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

发展中国家青少年不同 1 型糖尿病治疗方案的评估

• 批准号: 8044978
• 负责人: TREVOR J. ORCHARD
• 金额: $ 120万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2013-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8044978
• 关键词: Address; Adolescence; Adolescent; Adult; Affect; Africa South of the Sahara; Age; Area; Blood Glucose; Blood Tests; Budgets; Caregivers; Caring; Cellular Phone; Cessation of life; Child; Childhood; Chronic; Collaborations; Coma; Communicable Diseases; Communication; Country; Developing Countries; Diabetes Mellitus; Diagnosis; Dose; Eating; Education; Equilibrium; Evaluation; Food; Fright; Growth; Growth and Development function; Health; Health Personnel; Health Professional; Healthcare Systems; Hour; Household; Hyperglycemia; Hypoglycemia; Injection of therapeutic agent; Insulin; Insulin-Dependent Diabetes Mellitus; International; Internet; Isophane Insulin; Judgment; Kidney Failure; Knowledge; Language; Lead; Life; Link; Methods; Modeling; Parents; Participant; Patient Care; Patients; Personal Computers; Pharmaceutical Preparations; Population; Poverty; Professional Education; Protocols documentation; Public Health; Quality of life; Randomized Clinical Trials; Regimen; Research; Rwanda; Schools; Self Administration; Tablets; Testing; Time; Training; Uncertainty; United States National Institutes of Health; Universities; Youth; analog; basal insulin; base; comparative; cost; diabetes education; diabetes management; diabetes mellitus nursing; dosage; glargine; global health; programs; response; tool; trend

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.

申请者描述(申请人提供)：该申请是为了响应RFA的全球健康主题；它利用了匹兹堡大学、国际糖尿病联合会的儿童生命计划、糖尿病协会和卢旺达国立大学之间的持续合作，并已准备好启动。它将通过随机临床试验评估发展中国家(卢旺达)1型糖尿病(青年发病)的两种护理模式，包括它们的比较成本。这种类型的糖尿病通常始于儿童时期，对儿童及其父母、护理者和卫生保健提供者构成了严峻的挑战。它还需要相当多的知识、判断力和技术熟练程度，昂贵的药物和检测用品，以及每天多次血液测试和注射的自我管理。发展中国家的这些挑战可能是巨大的，因为贫困、不确定下一餐的时间和内容以及卫生保健提供者和用品的匮乏使这些挑战更加严重。由于供应不足和对低血糖的恐惧，许多患者服用最小剂量的胰岛素，导致控制和生长不良，从而导致猖獗的并发症。据推测，NPH胰岛素的主要使用加剧了这一趋势，NPH胰岛素的作用过程可变，一旦服用，在很大程度上决定了未来10-12小时的饮食和活动，这在发展中国家构成了一个重大挑战。因此，本申请将把这种目前的治疗方案与基于每天一次注射基础胰岛素的简单得多的糖尿病管理方案进行比较，该胰岛素没有任何峰值。此外，还将开发和评估一种通过个人电脑“平板电脑”提供糖尿病教育的简化和标准化方法，以帮助弥补可提供教育的训练有素的卫生保健专业人员的短缺。因此，我们计划开发和评估一种潜在的模式，用于在发展中国家管理儿童发病的糖尿病。 公共卫生相关性：这项申请解决了发展中国家1型糖尿病管理中的两个主要问题。因此，它有可能对公共卫生产生重大影响，特别是考虑到它与儿童生命方案的密切联系，该方案在22个国家开展业务。