As previously reported in Diabetes Voice, South and Central America has been among the regions hardest hit by the COVID-19 pandemic. People with diabetes and health professionals in the region have been impacted in many ways. In this article, we feature two perspectives from Argentina and Ecuador on how the ongoing pandemic is affecting the ability of people with diabetes to access the care and education they require to manage their condition and avoid long-term complications.
This pandemic is hardest on the most vulnerable
In Argentina, COVID-19 has exposed and exacerbated healthcare inequalities and inequities. This is most noticeable in people who are more vulnerable to the effects of the pandemic.
We all agree that older people are a vulnerable group that must be protected because they have a higher risk of health complications if they are infected with COVID-19. However, less talked about or reported in Argentina, is that people of all age groups living with diabetes and other chronic conditions also face an elevated level of risk. Many, for example, are not aware that a significant number of people living with diabetes have type 1 diabetes, an autoimmune disease most commonly diagnosed in childhood. It is therefore essential that people with diabetes of all age groups receive protection and support, since the effects of the virus can be more severe if they are infected.
One in ten people are estimated to be living with diabetes in Argentina. Many are socially disadvantaged. Despite a law that guarantees 100% coverage for treatment, many people with diabetes do not receive the insulin and other medications and supplies that they require to manage their condition. As the COVID-19 pandemic continues to spread in the country, barriers and vulnerabilities for people with chronic conditions are increasing and becoming more serious.
Lack of access has been an issue. Between April and July, our association, CUI.D.AR, conducted consultations of people with type 1 and type 2 diabetes. We registered over 1000 complaints related to difficulties accessing medicines and care throughout the country. These concerned all the different types of health coverage schemes available – public, prepaid, social assistance. Worryingly, one in three respondents indicated that they were not receiving insulin or blood glucose monitoring supplies. We were able to follow-up with over 80% of respondents to guide and assist them.
We were very concerned by the stories we heard. Some people with diabetes were trading insulin for necessities such as food. Others were exchanging insulins with other people with diabetes, if they had too much or too little of the type they were using. This, coupled with the lack of monitoring supplies, resulted in hospital admissions due to the inability to manage the condition appropriately. People with insulin-treated diabetes who cannot access insulin or ration their supply, skip doses or use insulins that they are not accustomed to, put themselves at risk of potentially devastating health consequences.
Inequality is increasing, and with it comes injustice. It is the duty of all of us invested in the health of people with chronic conditions to promote actions that support and protect this vulnerable group so they are not left behind in the context of COVID-19. The actions and strategies required may be unprecedented, but the pandemic itself is something unlike anything we have seen before. We must not , therefore, stand by and do nothing. We are writing a chapter in history and the future will judge us for our actions today. We must not let this moment pass by without standing up on behalf of those who need our support, and need it right now!
Living with type 1 diabetes during COVID-19
Roxana Vizcaíno Saltos
COVID-19 has provided a difficult backdrop for people living with diabetes. It has required us take a different perspective on how to manage our diabetes in uncertain times and has underlined the need for support and education, particularly for young people affected by the condition.
For those of us involved in supporting people with diabetes, education has always been the priority when responding to different types of situations. However, we must be honest and say that no one expected COVID-19 and everything that the pandemic brought with it.
I do not think that even the most experienced diabetes educator could ever have imagined living in such chaotic circumstances as those we have experienced in recent months. Chaotic because we never thought we would have to stay home to avoid exposure to a virus. The world has been turned upside down, and for families living with diabetes, our deepest and darkest fears have come to the surface.
I am sure that for many I am not exaggerating. The fear of not having enough food or sources of fast-acting glucose for emergencies at home, lacking the medicines and supplies to manage diabetes for long periods, not being able to access sufficient supplies in the outside world, rising prices, loss of employment and changes in routine. Anxiety, distress and above all, uncertainty, are words on the lips of many.
During the first few months of the pandemic, living under stress was a natural state for many people. How do you cope? By drawing strength from untapped places and the immense love that we have for the people with diabetes we care for. Life has given us an important lesson that nothing is safe and we must be prepared for any surprise that may come our way, while keeping calm and as composed as possible. We can achieve this through family support and teamwork. Like many of us do when faced with adversity. we must accept the situation and confront it head on.
Diabetes education is vital during these difficult times. Only knowledge will allow us to get through this situation and organise ourselves to manage our condition as best we can. Knowing not to neglect our glucose monitoring, how to make the right dosage adjustments, how to prioritise expenses and make sure we always have the reserve of supplies we need.
Governments should support vulnerable groups and ensure that that their rights are respected. I live in Ecuador, a country that has recorded a large number of COVID-19 cases. Negligence in the handling of the virus made the first few months very hard and the tough times are not over. Families have had to come together and support each other.
In July, a virtual camp made possible by the FUVIDA Foundation brought together young people living with diabetes. The platform allowed them to talk about their fears and how they were looking after themselves. It also helped them feel that they were not alone and that there was nothing wrong with being anxious or afraid. Opportunities like this for people with diabetes to share experiences, voice concerns and build support networks are of fundamental importance.
The pandemic and lockdown have been a learning experience for millions of us, irrespective of whether we have or do not have an underlying heath condition that makes us more vulnerable to COVID-19. For those of us with diabetes, we must continue to share our voice until the day when we are heard and supported, where support has not been fothcoming. The current situation can be managed as long as we remain united as a community and support each other.
Let’s look after each other by keeping our distance and wearing our face masks, but let’s not let the masks silence our voices!
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