Hospital Practice

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Ongoing efforts to improve the management of

patients with diabetes in Bangladesh and the
implications

Mainul Haque, Salequl Islam, Zubair Mahmood Kamal, Farhana Akter,

Iffat Jahan, Md Saghir Abdur Rahim, Nusrat Sultana, Abm Muksudul Alam,
Munzur-E-Murshid, M A Halim-Khan, Farzana Deeba, Muhammed Abu
Bakar, Shamsun Nahar, Miliva Mozaffor, Umme Laila Urmi, Taohidur
Rahman Saikat, Md Zakirul Islam, Monami Haque, Samiul Iqbal, Mohammad
Monir Hossain, Nurun Naher, Eleonora Allocati & Brian Godman

To cite this article: Mainul Haque, Salequl Islam, Zubair Mahmood Kamal, Farhana Akter, Iffat
Jahan, Md Saghir Abdur Rahim, Nusrat Sultana, Abm Muksudul Alam, Munzur-E-Murshid, M A
Halim-Khan, Farzana Deeba, Muhammed Abu Bakar, Shamsun Nahar, Miliva Mozaffor, Umme
Laila Urmi, Taohidur Rahman Saikat, Md Zakirul Islam, Monami Haque, Samiul Iqbal, Mohammad
Monir Hossain, Nurun Naher, Eleonora Allocati & Brian Godman (2021): Ongoing efforts to improve
the management of patients with diabetes in Bangladesh and the implications, Hospital Practice,
DOI: 10.1080/21548331.2021.1906083

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HOSPITAL PRACTICE
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CLINICAL FEATURE
ORIGINAL RESEARCH

Ongoing efforts to improve the management of patients with diabetes in

Bangladesh and the implications
Mainul Haque a, Salequl Islam b, Zubair Mahmood Kamal c, Farhana Akter d, Iffat Jahan e,
Md Saghir Abdur Rahim f, Nusrat Sultana g, Abm Muksudul Alam h, Munzur-E-Murshid i, M A Halim-Khan h
,
Farzana Deeba j, Muhammed Abu Bakar k, Shamsun Nahar b, Miliva Mozaffor l, Umme Laila Urmi m,
Taohidur Rahman Saikat n, Md Zakirul Islam o, Monami Haque p, Samiul Iqbal q,
Mohammad Monir Hossain r, Nurun Naher s,t, Eleonora Allocatiu and Brian Godman v,w,x
a
Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia),
Malaysia; bDepartment of Microbiology, Jahangirnagar University, Savar, Bangladesh; cResident, National Institute of Mental Health (NIMH), Dhaka,
Bangladesh; dDepartment of Endocrinology, Chittagong Medical College, Chattogram, Bangladesh; eDepartment of Physiology, Eastern Medical
College, Cumilla, Bangladesh; fBIRDEM General Hospital, Shahbag Square, Dhaka, Bangladesh; gDepartment of Endocrinology & Metabolism,
Bangabandhu Sheik Mujib Medical University Hospital, Shahbag, Bangladesh; hShaheed Suhrawardy Medical College and Hospital, Dhaka,
Bangladesh; iWISH2ACTION Project, Handicap International, Chamrargola, Kurigram Sadar, Kurigram, Bangladesh; jDepartment of Obstetrics and
Gynecology, Bangabandhu Sheik Mujib Medical University (BSMMU) Hospital, Shahbag, Bangladesh; kDepartment of Endocrinology and
Metabolism, Chattogram Maa-O-Shishu Hospital Medical College, Chattogram, Bangladesh; lDepartment of Biochemistry, Medical College for
Women & Hospital, Uttara, Bangladesh; mWorld Fish, Banani, Bangladesh; nDepartment of Biochemistry and Molecular Biology, Tejgaon College,
National University of Bangladesh, Dhaka 1215, Bangladesh; oDepartment of Pharmacology & Therapeutics, Eastern Medical College, Cumilla,
Bangladesh; pHuman Resource Department, Square Toiletries Limited, Rupayan Center, Bangladesh; qFaculty of Dentistry, BSMMU, Bangladesh;
r
Department of Anatomy, Eastern Medical College, Cumilla, Bangladesh; sDepartment of Anatomy, Ad-din Women’s Medical College, Dhaka,
Bangladesh; tInstituto Di Ricerche Farmacologiche ‘Mario Negri’ IRCCS, Milan, Italy; uMario Negri Institute for Pharmacological Research, Milano,
Italy; vStrathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK; wDivision of Public Health Pharmacy and
Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa; xSchool of Pharmaceutical Sciences,
Universiti Sains Malaysia, Penang, Malaysia

ABSTRACT ARTICLE HISTORY

Background: Prevalence rates of patients with diabetes are growing across countries, and Bangladesh Received 10 February 2021
is no exception. Associated costs are also increasing, driven by costs associated with the complications Accepted 17 March 2021
of diabetes including hypoglycemia. Long-acting insulin analogues were developed to reduce hypogly­
KEYWORDS
cemia as well as improve patient comfort and adherence. However, they have been appreciably more
Biosimilars; bangladesh;
expensive, reducing their affordability and use. Biosimilars offer a way forward. Consequently, there is diabetes; health policy;
a need to document current prescribing and dispensing rates for long-acting insulin analogues across insulins; insulin glargine;
Bangladesh, including current prices and differences, as a result of affordability and other issues. utilization; prices
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, now accounting for over 80% of all insulins dispensed in a minority of stores. This increase
has been helped by growing prescribing and dispensing of biosimilar insulin glargine at lower costs
than 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 insulin analogues 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.

1. Introduction [1]. However, this is not universal with rates of type 2 diabetes
falling in some countries in recent years with the introduction
There is a growing prevalence of diabetes worldwide
of preventative strategies [2]. Overall, 463 million people
enhanced by global incidence rates rising by over 100%
world-wide had diabetes in 2019, with the vast majority
between 1990 and 2017, reaching to 22.94 million in 2017
(80%) coming from low-income and middle-income countries

CONTACT Brian Godman [Link]@[Link] Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow,
United Kingdom.
© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License ([Link]
which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
2 M. HAQUE ET AL.

(LMICs) [3]. As a result of this increase, the economic burden of a concern particularly in LMICs where there are high patient
diabetes is estimated to reach 2.2% of Gross Domestic Product co-payments and lower costs for essential medicines can alle­
by 2030 unless addressed [3,4]. Bangladesh is no exception to viate the need for households to sell their assets or borrow
the general worldwide trend in the growing prevalence of money to fund treatments for chronic diseases [22].
diabetes. Currently, up to 8.4 million adults have diabetes in In view of this, there is a need to document current pre­
Bangladesh (8.1%), with prevalence rates expected to increase scribing and dispensing rates for long-acting insulin analogues
to 15.0 million by 2045 unless addressed [5,6]. Other authors across Bangladesh, including current prices and differences, to
have suggested higher prevalence rates at 13.0% of the popu­ provide future guidance. This was the objective of this paper.
lation in Bangladesh by 2030 [7]. Complications associated
with diabetes are also increasing, enhanced by poor glycemic
control and adherence to treatments [5], thereby increasing
2. Methods
the overall morbidity and mortality associated with non-
communicable diseases (NCDs) in Bangladesh [3,8]. We undertook a mixed approach. This initially included col­
However, despite the efforts of the government in lecting current prescribing data on insulins, including long-
Bangladesh with initiating many NCD-related programs, acting insulins, from five public and private hospitals among
there are concerns with their implementation and monitoring a representative sample of these hospitals across Bangladesh.
in practice [8]. This includes concerns with available facilities, Prescribing as opposed to utilization data was collected as
personnel and guidelines to adequately treat patients with long-acting insulin analogues are not dispensed in hospitals
coronary vascular disease (CVD) including hypertension and in Bangladesh, and patients typically have to purchase NPH
diabetes [9–12]. This is a concern in view of the implications of and other insulins themselves from pharmacies and drug
the poor management of patients with diabetes on subse­ stores once supplies run out in public hospitals.
quent morbidity and mortality [13]. For instance, poor man­ Consequently, just collecting utilization data would give
agement can increase the risk of CVD by up to threefold, with a false impression of current prescribing practices.
up to 30% of the patients with diabetes dying from CVD [3,14]. The information from hospitals was supplemented by
Consequently, there is a need to improve the care of these a survey among a range of community pharmacies and
patients. This includes greater use of long-acting insulin ana­ drug stores across Bangladesh to assess dispensing and pri­
logues, developed to reduce hypoglycemia where this is cing patterns for different insulin glargine preparations, as
a concern as well as improve patient convenience and com­ well as different insulin types, e.g., long-acting insulin analo­
pliance to treatment [3,15,16]. However, there have been con­ gues versus other forms of insulin, in 2019 and 2020. The
cerns with the additional costs of the long-acting insulin survey was conducted among pharmacies and drug stores
analogues versus neutral protamine hagedorn (NPH) and since, as mentioned, patients typically purchase their medi­
other insulins [3,17,18]. This is important in Bangladesh, cines from these locations, especially long-acting insulin ana­
where diabetes patients have paid an average of 35,385 BDT logues, with hospital physicians the principal initiators and
(US$454) per year for their medicines versus only 1609 BDT prescribers of insulin for patients with diabetes.
(US$21) for those without diabetes [19], medicines to manage Consequently, community pharmacies and drug stores can
NCDs in Bangladesh can be expensive by international stan­ provide a more accurate picture of physician prescribing
dards [20], and much of these costs are out-of-pocket [21]. patterns for the different insulins, including both originator
Consequently, an appreciable number of households in and biosimilar long-acting insulin analogues, than outpatient
Bangladesh are forced to sell their assets or borrow money hospital pharmacies.
to fund treatments [22]. This needs to be avoided if Only insulin glargine was broken down into the originator
Bangladesh is to achieve its sustainable development goals and biosimilar (100IU/ml) as this was the only long-acting
for NCDs [23]. insulin analog biosimilar routinely available in Bangladesh.
We are aware a number of Government hospitals in With respect to community pharmacies and drug stores, we
Bangladesh only fund NPH and other similar insulins until adopted a similar approach to our recently conducted study
the monies run out. Consequently, long-acting insulin analo­ on the impact of COVID-19 on the utilization, shortages and
gues need to be purchased directly from community pharma­ prices changes of pertinent medicines and equipment [29,30].
cies and drug stores when prescribed in both public and This included documenting actual changes in dispensing rates
private hospitals. Biosimilars, though, can help to appreciably and prices based on invoices where available. Alternatively, we
lower the costs of biologic medicines [24]. However, there just documented impressions in view of the confidentiality of
have been concerns with hypoglycemia if patients are some the information being sought, especially surrounding
switched between different administrative devices with differ­ current prices and discounts. In addition, we were not paying
ent characteristics when dispensed different originators and pharmacists for their time, similar to previous situations
biosimilars [25,26]. This, though, has to be balanced against [29,30]. We did not undertake a sample size calculation since,
improved patient care and outcomes with long-acting insulin to the best of our knowledge, no previous study has been
analogues. There have also been concerns that limited price conducted in this area to provide guidance on such calcula­
reductions for biosimilars versus the originators in some coun­ tions. However, our intention was to approach an appreciable
tries will reduce the attractiveness of the market for biosimilars number of pharmacies and drug stores throughout
for long-acting insulin analogues in practice [18,27,28]. Limited Bangladesh to provide a comprehensive picture, similar to
price differences between originators and biosimilars are our study with COVID-19 [29].
 HOSPITAL PRACTICE 3

Where pertinent, pricing data were converted to US$ for The long-acting insulin analog principally prescribed is
comparative purposes using current exchange rates (https:// insulin glargine, although there is growing prescribing of
[Link]/currencyconverter/). insulin detemir and insulin degludec (table 1). Issues of afford­
We did not seek ethical approval as this study did not ability are typically discussed with patients during the consul­
involve patients. However, we sought approval from pharmacy tation, with patients likely to follow the advice of their
managers and drug store owners before participation, with physician when obtaining their insulin from either pharmacies
interviewees given the opportunity to refuse. This is in line or drug stores. Affordability is a key issue as discussed by Islam
with previous studies undertaken by the coauthors in similar et al. (2017) given the high expenditure on medicines among
areas and circumstances [29–34]. Overall, 167 pharmacies patients with diabetes in Bangladesh versus those without
were included in the study with different information sets diabetes [19]. However, there is still considerable prescribing
provided depending on the information that could be of the originator in some hospitals due to concerns with other
supplied. formulations (table 1).
Table 2 contains details of the surveyed pharmacies and
drug stores including the response rates and locations in
3. Results Bangladesh. The overall response rate was 66.8%.
We first discuss prescribing patterns among the five participat­ Figure 1 shows overall a similar utilization of insulin analo­
ing hospitals before discussing dispensing and pricing pat­ gues vs. other insulins among 76 out of 82 pharmacies (table
terns from the 167 pharmacies providing this data. 2 – first group) providing such data. The percentages in the
Table 1 depicts current prescribing patterns for long-acting x-axis represent the percentages of the different insulins dis­
insulins, including different insulin glargine preparations, pensed in each pharmacy, i.e. analog versus other insulins, out
among the five participating hospitals in Bangladesh. The of the total amount of insulin dispensed. These have been
prescribing of long-acting insulin analogues has increased in grouped into bands, i.e. 0% to 20%, 21% to 30%, 31% to 40%
recent years, with long-acting insulin analogues more likely to and 41% to 50%, etc., for comparative purposes. As seen in
be prescribed by endocrinologists reflecting their perceived figure 1, the dispensing of the analogues increased in 2020 vs.
benefits of improved patient outcomes and convenience ver­ 2019. The analogues are principally long-acting insulin analo­
sus NPH and other insulins. Non-endocrinologists are more gues, and mainly insulin glargine, including both the origina­
likely to prescribe NPH and other insulins since these are tor and biosimilars. Similar to table 1, there is considerable
provide free-of-charge in public hospitals until funds run out. variation among the different pharmacies and drug stores in
However, even among non-endocrinologists, we have seen Rajshani and Dhaka regarding which insulin (analog and
increased prescribing on long-acting insulin analogues in others) is being dispensed.
recent years. Figure 2 depicts differences in the dispensing patterns of
originator vs. biosimilar insulin glargine among the first group
of pharmacies and drug stores taking part (Group One – table
Table 1. Current long-acting insulin prescribing patterns among target hospitals 1). Again, the percentages in the x axis represent the percen­
in Bangladesh.
tages of the different insulin glargine preparations dispensed
% long-
acting % insulin glargine in each pharmacy, i.e., originators vs. biosimilars, out of the
insulins vs. vs other total long- % insulin glargine total amount of insulin glargine dispensed. These have again
other acting insulin among different been grouped into similar bands for comparative purposes. As
Name of Hospital insulins analogues presentations
seen in figure 2, there was greater dispensing of biosimilars
Originator Biosimilar
(various) versus originators, with again dispensing rates of biosimilars
Chittagong 20–30% 70–80% 30% 70% marginally increasing in recent years.
Medical The considerable differences in the dispensing patterns
College –
Public among these 82 pharmacies and drug stores probably reflect
Shaheed 45–50% 70–80% 50–60% 40–50% appreciable differences in the prescribing habits of local
Suhrawardy
Medical
College –
Public
Bangabandhu 10–15% 20–30% 60–70% 30–40% Table 2. Details of pharmacies and drugs stored contacted and provided data in
Sheik Mujib Bangladesh.
Medical
University – Surveyed Number Number agreeing Response Rate in District of
Public Groups contacted to take part Percentage (%) Bangladesh
BIRDEM – Private 20–25% 50–60% 60% 40% First 150 82 54.7 Dhaka,
Teaching Group Rajshahi
Hospital Second 65 58 89.2 Dhaka,
Chattogram Maa- 15–20% 70–90% 2% 98% Group Cumilla
O-Shishu Third 40 15 37.5 Dhaka,
Hospital Group Cumilla
Medical Fourth 15 12 80.0 Dhaka,
College – Group Kurigram
Private
NB: The % response rate refers to the number of pharmacists and drug store
NB: % refer to actual prescribing rates within each of the three categories’ owners approached who agreed to take part
4 M. HAQUE ET AL.

30.0

% Pharmacies and Drug Stores

25.0

20.0

15.0

10.0

5.0

0.0
0-20 21-30 31-40 41-50 51-60 61-70 71-80 81-100

2019 Other insulins 2020 Other insulins 2019 Analogues 2020 Analogues

Figure 1. Dispensing patterns of different insulins among drug stores and pharmacies in Bangladesh 2019 and 2020.
NB: 2020 is up to early December 2020. Analogues are principally long-acting insulin analogues with other insulins incorporating the remaining insulins dispensed in 2019 and 2020

30.0
% Pharmacies and Drug Stores

25.0

20.0

15.0

10.0

5.0

0.0
0-20 21-30 31-40 41-50 51-60 61-70 71-80 81-100

2019 Originator 2020 Originator 2019 Biosimilar 2020 Biosimilar

Figure 2. Dispensing patterns of different insulin glargine preparations among 79 of the 82 Pharmacies and Drug Stores 2019 and 2020.
NB: 2020 includes data up to early December 2020

physicians coupled with discussions and issues regarding stores surveyed (79.3%) in recent years, with reductions noted
affordability. in just 9.8% of the pharmacies and drug stores, greatest for
The biosimilars were the principal preparations of insulin the originator (13.8%).
glargine dispensed in a further set of 15 pharmacies (Group 3) Table 4 contains current prices of common foods in
accounting for just under 90% of all insulin glargine dispensed Bangladesh, with workers, such as those working in garment
(89.4% in 2019 and 88.9% in 2020). Overall, there was a 16.7% factories of US$2 to 4/day [35]
increase in the number of insulin glargine packs dispensed in
these 15 pharmacies between 2019 and 2020.
Table 3 documents the typical selling prices for the differ­
4. Discussion
ent insulin glargine preparations among 85 different pharma­
cies in Bangladesh (Groups 2, 3, and 4), with an appreciable We believe this is the first study to assess prescribing and
price reduction for some biosimilars. dispensing patterns for the different insulins, especially long-
Among the 167 pharmacies and drug stores surveyed, price acting insulin glargine, among key stakeholder groups in
rises were seen for the different insulin glargine preparations Bangladesh. The 66.8% response rate among participating
in 2020 vs. 2019 among 10.8% of them, which was greatest for pharmacies and drug stores is encouraging given the confi­
the biosimilars (11.3% vs. 10.3%). However, there was typically dential nature of some of the information requested. This rate
no change in prices in the majority of pharmacies and drug is similar to our low refusal rate in previous studies regarding
 HOSPITAL PRACTICE 5

medicines for patients with COVID-19 in Bangladesh and Table 4. Prices of typical foods in Bangladesh (Source: M Haque personal
communication).
across Asia [29,30].
It is encouraging to see the growing prescribing and dis­ Food Name Stores (various in BDT and US$)
pensing of long-acting insulin analogues in Bangladesh in Potato per Kilogram 25–40 (US$0.30–0.47)
Rice Coarse per Kilogram 50 (US$0.59)
view of their impact on lowering rates of hypoglycemia, as Red Lentil per Kilogram 110–130 (US$1.30–1.54)
well as improving comfort for patients [3,16], with dispensing Egg per Dozen 100–170 (US$1.18–2.0)
rates reaching over 80% of all insulins dispensed in a minority Fish (Farm Fish) per Kilogram 150–200 (US$1.77–2.36)
Chicken (Fresh) per Kilogram 250–300 (US$2.95–3.54)
of pharmacies (figure 1). Overall, long-acting insulin analogues Cooking Oil (Soyabean) 5 Liter Bottle 650–700 ($7.68–8.27)
typically now account for between 40% and 60% of the insu­ Mutton (Fresh) per Kilogram 750–800 (US$8.86–9.45)
lins dispensed, mirroring some of the prescribing patterns
seen (table 1). This is despite issues of affordability among
patients in Bangladesh, with sometimes catastrophic conse­
exemplar to other countries, especially LMICs, as we see
quences when family members become ill [22] given average
growth in the prescribing of lower cost insulin glargine biosi­
salaries of some workers at US$2 4/day [35], the cost of
milars continuing to further benefit patients in the future.
medicines, such as insulins (table 3) and those of common
There could be additional discounts if the prescribing and
foodstuffs (table 4). Issues of affordability, though, are
dispensing of insulin glargine are threatened by an appreci­
reflected in higher rates of prescribing and dispensing of
able growth in the prescribing of insulin detemir and insulin
lower cost biosimilars (table 2 and figure 2) among physicians,
degludec. However, this is unlikely if considerable price differ­
pharmacies and drug stores in Bangladesh, with rates
ences exist.
approaching 90% among one group of pharmacies (Group
Overall, lower cost biosimilars should be welcomed by
3 – table 1). These findings are encouraging and provide
all key stakeholder groups as this will help with issues of
direction to other LMICs where utilization of long-acting insu­
affordability, allowing more patients in Bangladesh and
lin analogues is low, e.g., long-acting insulin analogues are
wider to access long-acting insulin analogues to improve
typically not reimbursed or funded within the public health
their care [3,39]. This, in turn, helps decrease current rates
system in Brazil or among a number of African countries due
of hypoglycemia and associated consequences. Alongside
to issues of affordability versus NPH and other insulins as well
this, the authorities in Bangladesh need to increase the
as perceived limited health gain [17,18,36,37].
number of ambulatory care facilities to better diagnose
The typically greater use of biosimilars versus the originator
and manage patients with diabetes in the first place
in our study is encouraging as this should enhance competi­
given current concerns as well as rising rates of diabetes
tion among biosimilar manufacturers as seen with recent bio­
[16]. In addition, ensure adequate supplies of equipment
similars in Europe, which helped to further their lower prices
are available to allow patients to monitor their blood
[24,38]. As a consequence, Bangladesh can serve as an
glucose levels at home to prevent complications as this is
a concern among LMICs [3,36]. We will continue to monitor
this.
Table 3. Typical selling prices for different insulin glargine preparations among
85 pharmacies and drug stores in Bangladesh. We are aware of a number of limitations with this study.
Selling price in the These include only approaching a limited number of hos­
pharmacy (local pitals. However, this was deliberate for the reasons stated.
Manufacturer Packs (insulin glargine) currency and US$) In addition, we were unable to obtain exact details on
Lantus ® (Sanofi-Aventis) 100IU/ml 3 ml Pen;
5 × 3 ml Pen
1220 BDT (US
$14.40); 6100 BDT
changes in the utilization and prices of pertinent insulins
(US$72.00) from all the pharmacists visited due to issues of confiden­
Lantus ® (Sanofi-Aventis) 100IU/ml – 3 ml
Cartridge; 5 × 3 ml
785 BDT (US$9.26);
3925 BDT (US$
tiality and having the data readily to hand. However, we
are confident with our findings, and believe these can help
Cartridge 46.31)
guide future strategies in Bangladesh and wider to
®
Abasaglar (Healthcare
Pharmaceuticals Ltd)
100IU/ml – 3 ml Pen 1085 BDT (US$12.80)
improve the management of patients with diabetes requir­
®
Abasaglar (Healthcare
Pharmaceuticals Ltd)
100IU/ml – 3 ml
cartridge, 100IU/
723 BDT (US$8,53)
to 3617 BDT (US
ing insulin.
ml – 5 × 3 ml $42.68)
cartridges
Glarine ® – ACI Limited 100IU/ml – 3 ml Vial;
100IU/ml – 3 ml Pen
600 BDT (US$7.08);
950 BDT (US
5. Conclusion
$11.21) In conclusion, we do see growing use of long-acting insulin
®
Glarine – ACI Limited 3 x 5 ml Pens 4750 BDT (US$56.05)
analogues in Bangladesh, which reflects increasing recognition
®
Insul Glargine (Popular 100IU/ml – 3 ml Vial 600 BDT(US$7.08)
Pharma Ltd), Insulet GN
(Aristo Pharma Limited),
® of their role and value in managing patients with diabetes.
This is increasingly biosimilars at lower prices in view of issues
®
Larsulin (Square
Pharmaceuticals), of affordability in Bangladesh. Increased competition should
®
Vibrenta (Incepta
Pharma)
help to further lower prices further enhancing access to long-
acting insulin analogues with resultant benefits to patients,
®
Larsulin (Square
Pharmaceuticals)
100IU/ml – 3ml Vial –
Pen Cartridge
600 BDT(US$7.08)
and we will be monitoring this. Alongside this, there is a need
®
Vibrenta (Incepta Pharma) 100IU/Ml – 3ml –
PenSet
600 BDT(US$7.08) for additional educational initiatives among pertinent physi­
cians to enhance their prescribing of long-acting insulin
6 M. HAQUE ET AL.

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