The insulin dilemma in resource-limited countries. A way forward?

Abstract

The International Insulin Foundation (IIF) has developed and validated a needs-assessment instrument called the Rapid Assessment Protocol for Insulin Access (RAPIA) which has been used in seven countries in four continents to analyse the constraints to delivering effective continuing care for people with diabetes. One major contributor to the difficulties in availability of insulin is a failure to use the least costly sources and types of insulin and other effective drugs for diabetes. The purchase of insulins can consume as much as 10% of government expenditure on drugs, this being highly sensitive to the selection of newer analogue insulins as first-choice options, which cost between three and 13 times more than biosynthetic human insulin. Insulin cartridges for use with injection pens further add to costs. Similar considerations apply to most of the newer treatments for people with type 2 diabetes, which may cost up to 40 times more than metformin and sulfonylureas, still considered first-line drugs by European and US guidelines. Both biosynthetic human insulin and the first-line oral hypoglycaemic drugs are available from generic manufacturers. With the present price differentials, there is thus a growing need for countries involved in tendering for sourcing insulin to be provided with the guarantees of Good Manufacturing Practice, quality and bioequivalence, which would come from a WHO Pre-Qualification Scheme as currently exists for a variety of drugs for chronic diseases, both communicable and non-communicable. The IIF has developed a position statement on the provision and choice of diabetes treatments in resource-limited settings which should be applicable wherever consideration of resources is a component of therapeutic decision making.

Selection of Essential Medicines for Diabetes in Low and Middle Income Countries: A Survey of 32 National Essential Medicines Lists

“…According to the WHO report, no clear advantage (with lack of clinically important benefits) over recombinant human insulin has been established [37]. Particularly in the absence of glucose self-monitoring, the benefits of insulin analogues is believed to be minimal [38]. Besides, concerns regarding cost effectiveness have been expressed even in developed countries [15].…”

Use and Out-of-Pocket Costs of Insulin for Type 2 Diabetes Mellitus From 2000 Through 2010

“…Compared with human synthetic and animal insulin for type 2 diabetes, short-acting insulin analogs may offer flexible dosing and convenience, long-acting insulin analogs less nocturnal hypoglycemia, 1 but both at 2–4 times the cost. 2 As insulin analogs have become increasingly popular, 3, 4 we examined trends in insulin utilization, out-of-pocket expenditures, and concurrent trends in severe hypoglycemic events among privately insured U.S. adults with type 2 diabetes, from 2000 through 2010.…”

The hypoglycemic effect of plant derived insulin like protein in comparison to the hypoglycemic effect of the human soluble insulin in diabetic mice

“…Sperm head abnormalities were observed in diabetic mice after 7 days, 14 days and 21 days of the treatment and in all 4 groups. Table ( 4) shows the relationship between sperm head abnormalities in all groups after 7, 14 and 21day of the treatment, After 7 days of the treatment, the difference between the 4 groups and head sperm abnormalities insignificant for normal and balloon head sperms while its insignificant for the rest types of abnormalities, , After 14 days of the treatment the difference between the4 groups is significant for normal, balloon head and thread head sperms while its insignificant for the no head and curved head no hook sperms. After 21 days of the treatment the difference between the 4 groups is significant for normal, balloon and insignificant for the rest types of abnormalities.…”