These days with the spread of Coronavirus a lot of attention has been directed to this disease; however, some Governments
.have neglected that there are other patients as well
The outbreak of Coronavirus and the internationally harsh situation it has brought, has changed priorities in health ministries. A sad point is that concerns of people with chronic diseases who are more vulnerable to Coronavirus have been disregarded. This means a red line
.in treatment patterns of diabetics
Diabetes is one of those diseases. Coronavirus pandemic, government and officials' viewpoint toward these people, sanctions, etc. have made the situation worrisome. We assume having access to treatment methods and healthcare services are our tangible rights. And no rule
.can ban us from reaching this right and basic need
In Iran there are more than 5 million people living with Diabetes who are now facing additional challenges with the shortage
.of Insulin
Devaluation of the Iranian Currency due to the sanctions, the high cost of Diabetes equipment, Insulin shortage and the fact that the government officials and relevant authorities are not taking responsibility toward these issues has forced the Diabetes community
.in Iran to launch a #thereisnoInsulin campaign on social media
Their goals are having access to valid insulin, problems of insulin pens delivery be solved, access to new and more affordable
.treatment and equipment, and improving the quality of life for the diabetics
In this reportage, we tried to study different kinds of concerns diabetics confront. We kept our study pure and far from any biased opinion
.or political issues. It is our duty as a member of NGO's to reform the present situation
Politics and Diabetes
Governments and global society should provide conditions for treatment methods to be delivered to diabetics without any political related concern. However, when we check the path we have passed, we notice that these basics have lost their meanings; none of governments
.nor UN has fully taken their responsibilities. It is the result of political lobbies, hurried decisions and weak supervisions
.nor UN has fully taken their responsibilities. It is the result of political lobbies, hurried decisions and weak supervisions
:As the insulin shortage happened, the chairman of the health economic commission of Tehran chamber of commerce announced
.“the import of insulin has been reduced recently”
Iranian organization of Food and Drug spokesperson in an unprofessional reply to a tweet suggested patients start reducing their insulin doses as a solution to the shortage!
:Nonetheless, he added
we are implementing a new system. So we will provide Insulin with lower prices soon. Meanwhile, Patients will need to show Identity Card to receive insulin.
.Because the price of Insulin in Iran is lower than most of other countries, preventative measures must be done against smuggling
we are implementing a new system. So we will provide Insulin with lower prices soon. Meanwhile, Patients will need to show Identity Card to receive insulin.
.Because the price of Insulin in Iran is lower than most of other countries, preventative measures must be done against smuggling
In addition, he stated: in Iran, the cost of analog Insulin known as insulin pen is high and the subsidy to insulin shows the price
.lower than world market while the cost of Bio similar Insulins is lower than original insulin. The use of analog insulin is raising in the world
.lower than world market while the cost of Bio similar Insulins is lower than original insulin. The use of analog insulin is raising in the world
Furthermore, he blamed sanctions and banking transactions for this problem. The main reason of insulin shortage is
.flagrant sanctions and companies' lax in their duties
.flagrant sanctions and companies' lax in their duties
The chairman of Iran food and drug organization believes the reason of insulin shortage is that a suitable budget is not attributed. He added: ''Iran requires 800 thousand analog pen per month''. He hopes the cost of insulin will reduce. A kind of media naughtiness has been created by foreign broadcasting services about the insulin pens transfer; they do not mention anything related to medicine sanctions. By the way, fortunately, medicine shortage statistics have just dropped.
Iranian health authorities have assured people that with lack of analog insulins at the Market, Isophane insulins and neutral insulins are available which leaves no worry.
They claim lower imports and a heavy subsidy system which has spurred smuggling of drugs out of the country are to blame for a recent shortage of insulin pens.
There are so many medicines in the long list of rare drugs. The condition of medicine is getting worse day by day.
Pharmaceutical & healthcare news agency (PHANA): hashtag of #thereisnoInsulin (#انسولین_نیست) is a part of the short and painful story of diabetics in this country. Insulin is necessary as Oxygen for Diabetics and this fact increases concerns about shortage.
There is a lack of insulin in pharmacies while it is sold out at the black market 10 times more expensive than in pharmacies. The import of pen needles has reduced too.
Iran’s insulin shortage has been exacerbated by stock piling of medicine by Iranian diabetics who are at higher risk of suffering complications from Coronavirus.
Sanctions against Iran means limited banking route options, which makes it more challenging to run our business in the country including availability of products.
The value of insulin consumers market in Iran is 140 million USD. Around 20-22 millions of insulin pen is our annual consumption. The pattern of insulin intake in Iran is 60% fast-acting, 30% long-acting, and 10% other types.
Head of Diabetes Department of the Ministry of Health and Medical Education claimed:
Unfortunately, Athletes use this type of insulin for bodybuilding and some of the opportunists sell Insulin at Black markets.
He added: insulin would be soon delivered to pharmacies. We do not have an insulin shortage in Iran but there is a lack of Insulin pen.
General Manager of Food and drug organization promises about 600 thousand pens of Insulin will be transferred from the storages to pharmacies.
Last year, director of national medical device directorate of Iran stated:
Based on our researches, we have shortage in 14 medical devices like bandages for EB patients because the non-domestic companies are very blasé about Iran and new sanctions are imposed every day.
NovoNordisk Pars has the highest earnings from insulin sales in Iran and Iranians have to buy Novo’s insulin pens at three to four times
.the reasonable price
.the reasonable price
120 physicians from all over medical universities of Iran sent letters to the president of Iran because of Insulin pens and blood sugar test strips problems.
At least there are 600 thousand person who need insulin daily, they said.
The president of Iran replied to them and promised to find a solution soon
Eghtesad 24 wrote:
Inflation in Iran is comparable to Germany in last century.
It is not important what type of merchandise e.g. onion or insulin is being Smuggled out of the country. Because in Iran goods are cheaper than outside of the country.
Smuggling to other countries occurs because of a deep devaluation of Iran national currency. Its result will be its cost and shortage.
Pupils Association News Agency(PANA) wrote: The insulin shortage problem will be discussed in health commission of Islamic parliament of Iran.
Mohammad Saleh Jokar, Yazd city's representative in Iran parliament on September 15th, had said:
Iranians are in suffer and hardship of providing the necessities, especially drugs like insulin. Why can't government do anything?
Islamic consultative Assembly News Agency, calls the rise of inflation, instability of currency, housing, automobile cost as the main causes of pressure on people.
In addition this agency wrote on November 2nd, Iranian MPs approve urgency of strategic plan to counter sanctions. Iran will produce 120 kg of 20%-enriched uranium annually.
Iranian police discovered insulin pens that were stored in Ghods city. However,
Few day later, Iran's food and drug organization announced those Insulins were not kept in proper temperature.
The Consistency of insulin shortage crisis in Yazd is obvious. Authorities' promise failed. Yazd has a high rank in Diabetes.
Government paid the subsidy to unnecessary goods and now we do not have enough money for insulin and agricultural products, Iranian Labor News Agency wrote.
Sanctions are not effective, the problem is past policy. Iran is an affiliate with the export of oil. If Iran had used the expense of importing insulin to build an Insulin factory, we would have become the biggest insulin producer.
Iran Metropolis News Agency wrote:
All medicines are scarce unless proved not to.
Not only is there lack of insulin, but also there is lack of the Plavix, The Flu vaccine, and Tetanus vaccine.
Islamic Republic of Iran Broadcasting: lack of insulin is the main cause of concerns in east Azerbaijan province
Insurance companies cover 70%-95% of Insulin costs.
People are worried because of the analog pens shortage.
The pharmacies believe that insulin is sold at black markets.
There is a lack of analog insulin but it does not mean there is no insulin. The vials of human insulin is accessible.
The Import subsidy of necessary goods must be cancelled and government have to allocate the subsidy in another way. Transferring insulin is the main cause of insulin shortage.
"There is no insulin" isn't only a hashtag on social media, it is actually the voice of 5 million people with diabetes.
The insulin shortage in Isfahan isn't a crisis. Insulin rationed in Iran, Public Relations Manager and Spokesperson of Isfahan University of Medical Sciences said.
Mardom news media quoting a critic, wrote: fundamental checking and observation of providing healthcare items like insulin is a necessity.
Because Iranian people problems will not be solved through buying a million dollars of insulin.
Iran distributed more insulin than last year in the market and we have scarcity yet.
Using TTAC application is the best and most modern way to find different kinds of medicine especially insulin in Iran.
:Donya e Eghtesad newspaper in quote of Tasnim news wrote
While the justification of spokesperson of IFDA is U.S sanctions, this is in direct contradiction with import statistics from Iran Customs House.
Nowadays while social media is replete with #thereisnoinsulin hashtag,some insulin shipments were found being smuggled from Iran to Iraq. Diabetics are recommended to reduce their insulin dosage by General manager of public relations in Ministry of Health.
Furthermore, Dr. Arash Moshiri who is an Internist, in an interview with the same newspaper says: About insulin related problems, Dr. Esteghamati claims: "the main material of domestically produced insulin is produced in China. This insulin is not of a high quality. Now, he is under pressure! The pharmacy company had threatened and forced him not to talk about other kinds of insulin with patients.
:Dr. Nima Ghasemzadeh, the development manager of goods in pooyesh Darou Biopharmaceutical Company reacted and said
based on scientific intuition, if there is any question or misgiving about drugs, they have to share the documents with drug industry specialists.
Based on a study by Gan and Lee, insulin production is approved in India, Indonesia, Thailand, Brazil, The Philippines, Turkey, Russia, Belarus, Czech Republic, and 20 more countries.
Denial of such approval seems to be a cognitive bias (Dunning- Kruger effect). Supervising the quality of manufactures and imported drugs in each country is the pharmaceutical regulatory Institution of that country.
Breaking news in quote of an official source wrote: the news of increased insulin import rate is not true; Iran has reduced insulin import this year.
In accordance with The Young Journalists Club (YJC) report, Iran's policy is based on Multi tire existing exchange rate system and this is another problem in Iran. The intake of insulin with insurance has reduced so much, so the selling and distribution of insulin is not in a proper way neither.
In addition, YJC adds around the U.S elections: The difference between Joe Biden and Donald Trump is like the difference between autumn and winter.
:The director of Yazd Diabetes Research Center, Dr. Aghaei, said on November 21st
"With the help of IFDA, the problem of insulin shortage in Yazd will be solved."
In addition, regarding the domestic production of analog insulin, he stated that it is not possible to issue a definite order for the production of Iranian insulin. Patients trust doctors and doctors recommend insulin types based on their possible side effects.
Mizan News Agency wrote on 23 November 2020: Behind the scenes of insulin imports due to insulin shortages in Iran, as always, Iranian officials linked the problems to sanctions, while according to documents, former IFDA executives have a key role in this problem.
April 4, 2015 is the black year of insulin in Iran, in which the former director of IFDA signed a contract with Vitane Pharmed and gave the company
.a monopoly on the production of Iranian insulin for 3 years, while the company did not produce insulin
.a monopoly on the production of Iranian insulin for 3 years, while the company did not produce insulin
The next problem is the monopoly of insulin imports in Iran to a Danish company that imports more expensive insulin to Iran than the
.world market
.world market
Decrease in economic growth, increased rate of unemployment, reduced incomes, non-fidelity of non-domestic companies and currency problem are main causes of diabetics problems growing. Furthermore, the U.S decided to increase economic pressure by cruel sanctions. Iranian patients need support of international communities to supervise medicines and equipments.Undoubtedly, it will hurt weak people more and more in this political game. Also some media are trying to express the voice of Diabetics in contrary to reality because of political issues
Advocacy
:Sina Mobasher Far, the representative of International Diabetes Federation in Iran and a member of the Iranian Diabetes Association says
There are two types of insulin in Iran. Analog and human. And because analogs are less peak effective, diabetics are less likely to have hypoglycemia which decreases their quality of life.
The Food and Drug Administration of Iran always gives full follow-up to patients but we have not seen any results and we have reports of no insulin in deprived areas. Although we can hardly find insulin in big cities.
Mohammad javad Asi, nutritionist at Yazd Diabetes research center says:
Although we are in 21 century, unfortunately, there are some Iranians who believe in unscientific treatments yet.
In addition, sedentary lifestyle is growing among Iranians who have to work more and more due to rising inflation while they do not attribute any time to exercise and physical activities.
Although Iranian do not have acceptable incomes, they tend to pay the high cost of medicines and treatment rather than being instructed in order to control their diabetes better. Diabetologists visit lots of patients daily while there are not many people getting advice from nutritionists. Nutritionists are trying to teach more and more diabetics but they have not been much successful.
The very first step to control diabetes is to teach these patients how to manage their food diets. Then, they must have their financial situation improved, so that they can buy equipments they need.
Today, Diabetes activists in Iran strive to change their society.
Shortage of insulin and equipments, lack of training and expensive diabetic supplies are the cause of their movement.
:Dr. Alireza Esteghamati, an endocrinologist says
Shortage of insulin pens is due to US sanctions and we have been facing this problem for 7 months. Also Under the influence of US sanctions, we are facing a lack of currency but The Central Bank of Iran did not allocate governmental currency to companies importing insulin. While the lives of diabetics depend on insulin.
Lack of insulin causes patients to reduce the dosage of insulin and as a result, unfortunately we are seeing an increase in sugar consumption and side effects in future, he said.
He believes that domestically produced insulin is not as much as patients need.
Dr. Sara Sedaghat, the head of education and research branch of Gabric Diabetes Education Association declares that medicine is expensive and there are few of them. And people have limited access to other medical items. It is not a new problem. During the previous year, people faced many difficulties as they couldn't supply their consumable medicines. Now it is diabetics turn. It is about days that they try to at least inform other people about their experience with this issue through social media, if it is not possible to tell their problem to authorities.
A diabetic person cannot live even a day without insulin.
:Tasnim Diabetes Association posted in its channel
While a diabetic life contains a lot of ups and downs, it is possible to control it with good coaching.
But these days, there is a real issue named lack of insulin pens that stops these teachings.
What masters of diabetes ask from government is to think about solving this problem once forever. Please do not cause diabetic children, youth, and elderly a new pain upon their painful disease.
Remember that insulin is not a luxury item, but vital for a diabetic person.
While there are insulins made in Iran, the problem is about the supply of analog insulin, which is not new.
:Hormoz keykhanzadeh, General Manager of Gabric Diabetes Education Association
.People are under pressure because of the disagreement between governments
In Iran 30% of Diabetics inject human insulin and 70% of them inject analog insulin
.They are unable to change analog insulin with human insulin especially in Covid-19 pandemic
Domestic productions such as insulin and glucometer are good but not accepted by Iranian diabetics. Insulin and glucometer are sensitive products.
?What do diabetics say
:Kamran
My name is Kamran. I live in Tehran with 30 years of diabetes experience. From my point of view, diabetics divide into two groups. The first group is a populated one that contains people who are not trained about diabetes and mostly do not have in-range blood glucose. The second group are trained about their diabetes and take care of their blood sugar.
It is important to know that there is no appropriate condition to train people about their diabetes in small towns and villages. While insurance organizations in Iran do not cover diabetic costs completely, there is no access to new technologies like Blood Sugar Monitors that are the easiest and most convenient kind of glucometers. On the other hand, insurance organizations cover drug costs like insulin for about 90 percent which is acceptable and diabetics receive insulin at a reasonable price
Another problem is domestic insulin. The government of Iran claimed that to make up the lack of fast-acting insulin, they have started to produce fast-acting insulin by NovoNordisk Pars Company. But still nothing is going on.
Moreover, there is Iranian long-acting insulin called “Basalin”, but it costs the same as the original one. Who knows why?
:Tahmin
My name is Tahmin, I’m diabetic since 2012. Unfortunately, in Iran the government does not care about diabetics and training them. Also, they do not pay enough attention to diabetics. We do not have access to justifiable facilities. However, insurance organizations covered pen insulin adequately before the spread of Covid-19, now the situation is not acceptable.
My name is Mitra, and I was diagnosed with diabetes at 10. I live in Shahin shahr which is located in Isfahan province. During previous year, we faced lack of insulin in a way that we couldn't find insulin for some months. Therefore, we started finding people who do not have insulin through social media and someone who has saved their insulin from before, will deliver some pens to those need it.
Drugstores recommend us to use similar insulins instead. While they are different in peak time of effect and also the time it takes to start affecting. Thus, it takes time to adapt ourselves to these new insulins.
Pay attention when a diabetic person can’t receive enough insulin. It causes a real problem in its diet and affects the immunity system, while it should not be this way especially in Coronavirus pandemic. If we do not have access to insulin, it makes the situation stressful, like what is happening nowadays. If a diabetic person does not have access to insulin for a long time, it causes Diabetic ketoacidosis, diabetic coma and finally death.
Sina, who has had diabetes for more than 18 years has been treated with human insulin for nearly 8 years and says in this regard
The main problem with this type of insulin (NPH specially) is that it will decrease the quality of life for people with diabetes.
The time of peak effect of this insulin has caused me to have severe hypoglycemia while sleeping and it bothered me a lot as a child until I switched to analog insulin. Easy to use, less Peak effect, Better blood sugar control and many other positive points results in an increased quality of life.
But these days we are facing lack of insulin in Iran. There are various reasons, but the most important is US sanctions. As you know economic sanctions cause exchange problems and importing insulin in dollars and euros is a big expense for the government.
On the other hand, we are facing a shortage of blood sugar test strips. Although we do not have access to modern devices like freestyle libre, dexcom and insulin pump, we expect to access minimum and basic diabetic necessities.
:Saman says
I am Saman from Iran with a 28-year history of diabetes. Unfortunately, my country is in a situation where it has always had a number of problems and shortcomings. One of these shortcomings is lack of medicine. Now that we are under a chain of brutal sanctions, many drugs have become scarce, such as insulin and blood sugar test strips.
:Mohammad Javad says
I'm Mohammad Javad. I have 6 years of diabetes experience. From the very first days, I have used analog insulin. It was last year that I experienced insulin shortage for the first time.
As a diabetic, this is too stressful when you know your most important medicine is becoming rare. To understand me better, imagine a fish left outside of the water. The reasons of this shortage are as followed
1- Medicine sanctions that are imposed on our country with the aim of making basics hard to get for Iranian.
2- Carelessness of authorities who have different responsibilities in related organizations.
3- Spending money not in crucial fields like medicine and prosperity, but in not very important ones.
These are main reasons of this horrible situation. We, Iranian diabetics, as a 6 million society want our voice to be heard by international organizations. We need this problem be solved as soon as possible.
The Economic cost of Diabetes
Total annual direct costs of diabetic and control participants were 2.3 ± 14.5 and .0 ± 5.8, respectively, which is indicative of 2.92 times higher costs in diabetic patients. The most expensive components of direct costs were medications and devices, and hospitalization in diabetic patients (28.7% and 28.6%, respectively). Total indirect costs were .6 ± 2.4 and .7 ± 1.1 in diabetic and non-diabetic individuals. The aggregate annual direct costs of diabetes were estimated to be 2.424 ± 10.732 million and 0.676 ± 65.985 million in Tehran and Iran, respectively. Diabetes complications contributed 53% of the aggregate excess direct costs of diabetes.
Diabetes is an expensive medical problem in Iran and planning of national programmers for its control and prevention is necessary.
And also based on a study in 2012 in Iran
Total economic costs of type II diabetes is calculated 37,942,315,040 Rials (4,079,818.8 $), that medical direct costs and indirect costs share was 3,994,348,680 (429,499.9 $) and 33,947,966,360 (3,650,319 $) Rials, respectively. Medical direct and indirect costs of diabetes in a type II diabetic patient in first half of 1387 was 815,173/2 (87.65 $) and 6,928,156/4 (744.96 $) Rials respectively, and altogether was 7,743,329/6 Rials (832.61 $).
Conclusion: Economic cost of type II diabetes is very high and complications of this disease can have an important influence on patient and their family. Because of restricting resources of medical-health in society, diabetes must be one of medical-health priorities in our country and measures should be taken to reduce costs and complications of this disease.
In a research in 2016
2898 number of cases were reviewed in this study; 63.8 % women and 36.2% men. 4.3% of the patients were placed group I; 50.1% in group II, and 34.6% and 11% in groups III and IV respectively. The age distribution of the patients varied widely from 30 to 90 years; 5.8% between 30 and 39 years, 62.3% between 40 and 59, and 31.9% at 60 and over. Nephropathy (72.4%), and neuropathy (39%) were the most frequent adverse effect among type 2 diabetics in Isfahan. The group III with spending 2.3 in total was absorbed the highest amount of the resources between the patients’ groups. The average direct medical cost of outpatient cares of diabetics per year was 155.8 US $.
The direct medical cost of diabetes management is progressed sharply in past years in Iran. Pharmaceutical expenditures were the main cost component of outpatient cares for diabetes. It is estimated that the Iranians directly spend approximately .05 milliard annually to manage 5.2 million diabetics in the country.
Also based on a research in YAZD in 2019
The majority of people with diabetes are aware, but half of them are not controlled. The ineffective care plan currently in use, should be reviewed. Patients need to be encouraged to improve their lifestyle. Active follow-up of patients is recommended to ensure continuity of care.
Based on a research about Challenges of managing diabetes in Iran published in 2020:
Six main themes were identified including holistic understanding of patients, leadership and governance difficulties, service delivery, workforce, financing, and information and research.
Challenges regarding the management of diabetes in Iran is multifaceted. Reforming the health care system or developing complementary strategies is essential to improve suitable health care model for patients with chronic conditions such as diabetic patients.
In addition, in a research published in 2020
The average cost was .228 for analog users and .826 for regular insulin users. An ICER of .093506/QALY was obtained. The present findings suggest that insulin analogs are more cost-effective than regular insulin.
And in another research:
After reviewing title, abstract and the full text of identified articles; a total of seven studies reported appropriate data for this meta-analysis. The pooled annual treatment cost per diabetes patient for EMRO countries was 1150 US$ (95% CI: 595–2221) which was 3358 US$ (95% CI: 2200–5124) in EMRO countries except Iran compared to 255 US$ (92–708) in Iran. The treatment cost of diabetes was higher in males, insulin-used and in the patient with family history of diabetes. The cost of diabetes significantly increased with the duration of diabetes (P = 0.001) as well. According to the results, the largest share of costs is related to medication costs. Finally, the pooled average annual treatment cost per patient by diabetes mellitus complications was varied from 2828 US$ in the patients that have cerebrovascular disease complications to 7261 US$ in the patients with Stroke complication.
This study demonstrated that the annual treatment cost of diabetes is varies within EMRO countries. Qatar and Iran have spent the highest and lowest cost for diabetes, respectively. This may be due to the large socioeconomic differences between countries and special conditions of them such as currency value in the region.
:Provided by
Virtual group of Iranian Diabetes Cooperation Council
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