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Natural disaster - flood

People with diabetes need uninterrupted access to medicines and care. They need healthy food and a safe space to exercise. During a disaster or emergency, the health system, living environments and the supply of medicines and vital goods are disrupted, making diabetes management even more difficult.

This disruption poses unique challenges to people living with chronic conditions like diabetes. A stable environment is necessary to manage the condition optimally. In disaster situations, people with diabetes may struggle to manage their condition as they are unable to access the medicines and supplies they need. This can place them at increased risk of life-threatening complications.

Procedures should be implemented to minimise disruptions to the availability and supply of medicines and health care in the aftermath of a disaster. An effective response to a disaster includes having the resources and tools available to meet priority health needs in a timely manner.

To learn more about the impact that disasters can have on people living with diabetes and the importance of the inclusion of essential diabetes medicines on disaster emergency lists, we spoke to Oliver Schnell, a Professor at Forschergruppe Diabetes e.V., Helmholtz Center in Munich, Germany.

In disaster situations, people with diabetes may struggle to manage their condition as they are unable to access the medicines and supplies they need.

What defines a disaster situation?

The Center for Research on the Epidemiology of Disasters (CRED) defines a disaster as “a situation or event which overwhelms local capacity, necessitating a request to a national  or international level for external assistance; an unforeseen and often sudden event that causes great damage, destruction and human suffering‘ (1).

CRED identifies (1) an event as a disaster if at least one of the following criteria is met:

  • 10 or more human deaths
  • Reports indicating that 100 or more people are affected
  • Declaration of a state of emergency
  • Request for international assistance

Examples of disasters include hurricanes, tornadoes, floods, landslides, earthquakes, volcanoes, power outages, acts of terrorism and wars (2.3). These events have severe effects on agriculture, infrastructure, the economy and individual health. They place populations affected at increased risk of diseases or health situations that are preventable (2).

Humanitarian emergencies often result in large-scale movements of populations. The arrival of displaced persons into unprepared locations puts severe pressure on healthcare resources. People affected are often resettled in densely-populated temporary locations with inadequate food and shelter, unsafe water and poor sanitation. These conditions are linked to an increased transmission of infectious diseases and the worsening of existing health conditions, such as chronic conditions like diabetes. This can lead to higher rates of death (1).

How do disaster situations impact people living with a chronic condition like diabetes?

Disasters frequently occur without warning and can seriously threaten individual health and wellbeing. Populations affected are often left without electricity, refrigeration, means of communication or transportation, while also experiencing shortages of food, clothing, and shelter. In addition, access to medical facilities, providers, medical records and medications may be limited (3). When care or treatment is disrupted, people living with diabetes are at higher risk of serious and life-threatening complications, such as heart attack, stroke, kidney failure, blindness and lower-limb amputation.

Research demonstrates that diabetes management is impacted by disaster situations in the following ways:

  • Blood glucose control often deteriorates after a disaster. Contributing factors include stress, reduced access to medicines, care, healthy food choices, clean water and sanitation, and possible exposure to infections (3).
  • Disaster situations increase the risk of morbidity and mortality due to diabetes complications (3).
  • People with diabetes often make more frequent visits to Hospital Emergency Departments (3). Increases in admissions of people with newly-diagnosed type 1 diabetes have also been reported after a disaster (4).
  • Certain populations, such as the elderly, people of low socioeconomic status, people without health insurance, and minorities, become even more vulnerable during disasters and experience increased morbidity and mortality (4).

In addition, disruptions to the supply of electricity and refrigeration can impact the efficacy of temperature-sensitive medicines such as insulin. Therefore, early planning and ensuring that essential diabetes medicines are included on emergency medicine lists can reduce the impact of disruptions to people with diabetes during and in the aftermath of a disaster (3).

Early planning and ensuring that essential diabetes medicines are included on emergency medicine lists can reduce the impact of disruptions to people with diabetes during and in the aftermath of a disaster.

Are there different medicines lists for disasters and other emergencies? Do they include insulin?

The words ‘emergency’ and ‘disaster‘ are synonymously used. During an emergency situation, having knowledge of the available resources and being able to carry out a correct management of the stock of drugs can be crucial (1). The European Association of Hospital Pharmacists (EAHP) recommends the preparation of two medicine lists:

  1. The disaster medicine assessment list that is based on the most relevant WHO emergency list and adapted to a European It also includes a calculation sheet that quantifies the number of drugs needed based on the number of patients and a self-assessment indicator that allows each hospital to rapidly evaluate its percentage of compliance with the proposed List of Emergency and Disaster Medicine List (5).
  1. The disaster stock management list which enables the management of drug stocks during an emergency, automatically updates the quantity of stock available and keeps notes regarding all restock and withdrawal movements through a printable form (1).

Standardised medicines lists in emergencies and disasters allow an effective response with medicines and medical devices using standard, pre-packed kits that can be kept ready to meet priority health needs during an emergency. This will help reduce increased rates of morbidity and mortality due to communicable and non-communicable diseases in populations affected by disasters and emergencies (2).

Currently, insulins are listed as disaster and emergency medicines in the following countries:

  • Most of Europe
  • The Caribbean
  • Oman
  • United States of America

In addition, the World Health Organization (WHO) has included insulins and SGLT2 inhibitors – oral medicines for type 2 diabetes – in its Essential Medicines List (EML).

What can the diabetes community do to advocate for change?

The diabetes community, particularly health professionals working in hospitals and clinics, can participate and contribute to key aspects of disaster preparedness such as:

  • Developing operational protocols
  • Staff training
  • Ongoing updates of therapeutic disaster guides
  • Locating critical medicines
  • Stock organisation (1).

Hospital pharmacies are also involved in updating the stocks of drugs needed in case of a disaster, to guarantee assistance to the populations affected (1).

The diabetes community can play an important role in ensuring that essential diabetes medicines and supplies are included in emergency medicine lists. Expert committees consider reports and recommendations from Medicines Working Groups for different diseases and evaluate the scientific evidence for the comparative effectiveness, safety and cost-effectiveness of a particular medicine. These committees  meet on a regular basis to review the latest scientific evidence on the efficacy, safety and cost effectiveness of medicines in order to revise and update the Essential Medicines List (5).

Diabetes care should be a key component of the response to any humanitarian emergency. If it is overlooked, diabetes will continue to take a heavy toll on populations affected and hinder global efforts to meet the Sustainable Development Goals.

On January 18, the International Diabetes Federation is organising a webinar that will discuss the importance of preparedness to ensure people living with diabetes have a stable supply of insulin in emergency situations. Learn more.

The diabetes community can play an important role in ensuring that essential diabetes medicines and supplies are included in emergency medicine lists.

References

1. European List of Emergency Medicines (ELEM), version 1.0, January 2020
2. Essential Medicines List for Emergencies and Disasters in the Caribbean, Pan American Health Organization
3. Gadiraju S, Allweiss P; Disaster Emergency Preparedness in Diabetes
4. Allweiss P, Albright A; Diabetes, disasters and decisions
5. The 2021 Expert Committee on Selection and Use of Essential Medicines


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