Insulin storage in hot climates without refrigeration: temperature reduction efficacy of clay pots and other techniques

Ogle, Graham D; Abdullah, M. I.; Mason, D.; Januszewski, Andrzej S.; Besançon, Stéphane

doi:10.1111/dme.13194

Cited by 46 publications

(45 citation statements)

References 22 publications

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“…Encouragingly, evidence indicates that this method is effective in reducing storage temperatures towards standard room temperature of 20-25°C. 150 In addition to treating the disease, health-care providers need to recognise that the emotional impact on young people with type 1 diabetes and their families is often severe, especially in countries with relatively low health literacy. 151 Knowledge can help to mitigate this burden, and, given the complexity involved in the management of type 1 diabetes, diabetes education of young patients, their families, and health professionals-tailored to culture, language, and education or knowledge levels-is critical to achieving good outcomes.…”

Section: The Lancet Diabetes and Endocrinology Commissionmentioning

confidence: 99%

Diabetes in sub-Saharan Africa: from clinical care to health policy

Atun

Davies

Gale

et al. 2017

The Lancet Diabetes & Endocrinology

370

432

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Key message 2: diabetes and its consequences are costly to patients and economies We estimate that, in 2015, the overall cost of diabetes in sub-Saharan Africa was US$19•45 billion or 1•2% of cumulative gross domestic product (GDP). Around $10•81 billion (55•6%) of this cost arose from direct costs, which included expenditure on diabetes treatment (eg, medication, hospital stays, and treatment of complications), with out-of-pocket expenditure likely to exceed 50% of the overall health expenditure in many countries. We estimate that the total cost will increase to between $35•33 billion (1•1% of GDP) and $59•32 billion (1•8% of GDP) by 2030. Putting in place systems to prevent, detect, and manage hyperglycaemia and its consequences is therefore warranted from a health economics perspective. Key message 3: health systems in countries in sub-Saharan Africa are unable to cope with the current burden of diabetes and its complications By use of information from WHO Service Availability Readiness Assessment surveys and World Bank Service Delivery Indicator surveys and the local knowledge of Commissioners, we found inadequacies at all levels of the health system required to provide adequate management for diabetes and its associated risk factors and sequelae. We found inadequate availability of simple equipment for diagnosis and monitoring, a lack of sufficiently knowledgable health-care providers, insufficient availability of treatments, a dearth of locally appropriate guidelines, and few disease registries. These inadequacies result in a substantial dropoff of patients along the diabetes care cascade, with many patients going undiagnosed and with those who are diagnosed not receiving the advice and drugs they need. We also noted scarce facilities to manage the microvascular and macro vascular complications of diabetes. Additionally, despite calls for adding the care of diabetes and other cardiovascular risk factors onto existing infectious disease programmes (such as those for HIV), we found little evidence that such combined programmes are successful at improving outcomes.

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Section: The Lancet Diabetes and Endocrinology Commissionmentioning

confidence: 99%

Diabetes in sub-Saharan Africa: from clinical care to health policy

Atun

Davies

Gale

et al. 2017

The Lancet Diabetes & Endocrinology

370

432

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“…Keeping insulin in clay pots is likely to cause contamination as it is difficult to keep it clean: this should be avoided. Clay pots have been previously recommended [ 24 ]. …”

Section: Insulin Transportation and Storagementioning

confidence: 99%

EADSG Guidelines: Insulin Storage and Optimisation of Injection Technique in Diabetes Management

et al. 2019

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To date, insulin therapy remains the cornerstone of diabetes management; but the art of injecting insulin is still poorly understood in many health facilities. To address this gap, the Forum for Injection Technique and Therapy Expert Recommendations (FITTER) published recommendations on injection technique after a workshop held in Rome, Italy in 2015. These recommendations are generally applicable to the majority of patients on insulin therapy, athough they do not explore alternative details that may be suitable for low- and middle-income countries. The East Africa Diabetes Study Group sought to address this gap, and furthermore to seek consensus on some of the contextual issues pertaining to insulin therapy within the East African region, specifically focusing on scarcity of resources and its adverse effect on the quality of care. A meeting of health care professionals, experts in diabetes management and patients using insulin, was convened in Kigali, Rwanda on 11 March 2018, and the following recommendations were made: (1) insulin should be transported safely, without undue shaking and exposure to high (> 32 °C) temperature environments. (2) Insulin should not be transported below 0 °C. (3) If insulin is to be stored at home for over 2 months, it should be stored at the recommended temperature of 2–8 °C. (4) Appropriate instructions should be given to patients while dispensing insulin. (5) Insulin in use should be kept at room temperature and should never be kept immersed under water. Immersing insulin under water after the vial has been pierced carries a high risk of contamination, leading to loss of potency and likelihood of causing injection abscesses. (6) The shortest available needles (4 mm for pen and 6 mm for insulin syringe) should be preferred for all patients. (7) In routine care, intramuscular injections should be avoided, especially with long-acting insulins, as it may result in severe hypoglycaemia. (8) The practice of slanting the needle excessively should be avoided as it results in sub-epidermal injection of insulin which leads to poor absorption and may cause “tattooing” of the skin and scarring. (9) In patients presenting in a wasted state, with “paper-like skin”, injections should, if possible, be initiated with pen injection devices, so as to utilise the 4-mm needle without lifting a skin fold (pinching the skin); otherwise lifting of a skin fold is required, if longer needles are utilised. (10) Reuse of needles and syringes is not recommended. However, as the reuse of syringes and needles is practiced for various reasons, and by many patients, individuals should not be given alarming messages; and usage should be limited to discarding when injections become more painful; but at any rate not to exceed reusing a needle more than 5 times. Electronic Supplementary Material The online version of this article (10.1007/s13300-019-0574-x) contains supplementary material, which is available to authorized users.

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“…This is commonly seen in developed multiethnic countries where immigrants from developing countries tend to continue their inappropriate practice [4]. The inappropriate storage of medications eventually leads to losing their potency [5][6][7]. A good example of that is insulin when left at a high temperature in countries with hot climate.…”

Section: Introductionmentioning

confidence: 99%

“…A good example of that is insulin when left at a high temperature in countries with hot climate. Mentioning that most manufacturers advise diabetic patients to store their insulin bottles in refrigerators at 2-8°C, but not frozen, with limiting usage or storage period to 1 month at room temperature (20-25°C), otherwise excursions of glucose level can dangerously ensue [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Awareness of home drug storage and utilization habits: Saudi study

Koshok¹,

Jan²,

AL-tawil³

et al. 2017

Med-Science

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The aim of the study was to investigate the awareness of residents in Saudi Arabia toward in-home drug storage and the using habits of their medications. This is a descriptive study that involved an electronic survey about drug storage and utilization habits. It was developed, pretested, and distributed via the social media among the population in Saudi-Arabia. About 1400 persons participated in this study. Around 84.4%, 96.6% and 58.3% of participants stored their insulin syringes, antibiotic or cough-syrup after opening in there frigerator, respectively. Moreover, most of them avoided use or discard their products upon exposure to the sun or forgetting them in the car for the whole day. 87.5% disclosed that they usually check the expiration date on drug products before using and 49.7% added they always follow the instructions regarding duration-of-use compared with 45.85% who said sometimes they follow it. 99.7% of them reported that they avoid using products upon change in color or formulation. Finally, variable-correlation was found between the age distribution of participants and their responses. The results revealed that the participants exhibited promising awareness toward the in-home drug storage in Saudi Arabia

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Insulin storage in hot climates without refrigeration: temperature reduction efficacy of clay pots and other techniques

Cited by 46 publications

References 22 publications

Diabetes in sub-Saharan Africa: from clinical care to health policy

Diabetes in sub-Saharan Africa: from clinical care to health policy

EADSG Guidelines: Insulin Storage and Optimisation of Injection Technique in Diabetes Management

Awareness of home drug storage and utilization habits: Saudi study

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