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Cost, quality of care impede improvements in type 1 diabetes rates in low-, middle-income countries
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CHICAGO — Type 1 diabetes incidence in low- and middle-income countries remains a problem, with cost and availability of insulin as the major barriers to care, according to two speakers who presented here during the ADA/JDRF Joint Symposium: Global epidemiology of type 1 diabetes and implications for public health.
In 1990, Jaakko Tuomilehto, MD, PhD, and colleagues in Finland and the US teamed up with the World Health Organization to conduct the DIAMOND study, which collected data on newly diagnosed pediatric cases of type 1 diabetes across the world; the registry compiled data for 10 years in more than 100 participating centers. However, Tuomilehto, who is emeritus professor of public health, University of Helsinki in Finland, said the information for low- and middle-income countries is very scarce, and very few populations that participated in the study have maintained their registries for type 1 diabetes.
“Only in a very few countries do we know what’s happening today; this is a pity because it’s relatively easy to monitor a child who has type 1 diabetes, but governments and so on are not funding those activities. It’s very unfortunate, but most unfortunate for the low- and middle-income countries that are lacking the data,” he said during a press conference.
Though there are many reasons for the variability in incidence and risk among these populations, Tuomilehto said genetics, survival and quality of care are primary factors.
“If you get the disease before the age of reproduction and develop severe complications or die prematurely, your family line stops there; your genetic information is not being transmitted to the next generation. Thus, the frequency of the disease in such a population remains low,” he said.
John S. Yudkin, MD, emeritus professor of medicine, University College London, and chairman of the International Insulin Foundation, also spoke about survival and subpar health care delivery for type 1 diabetes in low- and middle-income countries, citing the incidence in these countries as similar to that in the U.K. and the US. However, due to poor survival rates, the number of patients with type 1 diabetes in these countries is lower.
“Studies we’ve done suggest that if you develop type 1 diabetes as a child in rural Mozambique, your life expectancy is 1.5 years, similar to what it was like in Boston before the advent of insulin,” Yudkin said.
Poor survival rates are due, in part, to the high cost of insulin, he said, with vials costing between $5 and $10 each in low- and middle-income countries. In most countries, Yudkin said the cost is equivalent to 5 months of a family’s income, so when a child dies from type 1 diabetes, it is considered a relief because the financial burden is lessened.
To alleviate this problem, he and colleagues are working with the International Insulin Foundation, the International Union Against TB and Lung Disease and the WHO, with the Pan-American Health Organization, to create a non-communicable disease drug facility that will improve the availability and affordability of high quality medications, like insulin, for people in low-income countries. Currently, they are working to provide human biosimilar insulin from good manufacturers that can be sold for less than $5 to $10 per vial. According to Yudkin, researchers in Brazil are currently working on human generic insulin that can be sold at $1.80 per vial. – by Stacey L. Adams
For more information:
Tuomilehto J. Epidemiology of type 1 diabetes in low- and middle-income countries.
Yudkin JS. Health care delivery for type 1 diabetes in low- and middle-income countries. Presented at: ADA Scientific Sessions; June 21-25, 2013; Chicago.
Disclosure: The researchers report no relevant financial disclosures.