Ukrainian diabetes care, insulin access ‘severely disrupted’

Diabetes care and access to insulin and other drugs in Ukraine have been “severely disrupted” since the Russian invasion, with shortages stemming more from distribution issues than the supply itself, according to multiple sources.

In 2021, there were about 2.3 million people with diabetes in Ukraine, about 7% of the total population. Of these, about 120,000 have type 1 diabetes and depend on insulin for life, while a similar number were treated with insulin Type 2 diabetes.

Donations of insulin, other drugs and supplies have been pouring in since late February from sources including the Ukrainian diaspora, non-governmental organizations, other European governments, universities and product manufacturers. “The main problem now is logistics,” said Boris Mankovsky, MD, president of the Ukrainian Diabetes Association. Medscape Medical News in an interview.

Insulin maker Novo Nordisk’s warehouse continues to operate, although deliveries have been curtailed due to a lack of delivery staff. The company is working to get medicine to patients through pharmacies or humanitarian organizations and has funded efforts to support refugees, they said in a March 8 statement.

But even if supplies reach pharmacies, they may not reach patients for various logistical reasons, noted Mankovsky, who is head of the diabetology department at the PL Shupyk National Medical Academy for postgraduate education in Kyiv. “So there are a lot of problems. I don’t know exactly where the main bottleneck is, but there are definitely shortages.”

Insulin supplies were also very unevenly distributed across regions and types, with various shipments containing long-acting, short-acting, analogue or human insulins. “We’re very grateful for all of this. But it’s not centrally coordinated, which of course is understandable, but it means a lot of donations go to one place and no supplies go to another,” Mankovsky said.

Most of the donated supplies are destined for western Ukraine, where the capital Kiev is located. “But the main problem now is the eastern part of Ukraine. It is difficult and dangerous to deliver supplies there, especially [with] the terrible situation in Mariupol. Eastern Ukraine is now suffering the most, at least right now,” he said.

Diabetes specialists continue to work, at least for now

Ivan Smirnov, MD, PhD, head of the endocrinology department at Kharkiv Regional Hospital in the northeast of the country, said Medscape Medical News in an email, “I continue to stay in Kharkiv, despite the situation. Many people are killed, many people are injured. My hospital is full of injured civilians… many buildings are partially destroyed and some completely destroyed. “

Smirnov said he and his colleagues “found the way to overcome the fear… in constant work. Part of the work is online consultation support for routine patients… But the main time is now dedicated to providing insulin to diabetic patients. . It’s a heavy job to do indeed.”

Mankovsky, who practices adult diabetology and endocrinology in Kyiv, continues to manage patients, but mostly from a distance. “Practice is severely disrupted. I am willing to see patients but it is extremely difficult and dangerous for them and probably impossible to travel to see me. That is why all our communication is now remote, by phone or internet. We can communicate and I am able to provide recommendations for treatment changes or corrections in insulin therapy.”

Although the Russians are closing in on Kyiv, Mankovsky said: “I decided to stay as long as possible. So nobody knows of course, but I think I have to… We hear explosions every day. .. I’m downtown and the streets are empty. It’s heartbreaking.

Supplies reach refugees

Mankovsky said: “Now we have a huge movement of refugees. Among them there are a lot of people with diabetes who have left their homes and no one knows where they are. It’s really a huge disruption.”

According to type 1 diabetes advocacy organization JDRF says many diabetic men between the ages of 18 and 60 stay in Ukraine to fight, despite the increased risk of contracting the disease. But around 15,000 children with type 1 diabetes and their families are trying to escape the conflict by moving to western parts of the country or across borders.

“Those who travel to Hungary, Moldova, Poland or Romania are received with wonderful generosity. We have heard stories ranging from governments allowing insulin to be picked up for free without a script to individuals emptying their insulin cupboards for those in need is urgent,” JDRF said in a declaration March 2.

For its part, Novo Nordisk has donated 55 million Danish kroner (about 7.3 million euros, or 8.2 million US dollars) to support international humanitarian organizations in helping refugees.

Ivan Tkac, MD, PhD, professor of medicine at Safárik University, Faculty of Medicine in Kosice, Slovakia, helps refugees, including those with diabetes. Slovakia is mainly a transit country for refugees from Ukraine, he said Medscape Medical News.

“However, in solidarity with Ukraine, we are providing emergency medical care to Ukrainians and third-country refugees leaving Ukraine,” he said, noting that these people are mainly foreign students who go there. have studied.

“Asylum seekers are provided with comprehensive medical insurance paid for by the government of the Slovak Republic. As part of this care, refugees are provided with the necessary amount of insulin and other anti-diabetic drugs, as well as medical devices necessary for the treatment of diabetes. The European Commission is committed to supplying Slovakia with the necessary quantities of medicines for the treatment of diabetes in the coming weeks as part of its assistance to countries bordering Ukraine. some aid organizations organize supplies of insulin and other drugs for soldiers fighting in the Ukrainian army,” Tkac said.

How you can help

A number of organizations provide specific assistance to people with diabetes, as well as broader medical assistance to those who have remained in Ukraine and to refugees.

A collaboration between the Ministry of Health of Ukraine, the humanitarian agency Direct relief, and the International Diabetes Federation (IDF) is working to identify where supplies are in short supply, secure donations in Europe and open “green corridors” in Ukraine to get them quickly to where they’re needed. They asked those who wish to help to donate to Direct Relief and direct donations to the “Ukrainian crisis”.

Another effort organized by IDF Europe is Connect Solidaritya program that “aims to facilitate support for IDF Europe Member Associations across Europe who wish to assist other National Diabetes Associations in countries neighboring Ukraine, provide advice, medication and supplies to Ukrainian refugees”.

IDF President Andrew Boulton, MD, said Medscape Medical News that he has been in almost daily contact with experienced colleagues working in the field of diabetes in Ukraine and that he works with the charity affiliated with the organization The life of a child in addition to other charities. “We will continue to do our best to help people with diabetes living in Ukraine. However, it is of course very difficult, and we hope that we are doing our best in such a difficult situation. We all hope and pray for May this situation be resolved soon.”

The European Association for the Study of Diabetes takes a somewhat different approach, encouraging its members to “support those in poor health, including diabetes, with donations through [nongovernmental organizations] who have the ability to help on the spot, such as United Nations High Commissioner for Refugees Where International Committee of the Red Cross.

Mankovsky said Medscape Medical News that he is very grateful for all the support from around the world: “Just thank you. I have so much support, so many phone calls, so many letters… not just me, all of us. -wise, we feel supported. It’s really important, emotionally and with the supply of insulin and other medications. Without it, it would be much more difficult.”

Pandemic-induced changes enable diabetes care in wartime

The dramatic changes in the delivery of diabetes care in Ukraine necessitated by the COVID-19 pandemic proved indispensable during the Russian invasion.

In one room published in 2020 in the Journal of Diabetes Science and TechnologyMankovsky describes how the pandemic hit just as Ukraine’s healthcare system was shifting from government control to an insurance system.

Before the pandemic, patients with type 1 and type 2 diabetes were routinely admitted to hospital for routine check-ups, insulin dose management and other treatments, a “relic of medical practice of the Soviet era, which placed a strong emphasis on hospital admissions”. Mankovsky said Medscape Medical News.

This was the case, he wrote in the article, “despite the common understanding that such a system was a waste of resources…this policy was moving much more slowly than we would like”.

But the COVID-19 pandemic changed that practice “abruptly and drastically”, so that all hospitalizations of diabetic patients were stopped unless there was a real metabolic emergency.

Subsequently, Mankovsky wrote: “Almost all medical professionals recognize the special importance of new means of communication with patients and with other colleagues.”

Indeed, in his email to Medscape Medical NewsSmirnov mentioned that the routine diabetes management work he is still able to do remotely despite the extreme disruptions in his area “is easy due to the long-term experience of the COVID period.”

Also due to the pandemic, insulin prescriptions have moved from traditional paper to electronic transfer, so that patients can easily pick them up at the pharmacy. “This new… system has not only proven to be very convenient for all parties involved, but in the current situation, it has enabled us to avoid so many medically unnecessary visits to clinics, which otherwise would have posed the real threat. for patients’ health and the risk of infecting them,” Mankovsky wrote in 2020.

Now, with the new danger, he says, “the inability to see patients is probably the least of our problems”.

Miriam E. Tucker is a freelance journalist based in the Washington, DC area. She is a regular contributor to Medscape, with other work appearing in The Washington Post, NPR’s Shots blog, and Diabetes Forecast magazine. She’s on Twitter: @MiriamETucker.

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