1100-P: A Four-Humanitarian Agency Survey of Diabetes Care in 83 Humanitarian Settings

Background: We are currently facing unprecedented humanitarian crises. With diabetes at record-high levels and projected increases in humanitarian crises globally, data on the burden and management of DM in humanitarian crises is needed to stop unnecessary disability and death. Methods: We surveyed data on diabetes care provision in humanitarian medical services in 2018 across 4 humanitarian agencies (Doctors Without Borders, International Committee of the Red Cross, International Rescue Committee, United Nations High Commissioner for Refugees) with 83 randomly selected sites across 27 countries in 5 global regions. Of 83 sites, 65 (78%) reported collecting DM care data and were used for cross-sectional analysis of rates and proportions. Results: Of 65 sites, most were in the Eastern Mediterranean (n=29, 45%) and Africa (35%), with 20% elsewhere; 34% were refugee camps, 34% rural non-camp sites, 21% urban non-camp sites, 11% internally displaced persons (IDP) camps. Populations were mostly a mix of refugees, IDPs and the general population (n=46/65, 71%), with refugees only at 23% and IDPs only at 6% of sites. Of 65 sites, 58 were affected by conflict (89%), 5% epidemics, 1% natural disasters and 5% multiple crisis types. Most sites (n=49) were in protracted crises (75%), with 23% in recovery stages and 2% in acute crisis. Of 65 sites, 46 (71%) reported providing clinical DM management. However, only 66% had insulin available, 71% had capillary glucose testing, 55% urine dipstick glucose, 19% hemoglobin A1c testing, 22% home glucose monitoring, 35% community outreach, 58% patient education, 32% training of staff and 52% continuity of care systems. Conclusions: DM services were mostly provided in protracted humanitarian settings. Services were widespread but often rudimentary and delivered to the general population as well as refugees and IDPs. Improving DM care for crisis-affected populations is urgently needed.