Type 1 Diabetes Management Among Tribes: How Virtual Group Appointments Approach May Be Beneficial

We have read the article “Virtual Group Appointments reduce distress and improve management in young adults with type 1 diabetes” ¹ with great interest. India is considered as the Diabetic capital of the world. In Southeast Asia, India accounts for most of the children with type 1 diabetes mellitus (DM) than any other country. The challenging part is that approximately 90% of all health care center visits in India are made by people living in rural area, and most of them may have to travel 100 km to reach the nearest health facility.^2,3

Adding up the approach adopted by Bisno et al ¹ that whether a country like India will implement this Virtual Group Appointments (VGA) approach where rural and tribal population live far-flung to main health care facilities and the doctor-population ratio is also very poor (in comparison with the World Health Organization minimum threshold of 22.8 per 10 000 population), ⁴ it will be fruitful to type 1 DM patients, their parents, and the health system.

As tribal population does not have easy access to technologies, the possible solution could be allotting primary health care workers (Accredited Social Health Activist, Auxiliary Nurse and Midwives) of the particular area with appropriate devices and creating a group of patients with diabetes in person and then make them access the VGA with health care workers’ devices (as shown in Figure 1). By this, tribal patients with diabetes would be benefited, as there are high chances of them being technologically challenged. The assigned heath worker should also be trained first for processing of virtual groups. Telemedicine may be given to parents and children to improve their diabetes control and reduce its complications. ⁵

Figure 1.

Virtual Group Appointments approach in the tribal area: (a) A group of health care professionals who are endocrinologists should be appointed in tertiary care health centers. (b)–(d) Primary health care professionals in tribal areas should be trained by video conferencing. (e) Children and young adults will be assessed through Virtual Group Appointments. (f) and (g) After the appointments, the tribal population will be able to manage diabetes, which will lead to improved quality of life, both physically and mentally.

There should also be a special VGA for parents of children with diabetes, as they play an important role in the management of the disease and proper care of children. Parents should also be trained to find out the sign and symptoms of hypoglycemic episodes and diabetic ketoacidosis in their own language, as some studies have shown sharing of clinicopathological data may helpful in early diagnosis. ⁴ Proper benefits of the treatment should also be explained to them as the tribal population is usually influenced by their own traditional remedies. In addition, parents and guardians should be trained for injecting insulin before every meal to their children as it is impossible for health workers to inject insulin before each and every meal for each patient with diabetes. Simultaneously, virtual therapy session should also be organized, as children who have diabetes sometimes face depression and anxiety. These therapy sessions should ensure to counsel them and make them believe that they are not alone in facing the disease.

Finally, we can say that real-time VGA approach will definitely improve quality of life (both physical and mental) of children/people having type 1 DM in India; however, it is of utmost benefit if delivered in local languages and especially to women in rural and tribal areas.