Faculty

Fauzia Mohsin

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Diabetes management in a poor-resource country

An estimated 463.0 million adults aged 20–79 years worldwide have diabetes, nearly 80% of whom live in low- and middle-income countries. The incidence of Type 1 diabetes in children and adolescents is increasing worldwide, with an overall annual increase of 3%. Although the reported incidence rates of many low and middle income countries are low, their T1D burden is large given their population size. Overweight and obesity rates along with prevalence of type 2 diabetes in children and adolescents are rising. Difficulties in the management of children and adolescents with diabetes in resource-poor countries are multiple. Lack of awareness among health professionals and families about diabetes in children, lack of diagnostic facilities can often lead to delay in diagnosis/ misdiagnosis with fatal consequences. Lack of affordable insulin and other essential medical supplies are significant problems coupled with the dearth of accessible and trained medical personnel. Glucose meters and strips are not affordable by the majority. Other serious problems include the lack of refrigeration for insulin storage, social stigma, gender bias, poor support at school. Inability to manage common complications e.g. hypoglycaemia, sick day management, drop out from the clinic (which may be due to lack of motivation, long distance or extra cost involved in travel), psychological issues are other common problems. Organizing effective diabetes care in a low resource setting is challenging. Strategies such as sustainable government policy, epidemiological data, trained healthcare workers, public-private partnership, proactive diabetes associations are important. The use of telehealth can be very helpful. In spite of the above limitations there are encouraging example of diabetes health care delivery in resource poor setting. An example of such an effort is the Diabetic association Bangladesh (BADAS) which through BIRDEM and its 61 affiliated associations and projects is providing integrated diabetes care throughout the country. Changing Diabetes in Children (CDiC) and the Life for a Child (LFAC) have been assisting BADAS to provide free comprehensive outpatient service to underprivileged children and adolescents with diabetes in Bangladesh.

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