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niallvvInsulin, love and care
"Poor response" subset in a "have-not"
FREE type 1 diabetes clinic [DISHA] in India
Ms Uma Dayashankar
Samatvam Endocrinology Diabetes Center
Jnana Sanjeevini Diabetes Hospital
Bangalore, India
3-Sep-14
Ms Uma Dayashankar
Disclosures:
Nil
3-Sep-14
Horm Res 1989;31:204-209
2
Aims and Objectives
Insulin Love and Care
To identify the spectrum of glycemic control
and overall clinical responses associated
with recent provision of significant material
boost in a 3 decade long "philanthropic"
type 1 diabetes care program [DISHA].
3-Sep-14
State of Karnataka, India
Population total: 53
million
Population children:
10 million
T1DM children:
20000 30000
Project DISHA - 1987:
3000 (600 active);
rest untraceable
? dead
3-Sep-14
3-Sep-14
Jnana Sanjeevini
* www.jsindia.org
6
3-Sep-14
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Methods
Insulin Love and Care
3 Decades: Three Phases
Project DISHA + Insulin Lifeline:
1987 2005
Project DISHA + Insulin + SHBG:
2006 - 2011
Project DISHA + CDiC / LFAC:
2011 Ongoing
Changing Diabetes in Children
Life for a Child with Diabetes
3-Sep-14
Methods
Insulin Love and Care
Project DISHA + Insulin Lifeline: 1987 - 2005
Free insulin and syringes
Health education counseling
24 hour helplines
3-Sep-14
Methods
Insulin Love and Care
Project DISHA + Insulin + SHBG: 2006 - 2011
Rationed / Limited SHBG
BG meters and 5 -10 strips / month
Basal bolus insulin [100%]
Meal time regular plus bedtime NPH
3-Sep-14
Methods
Insulin Love and Care
Project DISHA + CDiC / LFAC: 2011 - Ongoing
250 children
100 BG strips per month
Limited biochemical evaluations
TSH, quarterly HbA1c testing, annual urine albumin:
creatinine ratio
Partial manpower financial support
Part time Diabetes Educator, Physician and
Ophthalmologist
3-Sep-14
10
Results
Insulin Love and Care
CDiC / LFAC enhanced support:
2 year follow up
3-Sep-14
11
DISHA
vs
DISHA + CDiC / LFAC
Substantial Material Boost: 2011
Support
DISHA
2006 - 2011
DISHA + CDiCLFAC
2011 - onwards
Insulin
Syringes
Free
Free
Free
Free
BG Meter
Free
Free
BG Strips / mo
5 -10
100
Biochemistry
Nil
HbA1c, UAC, S
Creatinine, TSH
Manpower financial Nil
support
3-Sep-14
Limited
SAMATVAM ENDOCRINOLOGY DIABETES CENTER * JNANA SANJEEVINI DIABETES HOSPITAL
12
DISHA
vs.
DISHA + CDiC / LFAC
Follow up 18 months; [n= 160]; Ages 2 18 y
Glycemic control trends: Response patterns
Group
n [%]
HbA1c % Baseline
and trend
Base Late
line
st
A: Prior discipline
Already good
17 [11]
<8 and stable
7.3
B: Responder High 35 [22]
>8 and >3 decline
14.8 9.1
C: Responder
59 [37]
>8 and 0.6 to 3 decline
10.9 9.2
D: Non- responder
Sad !!
49 [31]
>8 and < 0.6 decline
10.4 11.5
3-Sep-14
SAMATVAM ENDOCRINOLOGY DIABETES CENTER * JNANA SANJEEVINI DIABETES HOSPITAL
7.0
13
DISHA
vs.
DISHA + CDiC / LFAC
Follow up 18 months
Percent of children achieving HbA1c target
< 8 = 29%
< 7 = 12%
3-Sep-14
SAMATVAM ENDOCRINOLOGY DIABETES CENTER * JNANA SANJEEVINI DIABETES HOSPITAL
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DISHA
vs.
DISHA + CDiC / LFAC
Follow up 18 months
Nephropathy %
[mean UAC ratio g / mg of Creat]
Nil
58 %
[10]
Incipient
29 %
[88]
Overt
13 %
[1073]
3-Sep-14
SAMATVAM ENDOCRINOLOGY DIABETES CENTER * JNANA SANJEEVINI DIABETES HOSPITAL
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DISHA
vs.
DISHA + CDiC / LFAC
Follow up 18 months
Primary hypothyroidism
Newly detected 13%
3-Sep-14
SAMATVAM ENDOCRINOLOGY DIABETES CENTER * JNANA SANJEEVINI DIABETES HOSPITAL
16
Conclusions
Insulin Love and Care
Despite enhanced material support, a
subset of poverty associated type 1
diabetes children, do not demonstrate
improved glycemic control and overall
health.
Varying combination of detrimental
psychological, social and economic
factors probably contribute to this poorresponse.
3-Sep-14
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Conclusions
Insulin Love and Care
Identification of these negative therapeutic
factors and other coexisting life
challenges, and efforts to mitigate the
same [ie., molecular sociology ;
psychosocial therapy; High risk type 1
diabetes clinics], are crucial to health and
survival of these children.
The long term sustenance of such
programs, and support to newly arriving
children remains a big challenge.
3-Sep-14
18
Insulin, love and Care
Prof Johnny Ludviggson 1989
Beside physiological substitution of
insulin, psychosocial care is probably
the most important part of the
management of diabetes in children and
adolescents.
3-Sep-14
Horm Res 1989;31:204-209
SAMATVAM ENDOCRINOLOGY DIABETES CENTER * JNANA SANJEEVINI DIABETES HOSPITAL
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Spiritual Poverty and
Diabetes
Equation Childhood Diabetes
[Insulin] + [Love and Care]
=
HbA1c Health Happiness
3-Sep-14
Horm Res 1989;31:204-209
SAMATVAM ENDOCRINOLOGY DIABETES CENTER * JNANA SANJEEVINI DIABETES HOSPITAL
20
21
3-Sep-14
Jnana Sanjeevini
* www.jsindia.org
3-Sep-14
3 September
3-Sep-14
2014
JNANA SANJEEVINI MEDICAL CENTER
JnanaSAMATVAM
Sanjeevini
* www.jsindia.org
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