IDF21-0030 More than a third of SACA countries (South and Central America) do not have coverage of insulin, supplies and lab exams
Background: The IDF Diabetes Atlas 2019 points out that SACA is the region with the highest percentage of health expenditures on diabetes, 19.4%. The total number of individuals with diabetes in the region is 31.6 million, which means a prevalence of 9.4%. Countries with the largest percentage of expenditures are Cuba (24.3%), Brazil (24.2%), and Costa Rica (21.3%), while the lowest estimates are for Argentina (5.0%) and Uruguay (6.1%). Aim: Identify if insulin, oral medicines, supplies (syringes, test strips, needles, etc.) and lab exams are fully provided (free of charge) in those countries and if there is an association between percentage of expenditures on diabetes and care provision. Method: A digital online survey with 12 multiple choice questions was shared by e-mail and WhatsApp with all IDF members organizations in the SACA region. It was open for answers between April 4th and May 5th, during the COVID-19 pandemic. The question of interest for this abstract was specifically about access to medicines and lab exams. Mean diabetes-related expenditure (USD) per person with diabetes (20–79 years) was based on IDF Diabetes Atlas 2019 data. Wilcoxon signed-rank test was used to compare expenditures of countries providing free supplies with those without free medical supplies. Results: The questionnaire was answered by 16 of the 18 IDF SACA region countries. Colombia and El Salvador were the only countries with no response. Most of the countries reported free access to oral medicines (69%), insulins (63%), supplies (syringes, needles, test strips, etc. - 56%) and lab exams (63%). Honduras was the only country where free access started because of the COVID-19 pandemic. Associations between expenditures and provision of free oral medicines, insulins, medical supplies or exams were not statistically significant, i.e. free provision of any of the four items was not associated with higher expenditures. Discussion: Our study revealed that expenditure does not determine whether medicines, supplies and exams are provided for free or not. We hypothesize that countries spending less in providing these essential items for free are still spending similar amounts due to the high costs of treating diabetes chronic complications caused by lack of access to insulin, oral medicines, supplies and lab exams. At the same time that most of the SACA countries already count on full coverage of essential diabetes medicines and supplies, such as insulin, metformin, test strips, and exams, there are still 6 countries (Bolivia, Cuba, Dominican Republic, Ecuador, Peru and Puerto Rico) lacking coverage of 3 out of four or of all essential items. It is especially worrisome that 100 years after the discovery of insulin more than a third of the countries in SACA regions still do not count on full provision of this essential life-saving medicine.