Diabetes and the Need for Insulin

Insulin is a naturally occurring hormone that converts sugar, starches and other food into needed energy. People living with diabetes either no longer produce insulin (type 1 diabetes) or their bodies have become resistant to it (type 2 diabetes). For over 90 years those living with type 1 diabetes have relied on external insulin (currently available in bovine, human and analogue forms) to survive. Today, around 100 million people around the world need insulin, including all people living with type 1 diabetes and between 10-25 percent of people with type 2 diabetes. But globally, more than half of these people cannot afford and/or access this much-needed medicine. Without access to insulin, people living with type 1 diabetes will die. Many more will suffer from diabetes-related complications, like blindness, amputation and kidney failure, and, ultimately, premature death.

Barriers to Insulin Access
David Beran and the International Insulin Foundation studied access to insulin in Kyrgyzstan, Mali, Mozambique, Nicaragua, Vietnam and Zambia. Various health system factors, such as poor purchasing practices, distribution channel problems and irrational use, resulted in poor insulin availability and unaffordable treatment costs. In 2010, Health Action International undertook a global survey of insulin prices which showed a 5,000 percent variation, from US$1.55 per vial in Iran to US$76.69 per vial in Austria. Problems accessing insulin also exist in more unexpected places. For example, patients in some communities in the United States have reported rationing or even going without insulin due to high insulin costs.

These studies, and other work by the International Insulin Foundation, provide a good understanding of the barriers to insulin access at a country level. Attention is now needed on the global insulin market.

The ACCISS Study
A solid understanding of what is causing the barriers to insulin access is needed so inequities and inefficiencies in the global insulin market can be addressed. A global study, called Addressing the Challenge and Constraints of Insulin Sources and Supply (ACCISS), sets out to do this and more. ACCISS is being co-led by Margaret Ewen at Health Action International, David Beran from Geneva University Hospitals and the University of Geneva and Richard Laing from Boston University. It involves a unique group of leading international experts as members of the study’s advisory and technical groups. ACCISS is being funded by a US$1.25 million grant from The Leona M. and Harry B. Helmsley Charitable Trust. The three-year study is being conducted in phases and a virtual advocacy network will be developed over the course of the study.

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