Many health systems are not set up to help individuals conveniently manage chronic diseases, especially ongoing monitoring and care which is required at home. Over the course of his two decades living with diabetes, David has rationed medicine and test strips and reused syringes, exposing him to serious complications. This is an all-too-common tale for people living with diabetes in low- and middle-income countries. Despite the skyrocketing epidemiological burden of noncommunicable diseases (NCDs), many health systems do not offer accessible diabetes care.
With the goal of improving quality of life and health outcomes for people living with diabetes, PATH developed an affordable co-packaging solution that increases access to supplies needed for safe administration of insulin and monitoring of blood sugar. The Diabetes CarePak project began as a partnership with the Coalition for Access to NCD Medicines and Products, the Kenya Ministry of Health, people living with diabetes, health care providers, local advocacy groups, and other important stakeholders, including funding from the International Federation of Pharmaceutical Manufacturers and Associations, The Leona M. and Harry B. Helmsley Charitable Trust, and several industry partners. Today, the project is active in Mali, Mozambique, and Tanzania.
Assessing the CarePak's usability
In January 2024, a usability assessment of Diabetes CarePak was completed in Maputo and Matola provinces in Mozambique. David was randomly selected as one of the 50 beneficiaries of the project from a sample of outpatients at Matola Provincial Hospital to test the prototype CarePak for three months.
The Diabetes CarePak prototype contains syringes, a glucometer, glucometer strips, lancets, absorbent cotton, alcohol solution, a sharps container and educational content for people living with diabetes. Photo: PATH/Bruno Pedro.
During the three-month study period, David and the other participants received a monthly recurring kit of supplies for diabetes self-monitoring at his health unit, including one starter kit and two refill kits. The CarePak prototype contained syringes, a glucometer, glucometer strips, absorbent cotton, alcohol solution, lancets, a sharps container and educational content for people living with diabetes. The kit didn’t contain insulin or oral medications, but was designed to ensure kit users had supplies necessary to monitor their blood sugar and take medicine including insulin as prescribed.
To assess the impact of using the kit on the state of his health, David received a glycated hemoglobin measurement (HbA1c test) and was interviewed at the baseline and endline of the study. The HbA1c diagnostic test measures an individual’s average blood glucose level over a three-month period and is a well-established gauge of overall glucose control. An A1c result above 7% indicates a higher risk for diabetes complications. David’s A1C levels decreased from 8.2% to 6.6% while using the CarePak, indicative of greatly reducing his risk for diabetes-related complications and death. Among the other participants, 65% of the group had reduced HbA1c levels during the three-month period.
Beyond this clinical improvement, David’s self-care behavior improved significantly, as he began to test his blood sugar daily and not reuse syringes. He also improved his knowledge of healthy eating and the importance of physical activity in his routine.
David was not alone in seeing beneficial changes in his ability to manage his diabetes with the CarePak. At baseline, 83.7% of participants didn’t own a glucometer, an essential tool for measuring blood sugar levels, and only checked their blood sugar levels once a month or less at a health facility. With CarePak, study participants checked and recorded their blood glucose levels daily, a marked improvement toward reaching the self-care guidelines of checking blood glucose levels multiple times per day.
David’s A1C levels decreased from 8.2% to 6.6% while using the CarePak, indicative of greatly reducing his risk for diabetes-related complications and death.
Among other improvements, participants suffered through fewer symptoms of low blood sugar, they didn’t reuse needles, and didn’t develop skin infections as a result.
More than anything, regular access to CarePak supplies changed the confidence levels of people living with diabetes, eased the burden of having to trek to multiple health centers and pharmacies to gather supplies, and the anxiety and stress of self-management. The benefit of that kind of accessibility and self-ownership is hard to quantify, but David noted that, “the benefits [of the CarePak] are that on a scale of 1 to 100, it’s 100...the kit has helped me and its come at the right time.”
As a follow up to the Phase 2 study, PATH is conducting an initial market launch of Diabetes CarePak in Mozambique, producing 500-1,000 kits and selling them at partially subsidized prices through the Mozambican Diabetics Association and their hospital-based facilities/pharmacies. This market launch will explore ways to increase affordability and availability of CarePak while demonstrating the benefits and cost savings to the health system to advocate for broader uptake.
The future of the CarePak
PATH, the Coalition for Access to NCD Medicines and Products, and our partners are excited that access to a co-bundling solution is making it simpler for users to self-manage their diabetes and even lowering their risk for severe complications. As the CarePak project continues, we hope to build evidence that would make it a terrific option for inclusion in universal health coverage. Cases of diabetes continue to rise and more impactful interventions are needed for chronic disease care. Access to NCD medicines and products is a critical issue that governments, funders, and other stakeholders must address to meaningfully reduce the financial burden that people living with NCDs like diabetes face.
