The IDF Life for a Child Program Index of diabetes care for children and youth

Ogle, Graham D; Middlehurst, Angela C; Silink, Martin

doi:10.1111/pedi.12296

Cited by 45 publications

(63 citation statements)

References 24 publications

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“…Type 1 diabetes (T1D) occurs in children and adolescents across the world, and there are accepted international guidelines for effective management, notably from the International Society for Pediatric and Adolescent Diabetes (ISPAD) . In most well‐resourced countries, the resources to achieve such care are essentially fully covered by the respective national health systems, although there is a large variation in hemoglobin A1c (HbA1c) results between high‐income western countries . Furthermore, care is improving with advances in insulins, insulin pumps, glucose monitoring, and “closed‐loop” systems.…”

Section: Introductionmentioning

confidence: 99%

“…However, this is not the case in many middle‐income or low‐income countries. Insulin, blood glucose tests strips, and other components of care are often unavailable or remain inaccessible, as they must be purchased out‐of‐pocket by families . Access to physicians and nurses skilled in T1D management and diabetes education is also very frequently limited …”

Section: Introductionmentioning

confidence: 99%

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Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

et al. 2018

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Optimal care for children and adolescents with type 1 diabetes is well described in guidelines, such as those of the International Society for Pediatric and Adolescent Diabetes. High‐income countries can usually provide this, but the cost of this care is generally prohibitive for lower‐income countries. Indeed, in most of these countries, very little care is provided by government health systems, resulting in high mortality, and high complications rates in those who do survive. As lower‐income countries work toward establishing guidelines‐based care, it is helpful to describe the levels of care that are potentially affordable, cost‐effective, and result in substantially improved clinical outcomes. We have developed a levels of care concept with three tiers: “minimal care,” “intermediate care,” and “comprehensive (guidelines‐based) care.” Each tier contains levels, which describe insulin and blood glucose monitoring regimens, requirements for hemoglobin A1c (HbA1c) testing, complications screening, diabetes education, and multidisciplinary care. The literature provides various examples at each tier, including from countries where the life for a child and the changing diabetes in children programs have assisted local diabetes centres to introduce intermediate care. Intra‐clinic mean HbA1c levels range from 12.0% to 14.0% (108‐130 mmol/mol) for the most basic level of minimal care, 8.0% to 9.5% (64‐80 mmol/mol) for intermediate care, and 6.9% to 8.5% (52‐69 mmol/mol) for comprehensive care. Countries with sufficient resources should provide comprehensive care, working to ensure that it is accessible by all in need, and that resulting HbA1c levels correspond with international recommendations. All other countries should provide Intermediate care, while working toward the provision of comprehensive care.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

et al. 2018

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“…Nevertheless, with the increase in capacity in pediatric endocrinology in sub-Saharan Africa, there are now thousands of children and adolescents in need of a global management approach for type 1 diabetes, including access to insulin and glucagon. It is important to emphasize that for diabetes, in particular, access to medicines is only one aspect of disease management [3, 49, 50]. …”

Section: Discussionmentioning

confidence: 99%

“…Information on availability to the patient and cost in each country was obtained from a PETCA-trained pediatric endocrinologist in each country (J.D., E.A., J.M., F.R., E.S.M.). Also included were the scores for the LFAC index of diabetes care for children and adolescents, a 0–100 scale that takes into account all major components of diabetes care, and where a higher number reflects more comprehensive care [3]. …”

Section: Methodsmentioning

confidence: 99%

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Insights from the WHO and National Lists of Essential Medicines: Focus on Pediatric Diabetes Care in Africa

Rowlands

Ameyaw²,

Rutagarama

et al. 2018

Horm Res Paediatr

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Background: Access to essential medicines in pediatric endocrinology and diabetes is limited in resource-limited countries. The World Health Organization (WHO) maintains two non-binding lists of essential medicines (EMLs) which are often used as a template for developing national EMLs. Methods: We compared a previously published master list of medicines for pediatric endocrinology and diabetes with the WHO EMLs and national EMLs for countries within the WHO African region. To better understand actual access to medicines by patients, we focused on diabetes and surveyed pediatric endocrinologists from 5 countries and assessed availability and true cost for insulin and glucagon. Results: Most medicines that are essential in pediatric endocrinology and diabetes were included in the national EMLs. However, essential medicines, such as fludrocortisone, were present in less than 30% of the national EMLs despite being recommended by the WHO. Pediatric endocrinologists from the 5 focus countries reported significant variation in terms of availability and public access to insulin, as well as differences between urban and rural areas. Except for Botswana, glucagon was rarely available. There was no significant relationship between Gross National Income and the number of medicines included in the national EMLs. Conclusions: Governments in resource-limited countries could take further steps to improve EMLs and access to medicines such as improved collaboration between health authorities, the pharmaceutical industry, patient groups, health professionals, and capacity-building programs such as Paediatric Endocrinology Training Centres for Africa.

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Action4Diabetes: a non‐profit organisation bridging the type 1 diabetes gap in Southeast Asia

2023

Practical Diabetes

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The IDF Life for a Child Program Index of diabetes care for children and youth

Abstract: The index is a comprehensive, easily administered survey instrument. It demonstrated stark differences in access to numerous components of care necessary in achieving good outcomes for children and youth with diabetes.

Cited by 45 publications

References 24 publications

Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

Insights from the WHO and National Lists of Essential Medicines: Focus on Pediatric Diabetes Care in Africa

Action4Diabetes: a non‐profit organisation bridging the type 1 diabetes gap in Southeast Asia

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