Management of Type 1 diabetes in a limited resource context: A study of the diabetes research education and management trust model in Nagpur, Central India

• Main Authors: Caroline Sarah Zuijdwijk, Sharad Pendsey, James Ron, Kathryn A Williams, Salwa Akiki, Seema Chalkhore, Graham D Ogle, Alexandra Ahmet
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2017-01-01
• Series: Journal of Diabetology
• Subjects: Haemoglobin A1c; insulin; poverty; stigma; type 1 diabetes mellitus
• Online Access: http://www.journalofdiabetology.org/article.asp?issn=2078-7685;year=2017;volume=8;issue=2;spage=37;epage=44;aulast=Zuijdwijk

Background/Objective: Diabetes Research Education and Management (DREAM) Trust (DT) is a charitable organisation that offers free insulin and healthcare to children and youth with type 1 diabetes (T1D) in central India. We systematically describe DT's model of care and evaluate medical and sociodemographic factors influencing glycaemic control in this resource-poor setting. Methods: Study of DT patients diagnosed with T1D <16 years old and followed at DT ≥1 year. Participants completed an interview, retrospective chart review and prospective haemoglobin A1c (HbA1c) measurements. Uni- and multi-variate linear regressions determined factors associated with HbA1c. Percentage of underweight patients (as proxy for glycaemic control) was compared at presentation to DT versus time of interview. Results: A total of 102 DT patients (51% female) completed the interview and chart review. 74 had HbA1c measured. Median HbA1c was 10.4% (90.2 mmol/mol). In multivariate regression, higher HbA1c was independently associated with higher insulin dose/kg (P < 0.001) and holding a below the poverty line certificate (P = 0.004). There was no association between HbA1c and age, sex, caste, religion or experience of stigma. However, the psychosocial burden of T1D (expressed as concern about others learning about the diagnosis, and worry about the future), and experience of stigma were substantial. Percentage of patients with underweight body mass index was significantly lower at the time of study vs. presentation to DT (P = 0.005). Conclusions: The DT charitable programme overcomes social status, gender inequalities and experience of social stigma to provide life-saving treatment to children with T1D in central India. Glycaemic control remains inadequate however, with children living in extreme poverty most at risk.