Tehran, IRAN

From initial struggles with diabetes to becoming an ambassador for Iran’s national diabetes society, the journey has been awe-inspiring for Nilofar Atayee, 30, who has been a diabetic her entire life.

A Type 1 diabetic, Atayee is also a representative in Iran for the International Diabetes Federation (IDF), an umbrella organization of more than 230 diabetes unions in 170 countries.

She is a classic example of how adversity can be turned into an opportunity, especially in a place where diabetic patients have often faced near-death experiences due to the scarcity of life-saving medicine.

Last October, when an acute shortage of insulin pens caused by a new round of US sanctions put millions of lives at risk in Iran, Atayee used all her resources to help other at-risk diabetic patients, while dealing with the problem herself.

“Considering that I am a medical practitioner and I work in the field of medicine and medical equipment, I struggled with the same problem,” Atayee, who until recently worked at the Gandhi Hospital in Tehran, told Anadolu Agency.

While the problem has been temporarily addressed, she said diabetic patients in Iran continue to face a “myriad of challenges,” especially in smaller cities and towns where there is less awareness about the disease.

According to IDF estimates, there are 5.4 million cases of diabetes in the adult Iranian population of around 57 million, with a 9.4% nationwide prevalence.

But an independent study conducted by researchers at the Tehran University of Medical Sciences (TUMS) in October put the figure at 7.5 million, which means 15% of the adult population.

Atayee attributes the spike in cases to a “lack of accurate screening, information and training,” which is the primary focus of the Iranian Diabetes Society (IDS), which has more than 20 branches in Iran.

That, in turn, is made worse by a lack of access to essential medicine, either because of shortages or high prices, which keep getting higher amid economic woes.

- Sanctions and Mismanagement

Diabetic patients in Iran have long grappled with a lack of access to medicine, including insulin pens, due to shortages or exorbitant prices, a problem that experts acknowledge is caused by sanctions and mismanagement.

Out of an estimated 7.5 million patients in Iran, around 1 million require daily insulin injections and the use of blood glucose test strips to measure blood sugar level, Dr. Amin Beheshti, a diabetes specialist, told Anadolu Agency, pointing to occasional shortages.

"Although insulin pens are covered under insurance in Iran, local pharmacies often run out of their supplies, which leads to their skyrocketing prices on the black market," he said, blaming the situation on sanctions and smuggling.

Although Iran has homegrown insulin pens, the demand for foreign-made pens remains high, which becomes "problematic" with banking transactions hit by sanctions, he added.

Maryam Rajab, a trainer and counselor at the IDS, said insulin pens "may not" be available at all pharmacies, blood sugar test strips are "expensive" and oral medications are "sometimes not covered under the insurance."

Saman Berahmani, a diabetic and an amateur cyclist, said procuring insulin pens has become a "difficult and tedious task" even for someone like him with health insurance, as prices have surged.

"This time last year, I would buy a pack of 100 needles for 70,000 toman ($2.5). Now, the same pack costs me 280,000 toman ($10), which is a four-fold increase," he told Anadolu Agency, suggesting that even life-saving medicine has become expensive with sanctions sending local currency into a tailspin.

He also blamed it on what he termed "wrong policies" of the Food and Drug Organization, a regulatory body that operates under the Health Ministry.

Shaqayaq Madani, a diabetic and ambassador for the IDS, echoed the same concerns. She told Anadolu Agency that the cost of diabetes care equipment has become "very high" in Iran.

She said it was "hard" for her in the beginning to cope with the disease, but later it became "easier" after she became associated with the national diabetes society.

The IDS is a non-governmental body, affiliated with the IDF, that seeks to raise awareness about the disease through outreach programs and training.

"Awareness helps to better control blood sugar and prevent irreversible complications of diabetes," Rajab, who has been associated with the organization for 24 years, told Anadolu Agency.

- Alarming surge

Iran is home to the second largest diabetic population in the Middle East, which experts fear could jump to 9.5 million by 2030, with mortality associated with the disease assuming alarming proportions.

The prevalence of diabetes has almost doubled in the last two to three decades in Iran, with a staggering surge recorded in the last five years, according to Baqer Larijani, the head of the Endocrinology and Metabolism Research Institute at TUMS.

Talking to reporters on the sidelines of a program to mark National Diabetes Week, which coincides with World Diabetes Day, Larijani said efforts are being made to step up awareness programs and the expansion of diabetes clinics in different provinces.

"Obesity, air pollution and lack of physical activity are three main factors behind the surge in diabetes in Iran," he said, adding that kidney diseases and neurological complications also quite often result from the disease.

Commenting on the effect of coronavirus on diabetic patients in Iran, the official said 12% of those hospitalized for the virus were diabetics, putting their mortality rate at 14%, compared to the overall 8.4%.

Alireza Mahdavi, director of the National Diabetic Prevention and Control Program at the Health Ministry, speaking on state television earlier this week said there has been an increase in diabetic patients in Iran since the outbreak of the virus early last year.

He said Type 1 diabetes is more common in children and adolescents, while Type 2 is more prevalent in adults in Iran, although both face the same degree of risk.