Access to insulin delivery devices and glycated haemoglobin in lower-income countries

ARTICLE HIGHLIGHTS

Research background

People with type 1 diabetes, especially those that are young, require tools beyond insulin to help them improve their glycaemic control and avoid acute and long-term complications. These include insulin delivery devices and glycated haemoglobin (HbA1c) testing. Presently, many low-and-middle income countries (LMICs) have difficulty in providing adequate access to these two supplies. Therefore, this study investigates these barriers and provides recommendations for overcoming them. This is essential to helping health systems in LMICs make progress towards providing appropriate type 1 diabetes care to all in need.

Research motivation

With regards to insulin delivery devices and HbA1c testing, study authors sought to investigate the range of access challenges for patients, health care providers, and health systems. Authors further endeavoured to understand the specific challenges associated with provision, costs, availability, usage details, and perceived hardships.

Research objectives

As no existing studies have comprehensively looked into access of solely non-insulin supplies, study objectives were to do this for non-insulin essential devices within LMICs. This study was able to fulfil and apply this objective to 37 countries. By accomplishing this, future recommendations can be provided to help countries improve access to these supplies.

Research methods

A survey was completed by senior leads of diabetes centres supported by the Life for a Child Program. These included 37 LMICs within Africa, the Americas, Asia, Caucasus/Central Asia, and Western Pacific. Respondents ranged from national diabetes association chiefs, diabetes nongovernmental organisations, government hospitals, senior endocrinologists, Ministry of Health officials, and a mission hospital. Survey questions covered provision, cost, and availability of HbA1c testing and insulin injection devices.

Research results

For insulin injection devices, results demonstrated that roughly half of the surveyed health systems provided syringes for insulin use. Further, a number of respondents noted that their patients used syringes with suboptimal practice surrounding reuse, site rotation, and disposal. For HbA1c testing, provision across the surveyed countries was more wide-ranging. Testing was not always available even in the countries where it was provided within public health settings. In these instances, patients could only access tests at private pharmacies, where they received no financial assistance. A number of respondents noted that, as health care providers, they faced many challenges in providing testing to patients including maintaining supply stock, maintenance, and health professional education.

Research conclusions

This novel study shows that access to appropriate insulin delivery devices and HbA1c testing in LMICs is largely inadequate. For insulin delivery devices, poor access was largely due to lack of provision in health systems, stigma associated with syringes, cost, and inappropriate needle lengths, sizes, and gauges. For HbA1c testing, poor access for patients mainly stemmed from lack of availability and high purchase costs, and the taxes and tariffs levied of testing equipment within health systems. Sustaining maintenance and supply stock were further challenges. Research findings could serve as material to help patients, health care professionals, and civil society organisations advocate for increased provision of non-insulin essential diabetes supplies.

Research perspectives

When people with diabetes cannot access insulin delivery devices, challenges arise associated with needle reuse, infection, and disposal. Further, inadequate access to HbA1c testing is problematic for people with diabetes, and also challenging for their health care providers, as the information derived can help to promote effective self-management and mitigate the risk of developing complications. Learning from the findings of this study, the authors encourage health systems to focus on provision of affordable and appropriate needle gauges, lengths and sizes, and accurate information on needle reuse and disposal. For HbA1c testing, it is essential that available and affordable testing be available within health systems, whereby health professionals and patients are appropriately education on usage. Preferential pricing arrangements, and reduction or elimination of taxes and tariffs are also ways to help improve access to these two supplies. Increased access means that health care providers can provide the resources necessary to enable patients to effectively lead their Type 1 diabetes self-management and mitigate risks of developing complications.