ECHO model for type 1 diabetes (T1D) in Latin America: An Ecuadorian experience during COVID-19

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Morbidity and mortality due to T1D in Ecuador is unacceptable. Underlying factors for this inconvenient truth include the lack of diabetes specialists, the lack of focus on diabetes management in medical education, and the lack of confidence among primary care providers (PCPs) in managing T1D. In this context, UTE collaborated with Stanford University to implement a Project ECHO® (Extension for Community Healthcare Outcomes) model for T1D in Ecuador. The goal was to empower PCPs in Ecuador to provide enhanced T1D care management in the primary care setting in the context of limited resources.


Using the ECHO hub-and-spoke model and Zoom platform, we recruited and trained 55 spokes from 8 different primary care centers affiliated with the largest Ecuadorian public health system, Instituto Ecuatoriano de Seguridad Social (IESS). Participation was free and included pediatricians, family doctors, internists, psychologists, nurses, social workers, nutritionists, and laboratory workers. UTE served as the coordinating hub site, and faculty consisted of adult and pediatric endocrinologists, diabetes educators, behavior health specialists, nutritionists, and community support representatives from diabetes associations.


The program launched in December 2019, and spoke attendance rates were 75% during the first trimester of 2020. Then, in March, attendance fell to 20% due to COVID-19, and the program went on hiatus. The program was resumed with increased attendance in June after pivoting to address diabetes concerns related to COVID-19.


This program marks the first implementation of an ECHO T1D program outside of the US. Our program is a proof-ofconcept for implementation of the model in both a middle-income and Latin American country. The model is a tool to reach medically vulnerable and underserved patients with T1D who would not otherwise have access to diabetes specialists.