Swaminathan Krishnan, Mukhekar Vinaykumar, Cohen Ohad
Consultant Endocrinologist, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India.
Medtronic Diabetes, Medtronic Ltd, India.
Indian J Endocrinol Metab. 2019 Mar-Apr;23(2):242-245. doi: 10.4103/ijem.IJEM_645_18.
To assess whether the socioeconomic and stereotypical barriers for the adoption of advanced diabetes technologies can be overcome in the underprivileged children and their families in India, predominantly from the rural areas, by providing insulin pump therapy (CSII) to deserving patients.
All patients were selected from the type 1 diabetes mellitus (T1DM) database of the Kovai Medical Center and Hospital, Coimbatore. Sixteen people with type 1 diabetes (PWD) were chosen due to poor control or an urgent situation like pregnancy or renal failure. Demographic data along with variables such as age, sex, time of diagnosis of T1DM, duration of CSII therapy, total daily insulin dose, hypoglycaemias, hospitalisations, glycosylated haemoglobin pre- and post-pump were collected. The glycosylated haemoglobin values were collected at 3, 6 and 12 months, post-CSII hypoglycaemia was defined as self-reported hypoglycaemia by the patient.
During 12 month follow-up, all 16 PWD were using the insulin pump with significant reductions in HbA1c from 11.4% at baseline to 8.0% ( < 0.001) and 7.6% at the end of 3 and 6 months, respectively.
Our results indicate that the CSII therapy without prejudice can lead to significant reductions in glycaemic control, hospitalisations and quality of life. This pilot work will help us lobby government policy makers to ensure policy changes that help the underprivileged with T1DM in India.
通过为符合条件的患者提供胰岛素泵治疗（持续皮下胰岛素输注，CSII），评估印度农村地区贫困儿童及其家庭采用先进糖尿病技术时所面临的社会经济和刻板障碍是否能够被克服。
所有患者均选自哥印拜陀市科瓦伊医疗中心和医院的1型糖尿病（T1DM）数据库。因血糖控制不佳或处于怀孕或肾衰竭等紧急情况，挑选出16名1型糖尿病患者（PWD）。收集了人口统计学数据以及年龄、性别、T1DM诊断时间、CSII治疗时长、每日胰岛素总剂量、低血糖发作次数、住院次数、泵治疗前后糖化血红蛋白等变量。糖化血红蛋白值在CSII治疗后3、6和12个月收集，CSII治疗后低血糖定义为患者自我报告的低血糖。
在12个月的随访期间，所有16名PWD均使用胰岛素泵，糖化血红蛋白水平显著降低，从基线时的11.4%分别降至3个月和6个月结束时的8.0%（<0.001）和7.6%。
我们的结果表明，无偏见的CSII治疗可显著降低血糖水平、减少住院次数并改善生活质量。这项试点工作将有助于我们游说政府政策制定者，以确保政策改变，从而帮助印度贫困的1型糖尿病患者。
