Search

ACCEDE logo

ACCEDE operational research study

Background

Diabetes mellitus (diabetes) is a widespread chronic condition that represents a major public health and clinical concern globally. Recent data shows that approximately 537 million adults (aged 20-79) are living with diabetes worldwide and this number is projected to rise, driven by factors such as aging populations, urbanization, and lifestyle changes. Efforts in prevention, early detection, and management are critical in addressing this growing public health challenge.

Self-monitoring of blood glucose (SMBG) is a critical part of the care of individuals with diabetes. SMBG entails capillary fingerstick blood glucose testing multiple times per day. Many people with diabetes find this testing painful and cumbersome, often resulting in poor compliance to a glucose self-monitoring schedule. Furthermore, SMBG only provides limited visibility on daily and nightly glucose profiles, meaning that hypo- and hyperglycaemic episodes can be missed or detected with delay.

This study is essential in evaluating various continuous glucose monitoring use cases in low-resource settings. Our goal is to generate critical data to improve diabetes care and outcomes for individuals with type 1 diabetes in South Africa, Kenya and beyond”

Dr Beatrice Vetter

FIND, Director, NCD Programme

The use of minimally invasive continuous glucose monitoring devices (CGMs) in diabetes management circumvents these challenges as CGMs measure glucose every few minutes over a period of 1-2 weeks or 3 months depending on the model, through a sensor with a fine needle that is inserted once into a user’s arm or abdomen. This enables periodic glucose measurement without repeat finger pricks and provides the user with a detailed glucose profile over the entire wear time of the sensor, thus enabling better adjustment of therapy or behaviour.

In populations where CGMs are accessible to people with diabetes as standard of care and without additional cost, many people with type 1 diabetes have switched from SMBG via fingerstick to the use of CGMs permanently, using the devices continuously. This is rarely possible for people with type 1 diabetes in the public sector in LMICs as CGMs are not provided as standard of care. Little data on the effectiveness, feasibility, acceptability, and cost of the use of CGMs in LMIC populations is available to inform clinical models for integrating CGMs into diabetes management. Furthermore, it has not been investigated if intermittent, as opposed to continuous use of CGMs provides clinical benefit. Intermittent CGM use could be beneficial for people with diabetes who do not have the means to pay for continuous use of CGMs.

This trial aims to evaluate the effectiveness, feasibility, acceptability, and cost of intermittent and continuous use of CGM among people with type 1 diabetes in Kenya and South Africa.

Study timeline: South Africa September 2023 until August 2025
Kenya to be confirmed.

Objectives

The ACCEDE Operational Research study will assess the impact of continuous and intermittent CGM use on blood glucose levels in comparison to the standard of care in people living with type 1 diabetes.

In addition, we will assess the impact of continuous and intermittent CGM use on the variability of blood glucose concentrations related to diabetes, unplanned visits to outpatient clinics and/or hospital related to diabetes complications, quality of life of recipients of diabetes care and their caregivers (where applicable) as well as the acceptability, feasibility and cost of continuous and intermittent CGM use.

Outcomes

This study aims to address the substantial evidence gap on the impact of CGM device use on clinical and health economic outcomes in LMICs, specifically in South Africa and Kenya. The study results will provide evidence to inform policy, treatment and funding decisions in these countries.

Partners & Collaborators

 

South Africa

Steve Biko Academic Hospital, University of Pretoria
Prof. Paul Rheeder,
Principal Investigator
Dr Maria Karsas,
Co-Principal Investigator
Dr Tanja Kemp,
Investigator
Dr Johane Freitas,
Investigator
Ms Razana Allie,
Diabetes Specialist Nurse
Ms Cleon Lekabe,
Research Assistant
Ms Mary-Jane van Zyl,
Research Assistant
Groote Schuur Hospital – Diabetes Centre, University of Cape Town
Prof. Joel Dave
Principal
Investigator
Prof. Ian Ross
Co-Investigator
Dr William Toet
Co-Investigator
Dr Sophie Davies- Van Es
Co-Investigator
Dr Melanie Moyo
Study Physician
Dr Maleeka Abrahams-Kahaar
Co-Investigator
Dr Hanadi Alganeeb
Co-Investigator
Ms Buyelwa Majikela-Dlangamandla
Diabetes Nurse Educator
Mr Neil Meiring
Diabetes Nurse Educator
Ms Tyamkazi Nqekeza
Diabetes Nurse Educator
Ms Lisa van Wyk
Research Assistant
Red Cross War Memorial Children’s Hospital, University of Cape Town
Dr Michelle Carrihill
Principal Investigator
Dr Wayne S. Rajah
Medical Doctor
Dr Amith Ramcharan
Medical Doctor
Dr Deepika Goolab
Medical Doctor
Sr Laura Symmonds
Diabetes Nurse Educator
Sr Lindi Gqamana
Diabetes Nurse Educator
Sr Santie Horn
Diabetes Nurse Educator
Dr Lindsay Rajah
Research Coordinator

FIND

FIND ACCEDE Team

Dr Lorrein Muhwava
Scientist, NCD Programme
Dr Yvonne Kamau
Scientist, NCD Programme
Dr Elena Marban
Scientist
Dr Juvenal Nkeramahame
Clinical Trials Manager
Dorcas Akach
Clinical Data Manager
Sonjelle Shilton
Deputy Director,
Operational & Implementation Research
Dr Beatrice Vetter
Director, NCD Programme
Cathy Haldane
Senior Scientist, NCD Programme
Vincent Fiechter
Vincent Fiechter
Senior Project Manager

People living with type 1 diabetes in lower- and middle-income countries deserve access to the same quality care as those in high-income countries. By making continuous glucose monitoring devices accessible in Kenya and South Africa, the ACCEDE project is paving the way to deliver the highest standard of care to everyone.

Gina Agiostratidou

T1D Program Director at the Helmsley Charitable Trust

Contact the ACCEDE team

Do you have any queries? Please send us an email with the word "ACCEDE" in the subject of your email

Funding

This research is funded through a grant from The Leona M. and Harry B. Helmsley Charitable Trust.