August 10, 2020
Managing type 1 diabetes during COVID-19 in India
Ahmedabad has been the worst district affected by COVID-19 in the state of Gujarat.
By Banshi Saboo, Mahira Saiyed, Maitry Pancholi
Type 1 diabetes is an autoimmune condition that results in the destruction of beta cells in the pancreas. The condition largely affects children and adolescents but is also commonly diagnosed in other age groups. Dia care is a comprehensive diabetes clinic located at the heart of Ahmedabad, with facilities for diagnosis, treatment and prevention of diabetes, and its complications. The clinic is responsible for the care of approximately 1800 children living with type 1 diabetes, from different economic backgrounds, providing insulin and all the essential medication they require. The children we support are from different regions in Gujarat, including urban and remote rural areas.
The COVID-19 pandemic has caused unforeseen changes in our lives. Lockdown was imposed abruptly in Ahmedabad, the worst district affected in Gujarat. The decision was a necessity but it did not allow people with diabetes enough time to secure the essential medication and supplies they needed, posing challenges to individuals with diabetes, their families and their care teams.
As a center supported by the Changing Diabetes In Children and Life for a Child programmes, we are able to provide free insulin, syringes and testing strips to children living below the poverty line. Follow-up visits are normally scheduled every two to three months. Having looked after some of the children and young adults in our care for many years, we share a special bond with each of them.
Our clinic looks after approximately 1800 children living with type 1 diabetes from different economic backgrounds.
The pandemic has made it more difficult for us to manage the children we support, affordability and accessibility being the biggest issues. With the lockdown in place, it was important for us to stay connected with the maximum number of children to help build their knowledge on managing their diabetes. Our home-based staff reached out to all the children by phone, checking on their blood glucose levels, the COVID-19 situation in their area, advising on how to adjust medication and treatment and making themselves available when needed. We also used our Whatsapp groups for adults and teens with type 1 diabetes to post regular updates on COVID-19 and information on the precautionary measures to follow to reduce the risk of infection in this high-risk group. We organized an educational webinar which was very well attended. Pharmaceutical companies supported our efforts by making it possible for insulin to be delivered to the children’s homes.
Since the start of the lockdown in March, we have diagnosed three new cases of type 1 diabetes, all in young women under the age of 18. Diagnosing diabetes during the pandemic brought several challenges. The first was treating diabetic ketoacidosis through telemedicine. Our goal was to treat dehydration, flush ketones and initiate insulin as soon as possible to control hyperglycemia. The first two goals were met within 48 hours of treatment but starting the children on insulin was the most challenging. A doctor, diabetes educator and dietician reached out to the children and their families to provide education on the basics of type 1 diabetes. Appointments lasting almost one hour with each professional were scheduled on different days. We tried to teach insulin techniques and the use of blood glucose meters through video calls. In order to offer support and promote confidence, we connected the families of children with type 1 diabetes living in the same region. This allowed one adult with type 1 diabetes to become a peer educator and act as an inspiration to the others.
We contacted each child regularly over a week to get blood glucose under control. Once this was achieved, we scheduled a call to discuss complications and their prevention and address myths and misconceptions about the condition.
When dealing with a lifelong condition by phone, it is important to build a good relationship and trust between the diabetes team and the family.
A multidisciplinary team approach is a good way to successfully provide comprehensive diabetes care. When dealing with a lifelong condition by phone, it is important to build a good relationship and trust between the diabetes team and the family. Due to the complexity and unpredictable nature of the condition, structured and continuous education is the only tool to improve quality of life for children with type 1 diabetes.
For the families of the newly diagnosed child, the COVID-19 pandemic has made a difficult experience even more challenging. However, advances in technology and telemedicine for diabetes care have proved very effective. Our use of telemedicine proved both time and cost-saving and resulted in high appointment adherence with minimum difficulties. The approach was well-received by people living with diabetes and their families. Based on our experience, we believe that, in the aftermath of COVID-19, telemedicine will be a promising solution for those seeking an alternative but effective way to deliver diabetes care for people living with type 1 diabetes.
Dr. Banshi Saboo, Dr. Mahira Saiyed and Ms Maitry Pancholi work at the Dia Care Advanced Diabetes Care Center in Ahmedabad, India.