Endocrine Abstracts

Background: In numerous low-income countries (LMICs) across Southeast Asia, the standard insulin therapy for people diagnosed with type 1 diabetes (T1D) is twice-daily premix insulin regimen. In Laos, the national health coverage fdoes not include provisions for insulin or blood glucose testing kits. Prior to 2016, no Laotian individuals were known to have survived with T1D. Intensive insulin therapy utilising a multiple daily insulin (MDI) regimen has now become the recommended standard of care for all individuals with T1D. MDI has demonstrated improvements in glycaemic control and a reduction in the risk of long-term complications compared to the traditional twice-daily insulin regimen.

Methodology: A qualitative approach employing semi-structured, in-depth interviews was used to explore the barriers, and effects on quality of life associated with managing diabetes at home, school, and during leisure activities. Participants were identified and invited to participate within a specified timeframe, and written consent was obtained prior to the interviews. Thematic analysis was employed to analyse the data.

Results: Fifteen participants (4 males) were involved in the study. The mean age at diagnosis was 10.93 years (ranging from 2 to 18 years), and the mean age at the switch to MDI was 14.73 years (ranging from 3 to 20 years). Prior to the transition, concerns related to a lack of confidence in carbohydrate counting and administering injections during school hours were identified as barriers. Following the transition, a majority of respondents viewed the switch to MDI positively, citing benefits such as improved glucose stability, greater dietary flexibility, fewer hypoglycaemic events, and an enhanced overall sense of well-being. Overall satisfaction levels were high post-transition to MDI.

Conclusions: This study is significant because it provides valuable insights that will guide future work in supporting the switch for children and young people with type 1 diabetes from twice daily to multiple daily insulin regimen in LMICs. By understanding their needs and priorities, we can develop strategies to support healthcare professionals, carers and parents to understand the barriers and align with the child’s lifestyles and expectations. This will help to improve their well-being and support in managing their diabetes