Ongoing efforts to improve the management of patients with diabetes in Bangladesh and the implications

Haque, Mainul and Islam, Salequl and Kamal, Zubair Mahmood and Akter, Farhana and Jahan, Iffat and Rahim, Md Sagir Abdur and Sultana, Nusrat and Alam, ABM Muksudul and E-Murshid, Munzur and Khan, MA Halim and Deeba, Farzana and Bakar, Muhammed Abu and Nahar, Shamsun and Mozaffor, Miliva and Urmi, Umme Laila and Saikat, Taohidur Rahman and Islam, Zakirul and Haque, Monami and Iqbal, Samiul and Hossain, Mohammad Monir and Naher, Nurun and Allocati, Eleonora and Godman, Brian (2021) Ongoing efforts to improve the management of patients with diabetes in Bangladesh and the implications. Hospital Practice, 49 (4). pp. 266-272. ISSN 2377-1003 (

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Background: Prevalence rates of patients with diabetes are growing across countries, and Bangladesh is no exception. Associated costs are also increasing, driven by costs associated with the complications of diabetes including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia as well as improve patient comfort and adherence. However, they have been appreciably more expensive reducing their affordability and use. Biosimilars offer a way forward. Consequently, there is a need to document current prescribing and dispensing rates for long-acting insulin analogues across Bangladesh, including current prices and differences, as a result of affordability and other issues. Methods: Mixed method approach including surveying prescribing practices in hospitals coupled with dispensing practices and prices among community pharmacies and drug stores across Bangladesh. This method was adopted since public hospitals only dispense insulins such as soluble insulins free-of-charge until funds run out and all long-acting insulin analogues have to be purchased from community stores. Results: There has been growing prescribing and dispensing of long-acting insulins in Bangladesh in recent years, accounting for over 80% of all insulins dispensed in a minority of stores. This has been helped by growing prescribing and dispensing of biosimilar insulin glargine at lower costs that the originator, with this trend likely to continue with envisaged growth in the number of patients. Consequently, Bangladesh can serve as an exemplar to other low- and middle-income countries struggling to fund long-acting insulins for their patients. Conclusions: It was encouraging to see continued growth in the prescribing and dispensing of long-acting insulin analogues in Bangladesh via the increasing availability of biosimilars. This is likely to continue benefitting all key stakeholder groups.