Sustainable T1D Management

Background

Type 1 diabetes (T1D) is a potentially deadly auto-immune condition that often presents in childhood or early adolescence. Globally, some 480,000 children aged 0-15 live with T1D, and each year, medical practitioners worldwide make 76,000 new childhood diagnoses. When properly managed, children with T1D can live healthy and productive lives, but this requires consistent and affordable access to insulin, blood testing equipment, and other supplies. Given these costs, T1D management in the developing world is rarely optimal. Often, T1D leads to rapid death or severe health complication.

t1d-dream-trust@2XIn India, some 113,500 children aged 0-14 currently live with T1D, and each year, Indian medical practitioners make 18,300 new childhood diagnoses. And while India is one of the world’s fastest-growing economies, it does not provide adequate healthcare to much of its population. Although the country has many public hospitals and clinics, they are often grossly under-funded. The quality and cost of private care, moreover, is highly variable, ranging from the very best, to very inadequate. With insulin and supplies costing up to 30% of an average family’s income, optimal T1D management is simply too expensive for most families.

To address the needs of local children with T1D, an Indian diabetologist in the central city of Nagpur created the Dream Trust (DT) in 1995. With financial assistance from Indian and international donors, the Trust offers free diabetes care to over 500 children & young adults.

In summer 2010, Prof. Ron and physicians from the Children’s Hospital of Eastern Ontario (CHEO) visited the Dream Trust and witnessed an apparently effective, ethical, and financially sustainable system of T1D management. The Trust’s methods include provision of free insulin, syringes, and diabetes education; minimal blood glucose testing; and low-tech insulin storage.

Following this visit, CHEO’s pediatric endocrinology unit created a partnership with the Dream Trust, and is now raising funds for their work from Canadian T1D patients & families, medical practitioners, and pharmaceuticals. In addition, Prof. Ron and colleagues from CHEO, Life for a Child and the Dream Trust are pursuing research to rigorously evaluate the Trust’s patient outcomes.

This pilot study is the first step in what will eventually become a larger and more wide-ranging analysis of practical T1D management models in the developing world.

Click here to meet the T1D Research Team.

Question

Has the Dream Trust established a successful, ethical, and cost-effective model for treating underprivileged children living with T1D? If so, under what conditions might this model be appropriate for other resource-poor contexts? Is it possible to achieve good diabetes management with minimal blood testing and no insulin refrigeration?

Research

t1d-explaining-trust-activities@2XBased on a research protocol developed by Canadian and Indian researchers, Dream Trust personnel began collecting data in summer 2011 on all the Trust’s 500+ patients. Simultaneously, a local Indian pharmaceutical donated a year’s worth of HbA1c tests for all Trust patients (four tests per patient), giving researchers a series of rigorous outcome measures.

Documents

Proposal to the CHEO Research Ethics Board (approved June 15, 2011)

Patient Consent Form (English version; Hindi version on file in India)

Information on the CHEO-Dream Trust Partnership.

Newspaper Commentary

2010

Ron, J., Alex Ahmet & Caroline Zuijdwijk. “A Made-In-India Solution to a Tragic Health Scourge.” Ottawa Citizen, October 5, 2010.