WHO plans to increase access to affordable, quality-assured testing and treatment for diabetes

Over a four-day workshop that ended on 25 September 2020, WHO and key international health partners mapped out a plan to boost access to affordable and quality-assured testing and treatment for diabetes.

There are more than 420 million people living with diabetes. Diabetes is the seventh leading cause of death and a major cause of costly and debilitating complications such as heart attacks, strokes, kidney failure, blindness and lower limb amputations.

People with type 1 diabetes need insulin for survival. However, many in low- and middle-income countries are not receiving it, largely due to high prices and supply challenges.

People with type 2 diabetes need insulin for controlling blood glucose levels to avoid complications when oral medicines become less effective in the progressive course of the illness. About 60 million people with type 2 diabetes need insulin, but only about half of them are able to access it.

One problem with insulin costs is that three originator companies control 96% of the global market, setting prices that are prohibitive for many countries. In addition, delivery devices for insulin and glucose meters to monitor blood sugar levels are missing or scarce in many countries.

It is a failure of society and the global community as a whole that people who need insulin should encounter financial hardship to buy it or go without it and risk their life."

Dr Tedros Adhanom Ghebreyesus, Director-General, WHO

WHO has been working on a package of special focus measures to address the growing diabetes burden in all countries. In November 2019, WHO launched an insulin prequalification pilot to quality-assure more insulin products entering the international market, giving countries greater choice and potentially lower prices, thus contributing to improved access.

There are many different stakeholders working on insulin and WHO's workshop this week was an initial effort to bring all the workstreams together for greater impact at country level.

Bringing all stakeholders together, including regulators, civil society and UN partners, the workshop highlighted opportunities to change the game and do things differently through:

• global partnerships and patient-centred approaches                                                                                       
• better gauging the global impact of diabetes and improving coverage and quality of diagnosis                       
• scaling up access to essential diabetes medicines including insulin and associated devices (i.e., insulin delivery devices, blood glucose meters and test strips)                                                               
• greater advocacy to create awareness of the continuing challenges in access to insulin, even as we approach the 100th anniversary of its discovery.                                                                                   
• better training for health care professionals.                                                                                           
• agreement on a global treatment target for diabetes, including the % of people diagnosed, the % of people on treatment, and the % on insulin.

Quick Facts:

• Diabetes is a global epidemic. Today, more than 420 million people are living with diabetes worldwide. This is 6% of the world population. It is also four times more than in 1980. This number is estimated to rise to 570 million by 2030 and to 700 million by 2045.                                 
• 1 in 2 adults with diabetes are unaware of their status. 4 out 5 adults with undiagnosed diabetes live in low- and middle-income countries. Persons unaware of their status are at great risk of debilitating complications.                                                                                                                     
• All people with type 1 diabetes need insulin. Sixty million people with type 2 diabetes also need insulin, but about half of them cannot get the insulin they need because their country's health systems cannot afford it.                                                                                                                       
• This year's WHO Global Capacity Survey on NCDs reveals that less than half of low-income countries have general availability of insulin in the public sector.                                                       
• Last year's WHO UHC Monitoring Report shows that NCD services are conspicuous by their lack of progress in comparison to communicable diseases.                                                                           
• Prevention, screening, early diagnosis and appropriate treatment of diabetes and other NCDs were taken up by WHO's Member States as a priority in 2000, following a call for action by the World Health Assembly, but over the last two decades WHO has had to report to the World Health Assembly that there is not enough progress in countries in meeting the health-care needs of people living with diabetes.                                                                                                                               
• At this pivotal moment, with COVID-19 still spreading, many people who need treatment for diabetes are not receiving the health services and medicines they need. A recent survey conducted by WHO found that 50% of countries had disrupted their services for diabetes and diabetes-related complications.                                                                                                                                           
• People with diabetes are also at increased risk of severe disease and death from COVID-19, and this poor prognosis seems to be heightened with advanced age. Early clinical evaluation is warranted for any suspect symptoms.                                                                                                           
• With the release of WHO's operational guidance for maintaining health services in the COVID-19 context in June, WHO provides guidance on how to modify diabetes care for safe delivery of services, and how to transition towards restoration.