A century past the discovery of insulin: global progress and challenges for type 1 diabetes among children and adolescents in low-income and middle-income countries

AbstractThe discovery of insulin in 1921 changed the prognosis for people with type 1 diabetes. A century later, availability and affordability of insulin remain a challenge in many parts of the globe. Using the WHO’s framework on understanding the life cycle of medicines, this review details the global and national challenges that affect patients’ abilities to access and afford insulin. Current research and development in diabetes has seen some innovations, but none of these have truly been game-changing. Currently, three multinational companies control over 95% of global insulin supply. The inclusion of insulin on the WHO’s Prequalification Programme is an opportunity to facilitate entry of new companies into the market. Many governments lack policies on the selection, procurement, supply, pricing and reimbursement of insulin. Moreover, mark-ups in the supply chain also affect the final price to the consumer. Whilst expenses related to diabetes are mostly covered by insurance in high-income countries, many patients from low- and middle-income countries have to pay out of their own pockets. The organisation of diabetes management within the healthcare system also affects patient access to insulin. The challenges affecting access to insulin are complex and require a wide range of solutions. Given that 2021 marks the centenary of the discovery of insulin, there is need for global advocacy to ensure that the benefits of insulin and innovations in diabetes care reach all individuals living with diabetes. Graphical abstract

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Temporal trends in the cardiorespiratory fitness of children and adolescents representing 19 high-income and upper middle-income countries between 1981 and 2014

British Journal of Sports Medicine ◽

10.1136/bjsports-2017-097982 ◽

2017 ◽

Vol 53 (8) ◽

pp. 478-486 ◽

Cited By ~ 56

Author(s):

Grant R Tomkinson ◽

Justin J Lang ◽

Mark S Tremblay

Keyword(s):

Children And Adolescents ◽

Cardiorespiratory Fitness ◽

Low Income ◽

Polynomial Regression ◽

Temporal Trends ◽

High Income ◽

Middle Income ◽

Middle Income Countries ◽

International Trends ◽

Health Related

ObjectiveTo estimate international and national temporal trends in the cardiorespiratory fitness (CRF) of children and adolescents and to examine relationships between temporal trends in CRF and temporal trends in broad socioeconomic and health-related indicators across countries.MethodsData were obtained from a systematic search of studies that explicitly reported 20 m shuttle run test (a validated measure of CRF) descriptive data on apparently healthy individuals aged 9–17 years. Following the estimation of relative peak oxygen uptake (mL/kg/min) as a measure of CRF, sample-weighted temporal trends were estimated at the country–sex–age level using best-fitting linear or polynomial regression models relating the year of testing to mean CRF. Poststratified population-weighted mean changes in absolute and per cent CRF were estimated. Pearson’s correlations were used to describe the association between linear temporal trends in CRF and linear temporal trends in broad socioeconomic and health-related indicators.ResultsTemporal trends were estimated from 965 264 children and adolescents from 19 high-income and upper middle-income countries between 1981 and 2014, using data from 137 studies. Collectively, there was a moderate decline in CRF of 3.3 mL/kg/min (95% CI −3.5 to −3.1), equivalent to a decline of 7.3% (95% CI −7.8% to −6.7%) over the 33-year time period. This international decline diminished with each decade and stabilised near zero around 2000. The decline was larger for boys than girls and was similar for children and adolescents. Trends also differed in magnitude and direction between countries, with most showing declines. There was a strong negative association between country-specific trends in income inequality (Gini index) and trends in CRF across 18 countries; meaning, countries approaching income equality had more favourable trends in CRF.ConclusionsThere has been a substantial decline in CRF since 1981, which is suggestive of a meaningful decline in population health. However, the international trend in CRF has not followed the anticipated trajectory, diminishing and stabilising with negligible change since 2000. CRF data are needed from children in low-income and middle-income countries to more confidently determine true international trends and determine whether temporal trends are similar to those observed in high-income and upper middle-income countries.

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‘La Vida Normal’: Young people adapting to Type 1 diabetes in Bolivia

Chronic Illness ◽

10.1177/1742395319843172 ◽

2019 ◽

pp. 174239531984317

Author(s):

Katherine J Souris ◽

Maria del Carmen Caballero Gonzales ◽

Clare Barrington ◽

Emma L Klatman ◽

Barbara J Anderson ◽

...

Keyword(s):

Type 1 Diabetes ◽

Young People ◽

Clinical Education ◽

Clinical Care ◽

International Diabetes Federation ◽

Structured Interviews ◽

Middle Income ◽

Middle Income Countries ◽

And Coping

Objectives To identify challenges and coping strategies of young people with Type 1 diabetes (T1D) and their families in Bolivia through qualitative analysis of interviews with beneficiaries of Centro Vivir con Diabetes (CVCD), a diabetes health center supported by the International Diabetes Federation Life for a Child (LFAC) program. Methods Eighteen young people aged 14–33 and at least one caregiver participated in semi-structured interviews in five cities in Bolivia from May to June 2016. Interviews were recorded, transcribed, and analyzed using inductive thematic analysis. Results Participants described needing guidance at diagnosis and facing stigma in communities. Young people expressed that life with T1D was ‘la vida normal’ (a normal life), although interpretations of normalcy varied. For some, ‘la vida normal’ meant resistance to T1D; for others it indicated acceptance. Discussion Access to interdependent spheres of support allowed young people to form a new normal around T1D. Receiving supplies through the CVCD/LFAC partnership maintained family connection to clinical care, CVCD education helped families share in T1D management, and peer support mitigated stigma for young people. Programs like CVCD that combine supply-based aid with clinical education for whole families, create effective support for young people with T1D in low- and middle-income countries.

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Missing during COVID-19 lockdown: children with new-onset type 1 diabetes

10.21203/rs.3.rs-28594/v1 ◽

2020 ◽

Cited By ~ 2

Author(s):

Devi Dayal ◽

Saniya Gupta ◽

Dhvani Raithatha ◽

Muralidharan Jayashree

Keyword(s):

At Risk ◽

Type 1 Diabetes ◽

Pediatric Population ◽

Middle Income ◽

Onset Type ◽

Middle Income Countries ◽

Healthcare Settings ◽

The Impact ◽

New Onset

Abstract The redistribution of healthcare resources for coronavirus 2019 (COVID-19) pandemic has resulted in unintentional neglect of essential non-COVID-19 care (1). In low- and lower-middle income countries (LMIC), the already overstretched healthcare systems have crumbled under the COVID-19 pressure (2). Additionally, hardline lockdown restrictions, and fear of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in healthcare settings have forced patients with non-COVID-19 illnesses to stay home and suffer until their illness deteriorates substantially, and sometimes irreversibly. The impact of COVID-19 on the pediatric population has so far been mild, except in children with comorbidities (3). However, children who develop new time-sensitive non-COVID-19 illnesses during the pandemic are at risk of worsening or death due to compromised access to hospital care. In particular, children with new-onset type 1 diabetes (T1D) may progress rapidly to diabetic ketoacidosis (DKA) if treatment with insulin is delayed, and are therefore at risk of increased morbidity and mortality.

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Screening, prevalence, treatment and control of kidney disease in patients with type 1 and type 2 diabetes in low-to-middle-income countries (2005–2017): the International Diabetes Management Practices Study (IDMPS)

Diabetologia ◽

10.1007/s00125-021-05406-6 ◽

2021 ◽

Author(s):

Jean Claude Mbanya ◽

Pablo Aschner ◽

Juan J. Gagliardino ◽

Hasan İlkova ◽

Fernando Lavalle ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Kidney Disease ◽

Management Practices ◽

Diabetes Management ◽

Middle Income ◽

Middle Income Countries ◽

And Control

Abstract Aims/hypothesis Diabetes is the leading cause of kidney disease worldwide. There is limited information on screening, treatment and control of kidney disease in patients with diabetes in low-to-middle-income countries (LMICs). Methods The International Diabetes Management Practices Study is an ongoing, non-interventional study of clinical profiles and practices among patients receiving outpatient care mainly by internal medicine physicians and endocrinologists in LMICs. We examined screening, prevalence, treatment and control of kidney disease across seven waves (W) of data collection between 2005 and 2017. Results Among 15,079 patients with type 1 and 66,088 patients with type 2 diabetes, screening for kidney disease increased between W2 and W3 followed by a plateau (type 1 diabetes: W2, 73.7%; W3, 84.1%; W7, 83.4%; type 2 diabetes: W2, 65.1%; W3, 82.6%; W7, 86.2%). There were also decreasing proportions of patients with microalbuminuria (type 1 diabetes: W1, 27.1%; W3, 14.7%; W7, 13.8%; type 2 diabetes: W1, 24.5%; W3, 12.6%; W7, 11.9%) and proteinuria (type 1 diabetes: W1, 14.2%; W3, 8.7%; W7, 8.2%; type 2 diabetes: W1, 15.6%; W3, 9.3%; W7, 7.6%). Fewer patients were reported as receiving dialysis for both type 1 diabetes (W2, 1.4%; W7, 0.3%) and type 2 diabetes (W2, 0.9%; W7, 0.2%) over time. While there was no change in mean HbA1c or prevalence of diagnosed hypertension (type 1 diabetes: W1, 22.7%; W7, 19.9%; type 2 diabetes: W1, 60.9%; W7, 66.2%), the use of statins had increased among patients diagnosed with dyslipidaemia (type 1 diabetes: W1, 77.7%; W7, 90.7%; type 2 diabetes: W1, 78.6%; W7, 94.7%). Angiotensin II receptor blockers (type 1 diabetes: W1, 18.0%; W7, 30.6%; type 2 diabetes: W1, 24.2%; W7, 43.6%) were increasingly used over ACE inhibitors after W1 (type 1 diabetes: W1, 65.0%; W7, 55.9%; type 2 diabetes: W1, 55.7%, W7, 41.1%) among patients diagnosed with hypertension. Conclusions/interpretation In LMICs, real-world data suggest improvement in screening and treatment for kidney disease in patients with type 1 and type 2 diabetes attending non-nephrology clinics. This was accompanied by decreasing proportions of patients with microalbuminuria and proteinuria, with fewer patients who reported receiving dialysis over a 12-year period. Graphical abstract

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