BACKGROUNDYoung people with type 1 diabetes in low-and-middle income countries facemany challenges in accessing care, with various essential supplies needed forsurvival and long-term health.AIMTo study insulin deliver...BACKGROUNDYoung people with type 1 diabetes in low-and-middle income countries facemany challenges in accessing care, with various essential supplies needed forsurvival and long-term health.AIMTo study insulin delivery devices and glycated haemoglobin (HbA1c) testing.METHODSA survey was conducted in 2019 of leading diabetes centres in 41 countriessupported by the Life for a Child Program. The survey covered numerous aspectsconcerning availability and costs at all levels of the health system, local usagepatterns and attitudes, obstacles, and other aspects.RESULTSThirty-seven countries returned the survey (90.2% response rate). Key findingsincluded: Syringe use was most common (83.1%), followed by insulin pens(16.7%) and pumps (0.2%). 48.6% of public health systems did not providesyringes, even with a co-payment. Use of suboptimal syringe/needlecombinations was common. Needles were generally reused in almost all countries(94.3%, n = 35). Aside from donated supplies, there was variable access to HbA1ctesting within public health facilities, and, when available, patients often had tocover the cost. Provision was further compromised by numerous problemsincluding stock-outs, and challenges with understanding the test, equipmentmaintenance, and refrigeration.CONCLUSIONLarge gaps exist for adequate access to appropriate insulin delivery devices andHbA1c testing. Public health systems in low-and-middle income countries shouldincrease affordable provision. There are also needs for specific health professional training and diabetes education;elimination of customs duties and taxes;development of inexpensive, robust HbA1c testing methods that do not requirerefrigeration of testing supplies;differential pricing schemes;and other solutions.展开更多
目的:系统评估应用无针注射器与胰岛素笔注射胰岛素降糖的疗效和安全性。方法:按照纳入和排除标准,计算机检索无针注射器与胰岛素笔的前瞻性队列研究文献。对所纳入文献进行质量评价及提取资料后,采用Rev Man 5. 3软件进行Meta分析。结...目的:系统评估应用无针注射器与胰岛素笔注射胰岛素降糖的疗效和安全性。方法:按照纳入和排除标准,计算机检索无针注射器与胰岛素笔的前瞻性队列研究文献。对所纳入文献进行质量评价及提取资料后,采用Rev Man 5. 3软件进行Meta分析。结果:根据纳入排除标准共纳入8篇符合标准的文献,包括466例患者,8项研究NOS评分均大于8分。Meta分析的结果表明,在降低HbA1c水平方面无针注射器组优于胰岛素笔组[MD=-1.05,95%CI(-1.88,-0.22),P=0.01];在降低FBG、早餐后2 h BG和2 h PG方面,无针注射器组显著优于胰岛素笔组[MD=-1.37,95%CI(-1.82,-0.92),P <0.00001;MD=-1.14,95%CI(-1.49,-0.78),P <0.00001;MD=-2.26,95%CI(-3.04,-1.48),P <0.000 01]。在安全性方面,低血糖发生率、注射后疼痛和出血/瘀斑发生率,无针注射器组和胰岛素笔组比较差异无统计学意义[RR=0.30,95%CI(0.08,1.06),P=0.06;RR=0.33,95%CI(0.07,1.58),P=0.17;RR=0.39,95%CI(0.01,19.86),P=0.64],但注射后发生红肿硬结的发生率,无针注射器组少于胰岛素笔组[RR=0.26,95%CI(0.08,0.82),P=0.02]。结论:用无针注射器注射胰岛素可以提高疗效,减少红肿硬结的发生。展开更多
目的探讨胰岛素无针注射器在糖尿病患者中的应用效果。方法选取我院收治的104例糖尿病的患者为研究对象,按照随机数表法将其分为对照组(52例,胰岛素有针注射器)与观察组(52例,胰岛素无针注射器)。比较两组患者的应用效果。结果应用后,...目的探讨胰岛素无针注射器在糖尿病患者中的应用效果。方法选取我院收治的104例糖尿病的患者为研究对象,按照随机数表法将其分为对照组(52例,胰岛素有针注射器)与观察组(52例,胰岛素无针注射器)。比较两组患者的应用效果。结果应用后,两组的FBG、2 h PBG、HbA1c水平、HAMA及HAMD评分均降低,且观察组低于对照组(P<0.05)。观察组疼痛、残留药物发生率低于对照组,皮肤红肿或硬结发生率高于对照组(P<0.05)。应用后,两组生理功能、躯体疼痛、情感职能及精神健康评分均升高,且观察组高于对照组(P<0.05)。结论胰岛素无针注射器在糖尿病患者中的应用效果显著,可以降低患者的血糖水平、疼痛及残留药物情况,改善患者的焦虑抑郁情绪,提高患者的生活质量,值得推广与应用。展开更多
基金We thank the survey respondents in all countries for their time and insights. Thecentres were: The Endocrine Center (Azerbaijan), Bangladesh Institute of Research andRehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM)(Bangladesh), Centro Vivir con Diabetes (Bolivia), CHU Yalgado Ouedraogo (BurkinaFaso), PNILMCNT - MSPLS (Burundi), Clinique Diabetique de Bangui (CentralAfrican Republic), MEMISA Belgique en RDC (Democratic Republic of Congo),Aprendiendo a Vivir (Dominican Republic), FUVIDA (Ecuador), Central HealthLaboratory (Eritrea), Ethiopian Diabetes Association (Ethiopia), Komfo AnokyeTeaching Hospital (Ghana), Asociacion Creciendo con Diabetes (Guatemala), GuyanaDiabetic Association (Guyana), FHADIMAC (Haiti), Diacare, Ahmedabad (India),Diabetes Association of Jamaica (Jamaica), Ganta United Methodist Hospital (Liberia),Diabetes Society of Maldives (Maldives), Santé Diabète (Mali), AMLCD (Mauritania),Federacion Mexicana de Diabetes (Mexico), Patan Hospital (Nepal), Lagos UniversityTeaching Hospital (Nigeria), Choe Kyong Tae Endocrine Research (North Korea),National Institute of Child Health (Pakistan), Cardinal Santos Medical Center(Philippines), Maison Bleue du Diabète (Republic of Congo), Rwandan Diabetes Association (Rwanda), Diabetes Association of Sri Lanka (Sri Lanka), St. LuciaDiabetes and Hypertension Association (St Lucia), National Republican EndocrinologyCentre (Tajikistan), Tanzanian Diabetes Association (Tanzania), Centre ATD dePrévention du Diabète (Togo), St Francis Hospital (Uganda), Endocrinological andDiabetes Association of Uzbekistan (Uzbekistan), and Hue Central Hospital (Vietnam).We also thank Jayanthi Maniam for assistance in submitting the manuscript.
文摘BACKGROUNDYoung people with type 1 diabetes in low-and-middle income countries facemany challenges in accessing care, with various essential supplies needed forsurvival and long-term health.AIMTo study insulin delivery devices and glycated haemoglobin (HbA1c) testing.METHODSA survey was conducted in 2019 of leading diabetes centres in 41 countriessupported by the Life for a Child Program. The survey covered numerous aspectsconcerning availability and costs at all levels of the health system, local usagepatterns and attitudes, obstacles, and other aspects.RESULTSThirty-seven countries returned the survey (90.2% response rate). Key findingsincluded: Syringe use was most common (83.1%), followed by insulin pens(16.7%) and pumps (0.2%). 48.6% of public health systems did not providesyringes, even with a co-payment. Use of suboptimal syringe/needlecombinations was common. Needles were generally reused in almost all countries(94.3%, n = 35). Aside from donated supplies, there was variable access to HbA1ctesting within public health facilities, and, when available, patients often had tocover the cost. Provision was further compromised by numerous problemsincluding stock-outs, and challenges with understanding the test, equipmentmaintenance, and refrigeration.CONCLUSIONLarge gaps exist for adequate access to appropriate insulin delivery devices andHbA1c testing. Public health systems in low-and-middle income countries shouldincrease affordable provision. There are also needs for specific health professional training and diabetes education;elimination of customs duties and taxes;development of inexpensive, robust HbA1c testing methods that do not requirerefrigeration of testing supplies;differential pricing schemes;and other solutions.
文摘目的:系统评估应用无针注射器与胰岛素笔注射胰岛素降糖的疗效和安全性。方法:按照纳入和排除标准,计算机检索无针注射器与胰岛素笔的前瞻性队列研究文献。对所纳入文献进行质量评价及提取资料后,采用Rev Man 5. 3软件进行Meta分析。结果:根据纳入排除标准共纳入8篇符合标准的文献,包括466例患者,8项研究NOS评分均大于8分。Meta分析的结果表明,在降低HbA1c水平方面无针注射器组优于胰岛素笔组[MD=-1.05,95%CI(-1.88,-0.22),P=0.01];在降低FBG、早餐后2 h BG和2 h PG方面,无针注射器组显著优于胰岛素笔组[MD=-1.37,95%CI(-1.82,-0.92),P <0.00001;MD=-1.14,95%CI(-1.49,-0.78),P <0.00001;MD=-2.26,95%CI(-3.04,-1.48),P <0.000 01]。在安全性方面,低血糖发生率、注射后疼痛和出血/瘀斑发生率,无针注射器组和胰岛素笔组比较差异无统计学意义[RR=0.30,95%CI(0.08,1.06),P=0.06;RR=0.33,95%CI(0.07,1.58),P=0.17;RR=0.39,95%CI(0.01,19.86),P=0.64],但注射后发生红肿硬结的发生率,无针注射器组少于胰岛素笔组[RR=0.26,95%CI(0.08,0.82),P=0.02]。结论:用无针注射器注射胰岛素可以提高疗效,减少红肿硬结的发生。
文摘目的探讨胰岛素无针注射器在糖尿病患者中的应用效果。方法选取我院收治的104例糖尿病的患者为研究对象,按照随机数表法将其分为对照组(52例,胰岛素有针注射器)与观察组(52例,胰岛素无针注射器)。比较两组患者的应用效果。结果应用后,两组的FBG、2 h PBG、HbA1c水平、HAMA及HAMD评分均降低,且观察组低于对照组(P<0.05)。观察组疼痛、残留药物发生率低于对照组,皮肤红肿或硬结发生率高于对照组(P<0.05)。应用后,两组生理功能、躯体疼痛、情感职能及精神健康评分均升高,且观察组高于对照组(P<0.05)。结论胰岛素无针注射器在糖尿病患者中的应用效果显著,可以降低患者的血糖水平、疼痛及残留药物情况,改善患者的焦虑抑郁情绪,提高患者的生活质量,值得推广与应用。
