Prospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Mar 15, 2019; 10(3): 224-233
Published online Mar 15, 2019. doi: 10.4239/wjd.v10.i3.224
Optimized health care for subjects with type 1 diabetes in a resource constraint society: A three-year follow-up study from Pakistan
Muhammad Yakoob Ahmedani, Asher Fawwad, Fariha Shaheen, Bilal Tahir, Nazish Waris, Abdul Basit
Muhammad Yakoob Ahmedani, Abdul Basit, Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi 74600, Pakistan
Asher Fawwad, Department of Biochemistry, Baqai Medical University, Research Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi 74600, Pakistan
Fariha Shaheen, Bilal Tahir, Nazish Waris, Research Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi 74600, Pakistan
Author contributions: Ahmedani MY contributed to concept, design, designing quality assurance measures interpretation of data, edited approved the final submitted version; Fawwad A contributed to concept, design, designing quality assurance measures, research data, edited and approved the final submitted version; Shaheen F and Tahir B contributed to literature search, data analysis, interpretation of data, wrote and approved the final submitted version; Waris N contributed to literature search, data analysis, wrote and approved the final submitted version; Basit A contributed to concept, design, edited and approved the final submitted version.
Institutional review board statement: Ethical approval was obtained by the Institutional Review Board (IRB) of BIDE with approval/reference number: BIDE/IRB/Prof.Yakoob-IML/02/11/10/025.
Informed consent statement: Informed consent was obtained from patients above 19 years of age and below 19 years were enrolled after obtaining informed consent from their parents.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CONSORT 2010 statement: The guidelines of the CONSORT 2010 Statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Muhammad Yakoob Ahmedani, FCPS, Professor, Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Plot No. 1-2, II-B, Nazimabad No. 2, Karachi 74600, Pakistan. research@bide.edu.pk
Telephone: +92-21-36688897 Fax: +92-21-36608568
Received: January 26, 2019
Peer-review started: January 27, 2019
First decision: February 19, 2019
Revised: March 6, 2019
Accepted: March 8, 2019
Article in press: March 9, 2019
Published online: March 15, 2019
Processing time: 48 Days and 20.7 Hours
Abstract
BACKGROUND

Inadequate health infrastructure and poverty especially in rural areas are the main hindrance in the optimal management of subjects with type 1 diabetes (T1D) in Pakistan.

AIM

To observe effectiveness of diabetes care through development of model clinics for subjects with T1D in the province of Sindh Pakistan.

METHODS

A welfare project with name of “Insulin My Life”, was started in province of Sindh, Pakistan. This was collaborative work of Baqai Institute of Diabetology and Endocrinology, World Diabetes Foundation and Baqai Medical University between February 2010 to February 2013. Under this project thirty-four T1D clinics were established. Electronic database was designed for demographic, biochemical, anthropometric and medical examination. Monthly consultation was part of the standardized diabetes care. All the recruited subjects with T1D were provided free insulins and related materials.

RESULTS

Out of 1428 subjects, 795 (55.7%) were males and 633 (44.3%) were females. Subjects were categorized into ≤ 5 years of age 103 (7.2%), between 6-12 years 323 (22.6%), between 13–18 years 428 (29.7%) and ≥ 19 years of age 574 (40.2%) groups. Glycemic control as assessed by HbA1c was significantly improved (P < 0.0001) at three years follow up as compared to baseline in all age groups. Decreasing trends of mean self-monitoring blood glucose were observed at different meal timings in all age groups. No significant change was found in the frequency of neuropathy, nephropathy and retinopathy during the study period (P > 0.05).

CONCLUSION

This study gives us long-term longitudinal data of people with T1D in a resource constraint society. With provision of standardized and comprehensive care significant improvement in glycemic control without any change in the frequency of microvascular complications was observed over 3 years.

Keywords: Insulin My Life; Type 1 diabetes; Insulin; Care; Pakistan

Core tip: This study adds the three years follow up of subjects with type 1 diabetes (recent) by providing all healthcare related facilities. This study will highlight the impact of integrated and comprehensive care on the glycemic control and complications of diabetes.