ESPE Yearbook of Paediatric Endocrinology

Lancet Diabetes Endocrinol 2019 Published Online March 13, 2019. DOI: 10.1016/S2213-8587(19)30083-X

• Practical challenges associated with diabetes care in humanitarian contexts in low- and middle- income countries abound.

• In this position paper, the authors articulate the important needs around diabetes care in the context of the 6 building blocks proposed in the WHO Health Systems Framework (1).

Three articles included in this chapter focus on access to insulin, metformin and blood glucose monitoring tools. Managing diabetes in a humanitarian setting markedly differs from care provided in otherwise stable low-resource settings. With more than 400 million people suffering from (mainly Type 2) diabetes, it is not surprising that diabetes, an NCD that has become a priority on the United Nations agenda, is a common cause of health consultations in refugee camps. This important article highlights several practical issues that go well beyond access to insulin and glucose strips. It makes us reflect on specific needs in emergency, high-risk situations and how to address them.

Key questions include: How to integrate diabetes care in general primary healthcare where expertise is usually unavailable? How to ensure self-management in conditions of food insecurity? How to store insulin and other temperature-sensitive medicines when electricity may be discontinued without warning? How to ensure treatment continuity when the unstable political situation may result in medication interruption (lessons learned from experience in HIV and tuberculosis treatment include the use of buffer stocks and runaway packs to help minimise interruption to medication)? Where to find protocols adapted to these particular conditions (Médecins Sans Frontières has developed guidelines to this effect (2)).

References 1. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. World Health Organization 2010. https://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf (accessed June 28, 2019).

2. Médecins Sans Frontières. Non-communicable diseases: programmatic and clinical guidelines, version 3. 2018. https://fieldresearch.msf.org/handle/10144/619084 (accessed June 28, 2019).