TACOMA, Washington — Diabetes is considered to be the most expensive chronic illness within the United States. Not only is the condition financially burdensome, but external challenges, such as access to healthcare specialists and country-specific stigmas, are also associated with Type 1 diabetes in developing countries. As a result, it is no surprise that Type 1 diabetics in impoverished countries are struggling with the associated costs of diabetes.
What is Type 1 Diabetes?
Type 1 diabetes is a lifelong condition in which the pancreas does not function properly, preventing the biological production of a hormone called insulin. Insulin helps to regulate blood sugar by enabling the metabolism of this glucose by the body’s cells. Therefore, Type 1 diabetics must inject themselves with insulin and monitor their blood sugar levels.
Type 1 Diabetes Supplies for Survival
Unfortunately, the requirements to live with Type 1 diabetes are far from simple. In addition to the constant fear placed upon the individual and their family members due to complications associated with diabetes, the financial burden placed upon families is also overwhelming.
The list of supplies a Type 1 diabetic needs to remain healthy is interminable, including, but not limited to, an insulin pump, syringes, insulin vials and a blood glucose monitor. All of which individually carry hefty costs.
“Even though insulin is obviously the thing that keeps people with Type 1 diabetes alive, if you don’t have [a glucose monitoring device, which acts as a]blueprint to dose a potentially very dangerous drug, then it can be quite risky and very minimal knowledge can be gained to sort of guide improvements in glycemic control,” said Emma Klatman in an interview with The Borgen Project.
Klatman is the Health Systems Specialist for Life for a Child, a nonprofit organization with the mission to prevent Type 1 diabetes mortalities and early complications in juveniles. As of 2019, Life for a Child has partnered with healthcare centers and providers in 42 developing countries across the globe to provide resources and educational tools that are crucial to improving the care provided to Type 1 diabetics.
Klatman said that during her time with Life for a Child, there have been growing concerns regarding insulin rationing as a solution to the high costs of insulin vials in the United States.
In the United States, a 10mL vial of Novolog, a common insulin brand used by Type 1 diabetics, costs $351. This is less than 1% of the nation’s income per capita. Conversely, in impoverished countries such as Mali, one vial of insulin costs 38% of the country’s low per capita income. This percentage only accounts for one insulin vial and does not include costs related to syringes, blood sugar monitors and insulin pumps, among others.
These high costs are largely due to market domination by a small number of dominating manufacturers. However, it is simply not sustainable for families living in poverty who must also budget to feed, clothe and care for their families.
“The only way for impoverished families to maintain their lives [with a diabetic child]is by cutting down on doses of insulin because they cannot afford to have full insulin doses. This leads to very bad control, high glucose and high glycohemoglobin levels,” said Dr. Alberto Hayek, an endocrinologist and the president and co-founder of Diabetes Research Connection, in an interview with The Borgen Project.
This practice, often termed insulin rationing, is highly dangerous for Type 1 diabetics. Not providing the body with a sufficient amount of insulin and remaining at high glycemic levels leads to a series of latter complications, such as ketoacidosis, kidney failure, coma and even death. The dangers of insulin rationing is supported by evidence, as researchers have found that the most common cause of death of Type 1 diabetics worldwide is insufficient access to insulin.
Lack of Endocrinologists
In addition to the inaccessibility of supplies needed for Type 1 diabetics to survive, access to suitable healthcare specialists in the form of endocrinologists is also limited in developing countries.
In 2015, a study conducted in Mali found only two doctors who specialized in the treatment of diabetes in the country, both of which were practicing in the capital city of Bamako.
Klatman explained that the limited number of endocrinologists available to Type 1 diabetics in developing countries like Mali, as well as their centralization in capital cities, creates an extra layer of challenges with regards to accessing skilled medical care.
“Due to rural-urban disparities, it can be really hard and such a barrier for most people to get to a capital city. It often means that a young person might be missing school. It will definitely mean that their parent will be missing a day’s worth of wages, and it can mean a lot of extra money for travel costs,” said Klatman.
Misdiagnosis of Diabetes
Not only does a lack of endocrinologists in developing countries cause incurred travel costs for patients, but the absence of diabetes expertise in medical clinics in rural areas often results in misdiagnosis.
“It is not uncommon for a young person to present at a hospital with severe stomach pains and obviously be in DKA, [or diabetic ketoacidosis,]but a healthcare professional that’s not educated properly on Type 1 diabetes in children might think that this young person has appendicitis,” said Klatman.
This lack of diagnosis or delayed diagnosis is detrimental to the health of these individuals.
The work of Life for a Child and related organizations ultimately aims to diminish issues correlated with high costs of diabetes care and high rates of deaths related to Type 1 diabetes in developing countries. Partial relief of medical expenses and stability for these individuals and families reduce the death rates of Type 1 diabetics in developing countries. Moreover, these organizations also help alleviate poverty by allowing families to allocate a larger portion of their income to other aspects of nourishment and survival.