Availability and accessibility of insulin and insulin supplies among insulin-dependent patients in Yerevan, Armenia

Abstract

Diabetes is one of the most common non-communicable diseases in the world and is reaching epidemic proportions worldwide. The availability of insulin and insulin supplies is known to be compromised in many countries, leading to early complications and premature death caused by the progression of the disease. Nowadays, patients with diabetes in Armenia constitute a distinct group of population, qualified as having a “special disease.” This status entitles diabetes patients to free-of-charge drug supplies, catered by polyclinics, or other ambulatory institutions, under a state guarantee. Objectives: The study aims at assessing accessibility/availability of insulin and insulin supplies and thus, determining the barriers to availability of insulin and insulin supplies among insulin-dependant diabetes patients in Yerevan, Armenia. There are no official data on the extent of insulin and insulin supplies availability and accessibility among the insulin-dependent diabetes patients in Armenia. The study will help to understand the current situation of insulin and insulin supplies availability and fill the research gap in this area. Study Methods and Design: The study employs descriptive cross-sectional design. Key informant interviews have been conducted with two endocrinologists. Seventy patients diagnosed with diabetes from twelve polyclinics and diabetic clinic of Yerevan participated in the study. Interviewer-administrated questionnaire has been used to collect information from the sample diabetes patients. The study has been reviewed and approved by the Institutional Review Board Committee of the College of Health Sciences at American University of Armenia. Results: The data analysis has indicated that 68.6% of the surveyed diabetes patients experienced insulin interruption during the last one year. Among the major reasons for the interruption were “occasional” absence of insulin in polyclinics/diabetic clinic, insufficient amount of insulin provided to patients, and the deficiency of the needed type of insulin. The data have revealed low levels for self-monitoring of blood glucose and self-management of glucose testing in urine by patients. In particular, 47.1% did not perform blood glucose testing, while 91.4% have skipped urine glucose testing at home. The main reason for low self-testing is the lack of device, special strips, as well as inadequate level of appropriate patient knowledge. Conclusion: The study has revealed that there are often interruptions in insulin provision among the diabetes patients and lack of insulin supplies leading to low self-monitoring. Based on the results of the study, it is recommended to design and conduct studies among the primary-level physicians and other stakeholders, with following recommendations on drug distribution policy improvement. To increase the knowledge on diabetes self-management educational programs should be arranged and provided to diabetes patients.