UNSWEETENED LIFE FROM SUGAR

On this date people around the world mark World Diabetes Day. Every year November 14 takes on more importance as the number of diabetes patients is soaring. So, what problems do diabetes patients face in Azerbaijan?

Aydan Sirinova (the name has been changed upon a request of the person in question) is just 20 years old. She began to suffer from Type 1 (insulin-dependent) diabetes when she was 12. Then the carefree period of the teenage girl came to an end, and she had to deal with spending long days in the hospital, endless insulin injections, the need to regularly control the blood sugar level, and the bitter understanding of the fact that she will fight this disease for the rest of her life.

The girl has been registered with a medical institution since the age of 14. Here she receives actrapid, medicine containing insulin, every month.

"But this is not enough," she says. "Besides that, I am having to buy humulin, expensive (30 manats) medicine for injections. They don't provide it at the clinic."

It is worth mentioning that people who begin suffering from diabetes at an early age are often attributed to Type 1 insulin-dependent patients and are in need of regular injections, unlike those who get sick at mature stages in life or when they grow old. For those people, quite a "light" treatment using pills is sufficient. Expensive injections are meant for long-term effect, Sirinova explains. The injection is done in the morning to support the patient's health during the day, unlike short-term methods of treatment which are used before every meal.

One of the most important things for diabetes patients is the need to regularly control the blood sugar level. Glucose meters help to control it. These devices are on sale and are also provided in medical institutions. They are of different quality. In Aydan's case, free devices are simply unable to control the sugar level, because they are far from being perfect. That's why Aydan had to acquire a device on her own for 80 manats.

Dilbar Alakbarova, a Sumgayit resident suffering from diabetes, also had to buy a glucose meter.

"The diabetes patients I know, who received glucose meters in medical institutions, say they are not of very good quality and break down soon," she says.

Challenges of diabetes patients 

In order to fight the increase in the number of diabetes patients, on December 23, 2003 Azerbaijan passed the Law on State Care for Persons Suffering from Diabetes as well as the State Program on Diabetes, the execution and control over which were vested in local executive authorities. According to this program, diagnosis and treatment of diabetes patients is carried out at the state expense. The necessary first aid, injections, insulin-containing and other medicine which reduce the blood sugar level, as well as means of control over the sugar level -- all this is overseen by the local executive bodies.  The same bodies are in charge of registering diabetes patients.

However, diabetes patients believe the involvement of executive authorities in distributing life-supporting medicine implies redundant red tape, which complicates their already tough life. It is believed that the executive authorities' being part of the "Health Ministry-medical institution-patient" chain causes a number of bureaucratic obstacles in the treatment process.

For example, Aydan Sirinova says only those patients who have been discharged from hospital can undergo registration. Moreover, every year they have to undergo a commission test, more precisely, kind of a "re-commissioning" so that the patient would not be taken off the books. And that requires checking into a hospital every year.

"I don't understand why this is necessary, as it is known that diabetes is an untreatable disease and insulin-dependent patients have to take insulin throughout their life," Sirinova says. "I can't just get well all of a sudden in a year's time. But if I don't go through commission screening, i.e. if I don't check into a hospital, I would be taken off record, and I won't be receiving medicine any more."

The statistics on diabetes patients is, quite frankly, depressing. In 2005 the number of patients was over 62,000, in 2006 the figure was about 68,000, in 2008 it increased to 100,000, and today it is 180,000 (of course, only registered patients are in question).

The Health Ministry told R+ that the increase in the number of patients is due to the fact that more people are being registered. Moreover, there a tendency of an increasing rate worldwide, and this is turning into not only a medical but also a social problem.

Mominat Omarova, head of the Azerbaijan Diabetes Society (ADS), told R+ that the main factors of diabetes are deteriorating environmental situation in the world, stress, malnutrition, and inert lifestyle. Given that the national cuisine includes a lot of greasy dishes, as well as a tendency of leading an inactive lifestyle, it can be concluded that diabetes is assuming "national" features in Azerbaijan.

At the same time, the treatment of diabetes patients has its own challenges, Mrs. Omarova says. For instance, glucose meters require special one-time strips. Though state-run institutions provide them, there is still a shortage, and patients have to buy them. Also, some patients require not regular insulin for injections (for instance, pregnant women, children). They need a special analogous insulin, which costs more and also has to be purchased. And we have to admit that there is not enough insulin available for all diabetes patients.

According to Mrs. Omarova, the provision of patients with insulin is worse than in Baku. This particularly holds true for analogous insluin, which children are in dire need of. Moreover, in the regions medicine which must be provided in clinics for free are sold expensively in nearly drugstores, Mrs. Omarova said.

The situation with "smuggled" insulin available in the Azerbaijani market is not very clear either. There are the three biggest companies that have been in business since the 1920s, Xekst Aventis, Eli Lilli и Nova-Nordix. Russia also produces insulin, but despite its relatively low price, the Azerbaijani Health Ministry, which is the only buyer of insulin in the country, avoids purchasing insulin of substandard quality and gives preference to Danish products. But for unclear reasons, which cannot be explained even at the Health Ministry, Russian-made insulin is also available in the Azerbaijani market. The ministry says these are isolated cases, and Russian-made insulin is smuggled in. If this is the case, the ministry says, control over this process should be a key task, to prevent substandard products from accessing the domestic healthcare sector, which further aggravates the lives of diabetes patients. Also, the ministry says it is necessary to tightly control funding and sending in the country's regions in order to put an end to sales of insulin to the patients there. 

What should be done? 

One of the main problems is the insufficient public awareness of the diabetes-related risks. According to Mrs. Omarova, doctors treating diabetes patients often have no time to provide them with additional information about their disease. Every day an endocrinologist at a clinic has to receive over 30 patients., who come to get insulin. Doctors have enough time just to write prescriptions. An endocrinologist physically has no time to conduct a medical examination and provide the needed advice. Nonetheless, it is known that patients who know more about diabetes, its risks, and lifestyles are better off and the process of their treatment is more effective.

The process of promoting public awareness in educational institutions and the society as a whole is not very proper. Given that diabetes is not only widespread in the country but is also affecting a lot of young people, teenagers and children, public awareness in this regard should be part of the education and social policy.

Enlightenment efforts should be "put on the rails" in the country's regions, because there the situation is often complicated by the fact that some patients don't want to be registered.

"Such instances are also observed in Baku, but ADS has recorded more of those in the regions of Azerbaijan -- mostly among teenagers and young people, who conceal the disease from their peers; among women the concealing of the disease is due to being falsely ashamed. 'If they find out I have sugar level problems, they won't marry me'," Mrs. Omarova says.

Every year, within the state program on fighting diabetes, considerable funds are allocated from the state budget. For instance, in 2008 the allocated amount was 13.8 million manats and in 2009 it rose to 19.2 million manats. Though this amount increases year-on-year, sources at state bodies admit that the allocated funds are not enough to solve all problems facing diabetes patients.

According to the ADS chair, in 2013 the amount tripled to 33.7 million manats. The same amount is designated in the 2014 draft budget, she says. But until all the state funds meant for diabetes prevention are spent in a centralized manner and only through the healthcare sector, there will still be abuse in this sphere.

"The state care for the persons prone to diabetes has increased, but is clearly insufficient for comprehensively improving the quality of their life, extending the term of employment and reducing disability.  With regard to this issue, we have conducted a monitoring jointly with the Finance Ministry and the Accounting Chamber of the Azerbaijan Republic, which indicated the appropriateness of executing the State Diabetes Program by the Health Ministry fully and in a centralized manner. The shortfalls in spending the funds meant for the implementation of the state program in a number of cities and regions were indicated in the conclusions of the Accounting Chamber. The same conclusion was made by the Center for Public Health and Reform of the Ministry of Health. However, so far the funds allocated every year from the state budget for the implementation of the State Diabetes Program are still directed to the local budgets of the cities and regions," the ADS chair said.

Much work in this regard has been done by the Heydar Aliyev Foundation and personally by its President, MP, Mrs. Mehriban Aliyeva. In 2004, when there were clear shortages in providing patients with insulin, the Foundation, jointly with the ADS, implemented "The best care for sick children" project. As a result, all the sick children received insulin for a year, according to the ADS head. The Foundation continues realizing such projects in the following years. These efforts have played a positive role in the treatment of diabetes patients, improved the quality of their lives, and we would like to hope that in the future Azerbaijan will be able to considerable increase the funds spent on prevention, treatment and rehabilitation of diabetes patients and the issue of supplying them with medicine will be solved.