Breaking socioeconomic barriers in diabetes technologies: Outcomes of a pilot insulin pump programme for the underprivileged in Rural India

Abstract

Aim: To assess whether the socioeconomic and stereotypical barriers for the adoption of advanced diabetes technologies can be overcome in the underprivileged children and their families in India, predominantly from the rural areas, by providing insulin pump therapy (CSII) to deserving patients. Materials and Methods: All patients were selected from the type 1 diabetes mellitus (T1DM) database of the Kovai Medical Center and Hospital, Coimbatore. Sixteen people with type 1 diabetes (PWD) were chosen due to poor control or an urgent situation like pregnancy or renal failure. Demographic data along with variables such as age, sex, time of diagnosis of T1DM, duration of CSII therapy, total daily insulin dose, hypoglycaemias, hospitalisations, glycosylated haemoglobin pre- and post-pump were collected. The glycosylated haemoglobin values were collected at 3, 6 and 12 months, post-CSII hypoglycaemia was defined as self-reported hypoglycaemia by the patient. Results: During 12 month follow-up, all 16 PWD were using the insulin pump with significant reductions in HbA1c from 11.4% at baseline to 8.0% (P < 0.001) and 7.6% at the end of 3 and 6 months, respectively. Discussion: Our results indicate that the CSII therapy without prejudice can lead to significant reductions in glycaemic control, hospitalisations and quality of life. This pilot work will help us lobby government policy makers to ensure policy changes that help the underprivileged with T1DM in India.

Keywords

• CSII – continuous subcutaneous insulin infusion
• MDI – multiple daily injections
• PWD –people with type 1 diabetes