ESPE Abstracts

Introduction: As COVID-19 spread across Southeast Asia (SEA) in 2020-2021, healthcare systems in Cambodia, Laos and Myanmar braced as public health officials closed many outpatient diabetes clinics and healthcare professionals (HCPS) were redeployed to COVID-treatment zones. Action 4 Diabetes (A4D) is a UK non-profit organisation that has been providing free insulin and medical supplies to LMICs in SEA since 2016. With historically limited healthcare coverage in Cambodia, Laos and Myanmar, patients enrolled on A4D’s programme travel hundreds of miles to diabetes clinics to collect free insulin, blood glucose strips and other medication. Due to COVID-19 lockdowns, insulin often arrived with short expiry dates due to delays in shipments caused by bottlenecks at international logistic hubs, and patients were known to ration insulin due to lack of supply. For disadvantaged people with Type 1 diabetes (T1D) in SEA low-middle-income countries (LMICs), this posed a serious threat due to inaccessible insulin and medical supplies.

Methods: A4D developed a strategic plan to maintain insulin and medical supplies to LMICs in collaboration with local HCPs on the ground to ensure that the T1D community regained access to insulin and essential medical supplies, as well as supporting the development of remote-consultation with patients.

Results: Access to medical supplies A4D initiated networks of couriers to rural parts of Myanmar, Laos and Cambodia to deliver medical supplies. In Cambodia, TukTuk drivers who ferried tourists around Angkor Wat were used to deliver insulin to the T1D in farming communities. In Myanmar, truck drivers that transported vegetable crops were used to transport medical supplies to remote areas. During COVID-19, A4D used local suppliers for insulin and had to purchase insulin and blood testing strips at a premium rate. Access to education and consultation Prior to COVID-19, clinic visits were a primary source of advice and management for the patient and family. With clinic closures, A4D initiated remote access consultation working with local HCPs to support disadvantaged families. By end 2021, 3 deaths were reported of patients on the A4D programme as result of the pandemic, and incidence of diabetic ketoacidosis rose sharply among the 350 people with T1D on A4D’s programme.

Conclusion: For many disadvantaged people with T1D in SEA, the COVID-19 pandemic reinforced the fragile nature of their T1D management. Through collaborating closely with HCP and partners on the ground, A4D has developed a more dynamic and resilient logistical system to maintain key life-saving medical supplies.