Pulungan Aman B, de Beaufort Carine, Ratnasari Amajida F, Puteri Helena A, Lewis-Watts Laura, Bhutta Zulfiqar A
Department of Child Health, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
International Pediatric Association (IPA).
Clin Pediatr Endocrinol. 2023;32(3):137-146. doi: 10.1297/cpe.2023-0017. Epub 2023 Apr 19.
A decade since the discovery of insulin, the increasing prevalence of type 1 diabetes mellitus (T1DM) has underscored the prevailing inequalities in the provision of essential care for T1DM worldwide. However, the details on the availability of insulin types and associated medical devices remain unclear. A cross-sectional electronic survey was distributed across a global network of pediatric societies under the umbrella of the International Pediatric Association (IPA). Access to and availability of pediatric diabetes care were investigated using standardized questions. Responses from 25 of 132 pediatric societies across six regions were included. Pediatric endocrinologists typically manage T1DM together with pediatricians or adult endocrinologists. Nonetheless, 24% of the respondents reported pediatricians to be the sole healthcare professionals. According to the respondents, the patients were either partially or completely responsible for payments of insulin (40%), A1C (24%), C-peptide (28%), and antibody testing for diagnosis (28%). Government support is generally available for insulin, but this was merely 20% for insulin pumps and 12% for continuous glucose monitors. There are considerable disparities in the access, availability, and affordability of diabetes testing, medications, and support between countries with significant out-of-pocket payments for care. Country- and region-specific improvements to national programs are necessary to achieve optimal pediatric diabetes care globally.
自胰岛素被发现十年以来，1型糖尿病（T1DM）患病率的不断上升凸显了全球范围内在提供T1DM基本护理方面普遍存在的不平等现象。然而，胰岛素类型及相关医疗设备的可及情况细节仍不明确。一项横断面电子调查在国际儿科学会（IPA）旗下的全球儿科协会网络中展开。通过标准化问题对儿科糖尿病护理的可及性和可用性进行了调查。纳入了六个地区132个儿科协会中25个协会的回复。儿科内分泌学家通常与儿科医生或成人内分泌学家共同管理T1DM。尽管如此，24%的受访者报告称儿科医生是唯一的医疗保健专业人员。根据受访者的说法，患者要部分或完全承担胰岛素（40%）、糖化血红蛋白（A1C，24%）、C肽（28%）以及诊断性抗体检测（28%）的费用。政府一般会为胰岛素提供支持，但胰岛素泵仅为20%，连续血糖监测仪仅为12%。在护理需大量自付费用的国家之间，糖尿病检测、药物和支持的可及性、可用性及可负担性存在相当大的差异。为在全球实现最佳的儿科糖尿病护理，有必要针对各国和各地区的国家项目进行改进。
