Improving glycaemic control in African diabetic patients on insulin: a resource-free approach.

In the resource-poor areas of the tropics, diabetic patients requiring insulin are often treated with once-daily injections of intermediate-acting insulin. Glycaemic control on this regime is usually poor. We trialled a simple change to twice-daily insulin (same total daily dose, two-thirds given in morning, and one-third in evening) in a group of 20 Ethiopian diabetic patients treated in this way. Nurse support and contact, and self-glucose monitoring were not available. After three months, the haemoglobin Alc (HbAlc) had improved from 10.5 +/- 1.8 to 8.0 +/- 1.5% (P < 0.001). No improvement occurred in the 20 control patients who remained on once-daily insulin. Among the twice-daily insulin group there was a small increase in weight and mild hypoglycaemic episodes. However, all patients were very satisfied and wished to continue the new system. We conclude that a simple change from once- to twice-daily insulin, without monitoring or support, can lead to a significant improvement in the overall glycaemic control, and is suitable for resource-limited tropical countries.

An accurate and portable system for glycated haemoglobin measurement in the tropics.

Measurement of glycated haemoglobin (HbA1c) is vital to provide meaningful diabetic care, but the assay is difficult and expensive, making its availability limited in resource-poor countries. We have field-tested a novel near-patient HbA1c meter (Glycosal; Provalis Diagnostics Ltd, UK) in northern Ethiopia. The machine was easy to use and gave results which correlated well (r = -0.96) with standard laboratory methods. The meter also performed well and retained accuracy at high ambient temperature (34.0 degrees C). Though still relatively expensive (pound 4 per test), this meter does give the opportunity for practical and appropriate HbA1c testing in tropical climes, and should be considered for at least intermittent use in diabetic patients.