Access to Insulin Delivery Devices and Glycated Haemoglobin in Lower-Income Countries

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.