Access to Insulin Delivery Devices and Glycated Haemoglobin in Lower-Income Countries
World Journal of Diabetes(2020)
摘要
BACKGROUND 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.AIM To study insulin delivery devices and glycated haemoglobin(HbA1 c) testing.METHODS 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.RESULTS 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 HbA1 c 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.CONCLUSION Large gaps exist for adequate access to appropriate insulin delivery devices and HbA1 c testing. Public health systems in low-and-middle income countries should increase affordable provision. There are also needs for specific health professionaltraining and diabetes education; elimination of customs duties and taxes; development of inexpensive, robust HbA1 c testing methods that do not require refrigeration of testing supplies; differential pricing schemes; and other solutions.
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关键词
Type 1 diabetes,Diagnostics,Glycated haemoglobin,Syringes,Insulin,Access
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