Optimized health care for subjects with type 1 diabetes in a resource constraint society: A three-year follow-up study from Pakistan

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. AIM To observe effectiveness of diabetes care through development of model clinics for subjects with TID in the province of Sindh Pakistan. METHODS A welfare project with name of "Insulin My Life", was started in province of Sindh, Pakistan. This was collaborative work of Baqai Institute of Diabetology and Endocrinology, World Diabetes Foundation and Baqai Medical University between February 2010 to February 2013. Under this project thirty-four T1D clinics were established. Electronic database was designed for demographic, biochemical, anthropometric and medical examination. Monthly consultation was part of the standardized diabetes care. All the recruited subjects with T1D were provided free insulins and related materials. RESULTS Out of 1428 subjects, 795 (55.7%) were males and 633 (44.3%) were females. Subjects were categorized into <= 5 5 years of age 103 (7.2%), between 6-12 years 323 (22.6%), between 13-18 years 428 (29.7%) and >= 19 years of age 574 (40.2%) groups. Glycemic control as assessed by HbA1c was significantly improved (P < 0.0001) at three years follow up as compared to baseline in all age groups. Decreasing trends of mean self-monitoring blood glucose were observed at different meal timings in all age groups. No significant change was found in the frequency of neuropathy, nephropathy and retinopathy during the study period (P > 0.05). CONCLUSION This study gives us long-term longitudinal data of people with T1D in a resource constraint society. 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.