Comprehensive Management of Type 1 Diabetes in a Marginalized Population in Northern India: a Seven Year Retrospective Review

Abstract

Indian children with type 1 diabetes (T1D) from resource-poor families often have poor prognoses due to unavailability or unaffordability of care. We utilized a team-based approach to treat marginalized T1D children with multiple daily insulin injection (MDI) basal bolus regimen. In this study, a chart review of all 48 patients treated from 2006-2014 were included. A team-based approach comprising a physician, a diabetes educator and a community health worker were used. All patients were administered MDI of glargine and short-acting human insulin. Extensive diabetes self-management education tailored to culture, language, and literacy level was provided. Carbohydrate counting of local foods was introduced with patients utilizing home blood glucose monitoring. The structured program included home visits, telephone and internet support and group meetings. Age (Mean ± SD) at enrolment was 13.9 ± 4.7 years (n=48), with 26 males (54%). For 25 patients followed for ≥ 3 years, HbA1c at baseline and years 1, 2 and 3 was (Mean ± SD) 13.0 ± 1.0%, (119 ± 11 mmol/mol) 9.0 ± 2.0% (75 ± 22 mmol/mol) 8.2 ± 1.5% (66 ± 17 mmol/mol) and 8.3 ± 1.4% (67 ± 15 mmol/mol), respectively and BMI improved from (Mean ± SD) 15.4 ± 2.4 to 19.0 ± 2.9 kg/m2. The most recent median HbA1c for all patients was 8.6% (70 mmol/mol). There were no hospital readmissions with ketoacidosis or severe hypoglycemia, and one death from unknown causes. Integral to the program′s success was provision of essential diabetes supplies and intensive locally-relevant diabetes education, including innovative approaches such as an internet-based support group. Our findings suggest that it is feasible to achieve successful and sustainable T1D management in an indigent population in rural India.

Keywords

• children
• diabetes
• developing countries
• patient education
• intensive therapy