Diabetes treatment > Access and supply

Bambi is a 19-year old Mauritanian woman. Illiterate and poor, she is married and has a four-year-old daughter. Early in 2008, she was diagnosed with type 1 diabetes. It took her 10 months of struggle to learn to read her blood glucose monitoring device and inject insulin.

President's editorial

Editor-in-Chief's editorial

People with diabetes occupy a significant proportion of hospital beds – about 10% in the UK, although this may be an underestimate. While diabetes specialists are often based in a hospital, the majority of people with diabetes who are admitted to hospital – at a time when their diabetes might be difficult to control – do not actually meet the diabetes team.

The number of people with diabetes is on the rise worldwide, posing previously unknown challenges for healthcare systems. In Germany, the prevalence of diagnosed diabetes is estimated to be nearly 7% – almost 6 million people. Additionally, it is estimated that  around another 3 million people living with diabetes are undiagnosed – around half the population with diabetes aged between 55 and 74 years according to one German study.

Diabetes in young people is a heavy burden all over the world but it is particularly severe in developing countries. Although the condition is the same, the context can be very different. Young people with diabetes in the Democratic Republic of Congo have to face a number of major challenges. They are perceived as having a ‘mysterious disease’ which requires a lot of attention on a daily basis throughout a lifetime. Belief in spells is quite common in Africa, and many families feel it is their responsibility to find the person responsible for causing the diabetes.

Approximately 13 million people reside in the 80 Mexican municipalities and 48 US counties located along the US-Mexico border; 86% of those people live in 14 pairs of sister cities – metropolitan areas divided by the frontier. Border residents share similar resources and environmental problems. Issues of great concern include air quality, the availability and quality of water, and animal control. The communities along the border are economically and socially interdependent, with more than a million legal north- and southbound crossings every day.

An article in this magazine in March 2004 described the Rapid Assessment Protocol for Insulin Access in Mozambique, and some of the results from its implementation. Since it was carried out in 2003, much has changed in Mozambique with regards to access to insulin and diabetes care. The Protocol provided vital information on the areas that the healthcare system needed to focus upon in order to improve care.

Like many other developing countries, Algeria is undergoing a transition in its disease  profile. The emergence of non-communicable diseases, including obesity-driven type 2

If a child with diabetes develops ketoacidosis, it is absolutely critical that his or her parents are able to contact a trained healthcare provider immediately, 24 hours a day. Many parents report particular difficulties finding an experienced paediatrician to manage this emergency at night, and during week-ends and holidays. It has been demonstrated that these difficult situations can be overcome effectively using widely available telephone technology.