Characteristics of PwT1DM and Caregivers.

Type 1 Diabetes mellitus (T1DM) affects a substantial population in India, with significant challenges related to healthcare access and financial burden. This study aims to explore the multi-level barriers and enablers of T1DM care in Karnataka state, providing evidence-based recommendations for policymakers to improve healthcare services. This qualitative study employed in-depth interviews (IDIs) and focus group discussion (FGDs) with multiple stakeholders, including ten People with Type-1 Diabetes Mellitus (PwT1DM) aged 5–23 years and their caregivers, 13 Healthcare providers (HCPs) -Endocrinologists, paediatricians, diabetes educators, and primary care physicians; and ten senior health officials and six Policymakers. Participants were selected using purposive sampling from both urban and rural settings across Karnataka. Data was collected over six months, and qualitative research software was used to analyse the transcribed data thematically. The study was approved by the Institutional Ethical Committee of M.S. Ramaiah Medical College. Significant obstacles include inadequate integration of policies within India’s national framework, erratic insulin availability, substantial out-of-pocket costs, and insufficient training for healthcare providers. Rural demographics face compounded disadvantages due to poor healthcare infrastructure, while caregivers, especially mothers, struggle with financial and emotional burdens; People with TIDM endure social stigma and mental health issues, particularly affecting females. The study highlights the critical need for formulating dedicated T1DM policies within the framework of the existing Non-Communicable Disease program. Implementation of subsidized insulin schemes and expansion of primary care services, along with a multi-sectoral strategy, encompassing enhanced training for HCPs, integration of digital health solutions, and development of community-based support systems, is essential for effective and sustainable T1DM management. Addressing financial and gender-based disparities is crucial to ensure equitable care in both urban and rural areas.1型糖尿病（Type 1 Diabetes mellitus, T1DM）在印度影响了大量人群，且在医疗可及性与经济负担方面存在诸多严峻挑战。本研究旨在探究卡纳塔克邦内1型糖尿病诊疗的多维度障碍与促进因素，为政策制定者优化医疗服务提供循证建议。本项定性研究采用深度访谈（in-depth interviews, IDIs）与焦点小组讨论（focus group discussion, FGDs）的方法，对接纳研究的多方参与者展开调研，其中包括10名年龄在5至23岁之间的1型糖尿病患者（People with Type-1 Diabetes Mellitus, PwT1DM）及其照护者、13名医疗服务提供者（Healthcare providers, HCPs）——涵盖内分泌科医师、儿科医师、糖尿病教育者与全科医师；另有10名高级卫生官员及6名政策制定者。研究对象通过目的性抽样法从卡纳塔克邦的城乡地区招募。数据收集工作历时六个月，并采用质性研究软件对转录后的文本开展主题分析。本研究已获得M.S.拉迈亚医学院（M.S. Ramaiah Medical College）机构伦理委员会的批准。主要障碍包括印度国家框架内的政策整合不足、胰岛素供应不稳定、高额的自付费用，以及医疗服务提供者培训不足。农村地区人群因医疗基础设施薄弱而面临更严重的劣势；照护者（尤其是母亲）则承受着经济与精神双重负担；1型糖尿病患者需忍受社会污名，并面临心理健康问题，女性患者受影响尤为显著。本研究强调，需在现有非传染性疾病防控项目框架内制定专门的1型糖尿病相关政策。实施胰岛素补贴计划、拓展基层医疗服务，同时采用多部门协同策略——包括加强医疗服务提供者培训、整合数字化医疗解决方案，以及构建社区支持体系——对于实现1型糖尿病的有效且可持续管理至关重要。解决经济与性别层面的不平等问题，是保障城乡地区医疗服务公平可及的关键所在。