Inventory of insulin access in Tunisia, IDF-MENA Region

The prevalence of diabetes is rising faster in low- and middle-income countries. In IDF-Middle East and North Africa (MENA), one in six adults (73 million) are living with diabetes, and the number of adults with diabetes is expected to reach 95 million by 2030 and 136 million by 2045. Tunisia, a part of the IDF-MENA Region, is burdened with diabetes that is responsible for substantial morbidity and mortality, as well as considerable healthcare expenditure. The prevalence of type 2 diabetes has increased from 3.8% in 1976 to 18.2% in 2019. It is higher in men. In 2016, distribution by type of treatment analyzed that 22.1% of treated people with diabetes (PWD) were on insulin and 9% were on insulin and oral antidiabetic drugs (OADs). This study confirmed that 27.4% have had good control of diabetes. PWD receiving insulin do not have good control of diabetes as compared to PWD treated on oral antidiabetic drugs. The government controls all medicines pricing including insulin. The prescription of insulin depends on the organization of care. The patients can receive their treatment of diabetes either in the primary healthcare or in the hospital. Therefore, access to insulin is provided, for patients, in both rural and urban areas and in the public and private sectors. Additional challenges to insulin administration include the fact that some health professionals do not know how to use insulin analogs as they were training only on human insulins. Therefore, in Tunisia many efforts are needed to improve the prescription and the accessibility of insulin.