An important Life for a Child / University of Pittsburgh study showing how low-income countries can reduce the rate of complications from type 1 diabetes (T1D) has been published by the academic journal Pediatric Diabetes.
Young people supported by Life for a Child live in in low- and middle-income countries with competing priorities for healthcare spending. Some governments only provide one component of care for their young citizens living with T1D (such as insulin) and many don’t provide anything at all.
“Consequently, the kinds of care that are offered to those with type 1 diabetes in these countries is often at a ‘minimal’ level. The bleak outcomes of this level of care include high mortality and the premature onset of devastating and costly chronic complications.” Dr. Graham Ogle, General Manager Life for a Child.
In order to support our local partners in their efforts to advocate for more government help for children with diabetes, we set out to demonstrate how effective even modest improvements in care provision can be.
We did this by looking at the costs and outcomes of diabetes care in six countries- Mali, Tanzania, Pakistan, Bolivia, Sri Lanka and Azerbaijan.
Specifically, we looked at the outcomes for young people receiving minimal and intermediate care. Minimal care was defined as twice daily human insulin injections with no self-blood glucose monitoring and minimal diabetes education. Intermediate care consists of multiple daily insulin injections, two to four blood glucose tests per day, diabetes education and HbA1c testing. For a comprehensive look at these definitions look at our 2018 study into levels of care.
Using a mathematical model we calculated the rate of a range of complications at different HbA1c levels over a 30-year period.
Mathematical modelling: Complications rates after 30 years
The graph above shows the 30-year complications rates at differing mean HbA1c levels, demonstrating the importance of reducing HbA1c.
The difference in chance of survival in each country depending on whether the young person is receiving ‘minimal’ or ‘intermediate care’.
As you can see, incidences of complications were lower for young people receiving intermediate care vs. minimal care. Intermediate care is the type supported by Life for a Child.
The study goes on to show that, although intermediate care is a little more costly to maintain than minimal care, acute and chronic complication costs are reduced and young lives are saved. This is a compelling argument for governments to increase provision of care for young people living with T1D.
Dr. Ogle is hopeful that the study will help to improve care: “Overall, these findings could greatly strengthen local efforts made by health care professionals, policymakers and advocates, who are working toward provision of acceptable type 1 diabetes care by their national health systems.”
View the study in Pediatric Diabetes or email us to request a copy at firstname.lastname@example.org.
Gahan is an 8-year-old boy from a small village in Bangladesh. He is a smart young man and hopes one day to become an engineer. As well as working hard at school, he loves to spend time outdoors with friends, playing cricket and badminton in the streets around his home.
Gahan’s father is a fisherman and his mother is a homemaker. He is their eldest son and has a 5-month-old little sister.
When Gahan was three years old his father was concerned to see his son losing weight, wetting the bed and often too tired to play outside with his friends. Over a number of weeks Gahan’s health deteriorated until it became so serious that they thought their child might die.
Gahan’s parents took him to the local hospital where they found that he had a very high blood glucose level. Staff quickly referred him to the Life for a Child partner center, which they knew would be better equipped to deal with Gahan’s diagnosis.
When the family arrived at the center they were disorientated and fearful.
“It seemed like the sky has fallen down on us. We felt hopeless.” Gahan’s Father.
Gahan was admitted to the hospital and doctors worked to stabilize his blood sugar. He spent 15 days and nights there, being nursed back to health, while his parents received diabetes education.
It was a steep learning curve. Gahan’s father said, “We had no idea about type one diabetes.” But, like most families dealing with a new type 1 diagnosis, they were forced to learn quickly, test, trial and find their way through the complex maze of management.
Thanks to initiatives like Spare a Rose, the family did not have to worry about finding the money to pay for Gahan’s insulin and supplies. The program manager at the center said, “Because of the very low income of his parents it would be very difficult for Gahan to manage his diabetes without the support of Life for a Child. His father said that the support is like a blessing from God.”
Gahan attends the Life for a Child partner center every two months to collect his insulin and supplies and has regular checkups with the team there.
Gahan’s diagnosis means he will continue to need access to insulin and blood glucose testing supplies every day. Can you Spare a Rose this February to help make sure Life for a Child can provide him with reliable and consistent care?