The department of health has failed to purchase a life-saving insulin device, putting diabetes patients at risk, say doctors.
The Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) is concerned that premixed insulin pens have been left out of the national department’s tender awards. Instead, tenders have been awarded for the supply of premixed insulin in vials and syringes.
Diabetes patients have to inject themselves with insulin. Getting the dose right is important. Vials and syringes are harder to use than the pens.
A circular by the national department lists the tenders awarded for insulin supply from May 2024 to April 2027. In the circular, no tenders have been awarded for suppliers to provide premixed insulin pen devices.
Why insulin pens are essential
Department of health spokesperson Foster Mohale said no bids had been received for the premixed insulin pen sets when the tender for insulin supply was advertised in June 2023. The tender was awarded in January this year, Mohale said.
Diabetes is a chronic illness related to the lack of insulin production (type 1 diabetes) or inefficient use of the insulin produced by the pancreas (type 2 diabetes). South Africa is estimated to have the second highest number of people living with type 2 diabetes in sub-Saharan Africa. In 2021, more than four million people were living with diabetes.
Insulin is typically used to treat type 1 diabetes from the onset. As the illness progresses for people with type 2 diabetes, insulin becomes the only treatment option, according to the University of Pretoria Tshwane Insulin Programme.
“Premixed insulin is a combination of the different types of insulin including long-acting insulin and short-acting insulin,” said endocrinologist and professor Alisha Wade. Wade is the executive director of Research in Metabolism and Endocrinology (RIME), a division of the Wits Health Consortium.
“Insulin pens are preloaded with insulin and you turn a dial on the pen to a pre-specified dose of insulin. This way, insulin can be administered much more easily with a lower risk of making mistakes. Visually impaired people, for example, can listen to the number of clicks to know how many times to turn the dial before injecting the insulin,” said Wade.
Insulin pens are either disposable (pre-filled with a certain amount of insulin) or reusable, where the pens are fitted with cartridges of insulin that can be replaced.
“In the public health sector currently, insulin pens are usually given to patients who are elderly, or with diminished vision or arthritis. But it depends on availability. Unfortunately, insulin pens are not always available,” said Dr Patrick Ngassa Piotie from the University of Pretoria Diabetes Research Centre. He said premixed insulin is designed to simplify treatment and make it easy for patients to comply by reducing the number of daily injections required.
Solving the problem
According to SEMDSA, not offering premixed insulin pens to people living with diabetes could lead to a decrease in compliance with treatment regimens. In addition, SEMDSA said, “the use of vials and syringes can lead to dosing errors which may, in some instances, have fatal consequences. The management of diabetes in children and elderly people is challenging, and the use of vials and syringes exacerbates these challenges.”
Dosage accuracy is crucial in insulin administration due to the risk of hypoglycemia (low blood sugar levels), which can lead to a coma or death in severe cases and hyperglycemia (high blood sugar levels).
“Underdosing can lead to high blood sugar levels. This can increase the risk of developing diabetic-related emergencies and in the long term, diabetic-related complications such as blindness and amputation,” said Dr Reyna Daya, SEMDSA chairperson.
On 12 April, SEMDSA sent a petition to the department of health urging the department “to source and consider alternative companies that are in a position to supply such disposable or reusable pens”.
The department is yet to respond to the petition but Daya said: “In the interim, we are liaising with the industry to improve understanding and training with regards to using vials and syringes.”
“We have engaged with diabetes advocacy groups and also tried to make patients aware of the impending change.
“We are in communication with pharmaceutical companies who may be able to step in and offer an alternate solution. We have put them in touch with the department of health,” said Daya.
Health department spokesperson Mohale said a supplementary tender had been advertised on 15 March 2024, and closed in April 2024. “The supplementary tender is currently in the bid evaluation process and, in the interim, quotations to support supply of pen sets are being obtained to bridge the supply gaps,” he said.
This article was first published in GroundUp.
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