Diabetes Care When Systems Are Under Strain

Diabetes does not pause for conflict, displacement or economic hardship. Insulin must be taken every day, kept at the right temperature and matched with monitoring. This quarter, three very different settings showed both how quickly care can collapse and how well people can do when it is protected.

In Gaza, reports in August described people with diabetes relying on expired insulin, and children admitted to intensive care with diabetic ketoacidosis. Estimates from the Palestinian Ministry of Health in 2024 suggested that around 71,000 people with diabetes in Gaza lacked adequate care. Dr Ibrahim Dhair, a diabetes consultant in southern Gaza, described a crisis beyond the capacity of the remaining health system.

In Europe, a study published on 24 July in Frontiers in Endocrinology offered a hopeful counterpoint. Researchers followed 143 Ukrainian refugee children with type 1 diabetes across nine Czech diabetes centres for three years. Median HbA1c fell from 7.5 per cent to 6.9 per cent, use of continuous glucose monitoring rose to 95.5 per cent, and use of automated insulin delivery rose from zero to 63.6 per cent. Children using automated insulin delivery reached the same glucose control as their Czech peers. Displacement did not determine their outcomes; access to care did.

In Kenya, Médecins Sans Frontières (MSF) called on 7 July for the Social Health Authority to add analogue insulin pens and pen needles to its benefits package. MSF cited an estimated 813,300 adults living with diabetes in Kenya in 2021, more than half of them undiagnosed, and noted that around 8,000 children already receive analogue pens through the Changing Diabetes in Children programme.