IDF21-0380 An integrated diabetes ecosystem to address patient barriers in low-income communities in Philippines

Abstract

Background: Diabetes in the Philippines is considered as a major public health concern. Diabetes care in the Philippines has challenges with respect to access to healthcare resources and government insurance coverage, With the national insurance system not covering comprehensive care and the private insurance companies only offer limited diabetes coverage. Patients mainly rely on the out-of-pocket system of healthcare for outpatient services such as lab procedures and medications. The high cost serves as a disincentive and contributes to low adherence and suboptimal care. Consequently, poor access to glycaemic monitoring and adherence to treatment impairs prevention of complications There is a need to improve diabetes care and its access in the Philippines to reduce overall clinical and economic burden. Aim: To evaluate an integrated diabetes care program addressing the healthcare awareness needs, screening, and accessibility of low cost medications to people living with Type 2 Diabetes (T2DM) and to also reinforce medical training to HCPs, to bring better outcomes in Diabetes care. Method: A stratified multistage sampling design was adopted where stratification was done on the geographical distribution and population size to provide a sample of individuals representing the Philippine population. A community inclusive approach was taken to understand patient barriers and develop services to address those challenges. All field workers (FW) underwent training before commencing field work. Field activities began with mapping procedures, spreading awareness, collection of data points like BMI, administering questionnaires, collecting Fasting Plasma Glucose (FPG) values, referring to health care providers, supplying of low-cost medications, etc. The program involved multi-organizational approach to provide comprehensive care, including diagnostics and monitoring devices (glucometers, strips). The program also provided insulins at 10 cents per day promise to patients ($2.5/vial) vs significantly higher market prices. With a door-to-door delivery method, patients could save long commutes to pharmacies and hospitals. Results: A total of 14,275 community residents were approached by FW to spread awareness about diabetes. One thousand nine hundred and forty-two people were screened using the risk assessment questionnaire and advised for FPG tests. Out of 1,942 people who took FPG test, 1,040 (56%) had FBG ≤99 mg/dl, 500 (26%) had FBG between 100 –125 mg/dl (prediabetes) and 352 (18%) had FBG ≥126 mg/dl. Among the 352 patients with diabetes, 22 (6.2%) patients had an HbA1c value of ≥ 9%. Based on the recommendations, HCPs prescribed insulin to 42 patients, of which, only 12 patients adhered to treatment with the low priced insulin. The treating HCPs also underwent a comprehensive medical educational module on diabetes where the impact of program was measured with pre and post-test questionnaire. The knowledge scores of pre & post training was recorded among HCPs (22.5/24 vs. 20/24) and nurses (18.3/24 vs. 15.7/24). The follow up of the12 patients on insulin is under progress and the outcome data will be updated on completion of 6 months. Discussion: This effort provides comprehensive data to understand how an evolving diabetes ecosystem involving awareness, screening, diagnosis, and affordable treatment (insulin) supplemented with medical education empowering HCPs can lead to better health outcomes among patients with T2DM.