Cost, access to treatment and stigma are all barriers to diabetes care in Iran. Access to necessary diabetes medications and supplies in Iran is not ideal. Insulin, test strips, glucose meters, syringes and insulin pumps are very expensive. While medical supplies for people with diabetes have been covered in the past, access has changed recently. According to a 2017 report, the rate of people and children with diabetes achieving targets (HbA1c < 7%) is low, compared with other areas of the world and consensus clinical targets.
People in Iran with diabetes are suffering economically. Pharmacies don’t sell enough insulin to people with diabetes, instead, insulin is sold in the free market with a higher price. Sometimes the parent of a child with diabetes can’t find insulin. Families of children and adults with type 1 diabetes may spend 20-30% of their monthly income on insulin. This doesn’t include test strips and all the other necessary supplies which are also expensive.
Additionally, insurance providers in Iran are decreasing financial support for diabetes treatments. The availability of insulin is limited and Iranian families who have children with diabetes manage this by decreasing the amount of carbohydrate in their child’s diet.
United States sanctions against Iran are another problem for Iranian people. Economic sanctions imposed on Iranian banks have decreased the importation of medications like insulin to Iran. To satisfy the needs of people with diabetes, Iran is trying to find a way to produce insulin. In addition, these sanctions trigger a reduction for Iranians with diabetes to access any new medical supplies and treatments. Without necessary tools, people can’t benefit from new treatments. Managing blood glucose becomes difficult. Sanctions have threaten the lives of people with diabetes, including children with type 1 diabetes.
Economic sanctions imposed on Iranian banks have decreased the importation of medications like insulin to Iran. To satisfy the needs of people with diabetes, Iran is trying to find a way to produce insulin.
Unfortunately, the educational level of Iranian families about their children’s diabetes is very low. Greater educational outreach and uptake is needed. It’s a hard task to reach out to parents and often, they believe false myths about care and treatment. Myths include cutting back on a child’s insulin because carers believe this is helpful, which in reality has dangerous results. There are many false advertisements on different social media platforms by marketers of Iranian products which distort diabetes and diabetes information.
Some nutritionists dictate that a child with type 1 diabetes can’t even eat a cookie! Some providers suggest very low carbohydrate diets for children with diabetes. Children need healthy carbohydrates for their growing bodies! As a result, many Iranian children and teens with diabetes conceal their condition and are too embarrassed to tell people about their diabetes. This stigma around diabetes makes them fearful. This is a serious issue because these youth abstain from injecting insulin and checking their blood glucose at school.
Children are our greatest treasure so we must help them by giving them all of our assistance.
In each Province for Iran, non-governmental organizations (NGOs) exist to support all people with diabetes. The Iranian Diabetes Society, Gabric Diabetes Education Association, Tasnim Diabetes Association and Meftah Diabetes Association are renowned for their advocacy and activities to support diabetes in Iran. These NGOs are fighting to get insurance coverage for medical supplies and equipment as well as decrease treatment costs especially insulin and supplies. Iranian NGOs also provide invaluable educational needs for youngsters with type 1 diabetes and their families. Online education services, and a variety educational courses in centers for diabetes are offered for families. There are peer groups for support and even an equipped roving bus, a Dia-Bus, for free services such as diagnostic testing.
Mahya and Melika are both 6 years old, and they live with type 1 diabetes in Iran. Mahya, who lives in Tehran, is 6 years and was diagnosed with type 1 diabetes at age four. Her mother tells us:
“When my Mayha was diagnosed with diabetes, I was anxious. After one month I decided to fight back with knowledge and learned so much about her diabetes. I’m reading about diabetes every day and I make all efforts to help her accept her diabetes well. Today she knows insulin is her friend and she uses it comfortably.”
Melika has only lived with type 1 diabetes for six months. She lives in Abadeh, a city in Fars Province-Iran. Her mother says:
“We try to accept her diabetes. Diabetes made us change our way of life.”
Globally, more than 1.1 million children are living with type one diabetes and nearly 16 percent of children with type 1 diabetes live in the Middle East. Type 1 diabetes or insulin-dependent, juvenile or childhood-onset diabetes is an autoimmune disease and characterized by deficient insulin production requiring daily administration of insulin. Insulin is necessary for survival. There were 4.985.500 cases of diabetes in Iran in 2017, according to the IDF Diabetes Atlas (2017). Approximately 11.5 percent are live with type 1 diabetes. Children with type 1 diabetes will need support during their entire life.
Worldwide, about 5% and 10% of people with diabetes have type 1 diabetes and more than 100,000 children are diagnosed with type one diabetes annually. Type 1 diabetes is on the rise.
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The author would like to thank the following people for their help in collecting information for this report:
Mrs. Maryam Askari
Epidemiologist at Yazd Diabetes Research Center
Mr. Ali Mahmoodi
Diabetes educator at Yazd Diabetes research center
Mrs. Mahboobeh Dehghan
Chief executive officer of Tasnim Diabetes Association of Yazd
Mr. Alireza Talebzadeh
Public relations of Tasnim Diabetes Association of Yazd
And all the mothers of children with type 1 diabetes in Yazd, Tehran, and Fars, Iran.
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