Gilligan Molly M, Linnes Jacqueline C, von Oettingen Julia E, Altenor Ketly
University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Kay Mackenson Clinic, Montrouis, Haiti.
Pediatr Diabetes. 2021 Aug;22(5):729-733. doi: 10.1111/pedi.13167. Epub 2021 Apr 22.
Diabetes prevalence within the global population has nearly doubled since 1980, with the most rapid growth occurring in low- and middle-income countries. Diabetes management in resource-limited settings such as Haiti presents many challenges, including the storage of insulin. Despite a lack of published data on insulin thermostability, storage at 2-8°C or at room temperature (25°C) is recommended. In Haiti, access to refrigeration and thereby proper insulin storage is severely limited. Commercial storage devices such as the FRIO cooling wallet are cost-prohibitive and not available locally, and alternatives such as small clay pots are fragile and nonportable. Here, we designed and tested the cooling efficacy of a homemade wallet made of acrylate polymer beads and a hand-sewn cotton pouch compared to a FRIO wallet and a clay pot. All studies were conducted over a ten-day period at the Kay Mackenson Clinic in Montrouis, Haiti. Temperature and humidity values were continuously collected using wireless monitors placed inside each device, and hourly ambient temperature and humidity values were manually recorded. Evaporative cooling efficacy was calculated using collected data. The homemade wallet and FRIO cooling wallet demonstrated comparable cooling efficacy with an average of 71% and 73%, respectively. The clay pot demonstrated significantly decreased efficacy with an average of 27% (p < 0.05). The homemade insulin wallet is a promising alternative for the storage of insulin in low-resource settings without the financial and physical barriers of commercial and locally sourced devices. Additionally, this wallet could be readily adapted for the storage of other perishable medical supplies in low-income countries.
自1980年以来，全球糖尿病患病率几乎翻了一番，其中低收入和中等收入国家增长最为迅速。在海地等资源有限的地区进行糖尿病管理面临诸多挑战，包括胰岛素的储存。尽管缺乏关于胰岛素热稳定性的公开数据，但仍建议在2-8°C或室温（25°C）下储存。在海地，制冷设备的获取以及胰岛素的妥善储存受到严重限制。诸如FRIO冷却钱包等商业储存设备价格昂贵且当地无法获取，而诸如小陶罐等替代品易碎且不便携带。在此，我们设计并测试了一种由丙烯酸酯聚合物珠和手工缝制的棉袋制成的自制钱包的冷却效果，并与FRIO钱包和陶罐进行了比较。所有研究均在海地蒙特鲁瓦的凯·麦肯森诊所进行，为期十天。使用放置在每个设备内的无线监测器持续收集温度和湿度值，并手动记录每小时的环境温度和湿度值。利用收集到的数据计算蒸发冷却效果。自制钱包和FRIO冷却钱包的冷却效果相当，平均分别为71%和73%。陶罐的冷却效果显著降低，平均为27%（p < 0.05）。自制胰岛素钱包是在资源匮乏地区储存胰岛素的一种有前景的替代方案，不存在商业和本地采购设备的资金和物理障碍。此外，这种钱包可以很容易地适用于低收入国家其他易腐医疗用品的储存。
