The importance of insulin donations for children in 43 low- and middle-income countries

Hogerzeil, Hans V; Recourt, Sterre

doi:10.1057/s41271-018-00159-w

Cited by 14 publications

(12 citation statements)

References 8 publications

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“…Currently, in both high- and low-income settings, the provision of care for type 1 diabetes is mainly centralised in hospitals located in capital cities or large urban areas, and a more decentralised approach could be considered. Some donation programmes have addressed the challenges of managing type 1 diabetes, even in low-income settings, but more needs to be done to ensure sustainable solutions are found [ 37 ]. As 2021 marks the centenary of the discovery of insulin, access to insulin remains problematic in many low-income populations, both in less developed and in more developed countries, and is a major contributor to decreased life expectancy [ 17 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Type 1 diabetes in 2017: global estimates of incident and prevalent cases in children and adults

Hede²,

et al. 2021

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Aims/hypothesis Data on type 1 diabetes incidence and prevalence are limited, particularly for adults. This study aims to estimate global numbers of incident and prevalent cases of type 1 diabetes in 2017 for all age groups, by country and areas defined by income and region. Methods Incidence rates of type 1 diabetes in children (available from 94 countries) from the IDF Atlas were used and extrapolated to countries without data. Age-specific incidence rates in adults (only known across full age range for fewer than ten countries) were obtained by applying scaling ratios for each adult age group relative to the incidence rate in children. Age-specific incidence rates were applied to population estimates to obtain incident case numbers. Duration of diabetes was estimated from available data and adjusted using differences in childhood mortality rate between countries from United Nations demographic data. Prevalent case numbers were derived by modelling the relationship between prevalence, incidence and disease duration. Sensitivity analyses were performed to quantify the impact of alternative assumptions and model inputs. Results Global numbers of incident and prevalent cases of type 1 diabetes were estimated to be 234,710 and 9,004,610, respectively, in 2017. High-income countries, with 17% of the global population, accounted for 49% of global incident cases and 52% of prevalent cases. Asia, which has the largest proportion of the world’s population (60%), had the largest number of incident (32%) and prevalent (31%) cases of type 1 diabetes. Globally, 6%, 35%, 43% and 16% of prevalent cases were in the age groups 0–14, 15–39, 40–64 and 65+ years, respectively. Based on sensitivity analyses, the estimates could deviate by ±15%. Conclusions/interpretation Globally, type 1 diabetes represents about 2% of the estimated total cases of diabetes, ranging from less than 1% in certain Pacific countries to more than 15% in Northern European populations in 2017. This study provides information for the development of healthcare and policy approaches to manage type 1 diabetes. The estimates need further validation due to limitations and assumptions related to data availability and estimation methods. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Type 1 diabetes in 2017: global estimates of incident and prevalent cases in children and adults

Hede²,

et al. 2021

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“…An article outlines in detail ten steps that donors and governments should take together to phase out donor support, ranging from detailed program knowledge transfer in the early stages, to eventual donor creation of intra-country differential insulin pricing mechanisms to ensure affordability of insulin. 32 We also acknowledge a few limitations to our study. We were unable to measure clinical outcomes, such as HbA1C levels, as existing data were limited and we were unable to collect samples as part of our study design.…”

Section: Discussionmentioning

confidence: 99%

Improving access to diabetes care for children: An evaluation of the changing diabetes in children project in Kenya and Bangladesh

et al. 2021

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Background: The changing diabetes in children (CDiC) project is a public-private partnership implemented by Novo Nordisk, to improve access to diabetes care for children with type 1 diabetes. This paper outlines the findings from an evaluation of CDiC in Bangladesh and Kenya, assessing whether CDiC has achieved its objectives in each of six core program components.Research design and methods: The Rapid Assessment Protocol for Insulin Access (RAPIA) framework was used to analyze the path of insulin provision and the healthcare infrastructure in place for diagnosis and treatment of diabetes. The RAPIA facilitates a mixed-methods approach to multiple levels of data collection and systems analysis. Information is collected through questionnaires, in-depth interviews and focus group discussions, site visits, and document reviews, engaging a wide range of stakeholders (N = 127). All transcripts were analyzed thematically. Results:The CDiC scheme provides a stable supply of free insulin to children in implementing facilities in Kenya and Bangladesh, and offers a comprehensive package of pediatric diabetes care. However, some elements of the CDiC program were not functioning as originally intended. Transitions away from donor funding and toward government ownership are a particular concern, as patients may incur additional treatment costs, while services offered may be reduced. Additionally, despite subsidized treatment costs, indirect costs remain a substantial barrier to care. Conclusion:Public-private partnerships such as the CDiC program can improve access to life-saving medicines. However, our analysis found several limitations, including concerns over the sustainability of the project in both countries. Any program reliant on external funding and delivered in a high-turnover staffing environment will be vulnerable to sustainability concerns.child, delivery of health care, low-and middle-income countries, public-private sector partnerships, type 1 diabetes

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“…These health system factors can also have an impact on the overall cost of diabetes management, with individuals needing to pay for travel from their home to a facility where insulin is present or only being able to access this medicine in the private sector at higher prices [5,30,34,40]. Although donation programmes have shown some success in demonstrating that, if access to insulin is improved, type 1 diabetes does not need to be a death sentence in LMICs, these programmes need to be better integrated into the health system [32]. Fig.…”

Section: Discussionmentioning

confidence: 99%

“…In the private sector, this is done via wholesalers and private pharmacies. Another source of insulin includes donation programmes, such as Life for a Child or Novo Nordisk's Changing Diabetes in Children [32]. Although these initiatives have had a positive impact for individuals with type 1 diabetes, they have not been integrated into the formal health system, which raises issues of sustainability [32].…”

Section: Human Insulin Analogue Insulinmentioning

confidence: 99%

A global perspective on the issue of access to insulin

et al. 2021

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The discovery of insulin in 1921 changed the prognosis for people with type 1 diabetes. A century later, availability and affordability of insulin remain a challenge in many parts of the globe. Using the WHO’s framework on understanding the life cycle of medicines, this review details the global and national challenges that affect patients’ abilities to access and afford insulin. Current research and development in diabetes has seen some innovations, but none of these have truly been game-changing. Currently, three multinational companies control over 95% of global insulin supply. The inclusion of insulin on the WHO’s Prequalification Programme is an opportunity to facilitate entry of new companies into the market. Many governments lack policies on the selection, procurement, supply, pricing and reimbursement of insulin. Moreover, mark-ups in the supply chain also affect the final price to the consumer. Whilst expenses related to diabetes are mostly covered by insurance in high-income countries, many patients from low- and middle-income countries have to pay out of their own pockets. The organisation of diabetes management within the healthcare system also affects patient access to insulin. The challenges affecting access to insulin are complex and require a wide range of solutions. Given that 2021 marks the centenary of the discovery of insulin, there is need for global advocacy to ensure that the benefits of insulin and innovations in diabetes care reach all individuals living with diabetes. Graphical abstract

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The importance of insulin donations for children in 43 low- and middle-income countries

Cited by 14 publications

References 8 publications

Type 1 diabetes in 2017: global estimates of incident and prevalent cases in children and adults

Type 1 diabetes in 2017: global estimates of incident and prevalent cases in children and adults

Improving access to diabetes care for children: An evaluation of the changing diabetes in children project in Kenya and Bangladesh

A global perspective on the issue of access to insulin

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