Global health policy: can we manage the ever-increasing rise of diabetes? – The Guardian

Blood glucose meters and testing strips are an important part of treating diabetes.Photograph: vitapix/Getty

Together with cardiovascular diseases, cancers and chronic respiratory diseases, diabetes has become one of the worlds four major non-communicable diseases (NCDs), and one of the only chronic diseases that continues to increase in prevalence.

According to the World Health Organization (WHO), the number of people with diabetes increased from 108 million in 1980 to 422 million in 2014, and in 2016 it caused 1.6 million deaths, making it the seventh leading cause of death. The WHO estimates deaths from diabetes will increase to 2.4 million in 2030 and 3.7 million in 2045.

Diabetes is a disease in which the body is unable to regulate blood sugar. Patients with type 1 diabetes cant produce insulin in the pancreas due to an auto-immune disease, while those with type 2, once called adult-onset as it often develops in later life no longer produce insulin because of issues such as excessive body weight and insufficient exercise. Its estimated that type 2 diabetes accounts for 90-95% of cases worldwide.

The pharmaceutical industry is ramping up efforts to tackle diabetes through Global Health Progress, with more than 40 partnerships now researching new medicines, as well as new ways in which to diagnose and raise awareness of the disease.

But whats important, says Vanessa Peberdy, head of NCD advocacy and policy at the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), is that the dialogue around diabetes treatment and care is not just confined to discussions on affordability and access to insulin. While this is clearly a critical issue, improving treatment and care requires a holistic approach that recognises the complexity of the condition. It needs to take in issues such as a lack of trained health practitioners, inadequate supply chains and weak health systems in developing countries.

Access is a complex issue, says Helen McGuire, programme leader, noncommunicable diseases at global health organisation Path. Failures of access in low-resource settings are rarely due to a single cause.

Barriers must be addressed by leveraging multi-sectoral partnerships, which bring the unique expertise and resources of governments, non-profits, and industry to the table. Solutions require a long-term approach addressing issues of quality, affordability, availability, acceptability, and sustainability.

Emma Klatman is a health systems specialist at the international diabetes charity Life for a Child, which is tackling type 1 diabetes in low and middle income countries, where mortality rates among young people are especially high.

Living without treatment can have horrific consequences, she says, and young people are faced with blindness, losing limbs, developing kidney problems, and they just remain chronically unwell. They can struggle to complete their education, and find employment and marriage partners, and really do face a lot of social stigma.

The charity supplies local health centres with insulin, as well as blood glucose meters and testing strips, which Klatman says are an equally important part of effectively treating diabetes.

Its a point echoed by McGuire. Self-care is essential to meet the daily demands of managing diabetes therefore it is critical to take a people-centered approach to designing solutions, she says. Co-packaging of insulin, syringes, and glucose monitoring devices and strips together at an affordable price would go a long way to support people living with diabetes to safely administer insulin and monitor their glucose levels in low- and middle-income countries.

Next year is the centenary of insulins discovery, and ever since its first use the pharmaceutical industry has been developing new ways in which it can be delivered to patients.

The first insulin pen was introduced in 1985 and immediately improved the accuracy of treatment. Now researchers are exploring an oral treatment for type 2 diabetes that will mean patients no longer need to inject at all. A smart insulin patch is also being developed that delivers tailored amounts of insulin into the bloodstream, and a new generation of insulin pumps can now be connected wirelessly to a blood glucose meter or under-the-skin sensor to monitor and regulate insulin.

Research into the development of an artificial pancreas at the University of Cambridge is on-going, as is R&D into cell therapy, when living cells are injected into patients to take over the function of the faulty ones.

Sanofi, which along with Novo Nordisk and Eli Lilly make up the big three insulin manufacturers, has recently changed its approach to diabetes, shifting emphasis from new treatments to helping people to use existing medicines more effectively.

Working with Biocorp, for instance, Sanofi is developing a new connected pen that automatically records dosage information through a mobile app. Its MyStar DoseCoach blood glucose meter uses a dose adjustment (titration) scheme to recommend daily doses of long-acting insulin, based on daily blood sugar measurements linked to any incidents of low blood sugar through the day.

Looking at the economics of diabetes, Novo Nordisks Base of the Pyramid programme in Kenya addresses the many barriers to diabetes care faced by people on low incomes. It takes on board issues such as poverty, geography and gender, as well as the limitations of national health systems. Cost of transport, having to miss a days work and the need to buy equipment such as syringes are also flagged up.

Through working in partnerships across the supply chain, one of its successes has been a 75% reduction in the price of insulin. But, explains Soraya Ramoul, Novo Nordisks director of global access to care, the programme also showed that the price reduction in itself does not provide people with access to good care. Diabetes is a complex condition, which requires a systemic approach to ensure basic quality care and management, she says.

Affordability of insulin is just one of the necessary components, along with creating awareness in the communities, building capacity for care and medicine supply, educating patients, improving demand forecasting and reducing transportation costs for the patients.

Klatman sees the growth of partnerships like this as crucial to providing the level of diabetes care that is needed in developing countries, and looks forward to the day when families are able to access insulin and other supplies without being exposed to financial risk, and having to make really tough decisions to keep their kids alive.

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Global health policy: can we manage the ever-increasing rise of diabetes? - The Guardian