 2008;9:401-406[PMID:18221426 DOI:10.1111/j.1399-5448.2007.00309.x]
10 Syed M,Khawaja FB,Saleem T,Khalid U,Rashid A,Humayun KN.Clinical profile and outcomes of paediatric patients with diabetic ketoacidosis at a tertiary care hospital in Pakistan.J Pak Med Assoc 2011;61:1082-1087[PMID:22125983]
11 Ahmedani MY,Fawwad A,Basit A,Nawaz A.Efficacy of Dongsulin(rDNA human insulin)in a normal clinical practice setting.Pak J Biol Sci 2008;11:2356-2359[PMID:19137871 DOI:10.3923/pjbs.2008.2356.2359]
12 Regional Health Systems Observatory,World Health Organization.Health system profile of Pakistan.2007;Available from:http://apps.who.int/medicinedocs/documents/s17305e/s17305e.pdf
13 Kurji Z,Premani ZS,Mithani Y.Analysis Of The Health Care System Of Pakistan:Lessons Learnt And Way Forward.J Ayub Med Coll Abbottabad 2016;28:601-604[PMID:28712245 DOI:10.1111/gcb.13743]
14 Basit A,Riaz M,Fawwad A.Improving diabetes care in developing countries:the example of Pakistan.Diabetes Res Clin Pract 2015;107:224-232[PMID:25467615 DOI:10.1016/j.diabres.2014.10.013]
15 The Diabetes Control and Complications Trial Research Group.The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.N Engl J Med 1993;329:977-986[DOI:10.1056/NEJM199309303291401]
16 Epidemiology of Diabetes Interventions and Complications(EDIC).Design,implementation,and preliminary results of a long-term follow-up of the Diabetes Control and Complications Trial cohort.Diabetes Care 1999;22:99-111[PMID:10333910 DOI:10.2337/diacare.22.1.99]
17 Insulin my life project.Available from:http://www.insulinmylife.com/
18 You WP,Henneberg M.Type 1 diabetes prevalence increasing globally and regionally:the role of natural selection and life expectancy at birth.BMJ Open Diabetes Res Care 2016;4:e000161[PMID:26977306DOI:10.1136/bmjdrc-2015-000161]
19 Dabelea D,Stafford JM,Mayer-Davis EJ,D'Agostino R,Dolan L,Imperatore G,Linder B,Lawrence JM,Marcovina SM,Mottl AK,Black MH,Pop-Busui R,Saydah S,Hamman RF,Pihoker C;SEARCH for Diabetes in Youth Research Group.Association of Type 1 Diabetes vs Type 2 Diabetes Diagnosed During Childhood and Adolescence With Complications During Teenage Years and Young Adulthood.JAMA2017;317:825-835[PMID:28245334 DOI:10.1001/jama.2017.0686]
20 De Meyts P.The Insulin Receptor and Its Signal Transduction Network.Feingold KR,Anawalt B,Boyce A,editors.Endotext,South Dartmouth(MA):MDText.com,Inc 2000;Available from:https://www.ncbi.nlm.nih.gov/books/NBK378978/?report=reader
21 Morgan E,Black CR,Abid N,Cardwell CR,McCance DR,Patterson CC.Mortality in type 1 diabetes diagnosed in childhood in Northern Ireland during 1989-2012:A population-based cohort study.Pediatr Diabetes 2018;19:166-170[PMID:28548453 DOI:10.1111/pedi.12539]
22 Nordwall M,Abrahamsson M,Dhir M,Fredrikson M,Ludvigsson J,Arnqvist HJ.Impact of HbA1c,followed from onset of type 1 diabetes,on the development of severe retinopathy and nephropathy:the VISS Study(Vascular Diabetic Complications in Southeast Sweden).Diabetes Care 2015;38:308-315[PMID:25510400 DOI:10.2337/dc14-1203]
23 Viswanathan V.Preventing microvascular complications in type 1 diabetes mellitus.Indian J Endocrinol Metab 2015;19:S36-S38[PMID:25941647 DOI:10.4103/2230-8210.155382]
24 Archinkova M,Konstantinova M,Savova R,Iotova V,Petrova C,Kaleva N,Koprivarova K,Popova G,Koleva R,Boyadzhiev V,Mladenov W.Glycemic control in type 1 diabetes mellitus among Bulgarian children and adolescents:the results from the first and the second national examination of HbA1c.Biotechnol Biotec Eq 2017;31:1198-1203[DOI:10.1080/13102818.2017.1379360]
25 Jendle J,Ericsson?,Hunt B,Valentine WJ,Pollock RF.Achieving Good Glycemic Control Early After Onset of Diabetes:A Cost-Effectiveness Analysis in Patients with Type 1 Diabetes in Sweden.Diabetes Ther 2018;9:87-99[PMID:29204855 DOI:10.1007/s13300-017-0344-6]
26 Nathan DM;DCCT/EDIC Research Group.The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years:overview.Diabetes Care 2014;37:9-16[PMID:24356592 DOI:10.2337/dc13-2112]
27 Reinauer C,Reinehr T,Baechle C,Karges B,Seyfarth J,Foertsch K,Schebek M,Woelfle J,Roden M,Holl RW,Rosenbauer J,Meissner T.Relationship of Serum Fetuin A with Metabolic and Clinical Parameters in German Children and Adolescents with Type 1 Diabetes.Horm Res Paediatr 2018;89:73-81[PMID:29207397 DOI:10.1159/000484896]
2 Patterson C,Guariguata L,Dahlquist G,Soltész G,Ogle G,Silink M.Diabetes in the young-a global view and worldwide estimates of numbers of children with type 1 diabetes.Diabetes Res Clin Pract 2014;103:161-175[PMID:24331235 DOI:10.1016/j.diabres.2013.11.005]
3 International Diabetes Federation,Pakistan.Available from:https://www.idf.org/our-network/regions-members
4 DIAMOND Project Group.Incidence and trends of childhood Type 1 diabetes worldwide 1990-1999.Diabet Med 2006;23:857-866[PMID:16911623 DOI:10.1111/j.1464-5491.2006.01925.x]
5 Basit A,Khan A,Khan RA.BRIGHT Guidelines on Self-Monitoring of Blood Glucose.Pak J Med Sci2014;30:1150-1155[PMID:25225546 DOI:10.12669/pjms.305.6006]
6 World Health Organization.Global Report on Diabetes,2016.Available from:http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf
7 Fawwad A,Ahmedani MY,Basit A.Integrated and comprehensive care of subjects with type 1 diabetes in a resource poor environment-“insulin my life(IML)”project.Int J Adv Res 2017;5:1339-1342[DOI:10.21474/IJAR01/3952]
8 Rashid MO,Sheikh A,Salam A,Farooq S,Kiran Z,Islam N.Diabetic ketoacidosis characteristics and differences In type 1 versus type 2 diabetes patients.J Ayub Med Coll Abbottabad 2017;29:398-402[PMID:29076669]
9 Shera AS,Miyan Z,Basit A,Maqsood A,Ahmadani MY,Fawwad A,Riaz M.Trends of type 1 diabetes in Karachi,Pakistan.Pediatr Diabetes 2008;9:401-406[PMID:18221426 DOI:10.1111/j.1399-5448.2007.00309.x]
10 Syed M,Khawaja FB,Saleem T,Khalid U,Rashid A,Humayun KN.Clinical profile and outcomes of paediatric patients with diabetic ketoacidosis at a tertiary care hospital in Pakistan.J Pak Med Assoc 2011;61:1082-1087[PMID:22125983]
11 Ahmedani MY,Fawwad A,Basit A,Nawaz A.Efficacy of Dongsulin(rDNA human insulin)in a normal clinical practice setting.Pak J Biol Sci 2008;11:2356-2359[PMID:19137871 DOI:10.3923/pjbs.2008.2356.2359]
12 Regional Health Systems Observatory,World Health Organization.Health system profile of Pakistan.2007;Available from:http://apps.who.int/medicinedocs/documents/s17305e/s17305e.pdf
13 Kurji Z,Premani ZS,Mithani Y.Analysis Of The Health Care System Of Pakistan:Lessons Learnt And Way Forward.J Ayub Med Coll Abbottabad 2016;28:601-604[PMID:28712245 DOI:10.1111/gcb.13743]
14 Basit A,Riaz M,Fawwad A.Improving diabetes care in developing countries:the example of Pakistan.Diabetes Res Clin Pract 2015;107:224-232[PMID:25467615 DOI:10.1016/j.diabres.2014.10.013]
15 The Diabetes Control and Complications Trial Research Group.The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.N Engl J Med 1993;329:977-986[DOI:10.1056/NEJM199309303291401]
16 Epidemiology of Diabetes Interventions and Complications(EDIC).Design,implementation,and preliminary results of a long-term follow-up of the Diabetes Control and Complications Trial cohort.Diabetes Care 1999;22:99-111[PMID:10333910 DOI:10.2337/diacare.22.1.99]
17 Insulin my life project.Available from:http://www.insulinmylife.com/
18 You WP,Henneberg M.Type 1 diabetes prevalence increasing globally and regionally:the role of natural selection and life expectancy at birth.BMJ Open Diabetes Res Care 2016;4:e000161[PMID:26977306DOI:10.1136/bmjdrc-2015-000161]
19 Dabelea D,Stafford JM,Mayer-Davis EJ,D'Agostino R,Dolan L,Imperatore G,Linder B,Lawrence JM,Marcovina SM,Mottl AK,Black MH,Pop-Busui R,Saydah S,Hamman RF,Pihoker C;SEARCH for Diabetes in Youth Research Group.Association of Type 1 Diabetes vs Type 2 Diabetes Diagnosed During Childhood and Adolescence With Complications During Teenage Years and Young Adulthood.JAMA2017;317:825-835[PMID:28245334 DOI:10.1001/jama.2017.0686]
20 De Meyts P.The Insulin Receptor and Its Signal Transduction Network.Feingold KR,Anawalt B,Boyce A,editors.Endotext,South Dartmouth(MA):MDText.com,Inc 2000;Available from:https://www.ncbi.nlm.nih.gov/books/NBK378978/?report=reader
21 Morgan E,Black CR,Abid N,Cardwell CR,McCance DR,Patterson CC.Mortality in type 1 diabetes diagnosed in childhood in Northern Ireland during 1989-2012:A population-based cohort study.Pediatr Diabetes 2018;19:166-170[PMID:28548453 DOI:10.1111/pedi.12539]
22 Nordwall M,Abrahamsson M,Dhir M,Fredrikson M,Ludvigsson J,Arnqvist HJ.Impact of HbA1c,followed from onset of type 1 diabetes,on the development of severe retinopathy and nephropathy:the VISS Study(Vascular Diabetic Complications in Southeast Sweden).Diabetes Care 2015;38:308-315[PMID:25510400 DOI:10.2337/dc14-1203]
23 Viswanathan V.Preventing microvascular complications in type 1 diabetes mellitus.Indian J Endocrinol Metab 2015;19:S36-S38[PMID:25941647 DOI:10.4103/2230-8210.155382]
24 Archinkova M,Konstantinova M,Savova R,Iotova V,Petrova C,Kaleva N,Koprivarova K,Popova G,Koleva R,Boyadzhiev V,Mladenov W.Glycemic control in type 1 diabetes mellitus among Bulgarian children and adolescents:the results from the first and the second national examination of HbA1c.Biotechnol Biotec Eq 2017;31:1198-1203[DOI:10.1080/13102818.2017.1379360]
25 Jendle J,Ericsson?,Hunt B,Valentine WJ,Pollock RF.Achieving Good Glycemic Control Early After Onset of Diabetes:A Cost-Effectiveness Analysis in Patients with Type 1 Diabetes in Sweden.Diabetes Ther 2018;9:87-99[PMID:29204855 DOI:10.1007/s13300-017-0344-6]
26 Nathan DM;DCCT/EDIC Research Group.The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years:overview.Diabetes Care 2014;37:9-16[PMID:24356592 DOI:10.2337/dc13-2112]
27 Reinauer C,Reinehr T,Baechle C,Karges B,Seyfarth J,Foertsch K,Schebek M,Woelfle J,Roden M,Holl RW,Rosenbauer J,Meissner T.Relationship of Serum Fetuin A with Metabolic and Clinical Parameters in German Children and Adolescents with Type 1 Diabetes.Horm Res Paediatr 2018;89:73-81[PMID:29207397 DOI:10.1159/000484896]