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

Table 1 Syringe provision and costs

Setting	% of settings where syringes are free of charge	Mean (range), range, costs of a syringe to the patient (for systems not providing for free)
Public health system	47.4	$0.27, $0.04 (Uzbekistan)-$0.97 (Tajikistan)
Private retail pharmacy	0.0	$0.29, $0.07 (Eritrea)-$1.25 (Bolivia)
Public health insurance program	50.0	$0.19, $0.10 (Burundi)-$0.28 (Nigeria)

Table 2 Syringe volume and needle length and gauge

Syringe volume (n = 37)
	1 mL/cc	0.5 mL/cc		0.3 mL/cc
Percentage	42.9 (n = 15)	34.3 (n = 12)		22.9 (n = 8)
Needle length (n = 33)
	5/16” (8 mm)		3/16” (5 mm)	1/8” (4 mm)
Percentage	36.4 (n = 12)		48.5 (n = 16)	15.2 (n = 5)
Needle gauge (n = 32)
	28		29	30	31
Percentage	43.8 (n = 14)		15.6 (n = 5)	15.6 (n = 5)	25.0 (n = 8)

Table 3 Injection sites encouraged by diabetes centres

Injection sites	Number (%) of centres
Thighs	36 (97.2)
Stomach	35 (94.5)
Back of arm	21 (56.7)
Buttocks	19 (51.3)
Front of arm	12 (32.4)
Other	1 (2.7)

Table 4 Ages recommended to begin self-administration of insulin injection

Age (yr)	Number (%) of centres
≤ 5	3 (10.0)
6	4 (13.3)
7	2 (6.7)
8	6 (20.0)
9	2 (6.7)
10	9 (30.0)
11	1 (3.3)
≥ 12	3 (10.0)

Table 5 Needle reuse

Times needle used before disposal	Number (n %) of centres
Single use	2 (5.7)
Two to four	18 (51.4)
Five to nine	10 (28.6)
Ten or more	5 (14.3)

Table 6 Glycated haemoglobin provision within the 29 countries that had some public health provision

Provision		Measurement methods			Costs per test			Availability
Level (s) of health system settings	Frequency of provision in defined setting	POCT	Laboratory analysis	Both	Number (percentage) providing at no cost to patient	Mean cost to patient (when not provided for free)	Range of cost to patient	Mean availability (when provided)
Primary health care facility	6 (20.7)	3	3	0	2 (33.3)	$10.95	$6.44 (Dominican Republic)-$17.41 (Philippines)	62.5%
District and regional hospitals	27 (93.1)	7	15	5	4 (14.8)	$9.74	$4.00 (Ethiopia and Uzbekistan)-$27.75 (St Lucia)	67.5%
Tertiary hospital	26 (89.7)	4	18	4	9 (34.6)	$11.92	$4.00 (Ethiopia)-$29.00 (Central African Republic)	75.5%

POCT: Point-of-care testing.

Table 7 Main challenges in providing glycated haemoglobin testing

Challenge	Number (%) of centres reporting this challenge
Cartridge cost	23 (70.9)
Stockouts	22 (68.8)
Maintenance of testing machine	21 (65.6)
Machine cost	18 (56.3)
Adequate supplies	15 (46.9)
Trained staff	15 (46.9)
Refrigeration	11 (34.4)
Adequate oversight of supplies	9 (28.1)
Other challenges	8 (25.0)