Integrated care for type 1 diabetes: The West Bengal model: 24-month follow-up

This study aimed to document outcomes of care for individuals with type 1 diabetes (T1D) facilitated by a government-funded model supporting establishment of clinics within secondary-level district hospitals in a lower-middle-income country.

This prospective, multicentre, single-arm pre-post implementation evaluation study was conducted in government-funded 'model' clinics in district hospitals in West Bengal, India. All consecutive persons with physician-diagnosed T1D (N = 366) were enrolled and immediately transitioned to basal-bolus insulin regimen, with structured monthly follow-up visits. Clinical measures, psychological well-being and diabetes-related expenditures were assessed at baseline, 12 months and 24 months.

At baseline, median age and age at diagnosis were 15 (10-21) and 8 (5-11) years, respectively, with 41.4% from lower socio-economic class, and most parents/caregivers had not completed primary education. There were no dropouts, with a mean of 23.5 follow-up visits over 24 months. Median glycated haemoglobin (HbA1c) fell from 79 mmol/mol (64-104) [9.4% (8.0-11.7)] at baseline to 72 mmol/mol (58-87) [8.7% (7.5-10.1)] at 12 months, which further fell to 64 mmol/mol (54-73) [8.0% (7.1-8.8)] at 24 months (p < 0.0001). No episodes of documented diabetic ketoacidosis, hospital admissions or deaths occurred. Psychological well-being improved. Median monthly expenditures dropped from 2600 INR (~30 USD) at baseline to 200 INR (~2 USD) at 24 months (p < 0.0001).

This novel public health system-supported model of T1D improved clinical parameters and psychological well-being of those living with T1D and their parents/caregivers and reduced expenditures.