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
ARTICLE HIGHLIGHTS
Research 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.

Research motivation

The current study with lack of an infrastructure provides health care system in a proper way with available resources, to evaluate patient centered outcomes in the measurement of progression and treatment. Such kind of data was considered as the best available option.

Research objectives

The objective of this study is to observe the effectiveness of diabetes care through development of model clinics for subjects with T1D in the province of Sindh Pakistan.

Research methods

In this welfare project “Insulin My Life (IML)”, subjects with only T1D were included. Thirty-four model T1D clinic were established and total of 654 community based awareness camps and group sessions were held. All registered subjects with T1D were asked to have free of cost consultation with physician, diabetes educators, free coverage for insulin and glucose testing equipment after every six months. Glycemic control was assessed by checking FBS and RBS at baseline and end of the study along with fasting HbA1c at baseline and after every 6 mo during 3 years follow up. Glycemic control was also assessed by using self-monitoring blood glucose level (SMBG) at different meal timings in all age groups.

Research results

Out of 1428 subjects 790 (55.3%) were males and 638 (44.7%) were females. Glycemic control as retrieved by HbA1c was significantly improved at final visit as compared to the baseline in all age groups. At baseline visit good glycemic control was observed in 3.6% subjects which increased to 25.9% at the end of study for ≤ 5 years of age. Similar trend can be seen in age 6-12 years, 13–18 years, and ≥ 19 years of age group. Comparatively lower mean SMBG values were observed compared to first month during the study period.

Research conclusions

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.

Research perspectives

This study helps us to know more about T1D in Pakistan than ever before, but much is still to be learned. This study need to be replicated at Nationwide level.