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Diabetes Inequality: Why are resources not available where they are most needed?

Problem: Access to Healthcare

Ten times more is spent per patient on diabetes care in high-income countries than lower-middle-income countries (LMICs) yet individuals living with diabetes disproportionately live in LMICs [1]. LMICs were home to more than 75% of the 463 million adults living with diabetes in 2015, but only 19% of global health expenditure on diabetes was spent there in the same year [3]. Working alongside Médecins Sans Frontières (MSF), our team aims to evaluate the strategies that may address inequality in access to diabetes care.

Diabetes: The Basics

Diabetes is a chronic and potentially manageable, non-communicable disease. Over time, sustained high blood glucose levels lead to serious multi-organ complications. This occurs as the body fails to produce or effectively use insulin, a hormone that regulates blood glucose level. Insulin injections are life-saving for some diabetic patients and 150-200 million people require insulin worldwide [2]. Insulin is vital for type I diabetes patients, as well as type II diabetes patients, when lifestyle changes and other pharmacological therapy is insufficient.

Who is Affected? 

There has been a rapid rise in the prevalence of diabetes in LMICs in recent years. Much of this increase is not adequately explained by conventional risk factors including age, tobacco consumption, family history, high BMI, low education and ethnicity [3].

Opportunity for Improving Healthcare 

Diabetes management strategies are often not effectively implemented in LMICs; only 60% of LMICs have operational national diabetes policies [4]. As of 2016, insulin was unavailable in a public health setting in 58% of LMICs [2]. Out of pocket payments, lack of insurance, inadequate quality, logistical challenges and insufficient resources are just some of the barriers to diabetes care in LMICs.

How Are We Tackling This Problem?

Our group is working to gather data on the current state of diabetes care and the ongoing challenges of access to therapy to develop recommendations for improving diabetes management in LMICs. Our findings will contribute to the MSF pledge for a strong WHO resolution on access to insulin.

References [1] WHO Diabetes country profiles 2016. Available at:

[2] International Diabetes Federation. IDF Diabetes Atlas, 9th edn. Brussels, Belgium: 2019. Available at:

[3] International Diabetes Federation. IDF Diabetes Atlas, 7th edn. Brussels, Belgium: 2015. Available at:

[4] WHO Global report on diabetes 2016


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