I say advocacy, but the title of the article is call for action. Either way this means that people around
the globe often cannot get access to insulin 95 years after the
discovery of insulin. This needs action to prevent this being a
continuing problem when insulin reaches its century mark in 2021.
More effort needs to be devoted to
ensuring people with diabetes have access to insulin. This is the
finding of a new in-depth review by three public-health experts. The
document was published
online February 5 in Lancet Diabetes &
Endocrinology by David Beran, PhD, of the division of tropical
and humanitarian medicine, Geneva University Hospitals and the
University of Geneva, Switzerland, and colleagues.
Much attention has been given to the
access of medicines for communicable diseases, think Ebola; however,
access to essential medicines for diabetes, especially insulin, has
had almost no focus. Very little has been done globally to address
the issue of access, despite the [United Nation's] political
commitment to address noncommunicable diseases and ensure universal
access to drugs for these disorders,
Insulin is essential for the survival
of people with type 1 diabetes and is needed for improved management
of diabetes for some people with type 2 diabetes. But, today, nearly
a century after its discovery, poor access to insulin translates to a
life expectancy as low as 1 year following onset of type 1 diabetes
in a child in sub-Saharan Africa.
The problem isn't limited to low- and
middle-income countries: even in the United States, one study found
that discontinuation of insulin use due to high cost was the leading
cause of diabetic ketoacidosis in people in an inner-city setting
(Diabetes Care. 2011;34:1891–1896).
The new paper outlines the complexity
of the problem, including the economic, regulatory, and political
aspects, and provides a call to action with potential remedies. The
document is aimed at all stakeholders, including professionals who
care for people with diabetes, Dr Beran told Medscape Medical News.
"Healthcare workers play an
essential role in ensuring that their patients have access to insulin
and the necessary education for its use. I also believe that in many
settings they should also help advocate for people's access to
insulin where this is problematic....The call to action applies for
all those who are concerned about the well-being of people with
diabetes," he stressed.
In WHO and Health Action International
surveys, there is a huge range in the price paid for insulin by
governments — across 10 studies, for example, the cost of a range
of insulin formulations varied from $2.55 to $48.25 per vial.
The experts stress that insulin also
needs to be available, both at a national level, something that can
be assessed by the presence of insulin on national essential-medicine
lists and guidance as to where insulin should be present, for example
health centers vs. hospitals, and at a global level.
The global control of the insulin
market by three multinational companies means that countries
have a small number of suppliers to choose from, and this has often
resulted in people having to change the type of insulin they take as
companies have withdrawn formulations from the market or hiked up the
price of insulin analogues.
At the same time, regulatory aspects
around biosimilars have limited the availability of cheaper
alternatives. The shift from use of vials to the more expensive
patented pen devices also plays a role, the authors note.
In linking both the availability and
affordability elements, only six of the countries surveyed would meet
the WHO's 80% availability target of affordable insulin in the public
sector, the authors note.
They also point out that insulin alone
"is not enough for proper diabetes management, which also
requires syringes, blood glucose meters, education, information, and
family support."
This is a complex problem that needs
support.
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