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

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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A global perspective on the issue of access to insulin

Diabetologia ◽

10.1007/s00125-020-05375-2 ◽

2021 ◽

Author(s):

David Beran ◽

Maria Lazo-Porras ◽

Camille M. Mba ◽

Jean Claude Mbanya

Keyword(s):

Type 1 Diabetes ◽

Diabetes Management ◽

Multinational Companies ◽

Global Perspective ◽

Patient Access ◽

Middle Income ◽

Middle Income Countries ◽

Wide Range ◽

Pricing And Reimbursement

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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Excess all-cause mortality before age 30 in childhood onset type 1 diabetes: data from the Brecon Group Cohort in Wales

Archives of Disease in Childhood ◽

10.1136/archdischild-2016-312581 ◽

2017 ◽

Vol 103 (1) ◽

pp. 44-48 ◽

Cited By ~ 10

Author(s):

Diana R Wasag ◽

John W Gregory ◽

Colin Dayan ◽

John N Harvey

Keyword(s):

Type 1 Diabetes ◽

Young People ◽

Mortality Risk ◽

Clinical Care ◽

Adult Life ◽

Chronic Complications ◽

Mortality Ratio ◽

General Populations ◽

Incident Cases

BackgroundLong-term outcomes in young people with type 1 diabetes continue to be of interest, and may help evaluate the effects of changes to the clinical care of children that have occurred in recent decades.AimsTo identify mortality and its causes before age 30 years in patients developing type 1 diabetes before age 15 years.MethodsSince 1995, paediatricians in Wales have compiled a prospective register of incident cases of type 1 diabetes occurring before age 15 years in Wales (the Brecon Cohort). Their subsequent mortality rates were compared with mortality in the general populations of Wales and England using the patient-years exposure method. Causes of death were ascertained from death certificates and from clinicians.ResultsThe standardised mortality ratio for young people with type 1 diabetes in Wales was 2.91 with no clear evidence of improvement or worsening of mortality risk over time. Most deaths occurred between ages 15 and 30 years although at a slightly younger age than in the general population. There were more deaths with increasing age at diagnosis of diabetes. Ketoacidosis remains the most common cause of death before age 30 years. Hypoglycaemia was difficult to ascertain with certainty but also caused some deaths. In this age group, chronic complications of diabetes were not a cause of mortality.ConclusionsDespite the developments in clinical care in recent years, the mortality risk for people developing type 1 diabetes in childhood remains high in young adult life before the onset of chronic complications.

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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

The Lancet ◽

10.1016/s0140-6736(21)02247-9 ◽

2021 ◽

Vol 398 (10313) ◽

pp. 1837-1850

Author(s):

Zulfiqar A Bhutta ◽

Rehana A Salam ◽

Apoorva Gomber ◽

Laura Lewis-Watts ◽

Tanya Narang ◽

...

Keyword(s):

Type 1 Diabetes ◽

Children And Adolescents ◽

Low Income ◽

Middle Income ◽

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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