Type 1 diabetes among

underserved youth in
the Dominican Republic
Nicolas Cuttriss, MD, MPH, FAAP
Pediatric Endocrinologist & Diabetes Specialist

Co-Founder & Chairman of the Board; AYUDA

Assistant Professor of Public Health Sciences
University of Miami Miller School of Medicine

Presenter Disclosures
Board Member: AYUDA

Background:
Dominican Republic
Population ~ 10Million
Upper-middle income country
~40% below national poverty rate
~2% below $1.25/day

Background: T1D in Youth

Santo Domingo, Dominican Republic
Promedia: Ministry of Health supported program via pediatric
hospital in Santo Domingo (Hospital Infantil Doctor Robert
Reid Cabral)
243 children with T1D (~2 to 6 visits per year)
Insulin: NPH/Regualr (90%) or Lantus/Regular (10%)
Blood glucose testing: meter + 3 BG strips per day
Limited/no support staff and education team

Pediatric hospital has unique

collaboration with Aprendiendo a
Vivir (AAV)

 Nonprofit diabetes
organization based
in Santo Domingo

Only Diabetes
Education Center in
DR

Year-round diabetes
education
programs& annual
diabetes camps

Youth Empowerment
Programs

National Education
Campaigns on
Diabetes and
Prevention

Campo Amigo
Dominicano

Background: T1D in Youth

Santo Domingo, Dominican Republic
AYUDA collaboration with AAV since 2008:
+100 volunteers trained/placed
+$1Million in volunteer & program services

Claudias story
Youth Leadership & Civic Engagement in the DR

HbA1c
12.9

HbA1c
6.5

Quantitative Data Support

Analysis of Programs

Objectives of Study
Investigate the level of T1D control
among underserved youth in the
DR to help in development of
strategies for delivering and
facilitating optimal diabetes
management to vulnerable youth in
a middle-income country in Latin
America.

Methodology
Analysis of youth at entry into a program that provides
comprehensive education and social support services

Youth with T1D in the DR were ascertained upon enrollment into

a diabetes educational program organized AAV

Criteria for inclusion

Age: 0.5 to 21 years old

Duration of T1D: >3months
First-time participation in AAV
Informed consent obtained

Criteria for exclusion

Renal failure
Attendance at another AAV education program

HbA1c values were determined using Siemens DCA Vantage

(upper limit of 14%) Donated by Life for a Child

Results
Characteristics of Youth with T1D
Enrollment: 28 (15 female)
Mean & median ages: 11.3 & 11.7 years-old
Mean & median duration of T1D: 3.5 & 1.8 yrs

Diabetes Management Routines:

Basal insulin only:
9 (32%)
Basal + bolus (NPH/R): 19 (68%)
2 shots per day:
12 (43%)
3 shots per day:
16 (57%)
*None using correction factors or carb ratios

Results
Characteristics by Age group
Age
(yrs)
<6
6 to <13

13 to <18

Mean HbA1c
(%)

8.9
(+/- 1.2)

13

12.1
(+/- 1.9)

5
(38.5%)

12.7
(+/- 1.6)

3
(42.6%)

> 18

All Ages

28

11.2
(+/- 1.3)
11.5
(+/- 2.1)

HbA1c
>14

0
8
(28.6%)

Median
HbA1c

Av. years
w/T1D

9.1

0.6
(+/- 0.5)

12.1

2.7
(+/- 2.4)

13.8

3.8
(+/- 2.5)

11.5
11.4

10.9
(+/ -8.2)
3.5
(+/- 4.1)

Results
HbA1c Ranges
HbA1c
Range

> 14

28.6%

12.0 - 13.9

14.3%

10.0 - 11.9

10

35.7%

8.6- 9.9
3
~90%
of baseline
youth10.7%
7.6- 8.5
2 T1D are7.1%
population
with
living
1
3.6%
with< 7.5
HbA1c values
>8.5%
No correlation between HbA1c level and duration of T1D, #
injections of insulin per day, or insulin regimen

Conclusion
Nearly all of the subjects in this study of underserved
youth had a HbA1c level above the target (< 7.5%)
recommended by ISPAD.

The shortcoming in diabetes care exists despite

access to insulin and blood glucose monitoring
supplies in government-supported facilities.

The observation indicates the need and also highlights

the potential value of supplemental ongoing diabetes
education to ensure optimal use of supplies.

Future studies will investigate the effectiveness of this

program in the improvement of their diabetes
management.

What are we trying to

prevent?

Death

Severe
hypoglycemia

Chronic
complications

DKA

What should we be trying to

enable in underserved diabetes
communities?
Life

Happiness

Productivity
The solution is more
complicated than insulin
(and access/affordability
to diabetes supplies)

Research Team & Support

JUNTOS SOMOS MAS FUERTES!
Together We Are Stronger!
Dr. Elbi Morla, Hospital
Infantil Doctor Robert Reid
Cabral, Pediatric
Endocrinology, Santo
Domingo, Dominican
Republic

Ikena Okoro, University of

Miami

Christopher Noble, AYUDA;

Boston University School of
Public Health

Aprendiendo a Vivir Team

AYUDA Team
Dr. Gary Berkovitz and
Pediatric Endocrinology
Team at University of
Miami Miller School of
Medicine

Thank you.
Together we can make a difference.
Nicolas Cuttriss, MD, MPH, FAAP
Co-Founder; Chairman of the Board
ncuttriss@ayudainc.net
www.ayudainc.net

Complexity of diabetes
requires a
comprehensive approach
but a comprehensive approach that is
also locally appropriate

Effect of Diabetes Camp & Year-Round Support on Hi-Risk Youth

Ecuador Example: Ecuadorian Campers with HbA1c >10 who attended camp
for 3 consecutive years (n=15)
14,5
13,5

HA1c Level

12,5
11,5
10,5
9,5
8,5
7,5 Every 1% point drop in A1C =
Reminder:
40% risk
6,5 reduction of microvascular complications

First test

Last test

Ervin P, Cuttris N, Welch L, Pasquel M. An analysis of data on Ecuadorian children with type 1 diabetes in a
camp setting. Diabetic Medicine. 2006, Dec; 23(s4):474.