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.

说明（由申请人提供）：本申请是为了响应区域区域论坛的全球健康主题；它利用了匹兹堡大学、国际糖尿病联合会的儿童生命项目、卢旺达糖尿病协会和卢旺达国立大学之间正在进行的合作，并准备启动。它将通过一项随机临床试验，评估发展中国家（卢旺达）治疗1型糖尿病（青年发病）的两种模式，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、照顾者和卫生保健提供者构成了严峻的挑战。它还需要相当的知识、判断力和技术熟练程度，昂贵的药物和检测用品，以及每天自我进行多次血液检测和注射。发展中国家面临的这些挑战可能是压倒性的，因为贫困、下一顿饭的时间和内容不确定以及缺乏卫生保健提供者和用品使这些挑战更加复杂。由于供应不足和对低血糖的恐惧，许多患者服用最低剂量的胰岛素，导致控制不良和生长，导致并发症猖獗。据推测，这种趋势因主要使用NPH胰岛素而恶化，这种胰岛素具有可变的时间作用过程，一旦服用，在很大程度上决定了接下来10-12小时的饮食和活动，这对发展中国家构成了重大挑战。因此，该应用程序将比较当前的管理方案与基于每日一次注射没有任何峰值的基础胰岛素的简化糖尿病管理方案。此外，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，以管理发展中国家的儿童发病糖尿病。