Global Diabetes Landscape Analysis Part II 

Healthcare
Written By Girls Who Impact .

— A Deep Dive into Kenya's Diabetes Treatment Availability for Patients

Author: Doris Li

Image source: Endocrine Society

Highlights:

  • Type 1 diabetes requires lifelong insulin management, alongside dietary and lifestyle adjustments. The global average cost of insulin and diabetes care can exceed 10% of a family's income in LMICs, posing a substantial financial burden.

  • In Kenya, a detailed study showed that only 32% of diabetes patients had achieved the recommended glycemic control targets, largely due to inadequate access to medications and monitoring devices.

  • Type 2 diabetes, comprising about 90% of all diabetes cases, can often be managed through oral medications, lifestyle changes, and in some cases, insulin therapy. However, in countries like Kenya, the prevalence of diabetes is increasing, yet over 60% of those needing insulin do not have consistent access.

  • General awareness and understanding of diabetes among the Kenyan public are low. There is a lower priority on generating diabetes awareness, prevention, and management, creating a gap in timely diabetes prevention/treatment education and a delayed disease diagnosis, making management more complex.

 

Introduction to Diabetes Treatment Dynamics

As diabetes continues to be a major global health crisis, affecting an estimated 463 million people worldwide, there is increased focus on the various disease management strategies employed across different socio-economic contexts. Particularly in low to medium-income countries (LMICs) such as India, Nigeria, Kenya, and Bangladesh, the challenge of diabetes treatment is exacerbated by a myriad of factors including economic constraints, healthcare infrastructure deficiencies, and a lack of widespread awareness and education about the disease. This analysis explores the treatment modalities for Type 1 and Type 2 diabetes and examines the state of diabetes care in low- and middle-income countries (LMICs), with a particular focus on Kenya. By concentrating on Kenya, the analysis aims to highlight disparities and identify potential pathways for improvement. The choice of Kenya as a focal point is intentional, providing a perspective on the complex challenges and opportunities involved in managing diabetes within the socio-economic and healthcare frameworks common to LMICs. Kenya's experience encapsulates critical issues such as economic barriers, healthcare delivery systems, and educational gaps faced by many LMICs, offering a valuable case study for drawing broader insights and strategies that could be applied or adapted in similar contexts worldwide. By closely examining Kenya's approaches to diabetes care, this analysis seeks to uncover actionable solutions and promote a deeper understanding of effective diabetes management in resource-constrained environments.

 

Type 1 Diabetes: An Insulin-Dependent Journey

As discussed in Part I of the Global Diabetes Landscape series, Type 1 diabetes requires continuous insulin therapy because the pancreas does not produce sufficient insulin. For patients with Type 1 diabetes, insulin treatment is essential for survival. However, accessibility and affordability of insulin pose significant challenges in low- and middle-income countries (LMICs). Approximately 35% of patients in LMICs purchase their medications out-of-pocket in the private market, where insulin prices are substantially higher compared to high-income countries, often around $50.

This substantial price disparity is influenced by various factors. The insulin market is dominated by a few multinational corporations that possess significant pricing power due to limited competition. Additionally, many LMICs rely heavily on imported insulin, which incurs high tariffs and additional supply chain costs, further inflating prices for consumers. Regulatory barriers in these countries frequently hinder the introduction of more affordable generic insulin, perpetuating high market prices. Economic factors, including weaker purchasing power, fluctuating exchange rates, and general economic instability, further contribute to the high costs of maintaining insulin supplies. Furthermore, limited healthcare infrastructure and logistical challenges in distributing insulin, especially in remote areas, exacerbate these issues.

The price of insulin is a heavy burden compared to the average monthly income in Kenya. According to the Kenya National Bureau of Statistics, it was about KES 50,833 (approximately $440) as of 2020. This means that for a typical family, purchasing insulin could consume over 10% of their monthly income, not accounting for other diabetes-related expenses such as glucose monitoring supplies, which can add financial burden. Furthermore, Analog insulins are often preferred due to their closer mimicry of the body's natural insulin release and lower risk of hypoglycemia. Analog insulin products cost two to six times more than the normal insulin that is widely used for treatment, and this significant cost disparity occurs despite the negligible difference in manufacturing costs between the two types of insulin. (CIDRAP: https://www.cidrap.umn.edu/report-low-access-insulin-poor-countries-hinders-diabetes-care)​.

 

Type 2 Diabetes: A Broad Spectrum of Management Approaches

Type 2 diabetes, which accounts for approximately 90% of diabetes cases worldwide, can often be controlled through oral hypoglycemic agents, lifestyle modifications, and, in certain situations, insulin. Despite the broader array of treatment options compared to Type 1 diabetes, the challenges of treatment accessibility, affordability, and adherence remain acute in LMICs. 

In Kenya, for example, the rising prevalence of Type 2 diabetes contrasts sharply with the availability of essential medicines and healthcare services. Furthermore, over 60% of Kenyans requiring insulin face significant obstacles in obtaining it, further compounded by a lack of access to regular medical consultation and diabetes education. Additionally, the report by CIDRAP revealed that in LMICs, including Kenya, many patients pay for their medications out-of-pocket on the private market, where insulin prices are higher compared to higher-income countries. This situation is exacerbated by infrastructure challenges that hinder the storage and distribution of insulin, making essential medication less accessible to those in need​ (CIDRAP: https://www.cidrap.umn.edu/report-low-access-insulin-poor-countries-hinders-diabetes-care)​.

 

Image source: National Institute of Diabetes and Digestive and Kidney Diseases

 

Kenya's Diabetes Treatment Landscape:  

In the vast field of global health challenges, diabetes stands out as a major issue, especially in low- and middle-income countries (LMICs) like Kenya. Kenya, like many other LMICs, struggles with diabetes care due to economic limitations and underdeveloped healthcare systems. 

Despite the country’s efforts to improve healthcare and provide subsidies for diabetes management, there is still a significant gap in meeting the needs of its population. According to data from the Kenya Ministry of Health, only 32% of Kenyans with diabetes are able to achieve the blood sugar control levels recommended by international health guidelines. 

In Kenya, as in many low- and middle-income countries, the struggle against diabetes highlights broader systemic challenges. The cost of essential diabetes medications, including insulin, imposes a heavy financial burden on families. This is largely due to the global insulin market's pricing strategies, and the fact that insulin medications are led by a few major 

pharmaceutical companies, which disproportionately affect patients in less affluent countries. Efforts to mitigate these challenges have been fragmented and limited in scope, failing to bring about significant change. Additionally, the scarcity of healthcare professionals trained in diabetes care, particularly in less urbanized areas, further complicates timely and accurate diagnosis. 

Moreover, the general awareness and understanding of diabetes among the Kenyan public are alarmingly low. Limited initiatives focusing on diabetes awareness and prevention mean that essential knowledge about the disease, its risk factors, and the importance of early detection and management is lacking. This gap in receiving timely diabetes prevention/treatment education contributes to delayed disease presentation and diagnosis, making management more complex. Addressing these challenges requires a coordinated, multifaceted approach, including policies to make diabetes care more affordable, expanding education and training for healthcare professionals, and enhancing public health campaigns to raise awareness. Such strategies are crucial steps towards a healthier future for diabetes patients in Kenya and other similar regions around the world.

 

Conclusion: Enhancing Diabetes Care in LMICs

The management of diabetes in LMICs, and particularly in countries like Kenya, calls for a multi-faceted strategy that transcends the mere provision of medications. Integral to this approach are strengthening healthcare systems, implementing cost-reduction measures for essential diabetes medicines and supplies, offering education and training programs for healthcare providers, and conducting widespread public awareness campaigns. Moreover, international collaboration and support are crucial in amplifying these efforts, leveraging global expertise and resources to build a sustainable model for diabetes care in LMICs. Achieving substantial progress in diabetes treatment in these regions requires a concerted effort from governments, non-governmental organizations, the private sector, and international health bodies.

 

Citations:

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