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Safary E, Beran D, Vetter B, Lepeska M, Abdraimova A, Dunganova A, Besançon S, Lazo-Porras M, Portocarrero Mazanett J, Pérez-León S, Maixenchs M, Nchimbi H, Ramaiya K, Munishi C, Martínez-Pérez GZ. 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. BMJ Open 2024; 14:e076685. [PMID: 38367964 PMCID: PMC10875487 DOI: 10.1136/bmjopen-2023-076685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/30/2024] [Indexed: 02/19/2024] Open
Abstract
AIMS Development 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. METHODS This 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. RESULTS Among 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. CONCLUSIONS Ease-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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Affiliation(s)
- Elvis Safary
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva, Geneva, Switzerland
- Geneva University Hospitals, Geneva, Switzerland
| | - Beatrice Vetter
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Molly Lepeska
- Health Action International, Amsterdam, The Netherlands
| | | | | | | | - Maria Lazo-Porras
- Division of Tropical and Humanitarian Medicine, University of Geneva, Geneva, Switzerland
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Silvana Pérez-León
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Happy Nchimbi
- Tanzania NCD Alliance, Dar es Salaam, Tanzania, United Republic of
| | - Kaushik Ramaiya
- Tanzania NCD Alliance, Dar es Salaam, Tanzania, United Republic of
| | - Castory Munishi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
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Beran D, Abidha C, Adler A, de Beaufort C, Lepeska M, Levitt N, Pfiester E, Zafra-Tanaka JH, Gale EA. Teplizumab approval for type 1 diabetes in the USA. Lancet Diabetes Endocrinol 2023; 11:78-80. [PMID: 36623522 DOI: 10.1016/s2213-8587(22)00384-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 01/09/2023]
Affiliation(s)
- David Beran
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine and University Hospital, University of Geneva, Geneva 1211, Switzerland.
| | - Carol Abidha
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Amanda Adler
- Oxford Centre for Diabetes Endocrinology and Metabolism, Oxford University, Oxford, UK
| | - Carine de Beaufort
- Department of Pediatric Endocrinology and Diabetes, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg; Faculty of Science, Technology and Medicine, University of Luxembourg, Luxembourg, Luxembourg; Department of Pediatric Endocrinology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Naomi Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Jessica H Zafra-Tanaka
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland; CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Edwin Am Gale
- Bristol Medical School, University of Bristol, Bristol, UK
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Abdraimova A, Besançon S, Portocarrero J, Ramaiya K, Dunganova A, Ewen M, Hogerzeil H, Lazo‐Porras M, Laing R, Lepeska M, Nchimbi H, Sidibé A, Swai A, Tenorio‐Mucha J, Yudkin JS, Zafra‐Tanaka JH, Zurdinova A, Beran D. Management of type 1 diabetes in low- and middle-income countries: Comparative health system assessments in Kyrgyzstan, Mali, Peru and Tanzania. Diabet Med 2022; 39:e14891. [PMID: 35621029 PMCID: PMC9543552 DOI: 10.1111/dme.14891] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/12/2022] [Accepted: 05/22/2022] [Indexed: 11/26/2022]
Abstract
AIMS To describe and compare the health system responses for type 1 diabetes in Kyrgyzstan, Mali, Peru and Tanzania. METHODS The Rapid Assessment Protocol for Insulin Access, a multi-level assessment of the health system, was implemented in Kyrgyzstan, Mali, Peru and Tanzania using document reviews, site visits and interviews to assess the delivery of care and access to insulin. RESULTS Despite the existence of noncommunicable or diabetes strategies and Universal Health Coverage policies including diabetes-related supplies, this has not necessarily translated into access to insulin or diabetes care for all. Insulin and related supplies were often unavailable and unaffordable. Across the four countries test strips and insulin, when paid for by the individual, represented respectively 48-82% and 25-36% of total costs. Care was mainly delivered at tertiary-level hospitals by specialists. Only Kyrgyzstan had data collection systems integrated into the Ministry of Health structure. In addition, issues with healthcare worker training and education and empowerment of people with diabetes were present in these health systems. CONCLUSIONS People with type 1 diabetes in these countries face different barriers, including the cost of insulin and care. Given the renewed attention to diabetes on the global health agenda tailored health system responses for type 1 diabetes are needed. Insulin should be prioritized as it is the foundation of type 1 diabetes care, but other elements of care and support need to be fostered by different actors.
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Affiliation(s)
| | | | - Jill Portocarrero
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
| | - Kaushik Ramaiya
- Hindu Mandal HospitalDar es SalaamTanzania
- Tanzanian Diabetes AssociationDar es SalaamTanzania
| | | | | | | | - Maria Lazo‐Porras
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Division of Tropical and Humanitarian MedicineUniversity of Geneva and Geneva University HospitalsGenevaSwitzerland
| | - Richard Laing
- Boston University School of Public HealthBostonUSA
- School of Public HealthUniversity of Western CapeSouth Africa
| | | | | | | | - Andrew Swai
- Tanzanian Diabetes AssociationDar es SalaamTanzania
| | - Janeth Tenorio‐Mucha
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
| | | | - Jessica H. Zafra‐Tanaka
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
| | | | - David Beran
- Division of Tropical and Humanitarian MedicineUniversity of Geneva and Geneva University HospitalsGenevaSwitzerland
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Beran D, Besançon S, Ewen M, Gale EAM, Lazo-Porras M, Lepeska M, Lipska K, Zafra-Tanaka J, Zhaparova A, Yudkin JS. Diabetes and the WHO Model List of Essential Medicines. Lancet Diabetes Endocrinol 2022; 10:17-18. [PMID: 34919864 DOI: 10.1016/s2213-8587(21)00323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 11/24/2021] [Indexed: 11/29/2022]
Affiliation(s)
- David Beran
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University of Geneva and Geneva University Hospitals, Geneva 1208, Switzerland.
| | | | | | | | - Maria Lazo-Porras
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland; CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Kasia Lipska
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Jessica Zafra-Tanaka
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland; CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - John S Yudkin
- Division of Medicine, University College London, London, UK
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Lepeska M, Beran D, Ewen M. Access to insulin: a comparison between low‐ and middle‐income countries and the United Kingdom. Pract Diab 2021. [DOI: 10.1002/pdi.2345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Molly Lepeska
- Health Action International Amsterdam The Netherlands
| | - David Beran
- Division of Tropical and Humanitarian Medicine University of Geneva and Geneva University Hospitals Geneva Switzerland
| | - Margaret Ewen
- Health Action International Amsterdam The Netherlands
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Beran D, Colagiuri S, Ernoult N, Ewen M, Fleury C, Lepeska M, Londeix P, Pfiester E, Yudkin JS, Besançon S. Failing to address access to insulin in its centenary year would be a catastrophic moral failure. Lancet Diabetes Endocrinol 2021; 9:194-196. [PMID: 33675694 DOI: 10.1016/s2213-8587(21)00048-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/20/2022]
Affiliation(s)
- David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva, Geneva 1211, Switzerland; Geneva University Hospitals, Geneva, Switzerland.
| | - Stephen Colagiuri
- Boden Collaboration, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, SNW, Australia
| | | | | | - Cynthia Fleury
- Conservatoire National des Arts et Métiers, Paris, France
| | | | - Pauline Londeix
- NGO Santé Diabète, Grenoble, France; Observatoire de la Transparence dans les Politiques du Médicament, Paris, France
| | | | - John S Yudkin
- Institute of Cardiovascular Science, Division of Medicine, University College London, London, UK
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