Right now, over half a billion adults around the world are living with diabetes, a chronic disease that can often lead to deadly and debilitating complications and for which there is no cure. It’s a staggering number made worse by the fact that an estimated one in two adults with diabetes go undiagnosed.
Acknowledging the need for urgency, in 2022 the World Health Organization Member States agreed to five global targets, the first of their kind, to address diabetes. These targets aim to accelerate action by member countries to stem the rise of diabetes while improving diagnosis and access to quality diabetes medicines, treatment, and care by 2030.
The global targets come at a critical time. Despite significant strides in effectively treating and managing the disease, cases continue to soar. In 2021, 6.7 million people died from diabetes or related complications, and by 2030 cases are expected to reach 643 million. Yet despite the scientific and medical progress being made, not every person has been able to benefit from it, says Saba Husain, Senior Director of Global Health Partnerships at Eli Lilly and Company and member of the Access Accelerated Steering Committee.
“There are glaring inequities in access to diabetes care for people around the world, particularly in low- and middle-income countries,” she explains. “Setting global targets is a powerful tool to elevate worldwide attention on identifying solutions to many critical health challenges that lead to these gaps.”
The WHO Global Coverage Targets for Diabetes
If targets are met, by 2030:
- 80% of people living with diabetes will be diagnosed
- 80% of people with diagnosed diabetes will have good control of glycaemia
- 80% of people with diagnosed diabetes will have good control of blood pressure
- 60% of people with diabetes aged 40 years or older will receive statins
- 100% of people with type 1 diabetes will have access to affordable insulin and blood glucose self-monitoring
Closing the gap in access to diabetes care
A century since the landmark discovery of insulin, an essential treatment for approximately 63 million people living with diabetes worldwide, estimates suggest that roughly half of the people who need it simply cannot afford or access it. This is especially true in low- and middle-income countries (LMICs). But what causes that gap – and how can we begin to close it?
“Funding for diabetes and other noncommunicable diseases has traditionally been limited in LMICs due to a lack of prioritization by both local governments and global donors,” says Ms Husain. “As a result, many health systems in resource-limited countries face critical gaps, such as a skilled health workforce, patient awareness and education, testing, and monitoring programs and the cold chain infrastructure needed to deliver insulin to patients where they need it.”
An example of a program that addresses some of these challenges is a long-time collaboration between Eli Lilly and Company and Life for a Child, which provides access to diabetes care, patient education, and healthcare provider training for children with type 1 diabetes in LMICs. The partnership has since expanded and is expected to reach 150,000 children by 2030.
Access Accelerated member companies and partners have been leading access programs to help bring life-sustaining medicines like insulin to patients. The Open Access Platform, an interactive database of Access Accelerated member and partner access programs, indicates that 22 programs dedicated to addressing diabetes have had far-reaching impacts, benefiting an estimated 13 million people in 103 countries since 2017.
One of these programs, a collaboration by Eli Lilly and Company and partner AMPATH, seeks to expand access to treatment and care by supporting capacity building, education, and training of local healthcare providers in Kenya. The program is currently being replicated in Ghana and Mexico and forms part of the company’s wider access to healthcare program, Lilly 30×30, which aims to reach 30 million people in low-resource settings each year by 2030.
Ms Husain sees a critical role for biopharmaceutical companies in leveraging their strength as innovators to develop and provide medicines that improve the lives of patients around the world. But making medicines available is only part of the challenge because availability doesn’t necessarily lead to access, especially when it comes to diabetes treatments like insulin which require complex cold-chain transportation, delivery, and storage.
“As an industry, we have the technical capabilities and expertise that can support governments and on-the-ground partners in improving health systems,” she says.
As an example of such support, Eli Lilly and Company have partnered with UNICEF in a four-year collaboration that is investing over USD 14 million to build health system capacity to provide care for children and adolescents living with type 1 diabetes and other noncommunicable diseases in LMICs, starting with five countries in sub-Saharan Africa and Southeast Asia.
“Through such initiatives, we’re able to take on an important role in developing and implementing sustainable, scalable solutions that better link patients to the care they need. Reaching the ambitious WHO targets will require multisectoral action that leverages all these capabilities and resources, not just from industry but from all stakeholders.”
Why is diabetes skyrocketing in lower-income countries?
In LMICs, rapid economic development is shifting lifestyle patterns in ways that are seriously exacerbating the diabetes situation, leading to poorer diets, and reduced physical activity – major contributing factors to type 2 diabetes.
In fact, four out of every five adults diagnosed with diabetes live in LMICs. That’s why programs by Access Accelerated member companies and partners, including PATH, the World Bank, and the World Heart Federation, are focused on bringing attention and life-saving treatment and care to these communities.
Innovating a community approach to addressing diabetes in Vietnam
In Vietnam, over 5 million people are living with a diabetes diagnosis and diabetes is expected to be among the country’s leading diseases causing death and disability by 2030.1 What’s more, diabetes is expected to increase by nearly 80% among Vietnamese adults between the ages of 20 and 79 in a span of less than three decades between 2017 and 2045. 2
“Only 35% of people living with diabetes in Vietnam know they have it,” says Dr Hien Le, NCD Program Director at PATH. “What we see is that a general lack of awareness of noncommunicable diseases in communities, combined with poor access to primary health care, means that far too many people with diabetes are being left undiagnosed.”
To address this, the Communities for Healthy Vietnam program, led by Vietnam’s Ministry of Health with the support of PATH and Access Accelerated, adopts a community-based, people-centered approach to hypertension and diabetes management. It leverages cross-sector partnerships with social enterprises and non-health partners to bring screening to convenient locations.
This primary healthcare model also incorporates capacity strengthening, a suite of self-care tools (including a mobile app for communities, blood pressure diary, and SMS texts with appointment reminders and healthy lifestyle guidance) and communication interventions to drive behavior change and uptake of services. It also trains community health volunteers to provide screening and referral services, educate and monitor, and conduct follow-up.
Clients are referred to a network of health facilities, where primary healthcare and health workers are trained to provide standardized, quality services with job aids and materials. The program has significantly increased case finding and retention in quality care. In partnership with the Ministry, a supply chain assessment for NCD medicines and commodities was also recently completed in Vietnam and interventions to address barriers, especially for access at the community level, are being implemented.
“The Communities for Healthy Vietnam program is rooted in community engagement and patient empowerment,” Dr Le explains. “We are meeting people where they live and work for screening and utilizing innovative approaches to increase the availability and continuity of hypertension and diabetes care.”
To date, the program’s efforts have screened close to 215,000 people and referred as needed for elevated blood pressure and diabetes. The national scale-up of the program is expected to be completed by 2023, when its benefits will be felt throughout the country.
Setting sights on 2030
Today, we have the technology, medicines, and treatment to help people living with diabetes better manage and control their disease, allowing them to live longer and healthier lives. The standards set by the WHO global coverage targets for diabetes offer an important rallying cry and a clear framework to catalyze action and address the gaps and barriers impeding access to diabetes care.
There is both a willingness and a way forward in achieving these targets: “Industry cannot just offer one-and-done solutions. We must work together with countries, local governments, and ministries of health to create sustainable solutions to public health challenges. Co-investing and collaborating with countries enable a shared vision to achieve these targets. The closer we work collectively, the more impact we can have on linking people to quality care and better health outcomes,” says Ms Husain.
1. Ngoc NB, Lin ZL, Ahmed W. Diabetes: What Challenges Lie Ahead for Vietnam? Ann Glob Health. 2020 Jan 2;86(1):1. doi: 10.5334/aogh.2526. PMID: 31934549; PMCID: PMC6952858.