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Swaminathan K, Mukhekar V, Cohen O. Breaking Socioeconomic Barriers in Diabetes Technologies: Outcomes of a Pilot Insulin Pump Programme for the Underprivileged in Rural India. Indian J Endocrinol Metab 2019; 23:242-245. [PMID: 31161111 PMCID: PMC6540893 DOI: 10.4103/ijem.ijem_645_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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.
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Affiliation(s)
- Krishnan Swaminathan
- Consultant Endocrinologist, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | | | - Ohad Cohen
- Clinical Professor of Medicine, Ch Sheba Medical Center, Tel Hashomer, Israel
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Friedemann-Sánchez G, Capistrant BD, Ron J, Novak L, Zuijdwijk C, Ogle GD, Anderson B, Moran A, Pendsey S. Caregiving for children with type 1 diabetes and clinical outcomes in central India: The IDREAM study. Pediatr Diabetes 2018; 19:527-533. [PMID: 28809093 DOI: 10.1111/pedi.12567] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/10/2017] [Accepted: 07/17/2017] [Indexed: 01/09/2023] Open
Abstract
AIMS Parental care influences outcomes for children's type 1 diabetes (T1D). There is little evidence about the impact of parental caregiving in developing countries, where fixed dose human insulin (conventional) therapy and limited self-monitoring of blood glucose are common. This article investigates whether performance of key T1D management tasks by children or their caregivers impacts hemoglobin A1c (HbA1c). METHODS We surveyed the caregivers of 179 children with T1D routinely treated in a specialized diabetes clinic in Maharashtra, India to determine who performs key diabetes care tasks: child or parent. We used linear regression to estimate the relationship between parental caregiving and HbA1c, and how this association varies by child age and time since diagnosis. RESULTS Caregivers of older children were less involved in care tasks, though caregivers of 11- to 18-year olds performed more care for children diagnosed for a longer duration. Parental involvement in key insulin delivery tasks was associated with lower HbA1c levels for all children. These reductions were greatest among children 11 to 14 years old and diagnosed for less than 2 years: mean HbA1c levels were 8.5% (69 mmol/mol) if the caregiver, and 14.4% (134 mmol/mol) if the child, performed the tasks (P < .05). CONCLUSION Parents of children diagnosed with T1D early in life remain involved in care throughout the child's adolescence. Parents of children diagnosed in late childhood and early adolescence are significantly less involved in care, and this is associated with worse glycemic control. Clinics must know who performs care tasks and tailor diabetes education appropriately.
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Affiliation(s)
| | - Beatrix D Capistrant
- School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota.,Statistics and Data Science, Smith College, Northampton, Massachusetts
| | - James Ron
- Hubert H. Humphrey School of Public Affairs and Department of Political Science, University of Minnesota, Minneapolis, Minnesota.,Centro de Investigación y Docencia Económicas (CIDE), Mexico City, Mexico
| | - Lindsey Novak
- Department of Economics, Colby College, Waterville, Maine
| | - Caroline Zuijdwijk
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario (CHEO), CHEO Research Institute, Ottawa, Canada
| | - Graham D Ogle
- International Diabetes Federation, Life for a Child Program, Glebe, Australia
| | - Barbara Anderson
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Antoinette Moran
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Sharad Pendsey
- Diabetes Research Education and Management Trust, Nagpur, India
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Jevalikar G, Kohli C, Bansal B, Mishra SK, Wasir JS, Singh S, Ahuja JK, Kaur P, Farooqui KJ, Mithal A. Childhood and Youth Onset Diabetes: A Single Centre Experience. Indian J Pediatr 2016; 83:792-8. [PMID: 26816135 DOI: 10.1007/s12098-015-2009-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 12/23/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To identify proportion of various types of diabetes and differences between type 1 and type 2 diabetes in patients with youth onset diabetes (onset below 25 completed years of age). In addition, concurrent autoimmune diseases in type 1 diabetes were studied in a subset of patients. METHODS A total of 577 patients (192 girls) with diabetes onset at median age of 14 y (range 1 mo-25 y) with median duration of 1 y (range day of diagnosis- 43 y) were included. Clinical details, investigations and complications were recorded in a proforma. Diabetes was classified using clinical criteria supported by laboratory tests of C peptide and anti GAD-65 antibody in a subset of patients. RESULTS Type 1 diabetes accounted for 368/421 (87.4 %) patients with age of onset <18 y and 99/156 (63.5 %) of patients with onset between 19 and 25 y of age. Proportion of type 2 diabetes was 36/421 (8.5 %) and 41/156 (26.2 %) in these two groups. Older age at onset, diabetes in one or both parents, absence of ketosis /weight loss and presence of acanthosis were significant predictors of type 2 diabetes. Hypothyroidism (TSH >10) and biopsy proven celiac disease was found in 11.6 and 9.7 % of type 1 diabetes patients respectively. CONCLUSIONS Type 1 diabetes is the most common type of diabetes in youth, however, a significant proportion of youth have type 2 diabetes. In these patients a combination of clinical factors, biochemical parameters and course over few months helps to guide the diagnosis.
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Affiliation(s)
- Ganesh Jevalikar
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India.
| | - Chhavi Kohli
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India
| | - Beena Bansal
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India
| | - Sunil Kumar Mishra
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India
| | - Jasjeet Singh Wasir
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India
| | - Shweta Singh
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India
| | - Jasmine Kaur Ahuja
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India
| | - Parjeet Kaur
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India
| | - Khalid J Farooqui
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India
| | - Ambrish Mithal
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India
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Verloo H, Meenakumari M, Abraham EJ, Malarvizhi G. A qualitative study of perceptions of determinants of disease burden among young patients with type 1 diabetes and their parents in South India. Diabetes Metab Syndr Obes 2016; 9:169-76. [PMID: 27274298 PMCID: PMC4876838 DOI: 10.2147/dmso.s102435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Diabetes is a leading threat to public health in India. A huge prevalence of type 1 diabetes among young patients is documented in literature; India is one of the countries with the highest number of new cases per year (10,900), of which 3-4 million face poverty along with diabetes. OBJECTIVE The aim of this study was to explore the perceptions of determinants of the disease burden among young patients with type 1 diabetes and their parents. METHODS In June 2014, perceptions were collected from eleven young patients and five available parents using the critical incident technique. RESULTS Disease burdens associated with the management of type 1 diabetes can vary significantly according to the different social and economic determinants facing each household. Determinants associated with good practices in the management of childhood type 1 diabetes included socioeconomic status, unawareness of health complications, and beliefs about nutrition. Coping strategies applied via lifestyle changes included monitoring glycemia and regular checkups by diabetologists. A general lack of awareness about type 1 diabetes in Indian society, stigmatization, and limited access and systematic barriers to the delivery of optimal health care were all perceived to be factors hindering the successful management of chronic type 1 diabetes by young patients and their parents. CONCLUSION Stigmatization, a lack of therapeutic adherence, and the financial strains placed on families, particularly on poor ones, are critical. More emphasis must be put on the prevention of acute and long-term complications and education.
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Affiliation(s)
- Henk Verloo
- Department Nursing Sciences, University of Applied Nursing Sciences, La Source, Lausanne, Switzerland
- Correspondence: Henk Verloo, Department Nursing Sciences, University of Applied Nursing Sciences, La Source, 30, Avenue Vinet, CH-1004 Lausanne, Switzerland, Tel +41 21 641 3867, Fax +41 21 641 3810, Email
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Sachan A, Zaidi G, Sahu RP, Agrawal S, Colman PG, Bhatia E. Low prevalence of latent autoimmune diabetes in adults in northern India. Diabet Med 2015; 32:810-3. [PMID: 25444459 DOI: 10.1111/dme.12644] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 02/02/2023]
Abstract
AIM To study the frequency of islet antibodies in a large cohort of clinic- and community-based patients with Type 2 diabetes in northern India. METHODS We measured glutamic acid decarboxylase (GAD) antibodies in 618 adults with Type 2 diabetes (378 patients with diabetes attending a hospital clinic, 240 patients diagnosed in a community survey) and in 192 healthy subjects residing in north India. Islet antigen 2 (IA2) antibodies were also studied in a proportion of the patients with diabetes (n = 492) and in a control population (n = 191). GAD and IA2 antibodies were measured by immunoprecipitation of the respective (35) S-labelled recombinant antigen. RESULTS We found that GAD antibodies were present in nine (1.5%) patients with diabetes (clinic population: 0.8%, community study: 2.5%), a prevalence similar to that among the subjects without diabetes (n = 2; 1%). IA2 antibodies were detected in seven patients with Type 2 diabetes (1.4%) and in two healthy control subjects (1.0%). The frequency of either GAD or IA2 antibodies was similar in people with and without diabetes (3.2 vs 2.1%). No subject was found to have both antibodies. Insulin requirement was higher among antibody-positive than among antibody-negative patients (GAD antibody: 33 vs 6.3%; P = 0.001; GAD or IA2 antibody: 23.1 vs 6.4%; P = 0.02); however, other clinical features were similar in the two groups. CONCLUSIONS In the present north-Indian population with Type 2 diabetes, the overall prevalence of GAD antibodies and the prevalence of either GAD or IA2 antibodies were considerably lower than those reported in white European populations.
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Affiliation(s)
- A Sachan
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - G Zaidi
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - R P Sahu
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - S Agrawal
- Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - P G Colman
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Victoria, Australia
| | - E Bhatia
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Mythili A, Kumar KD, Vivekananda B, Subrahmanyam KAV. Clinical profile of type 1 diabetes mellitus in a tertiary care hospital. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0366-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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