Africa: A Gamechanger for Diabetes Care in Refugee Settings or Resource-Poor Countries or in Hard to Reach Settings

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Seeking to explore ways to improve diabetes care in resource poor settings a joint study by Médecins Sans Frontières /Doctors Without Borders (MSF) and University of Geneva published in February in PLOS ONE , has demonstrated that a range of insulins can be stored at temperatures ranging between 25-37 degrees for a four–week period of use. This study confirms the possibility for people living with diabetes in similar temperature conditions to be able to use insulin, for a period of up to four weeks, even in the absence of access to refrigeration.

Diabetes is a chronic, progressive disease that can be controlled with effective treatment. However, in many countries, people living with diabetes are not getting the treatment they need to stay healthy and alive. It is a shameful fact that only about half of people requiring insulin have access to it. Access to insulin has been largely prevented due to high prices, challenging storage requirements and complex treatment protocols.

Strict storage recommendations for insulin are difficult to follow in tropical regions and even more challenging in conflict and humanitarian emergency settings, adding an extra burden for people managing their diabetes. Storage recommendations for insulin require refrigeration until its expiry date, or until it is opened for use. Once in use, the storage recommendations on the label of most human insulins are below 25°C for 42 days. In many settings, this results in people being asked to travel to the health clinic for injections and monitoring, at least twice a day, for life.

MSF works in over 70 countries worldwide and in most of these settings, insulin is often not available in public health facilities or private pharmacies. MSF has been engaged in providing treatment for diabetes care in multiple projects across number of countries (including Jordan, Lebanon, Iraq, Syria, South Sudan, Democratic Republic of Congo, Tanzania, Kenya, Zimbabwe, and Bangladesh) to people living in resource limited and humanitarian settings.

Philippa Boulle, Non-Communicable Diseases Advisor, MSF

“For far too long, we were unable to send people with diabetes back to their homes with insulin due to its cold storage requirements. Some of these people were travelling long distances daily and some even relocated to get their insulin injections at the clinic. With this new finding of no refrigeration requirement in a climate of up to 37 degrees and with a well-developed patient education and support programme, people with diabetes in resource limited and humanitarian settings will now be able to inject themselves in their homes greatly improving the significant disruption to their lives from having to attend hospital for twice-daily injections. The ability to self-inject insulin is a fundamental aspect of diabetes self-management and the ability of people with diabetes to be empowered for their health.

We now call for a consensus statement endorsed by the World Health Organization (WHO) to support the use of locally produced cooling devices for the home storage of insulin in order to dispel the notion that refrigeration is needed in every situation. Additionally, we hope that pharmaceutical corporations would urgently submit to regulatory authorities for use of insulin under expanded temperature ranges. It is time to ensure that everyone who needs insulin, regardless of where they live, can access it. For too many people living with diabetes, life is difficult enough without this burden.”


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