Dynamics, Impact, and Feasibility of Self-Monitoring of Blood Glucose in the Rural, Resource-Constrained Setting of Western Kenya

Abstract

There has been considerable concern regarding the rapidly growing prevalence of diabetes, particularly in resource-rich settings as a result of the shift toward more sedentary lifestyles that occurs with calorie-rich diets (1). Although much of the global attention to diabetes has focused on resource-rich settings and emerging markets, the diabetes epidemic has also been expanding in resource-constrained settings such as sub-Saharan Africa (2). Estimates from the International Diabetes Federation suggest that the prevalence of diabetes is expected to increase by 98% in sub-Saharan Africa by 2030, in contrast to an expected 54% increase in the rest of the world (3). Furthermore, there is an alarmingly high mortality rate attributable to diabetes in sub-Saharan Africa compared with all other parts of the world, with 76.4% of diabetes-related deaths occurring in people <60 years of age (4). Despite these disturbing trends, there has been little effort to address this growing burden. Currently, most funding for international health care development focuses on communicable diseases, especially HIV and tuberculosis (5). However, the infrastructure that has been established to manage chronic infectious diseases such as HIV can be adapted to address many other chronic diseases, including diabetes (6–8). The Academic Model Providing Access to Healthcare (AMPATH) disease management program based in western Kenya has provided comprehensive HIV care for >140,000 HIV-infected patients throughout a catchment area of >3.5 million people. AMPATH is a partnership between Moi Teaching and Referral Hospital (MTRH) and Moi University College of Health Sciences in Eldoret, Kenya, and a consortium of North American universities led by Indiana University (Indianapolis, Ind.). Its goal is to deliver comprehensive health care at all levels of the health care system, in partnership with the Kenyan government (9,10). AMPATH’s chronic disease management (CDM) program was formed to address the growing …