Doctors have warned that some diabetes patients’ lives could be at risk because the National Department of Health failed to list life-saving premixed insulin pens on its tender awarded for insulin supply from May 2024 to April 2027.
The Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) said that the department awarded tenders only for supply of premixed insulin in vials and syringes, reports GroundUp.
Department of Health spokesperson Foster Mohale said no bids had been received for the premixed insulin pen sets when the tender was advertised in June 2023. The tender was awarded in January this year, he added.
“Premixed insulin is a combination of the different types of insulin including long-acting insulin and short-acting insulin,” said endocrinologist and professor Alisha Wade, who is the executive director of Research in Metabolism and Endocrinology (RIME), a division of the Wits Health Consortium.
“Insulin pens are preloaded with insulin and you turn a dial on the pen to a pre-specified dose of insulin. This way, insulin can be administered more easily with less risk of making mistakes. Visually impaired people, for example, can listen to the number of clicks to know how many times to turn the dial before injecting the insulin.”
Insulin pens are either disposable (pre-filled with a certain amount of insulin) or reusable – fitted with cartridges of insulin that can be replaced.
“In the public health sector, insulin pens are usually given to elderly patients or those with diminished vision or arthritis. But it depends on availability. Unfortunately, insulin pens are not always available,” said Dr Patrick Ngassa Piotie from the University of Pretoria Diabetes Research Centre.
He said premixed insulin is designed to simplify treatment and make it easy for patients to comply by reducing the number of daily injections required.
According to SEMDSA, not offering premixed insulin pens to diabetics could lead to a decrease in compliance with treatment regimens. In addition, “the use of vials and syringes can lead to dosing errors which may, in some instances, have fatal consequences”.
“Under-dosing can lead to high blood sugar levels. This can increase the risk of developing diabetic-related emergencies and in the long term, diabetic-related complications like blindness and amputation,” said Dr Reyna Daya, SEMDSA chairperson.
On 12 April, SEMDSA sent a petition to the Department of Health urging it “to source and consider alternative companies that are in a position to supply such disposable or reusable pens”.
The department is yet to respond but Daya said: “In the interim, we are liaising with the industry to improve understanding and training with regards to using vials and syringes.”
“We have engaged with diabetes advocacy groups and also tried to make patients aware of the impending change, and are in communication with pharmaceutical companies who may be able to offer an alternate solution. We have put them in touch with the Department of Health.”
Mohale said a supplementary tender had been advertised on 15 March 2024, and closed in April 2024. “It is currently in the bid evaluation process and, in the interim, quotations to support supply of pen sets are being obtained to bridge the supply gaps,” he said.
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At least 60% of Africa’s diabetes goes undiagnosed – global report