title: The evolution of diabetes care in the rural, resource-constrained setting of western Kenya.
abstract: BACKGROUND
  The initial focused effort on addressing the HIV pandemic in sub-Saharan Africa has helped set the groundwork for addressing many of the other areas of the health-care system requiring support in resource-constrained settings. With the growing prevalence of diabetes in this setting, the US Agency for International Development-Academic Model Providing Access to Healthcare Partnership (USAID-AMPATH) has begun developing infrastructure to meet the growing need for diabetes care.
  
  
  OBJECTIVE
  To describe the evolution of diabetes care in the rural, resource-constrained setting of western Kenya and to analyze preliminary data on the current status of glucose control of patients.
  
  
  METHODS
  Through partnerships, USAID-AMPATH has facilitated the provision of basic modalities of diabetes care, including reliable stocks of insulin, hemoglobin A(1c) (A1C) testing, and point-of-care glucose-testing supplies.
  
  
  RESULTS
  Through the introduction of A1C testing, the poor quality of diabetes care was revealed, as the average A1C for the clinic population was 10.4%, with insulin-dependent patients constituting the majority of individuals with markedly elevated A1C levels. To address this, a contextualized electronic medical record and a cell phone-based home glucose monitoring program were created to improve glycemic control, which has led to significant reductions in A1C levels.
  
  
  CONCLUSIONS
  Through the inclusion of clinical data within the electronic medical record, there is an ongoing effort to research various aspects of diabetes care in this understudied population, with the goal of addressing many of the unanswered questions surrounding diabetes care in sub-Saharan Africa. The lessons learned from this pilot program will be used to create sustainable infrastructure for diabetes care in partnership with the Kenyan government and will serve as a model for similar programs.
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, IN, USA. spastaki@purdue.edu
authors.forename: Sonak D
authors.initials: SD
authors.lastname: Pastakia
authors.forename: Rakhi
authors.initials: R
authors.lastname: Karwa
authors.forename: Charles B
authors.initials: CB
authors.lastname: Kahn
authors.forename: Jak S
authors.initials: JS
authors.lastname: Nyabundi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring / Q000379:methods; D040421:Cell Phone; D002648:Child; D002675:Child, Preschool; D003920:Diabetes Mellitus / Q000503:physiopathology / Q000628:therapy*; D057286:Electronic Health Records / Q000458:organization & administration*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000600:supply & distribution / Q000627:therapeutic use; D007328:Insulin / Q000600:supply & distribution / Q000627:therapeutic use; D007391:International Cooperation; D007630:Kenya; D008875:Middle Aged; D010865:Pilot Projects; D019095:Point-of-Care Systems; D011787:Quality of Health Care; D019035:Rural Health Services / Q000458:organization & administration*; D014481:United States; D054702:United States Agency for International Development; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin