Diabetes patients in low- and middle-income countries (LMICs) lack access to the insulin they need to manage their condition, with only 27% of 108 poor countries registering all the insulins classified as essential medicines by the World Health Organization (WHO)—and 22% registering none.

Even when insulin is available, it may be unaffordable, leaving both adults and children vulnerable to complications such as cardiovascular disease, kidney failure, nerve damage, amputations, vision loss, and death.

These stark statistics are highlighted in a new Access to Medicine Foundation report, which asks what pharmaceutical companies are doing to expand access to diabetes care in LMICs, as well as proposes potential solutions.

Founded in 2003, the Netherlands-based Access to Medicine is a nonprofit that works to urge and guide drug companies to do more to serve the world's poorest countries, which are home to three out of four adults with diabetes.

The organization extracted information for the report from proprietary data, the public domain, peer-reviewed literature, and international health and policy reports. It reveals that three companies—Eli Lilly, Novo Nordisk, and Sanofi—produce 83% of the insulin sold in LMICs and hold 95% of the market share. A fourth, Biocon, is a major maker of biosimilar insulins but on a smaller scale.

While drug companies have taken steps to make insulins more affordable, their efforts have been siloed and have focused on only a few products in a few countries, mostly in Africa, the report says. Most of the initiatives have focused on pediatric programs, training, donations, and price ceilings. "At the end of the day, it's a patchwork, not integrated strategies," Claudia Martinez, research program manager at Access to Medicine, told CIDRAP News.

At the same time, many LMICs have the highest diabetes-related death rates in the world, with the Western Pacific region accounting for roughly 2.3 million deaths in 2021.

Read more...