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

描述（由申请人提供）：此应用程序是响应RFA的全球健康主题;它利用匹兹堡大学，国际糖尿病联合会儿童生命计划，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，并准备推出。它将通过一项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，包括其比较成本。这种类型的糖尿病通常始于儿童时期，对儿童及其父母，护理人员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，昂贵的药物和测试用品，以及每天多次验血和注射的自我管理。发展中世界的这些挑战可能是巨大的，因为贫穷、下一顿饭的时间和内容不确定以及保健提供者和供应品的缺乏使这些挑战更加复杂。由于供应不足和对低血糖的恐惧，许多患者服用最小剂量的胰岛素，导致控制不良和生长不良，从而导致猖獗的并发症。据推测，这种趋势因NPH胰岛素的主要使用而恶化，NPH胰岛素的作用时间过程可变，一旦服用，在很大程度上决定了接下来10-12小时的膳食和活动，这对发展中国家构成了重大挑战。因此，本申请将比较该当前管理方案与基于不具有任何峰值的基础胰岛素的单次每日注射的非常简化的糖尿病管理方案。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，以帮助弥补训练有素的医疗保健专业人员提供教育的短缺。因此，我们计划开发和评估一种用于管理发展中国家儿童期发病糖尿病的潜在模式。 公共卫生相关性：该应用程序解决了发展中国家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，特别是考虑到它与在22个国家运作的"儿童生命“方案的密切联系。

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.