Diabetes in humanitarian crises: the Boston Declaration

Abstract

Running Title: Boston DeclarationWord Count: 689 (not including the table) 2 Nearly three out of every four deaths globally in 2017 were caused by non-communicable diseases (NCDs). 1 Many countries have made progress reducing NCD risk factors such as tobacco use, hyperlipidemia, and hypertension, but no countries have successfully reversed the increasing trends in diabetes prevalence and mortality from diabetes is increasing. 1 This represents a massive global health failure considering the fact that type 2 diabetes is largely preventable with lifestyle modification and that cost-effective treatments exist for both type 2 and type 1 diabetes. 2 Specific concern is needed for type 1 diabetes, which without insulin, it is fatal.In parallel, forced migration has reached a record high with 68.5 million people displaced from their homes around the world, 85% being hosted in low or middle-income countries such as, Uganda, Lebanon, and Pakistan, and 65% occurring in protracted refugee situations. 3 In addition, there are over 100 million conflict-affected non-displaced people and 175 million people who are affected by natural disasters annually. 4 These individuals are particularly vulnerable in crises due to disrupted health services and unpredictable-and often unhealthy-food supplies, which may exacerbate their condition and lead to complications.To date, diabetes and other NCDs have largely been underserved in humanitarian settings. 5,6,7 The true scope of the problem has not been established and it is not known which interventions are efficacious, feasible, and cost-effective in these contexts. With respect to type 1 diabetes, arguably the most immediately life-threatening NCD, the supply and cost of insulin, blood glucose monitoring and diagnostic tools are barriers for both humanitarian responders and their host countries, as well as patient adherence, life expectancy, quality of life, follow-up and provider training in diabetes care.In order to begin to address these major gaps, on 4-5 April 2019, Harvard University convened a meeting of humanitarian and other actors in global health to discuss the immediate needs and barriers to tackling diabetes in humanitarian crises, and to adopt a unified, action-oriented agenda to address this pressing global health issue (http://globalendocrinology.bwh.harvard.edu/symposium). Whilst it was recognised that there are substantial gaps in care for diabetes in all low-resource settings, 8 not just humanitarian crises, and that many other NCDs (e.g., cardiovascular disease, chronic obstructive pulmonary disease and asthma) are also prevalent globally and inadequately addressed in humanitarian settings, 9 we chose to prioritize efforts on diabetes in humanitarian crises, for the following reasons:First, because people with type 1 diabetes who cannot access insulin and continuity of care in a crisis are at acute risk of death. The principles of the Humanitarian Charter and United Nations Universal Declaration of Human Rights include the right to life with dignity. 10 The human rig...

Incidence of type 1 diabetes among children and adolescents during peace and war times in Yemen

“…In humanitarian crisis during conflict and war periods, T1D is of particular concern, since it is fatal in the absence of insulin treatment. 36 Therefore, external assistance with uninterrupted insulin supply was made available free of charge for all insulin-treated patients in the country.…”

Insulin Storage: A Critical Reappraisal

“…This is in line with recent declarations that ask for developing a consensus statement and identification of needs for further research on insulin thermostability. 61 Manufacturers should consider releasing more detailed information on insulin stability at varying temperatures. Evaluations of data from CGM sensors, dosage of insulin, and temperature sensors will provide further insight into potential patterns of insulin sensitivity changes under real-world conditions.…”

An inter-humanitarian agency study of diabetes care and surveillance in humanitarian settings

“…2 Despite projections of further increases in the prevalence of diabetes and humanitarian crises, evidence on best practice interventions to guide feasibility and effectiveness of diabetes care delivery in humanitarian settings is lacking. [3][4][5] This was highlighted in the Boston Declaration, which outlined a priority agenda for addressing diabetes in humanitarian crises, including the need for improved data and surveillance. 3 Most data collected by humanitarian organisations, while providing humanitarian assistance, do not feature in academic literature.…”

“…[3][4][5] This was highlighted in the Boston Declaration, which outlined a priority agenda for addressing diabetes in humanitarian crises, including the need for improved data and surveillance. 3 Most data collected by humanitarian organisations, while providing humanitarian assistance, do not feature in academic literature. Diabetes prevalence, organisational practices, and barriers to care in these contexts are poorly understood.…”