Abstract
AimDiabetes is a growing burden especially in low and middle income countries (LMICs). Inadequate access to diabetes care is of particular concern and selection of appropriate diabetes medicines on national essential medicines lists (NEMLs) is a first step in achieving adequate access. This selection was studied among LMICs and influences of various factors associated with selection decisions were assessed.MethodsCountries were studied if they employed NEMLs for reimbursement or procurement purposes. Presence and number of essential diabetes medicines from different classes, both insulins and oral blood glucose lowering medicines, were surveyed and calculated. Data were also analyzed by country income level, geographic region, year of last update of the NEML and purpose of NEML employment. The effect of prevalence and burden of disease on the number of essential diabetes medicines was also studied. Non parametric tests and univariate linear regression analysis were used.ResultsNearly all countries (n = 32) had chosen fast (97%) and intermediate acting insulin (93%), glibenclamide and metformin (100% both) as essential medicines. The median number of essential diabetes medicines was 6, equally divided between insulins and oral medicines. 20% of the countries had selected insulin analogues as essential medicines. Among all the studied factors, an increase in burden of diabetes and wealth of countries were associated with selection of higher numbers of essential diabetes medicines (p = 0.02 in both cases).ConclusionsNearly all the studied LMICs had included the minimum required medicines for diabetes management in their NEMLs. Selection can still be improved (e.g. exclusion of insulin analogues and replacement of glibenclamide by gliclazide). Nevertheless, the known suboptimal and inconsistent availability of essential diabetes medicines in LMICs cannot be explained by inadequate selection of essential medicines. Countries should therefore be encouraged to give precedence to implementation of NEMLs to make essential diabetes medicines more accessible.
Highlights
Diabetes is a growing concern in both developed and developing countries
We examined if suboptimal diabetes care outcomes in low and middle income countries (LMICs) stem from inadequate selection of diabetes medicines in national essential medicines lists (NEMLs) and if there are differences between LMICs in this respect
Data collection and classification LMICs were eligible for this study if they had responded positively to the questions on the purpose of employment of their NEML in the Pharmaceutical Country Profile survey conducted by the World Health Organization (WHO) in 2011 [11,12]
Summary
Diabetes is a growing concern in both developed and developing countries. According to the World Health Organization (WHO), 350 million people worldwide have diabetes of whom over 80% live in low and middle income countries (LMICs). The WHO projects that diabetes deaths will double between 2005 and 2030 [1]. In developing countries diabetes care and access to diabetes medicines is a challenge [2]. In some LMICs the life expectancy for a child diagnosed with type 1 diabetes is less than 1 year. (3) Concerns have been expressed regarding access to type 2 diabetes care especially because its incidence is rapidly growing in LMICs [3]. Complications of diabetes have been reported to cause a massive burden to the African societies, with over 20%
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
