Valentina Ocheretenko, head of the council of the Ukrainian Diabetics Federation, told the Kyiv Post ahead of World Diabetes Day on Nov. 14 that the Ukrainian government needs a more effective treatment policy.
An estimated 1.38 million people in Ukraine — with the numbers rising fast — are potentially facing the lethal consequences of the disease.
“People in Ukraine are still not informed properly on how to prevent diabetes. Those who are already sick get no insulin, no proper treatment and even sometimes have no professional doctor for help,” Ocheretenko said on Nov. 8.
Diabetes is still being diagnosed too late in Ukraine, Ocheretenko said, and the true number of diabetics in Ukraine is not known — but could be double the 1.38 million estimate.
Globally, the number of people with diabetes has risen from 108 million in 1980s to more than 422 million in 2014, the World Health Organization reported. More than 156 countries have adopted comprehensive policies to reduce diabetes or help those with the disease.
A key feature — ensuring insulin to people — is not working well in Ukraine. “We have insulin reimbursement system in Ukraine. But it is far from perfect and not enough,” Ocheretenko said.
Money is life
Ocheretenko said that the average cost per month of insulin is more than Hr 3,000, about the same as the minimum wage of Hr 3,200.
The government spends approximately Hr 6,000 for every insulin-dependent patient a year, Ulyana Suprun, acting health minister said during a cabinet meeting on Aug.23. In April 2016, the Cabinet of Ministers adopted a plan for reimbursement of the costs of insulin and other drugs needed for patients with chronic diseases.
Insulin-dependent people can bring a prescription from a doctor to a pharmacy and get the insulin for free. The health ministry will compensate the pharmacies. However, only those patients registered in the insulin-dependent patients’ registry will get the free insulin.
The Health Ministry reported on Aug. 29 that, although the cabinet ordered creation of the registry in March, it did not fully operate until August.
“Insulin is a hormone, responsible for glucose splitting, which gives us energy, needed for survival. Diabetics just can’t produce this hormone naturally,” Ocheretenko said.
People with the first type of diabetes (5–10 percent from the 422 million people) need insulin every day, and sometimes a couple of injections, she added. “Even a single missed dose can have consequences. A couple of days can lead even to death. No insulin means no life,” Ocheretenko said.
The Ukrainian government spends more than Hr 600 million every year to purchase insulin, the health ministry reported on Aug. 29. That sum covers about half of the needs. Local councils were responsible for supplying the insulin, buying it through long and sometimes nontransparent tender procedures, which sometimes can last more than three months.
As a result, many people still have no timely access to insulin and have to purchase it with their own money, Ocheretenko said.
“The government’s reimbursement allowed the doctors, who have secret agreements with pharmacies, to intentionally prescribe the most expensive drugs. There are no price and quality control over the insulin,” Ocheretenko said. “All this must be changed. As the person’s life must not depend on the amount of money in his wallet.”
Mess with data
Not all diabetics need insulin. Only a doctor can decide, Ocheretenko said. However, in Ukraine, the system is slightly different, according to Suprun.
“Before the register, the government had been allocating money to buy insulin for more than 50,000 people, who are not among the insulin-dependent diabetics,” the minister said.
However, Suprun admitted that Kharkiv, Lviv and Dnipro authorities still hadn’t put data about their insulin-dependent inhabitants in the register as of August.
Already, however, 170,000 patients are in the register. The government will spend Hr 6,000 per patient or Hr 1 billion, Suprun said.
National policy
Ocheretenko said that reimbursement and a register are not enough. Better physician care is needed, she said. There are not enough endocrinologists in Ukraine.
“The situation is very unstable. It is still hard to find a credible endocrinologist whom a diabetic could entrust his or her life to,” Ocheretenko said.
No reliable statistics exist about number of deaths caused by diabetes in Ukraine, she said. “People here being diagnosed with diabetes too late to find the proper treatment,” Ocheretenko said.
The government blames people for not seeking medical care earlier. While true, Ocheretenko said that people need to be educated first about diabetes and the dangers they face.
Also, Ukrainians don’t pay enough attention to healthy lifestyles, including diet and exercise. “People still think tackling with the health problems can be postponed, which is wrong,” Ocheretenko added.
To improve the situation, the nation needs a more comprehensive policy to reduce diabetes, she said.
