Published online Aug 15, 2020. doi: 10.4239/wjd.v11.i8.358
Peer-review started: February 3, 2020
First decision: March 5, 2020
Revised: June 3, 2020
Accepted: July 1, 2020
Article in press: July 1, 2020
Published online: August 15, 2020
Processing time: 192 Days and 14.2 Hours
Young people with type 1 diabetes in low-and-middle income countries face many challenges in accessing care, with various essential supplies needed for survival and long-term health.
To study insulin delivery devices and glycated haemoglobin (HbA1c) testing.
A survey was conducted in 2019 of leading diabetes centres in 41 countries supported by the Life for a Child Program. The survey covered numerous aspects concerning availability and costs at all levels of the health system, local usage patterns and attitudes, obstacles, and other aspects.
Thirty-seven countries returned the survey (90.2% response rate). Key findings included: Syringe use was most common (83.1%), followed by insulin pens (16.7%) and pumps (0.2%). 48.6% of public health systems did not provide syringes, even with a co-payment. Use of suboptimal syringe/needle combinations was common. Needles were generally reused in almost all countries (94.3%, n = 35). Aside from donated supplies, there was variable access to HbA1c testing within public health facilities, and, when available, patients often had to cover the cost. Provision was further compromised by numerous problems including stock-outs, and challenges with understanding the test, equipment maintenance, and refrigeration.
Large gaps exist for adequate access to appropriate insulin delivery devices and HbA1c testing. Public health systems in low-and-middle income countries should increase affordable provision. There are also needs for specific health professional training and diabetes education; elimination of customs duties and taxes; development of inexpensive, robust HbA1c testing methods that do not require refrigeration of testing supplies; differential pricing schemes; and other solutions.
Core tip: This study reviews access to insulin delivery devices and glycated haemoglobin testing supplies in 37 less-resourced countries. Although these two essential non-insulin supplies are required to effectively manage Type 1 diabetes, the study’s results demonstrate that their access is largely insufficient within the health systems of the countries surveyed. Specific access barriers are summarised and recommendations to overcome these are advocated for by the authors.