Access to medicines and inequalities: the case of diabetes treatments

Diabetes is one of the most widespread chronic non-communicable diseases, with a major socio-economic and public health impact. The prevalence of diabetes is continuously increasing worldwide, especially in low- and middle-income countries. Today, more than 530 million adults are estimated to be living with diabetes globally, a number expected to rise to 640 million by 2030 (in Europe, around 60 million adults are affected).

This growing burden threatens already fragile healthcare systems, which are facing increasing pressure, and highlights unhealthy mechanisms and persistent inequalities in access to healthcare. In the globalized world we live in, the well-known “miraculous” weight-loss effects of drugs for type 2 diabetes have generated a sudden increase in demand from people seeking to use them not for health reasons, but for weight loss. In 2023, the Italian Medicines Agency (AIFA) issued two notices reporting shortages of these well-known medicines due to growing demand, reiterating that they are indicated exclusively for the treatment of adults with type 2 diabetes and that any other use, including weight management, “constitutes off-label use and currently puts the availability” of the drug for the intended population at risk. In this case, the spread of improper use of anti-diabetic medication triggered a global supply crisis, jeopardizing treatment for patients in need.

With regard to type 1 diabetes, critical issues instead affect children and young people living in low- and middle-income countries, who face enormous inequalities in the diagnosis and treatment of this disease. Access to Medicine Foundation is an independent non-profit organization committed to transforming the healthcare ecosystem and promoting progress toward global health equity. For more than twenty years, it has monitored and evaluated the behavior of the world’s most influential pharmaceutical companies, providing independent, data-driven analyses aimed at guiding the industry toward initiatives that make essential medicines accessible.

A recent report by the foundation analyzed the pharmaceutical industry’s efforts to ensure access to essential products for the treatment of type 1 diabetes in disadvantaged regions, where many children and young people are in desperate need of life-saving care. The report mapped 11 initiatives, highlighting the importance of these interventions and providing recommendations to expand and guarantee access for a greater number of patients. Although children and young people with diabetes receive essential support from these initiatives — which help bridge gaps in access to treatment, monitoring devices, essential supplies, and diabetes education, while also strengthening local healthcare systems in low- and middle-income countries — inequalities remain significant. Insulin is still out of reach for half of those who need it; for many people with type 1 diabetes in resource-limited settings, treatment remains a matter of survival.

The report also highlights promising results, showing that partnerships between companies and local actors are powerful drivers of change. However, to truly bridge the gap, long-term collaborative solutions between industry and healthcare systems are needed to support the transition from donation-based models to more stable mechanisms. The pharmaceutical industry must integrate access into its business models, governments must invest in healthcare system reform, philanthropy must help catalyze solutions, and people living with diabetes must be treated as partners, not merely as beneficiaries.