Early Implementation Insights from a Community-Integrated Care Model to Strengthen Type 1 Diabetes Management in Rural Gujarat

Background Type 1 diabetes (T1D) affects over 280,000 children in India, with their average life expectancy being only 29 years compared to 65 years in high-income countries. This is due to gaps in insulin availability, structured education, and systematic follow-up in the national public health system. Though there is an existing NPCDCS for diabetes control, its reach is exclusively for adults. In response, a comprehensive, integrated model for community-based T1D care was developed and piloted within the existing primary health care system in the Sabarkantha district, Gujarat. Objective This model initiative aims to strengthen the management of children/adolescents aged 0–19 years living with T1D. Methods The proposed model was developed & piloted in Sabarkantha district, from January 2024 onwards, leveraging existing primary healthcare infrastructure. It consists of various components, including capacity building of healthcare providers & community, food diary-based dietary monitoring, multi-tiered documentation, role clarification across healthcare cadres, financial support mechanisms, and quarterly specialist consultations. Results Within eight months, the initiative showed measurable improvements. 54% of the participants showed improvement in glycaemic control, 26.6% reduced insulin requirements, and 35% gained weight among those classified as underweight. Additionally, diabetic ketoacidosis-related hospitalisations were reduced by 66%. In terms of healthcare utilization, 48% shifted toward public facilities. Health system indicators documented establishment of a comprehensive district registry with 124 children/adolescents with T1D, standardization of care protocols, enhanced healthcare provider competency in pediatric insulin management, and improved family self-care practices. Financial support mechanisms provided expert consultations, & 44% of beneficiaries managed their insulin from various available funds. Conclusion This proposed Model demonstrates that comprehensive pediatric T1D care is achievable within resource- constrained settings through strategic optimisation of existing resources integration & offers a replicable blueprint for managing T1D conditions in rural and tribal settings.