Barriers to accessing diabetes care include a lack of resources and training to provide minimum standards of care, inadequate monitoring systems, and limited ability to improve insulin therapy.
People with insulin-dependent diabetes rely on insulin replacement and blood glucose self-monitoring, which are often unavailable or inaccessible in low-resource settings. In these settings, insulin is typically administered in a vial with a syringe rather than an insulin pen. Insulin pens are more common in high-income countries and are preferred by patients because they are easier to use, less painful, and less stigmatized.
Instead, most patients in MSF locations are required to attend outpatient facilities twice a day for insulin injections. This disruption impacts the ability to get to school or work, as people often have to travel significant distances, sometimes on foot, to access the nearest facilities.
Although this is also the absolute minimum number of doses per day needed to manage type 1 diabetes, in high-income countries it has become standard to follow a highly tailored insulin dosing regimen throughout the day depending on diet and physical activity. I am. Providing this type of insulin therapy requires people to be able to self-inject insulin at home, and both patients and clinicians need to know the patient's blood sugar levels throughout the day as they perform their normal activities. need to be understood through. In low- and middle-income countries, where self-monitoring of blood glucose levels is almost completely impossible, primarily due to cost, such visibility is lacking and finding a safe and effective insulin dose is difficult. It's getting difficult.
Treatment for type 2 diabetes usually begins with oral medications because the person still produces insulin but has decreased sensitivity to it. If the disease is not managed early, it can progress to an insulin-dependent form. The first-line treatment for type 2 diabetes is a drug called metformin, which is available to some extent in low- and middle-income countries, but there are more options in high-income countries and treatments have expanded significantly in recent years. . A new class of drugs that help control blood sugar levels and actively protect organs such as the kidneys. These drugs play an important role in controlling blood sugar levels, preventing complications, and preventing the need for insulin.
Patients with type 2 diabetes are often highly resistant to starting insulin due to shame, stigma, and associated practical and logistical challenges. But where MSF works, these vital medicines are almost completely unavailable due to cost, resulting in more patients having complications and navigating the transition to insulin.