Global Insulin Access: Challenges and Progress

Insulin, a life-saving medication for millions with diabetes, remains inaccessible to a significant portion of the global population. Despite being discovered over a century ago, access to this essential medicine is severely unequal, particularly in low- and middle-income countries (LMICs). This article examines the current state of insulin access, the barriers preventing equitable distribution and ongoing efforts to improve affordability and availability worldwide.

The Growing Diabetes Epidemic and Insulin Demand

The number of people living with diabetes has risen dramatically in recent decades, increasing from 200 million in 1990 to 830 million in 2022 [1]. This surge in prevalence is particularly rapid in LMICs. Over 60 million people with type 2 diabetes require insulin, yet nearly half are unable to obtain it [1]. The increasing diabetes burden underscores the urgent necessitate for improved insulin access globally.

Barriers to Insulin Access: The 4As Framework

The World Health Organization (WHO) utilizes a “4As” framework to analyze insulin access: Availability, Accessibility, Affordability, and Acceptability [1]. These interconnected dimensions highlight the complexities of insulin provision, from manufacturing and distribution to patient apply.

• Availability: Ensuring sufficient insulin is manufactured and supplied to meet global demand.
• Accessibility: Making insulin physically reachable for those who need it, including overcoming geographical and logistical challenges.
• Affordability: Reducing the financial burden of insulin, making it affordable for individuals and healthcare systems.
• Acceptability: Addressing cultural beliefs, stigma, and patient education to ensure people are willing to use insulin.

Current Status of Insulin Availability and Affordability

A recent cross-sectional survey of International Diabetes Federation (IDF) member associations revealed that insulin analogues were reported as available in 68.8% of settings, with full reimbursement in 63.5% [2]. However, significant disparities exist between older, widely used medicines and newer diabetes therapies [2]. Access to advanced diabetes technologies, such as continuous glucose monitors (CGMs) and insulin pumps, remains limited, particularly in resource-limited settings [3]. Clinicians in these settings often rely on older insulin formulations and traditional glucose monitoring methods, leading to less optimal glycemic control and increased risk of complications [3].

Global Initiatives to Improve Insulin Access

Recognizing the global insulin access crisis, several initiatives are underway to address the challenges:

• WHO Global Diabetes Compact: Launched during insulin’s centenary, this initiative aims to achieve 100% access to affordable insulin for people with type 1 diabetes and 80% treatment coverage for those with type 2 diabetes by 2030 [1].
• Health Diplomacy: Efforts to foster collaboration between governments, international organizations, and the private sector to address supply chain issues, reduce costs, and improve access [1].
• Research and Development: Ongoing research to develop more affordable and accessible insulin formulations and delivery systems.

The Role of Technology and Innovation

While advanced diabetes technologies are not yet widely available in LMICs, they hold significant promise for improving glycemic control and reducing complications. However, equitable access to these technologies is crucial. Bridging the gap requires addressing financial barriers, strengthening healthcare infrastructure, and providing adequate training for healthcare providers [3].

Looking Ahead

Improving global insulin access requires a multifaceted approach that addresses the interconnected challenges of availability, accessibility, affordability, and acceptability. Continued collaboration, investment in research and development, and a commitment to health equity are essential to ensure that everyone who needs insulin can access this life-saving medication. The Geneva Faculty Diabetes Centre is actively contributing to international efforts to promote equitable and sustainable access to insulin [4].