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The impact of limited and strategic blood glucose monitoring on metabolic control in a type 1 diabetes clinic in Central India

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Abstract

Background

Self-monitoring of blood glucose (SMBG) is an essential component of type 1 diabetes (T1D) management and typically involves several daily tests. However, due to high cost, SMBG supplies are often unavailable in low-resource settings. This study assessed whether the use of two SMBG tests per day improves glycemic control, measured by a change in HbA1c, in youth with T1D followed at the DREAM Trust (DT) in Nagpur, India.

Methods

Single-site prospective cohort study of youth ≤ 23 years of age with T1D ≥ 1 year followed by DT, who were provided with SMBG meters and two test strips per day. Patients received education regarding SMBG and how to respond to blood glucose values and trends. They were followed every 3 months with HbA1c and questionnaires for a total of 21 months.

Results

HbA1c declined significantly from 10.2 ± 2.5% (88 ± 4 mmol/mol) at baseline to 9.5 ± 2.4% (80 ± 3 mmol/mol) at 21 months (p < 0.001). In univariable analysis, change in HbA1c was associated with adherence to insulin dosing, number of patient education sessions, household income, and holding a below the poverty line certificate. In multivariable analysis, only adherence to insulin dosing was a significant predictor for a decrease in HbA1c. There was no increase in diabetes-related acute complications.

Conclusions

The use of two SMBG test strips per day for the management of T1D in a low-resource setting was safe, and over the 21 months following its introduction, there was a clinically and statistically significant decrease in HbA1c.

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Funding

The International Diabetes Federation (IDF) Life for a Child program provided funding for HbA1C measurement, database creation, and statistical support.

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Authors and Affiliations

Authors

Contributions

Caroline Zuijdwijk was involved in study conception and design, data interpretation, and writing the manuscript. Sharad Pendsey was involved in study conception and design and facilitated the collection of data in his clinic. James Ron was involved in study conception and design, as well as data interpretation. Graham Ogle provided scholarly input and was involved in data interpretation. Amisha Agarwal and Nick Barrowman were involved in data analysis and interpretation. Seema Chalkhore and Sanket Pendsey were involved in study design, as well as data collection and recording. Alexandra Ahmet was involved in study conception and design and data interpretation. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Corresponding author

Correspondence to Caroline S. Zuijdwijk.

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Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all participants by DT staff. If participants were too young to consent to study participation, informed consent was obtained from their parents/ legal guardians, and assent was obtained from the child.

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Zuijdwijk, C.S., Pendsey, S., Ron, J. et al. The impact of limited and strategic blood glucose monitoring on metabolic control in a type 1 diabetes clinic in Central India. Int J Diabetes Dev Ctries 40, 578–584 (2020). https://doi.org/10.1007/s13410-020-00817-4

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  • DOI: https://doi.org/10.1007/s13410-020-00817-4

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