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

Abstract

Background and objectives: Care for children and youth with diabetes varies markedly around the world. We developed a standardized, reproducible measure that can be used to document and compare critical factors influencing treatment outcomes.

Methods: A questionnaire consisting of 36 multiple-choice questions covering major components of care (such as insulin therapy, blood glucose monitoring, etc.) was sent to 75 countries: 43 under-resourced countries where the International Diabetes Federation's Life for a Child Program operates, and 32 others (mainly developed nations). Results for each country were scaled to a score with a range of 0-100.

Results: Responses were received from 71 countries. Scores varied widely and were highly correlated to per capita gross domestic product (R(2) = 0.72, P < 0.001) and health expenditure (R(2) = 0.77, P < 0.001). For the 37 low- and lower-middle income countries, only two had complete government provision of human insulin and none of blood glucose test strips. Marked differences according to income were also found for access to home refrigeration; usage of insulin pens, multiple daily injections, pumps, glucagon and ketone strips; hemoglobin A1c (HbA1c) testing; and complications screening.

Conclusions: 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.

Keywords: blood glucose monitoring; childhood diabetes; developing countries; index; insulin.