Access to diabetes care for children and young people: Pharma companies’ current actions and opportunities ahead

Children living with type 1 diabetes (T1D) can survive and go on to lead long, healthy lives with the right care. Yet, in low- and middle-income countries (LMICs), far too many children and young people (CYP) are still dying from this manageable disease because they lack access to timely diagnosis and treat- ment.

In 2024 alone, an estimated 30,113 preventable deaths oc- curred in people under 19 years of age due to T1D, with nearly 40 per cent (11,352) in sub-Saharan Africa – the high- est burden of any region. As T1D cases continue to rise among CYP, so does the urgency to make lifesaving insulin and other essential diabetes care products available where they are needed most.

In response to this pressing issue, dedicated initiatives have been established to provide diabetes care specifically for CYP. This report examines how Lilly, Novo Nordisk and Sanofi –three companies that are key players in global insulin production, including in LMICs along with leading biosimilar insulin manufacturer, Biocon, back 11 such initiatives providing support to CYP living with T1D in LMICs. Collectively, these 11 initiatives operate in 71 LMICs in scope. However, they are largely sustained by donations and are reaching a limited number of CYP living with T1D in these countries through the provision of dia- betes-related products.

What does the report find?
Companies are backing initiatives that supply essential diabetes care products and com- modities, strengthen local healthcare systems or combine both to improve diabetes care for CYP in LMICs. Five main findings help chart the current landscape of these initiatives, highlighting what progress is being made, where challenges persist, and what still needs to be done to scale access for CYP living with T1D.

Main findings
1. While over 50 per cent of LMICs in scope are being covered by company-supported initiatives, only a limited number of CYP are being reached across these countries.
2. Three companies are taking steps to broaden the types of products they provide to initiatives, including the provi- sion of insulin analogues and pens in certain LMICs.
3. All four companies contribute to capacity building initiatives – including educational efforts – within the CYP-focused initiatives they support.
4. All four companies provide donations to at least one of the 11 initiatives, which can pose risks to the long-term certainty of an initiative.
5. CYP’s access to long-term, affordable diabetes care re- mains a critical challenge

Safeguarding and scaling access to diabetes care for CYP amid successes like Glp-1 receptor agonist blockbustersAt the same time, recent decades have ushered in a number of breakthroughs in diabetes care. From new insulin formulations and delivery devices to groundbreaking treatments like GLP-1

We are in an era of unprecedented demand for diabetes care products, with the number of people living with T1D projected to nearly double in the next 16 years, reaching 16.4 million globally by 2040. At the epicentre of this crisis are LMICs, where the burden is expected to grow disproportionately.

At the same time, recent decades have ushered in a number of breakthroughs in diabetes care. From new in- sulin formulations and deliv- ery devices to groundbreaking treatments like GLP-1 receptor agonists for obesity and diabetes, these innovations hold the potential to dramatically improve care and the quality of life for millions.

Yet, as companies race to capitalise on these advancements – driven by high profits and demand from high income markets – they must not neglect the most vulnerable. Today, insulin remains out of reach for half of those who need it, meaning that for many CYP living with T1D in low-resource settings, diabetes care is not about effective management but mere survival. Even when they do gain access to treatment, it often falls below the standard of care offered elsewhere, highlighting stark disparities.

But companies have the power to change this. By making their products more accessible and ensuring that the diabetes treatments and technologies best suited to CYP are available where they are needed most, they can not only save countless lives but also enhance them. This way, no child will be left behind in the evolving landscape of diabetes care.

Recommendations to improve diabetes care

◆ How to scale and sustain access: As outlined in this report, children and young people (CYP) living with type 1 diabetes (T1D) are receiving vital support through company-backed initiatives that bridge gaps in access to treatment, monitoring devices, essential supplies and diabetes education, while also strengthening local healthcare systems in LMICs. However, despite their meaningful impact, the reality is that these programmes alone cannot support of CYP who remain in desperate need of diabetes care.

While companies are collaborating with partners to enhance initiatives and strengthen their sustainability, a fundamental shift is required to truly scale up access and reach CYP with unmet needs. Companies must move beyond the donation-based models that largely define diabetes care access efforts focused on CYP in LMICs. By taking actions to address af- fordability and product avail- ability, companies can help facilitate the successful transition to government owned T1D care in LMICs. This way, all CYP, regardless of where they live, can have access to lifesaving diabetes care products.

◆ Scale existing initiatives strategically to reach more cyp in need: Companies should work closely with partners to scale up initiatives for CYP beyond the eight per cent currently reached and expand access to underserved regions. Companies can prioritise countries where CYP initiatives are currently absent, access to care is severely limited and the burden of T1D is high. Engaging local governments, diabetes organisations and people living with T1D in LMICs is essential for identifying priority communities and directing resources where they are needed most. Furthermore, companies should enhance the sustainability of their efforts by aligning with broader initiatives like PEN- Plus, which integrates care for non-communicable diseases (NCDs), including T1D, in rural LMIC settings. By strategically combining partnership-driven expansion, local insights and alignment with existing CYP- focused initiatives, companies can maximise both reach and long-term impact.

◆ Ensure choice and access to a broader range of products: Companies should broaden the range of insulin products and delivery devices supplied in LMICs to meet the diverse needs of CYP living with T1D and ensure they receive the same standard of care as those in high-income countries.

Companies must engage with local stakeholders and PLWD to understand local needs, preferences and resources and tailor their product supplies accordingly. This could involve scaling access to analogue insulins and pens within initiatives, providing more CYP with more treatment options. Additionally, companies can engage in cross-sector partnerships to improve access to a wider range of diabetes care products for CYP in LMICs. For example, partnering with glucose monitoring device companies could improve the accessibility of glucose monitoring devices and their related commodities, including continuous glucose monitors, alongside insulin. Such partnerships can also be leveraged to bundle various diabetes products including insulin, delivery devices, glucose monitoring tools, and educational materials together in national public healthcare packages, which would provide CYP with broader access to the full continuum of diabetes care.

◆ Improve the sustainability of t1d care for CYP: To improve the sustainability and continuity of diabetes care for CYP living with T1D, companies should be clear about how long their support will last, setting clear commitments, to help governments plan and al- locate resources effectively. In parallel, companies can support governments as they pre- pare to transition to sustain- able national diabetes programmes. This involves aligning initiatives with national health priorities, sharing relevant data and insights, supporting local capacity building and helping develop exit strategies for donation- based programmes. Ultimately, to ensure long-term access, companies must make their products affordable and available through commercial operations and access strategies, enabling CYP and governments to access care independently of donations.

◆ Address the availability and affordability gap beyond cyp-focused initiatives: Many CYP living with T1D still lack access to basic diabetes care. To improve the availabil- ity of lifesaving products, insulin manufacturing companies, including biosimilar manufacturers, should expand product registration with national regulatory authorities and engage with frameworks like World Health Organisation (WHO) prequalification for eligible products to speed up this process. Investing in technology transfers and local production could also help improve availability and reach. Just as importantly, these approaches can contribute to greater affordability, which should go hand in hand with product availability to ensure CYP living with T1D can access the care they need. To further improve affordability, companies can implement pricing strategies that account for the ability to pay of all local stakeholders and apply them across a broader range of diabetes care products.

◆ Strengthen data-driven approaches for t1d access and policy: Many company supported initiatives collect on-the-ground data on the number of CYP reached and the outcomes of their efforts. This helps identify gaps in access and generate missing evidence on the burden of T1D in LMICs, including key metrics such as the number of undiagnosed CYP living with T1D. Companies should continue to make this a priority, working with local partners who play a crucial role in capturing, collating and reporting this information. By doing so, companies can support the enhancement of key data sources, like national reg- istries and the T1D Index, which provide governments and organisations with a clearer understanding of T1D’s impact.