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LETTERS TO THE EDITOR
Year : 2019  |  Volume : 23  |  Issue : 3  |  Page : 379

Cold chain and insulin: Should we follow the polio vaccine example?


Department of Endocrinology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India

Date of Web Publication30-Jul-2019

Correspondence Address:
Karthik Balachandran
Department of Endocrinology, Sri Ramachandra Medical College and Research Institute, New No 108, Vellala Street, Purasaiwakkam, Chennai - 600 084, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijem.IJEM_211_19

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How to cite this article:
Balachandran K. Cold chain and insulin: Should we follow the polio vaccine example?. Indian J Endocr Metab 2019;23:379

How to cite this URL:
Balachandran K. Cold chain and insulin: Should we follow the polio vaccine example?. Indian J Endocr Metab [serial online] 2019 [cited 2019 Aug 23];23:379. Available from: http://www.ijem.in/text.asp?2019/23/3/379/263682



Sir,

One of the problems with insulin storage is its temperature sensitivity. Exposure to high temperatures can result to loss of potency of insulin. Storage of insulin at 32--37°C reduces the potency of insulin by 14--18%.[1] To overcome this, several methods to storing of insulin in the neighbour's fridge to storing it in an earthen pot are used by our patients.[2],[3] Since these are unapproved frugal innovations, it is difficult to know the effectiveness of these “jugaad” methods. Even in insulin bought from pharmacies in remote villages, we have no way to know the integrity of the cold chain of insulin at the point of sale. This lack of attention to environmental temperature is not a major issue in Europe or parts of USA where the ambient temperature might be closer to 25°C. However, in a hot country like India, the ambient temperature can become crucial.

I propose that to tackle this problem, insulin manufacturers should be persuaded to use the same low cost technology used in polio vaccines in India. The vaccine vial monitor (VVM) is a thermochromic label put on vaccine vials,[4] which gives a convenient way to detect deficiencies in cold chain. It consists of a square within a circle. If the square becomes the same color or darker than the circle, the color change indicates that the vaccine has been exposed to higher than recommended temperature, putting the vaccine potency in jeopardy. This is cost effective enough to be executed in scale as has been shown by the polio vaccination in India. The WHO has said that the VVM is crucial to polio eradication programme.

The challenge is to produce an IVM---an insulin vial monitor, which will change color if a particular threshold is reached. From published information, 4--8°C is a reasonable threshold for assessing the integrity of the cold chain.[5] Since the number of insulin users is huge, the economics of scale would offset the additional costs associated with the use of IVM and in hot countries, the fractional additional cost, would be well worth for the peace of mind and confidence the IVM can provide not only to the doctor but also to the patient, that the insulin they get is of full potency.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Vimalavathini R, Gitanjali B. Effect of temperature on the potency and pharmacological action of insulin. Indian J Med Res 2009;130:166-9.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Arya SC. Insulin storage in a clay pot. Ann Saudi Med 2000;20:491.  Back to cited text no. 2
    
3.
Kalra S, Kalra B. Storage of insulin in rural areas. J Acad Med Sci 2012;2:88.  Back to cited text no. 3
    
4.
Aylward RB, Linkins J. Polio eradication: Mobilizing and managing the human resources. Bull World Health Organ 2005;83:268-73.  Back to cited text no. 4
    
5.
Chandler C, Gryniewicz CM, Pringle T, Cunningham F. Insulin temperature and stability under simulated transit conditions. Am J Health Syst Pharm 2008;65:953-63.  Back to cited text no. 5
    




 

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