Evaluation of Differing Type 1 Diabetes Regimens in Youth in the Developing World

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DESCRIPTION (provided by applicant): This application is in response to the Global Health theme of the RFA; it capitalizes on an ongoing collaboration between the University of Pittsburgh, the Life for a Child program of the International Diabetes Federation, the Association Rwandaise des Diabetiques and the National University of Rwanda and is ready to be launched. It will evaluate, by a randomized clinical trial, two models of care for type 1 diabetes (youth onset) in the developing world (Rwanda), including their comparative costs. This type of diabetes, which commonly starts in childhood, poses severe challenges to the children and to their parents, care givers and health care providers. It also requires considerable knowledge, judgment and technical proficiency, expensive medication and testing supplies, and the self administration of multiple blood tests and injections on a daily basis. These challenges in the developing world can be overwhelming, for they are compounded by poverty, uncertainty as to the timing and content of the next meal and a paucity of health care providers and supplies. Because of inadequate supplies and a fear of hypoglycemia, many patients take minimal insulin doses, leading to poor control and growth resulting in rampant complications. It is hypothesized that this trend is worsened by the predominant use of NPH insulin, which has a variable time course of action and once taken, largely determines meals and activity for the next 10-12 hours, which poses a major challenge in the developing world. This application will thus compare this current management regimen with a much simplified diabetes management regimen based on a single daily injection of a basal insulin that does not have any peaks. In addition a simplified, and standardized, method of delivering diabetes education via personal computer "tablets" will be developed and evaluated to help compensate for the shortage of trained health care professionals available to provide education. We therefore plan to develop and evaluate a potential model for the management of childhood onset diabetes in the developing world. PUBLIC HEALTH RELEVANCE: This application addresses two major issues in the management of type 1 diabetes in the developing world. It thus has the potential for a major impact on Public Health, particularly given its close links with the Life for a Child program, which is operating in 22 countries.