In early May 2024, the National Department of Health (NDoH) in South Africa faced a significant setback for people with diabetes. The department announced a potential shortage of insulin pen devices, directing health facilities to ration their distribution.
This alarming news came after a tender process that failed to meet the demand, leaving many patients in a challenging situation.
Novo Nordisk, the main supplier of insulin pens in South Africa, had previously provided over 14 million pens in just three years.
However, due to supply issues, insulin manufacturers began offering only vials, forcing patients to revert to using syringes for their injections.
Doctors Without Borders (MSF) Southern Africa raised concerns about this shift, highlighting the risks that come with using vials instead of pens.
They emphasised that switching to syringes could lead to complications for many diabetes patients, urging Novo Nordisk and other manufacturers to take responsibility and ensure a steady supply of insulin pens.
In recent years, insulin pens have become popular in the public health sector due to their numerous benefits.
They provide improved dosing accuracy, are easier to use, and help patients adhere to their treatment plans better.
This transition aligns with the National Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2022-2027, which aims to enhance diabetes management in the country.
The plan sets ambitious goals: to ensure that 90% of adults know their blood pressure and blood sugar levels, 60% of those with high levels get treatment, and 50% of treated individuals have their levels under control. These measures are crucial for improving diabetes care and outcomes in South Africa.
Dr Asafika Mbangata, the Medical Advisor for Diabetes at Sanofi, explained that the South African Department of Health issued a circular identifying patient groups that would benefit from these analogue insulins.
Vulnerable populations, including the elderly, young children, and individuals with visual impairments, were highlighted as priority groups.
Advantages of using insulin pens
Long-acting insulin analogues offer several benefits over traditional human insulin. They provide a longer duration of action, more stable blood sugar control, and a reduced risk of hypoglycemia (dangerously low blood sugar).
These advantages are crucial for patients who struggle with severe blood sugar drops. Studies have shown that these analogues can lead to better reductions in HbA1c, a key indicator of blood sugar levels.
Diabetes Type 1
In South Africa, more than 31 000 people live with Type 1 diabetes, requiring full insulin replacement therapy through multiple daily injections. Among these, about 5,000 are children.
Mbangata emphasised that insulin pens significantly enhance the quality of life for these patients. “Insulin pens are more accurate and user-friendly,” she noted.
They use short, fine needles that make injections less painful, which is especially important for children. When using pens, kids are more likely to stick to their treatment plans.
Diabetes Type 2
The situation is just as serious for those with Type 2 diabetes. According to the International Diabetes Federation, about 4.2 million South African adults have diabetes, with 84% relying on public healthcare.
Diabetes is the second leading cause of death in South Africa, following tuberculosis, and it is particularly deadly for women, explained Mbangata.
Among the elderly, over 600 000 individuals live with diabetes, with around 500 000 accessing care through the public sector. Given this context, the shift from insulin pens to vials and syringes poses significant risks.
The risks of using vials
The shift back to using vials and syringes due to insulin pen shortages poses serious risks for these patients.
While vials may be a temporary solution, they come with challenges such as less accurate dosing and increased discomfort during injections.
This can lead to poor adherence to treatment, worsening health outcomes, and higher risks of complications.
Treating diabetes in the elderly often requires a multidrug regimen, including insulin therapy. However, due to comorbidities such as dementia, vision loss, neuropathies, poor mobility, and manual dexterity issues, elderly patients are at increased risk of hypoglycaemia and dosing errors associated with insulin administration.
Insulin pen devices have been shown to provide more reliable, accurate, and simplified dosing, making them a safer and more acceptable method of insulin delivery for the elderly population.