Ukrainian Di­a­bet­ics Fed­er­a­tion head urges im­proved treat­ment


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.

Valentina Ocheretenko, head of the coun­cil of the Ukrainian Di­a­bet­ics Fed­er­a­tion, speaks in Kyiv on Nov. 9 dur­ing a press con­fer­ence ded­i­cated to World Di­a­betes Day, which is Nov. 14. (Volodymyr Petrov)

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