Integrated Care for Type 1 Diabetes: The West Bengal Model

Introduction

A structured dedicated health programme for Type 1 diabetes mellitus (T1DM) has been initiated in the state of West Bengal, India.

Aim

The aim is to provide comprehensive healthcare to all children, adolescents and young adults living with T1DM, along with the provision of free supply of insulin, glucose measuring devices, blood glucose test strips, and other logistics. The strategic framework for programme implementation is to utilise the infrastructure and manpower of the already existing non-communicable disease (NCD) clinic under National Health Mission.

Methodology

Establishing dedicated T1DM clinics in each district hospital by utilising existing healthcare delivery systems, intensive training and hand-holding of named human resources; providing comprehensive healthcare service and structured diabetes education to all T1DM patients; and building an electronic registry of patients are important components of the programme. T1DM clinics run once a week on the same day throughout the state. All T1DM patients are treated with the correct dose of insulin, both human regular insulin and glargine insulin. Patients are routinely monitored monthly to ensure good glycaemic control and prevent complications of the disease. Routine anthropometric examination and required laboratory investigations are conducted in the set-up of the already existing NCD clinic. Ongoing monitoring and evaluation of the T1DM programme are being conducted in terms of glycated haemoglobin (HbA1c) values, growth and development, complication rates, psychological well-being, quality of life, and direct and indirect expenditure incurred by families. Through this programme, any bottlenecks or gaps in service delivery will be identified and corrective measures will be adopted to ensure better health outcomes for those living with T1DM.

Mortuary Profile for Unnatural Deaths at Forensic Medicine Department of Dhaka Medical College

Death is unnatural when caused permaturely against the order of nature by injury, position or other means of violence. Data on unnatural deaths may reflect the law and order situation in a particular area of jurisdiction. This study is concerned with pattern of unnatural deaths in Dhaka Medical College mortuary during 1996. We found 1725 (97%) cases of unnatural deaths by analyzing 1772 cases of deaths. Data gives 18.37% increment in unnatural deaths 77.28% was males and 22.71% females. The frequency pattern of unnatural deaths were 68.92% RTAs, 11.69% homicide, 08.00% suicide and 2.80 natural. Burn, electrocution and others comprise the rest 11.565 unnatural deaths. Males suffer 3.4X more unnatural deaths than females. But RTAs males were 5.31X, in homicide 11.40X, in suicide 1.70X respectively than females. In hanging, female were predominant (1.72X of male deaths). 21-40 years is the age group showing peak frequencies on different types of unnatural deaths though hanging showed peak on 11-20 years. Besides, 95.47% of the unnatural deaths were the Muslims, 4.25% were Hindu and .14% was Christians. Firearms were used in 29.40% cases, blunt weapon in 38.46% cases and sharp cutting weapon in 31.60% cases of homicides respectively. Key words: Unnatural Death, RTA, Homicide   DOI: 10.3329/bmj.v38i2.3572 Bangladesh Medical Journal 38(2) 2009 44-47