More than 400 million people have diabetes. While the condition can be treated effectively in the west, in low-income countries there is a need to improve access to insulin, medical devices, and health programmes to ensure early diagnosis and care.
Together with cardiovascular diseases, cancers and chronic respiratory diseases, diabetes has become one of the world’s four major non-communicable diseases (NCDs), and one of the only chronic diseases that continues to increase in prevalence.
According to the World Health Organization (WHO), the number of people with diabetes increased from 108 million in 1980 to 422 million in 2014, and in 2016 it caused 1.6 million deaths, making it the seventh leading cause of death. The WHO estimates deaths from diabetes will increase to 2.4 million in 2030 and 3.7 million in 2045.
The pharmaceutical industry is ramping up efforts to tackle diabetes through Global Health Progress, with more than 40 partnerships now researching new medicines, as well as new ways in which to diagnose and raise awareness of the disease.
But what’s important, says Vanessa Peberdy, head of NCD advocacy and policy at the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), is that “the dialogue around diabetes treatment and care is not just confined to discussions on affordability and access to insulin. While this is clearly a critical issue, improving treatment and care requires a holistic approach that recognises the complexity of the condition. It needs to take in issues such as a lack of trained health practitioners, inadequate supply chains and weak health systems in developing countries.”
The first insulin pen was introduced in 1985 and immediately improved the accuracy of treatment. Now researchers are exploring an oral treatment for type 2 diabetes that will mean patients no longer need to inject at all. A smart insulin patch is also being developed that delivers tailored amounts of insulin into the bloodstream, and a new generation of insulin pumps can now be connected wirelessly to a blood glucose meter or under-the-skin sensor to monitor and regulate insulin.
Research into the development of an artificial pancreas at the University of Cambridge is on-going, as is R&D into cell therapy, when living cells are injected into patients to take over the function of the faulty ones.
Through working in partnerships across the supply chain, one of its successes has been a 75% reduction in the price of insulin. But, explains Soraya Ramoul, Novo Nordisk’s director of global access to care, the programme also showed that the price reduction in itself does not provide people with access to good care. “Diabetes is a complex condition, which requires a systemic approach to ensure basic quality care and management,” she says.
“Affordability of insulin is just one of the necessary components, along with creating awareness in the communities, building capacity for care and medicine supply, educating patients, improving demand forecasting and reducing transportation costs for the patients.”
Klatman sees the growth of partnerships like this as crucial to providing the level of diabetes care that is needed in developing countries, and looks forward to the day when families “are able to access insulin and other supplies without being exposed to financial risk, and having to make really tough decisions to keep their kids alive”.