The pharmaceutical industry's growing focus on lucrative GLP-1 weight-loss medicines risks diverting attention and investment from essential diabetes treatments such as insulin, the Access to Medicine Foundation has warned.
In its latest report, the Netherlands-based non-profit organisation said the rapid expansion of the market for medicines such as Novo Nordisk's Ozempic and Eli Lilly's Mounjaro had raised concerns about whether pharmaceutical companies would maintain their commitment to supplying older, less profitable treatments.
Although GLP-1 medicines were initially developed to manage type 2 diabetes, their increasing use for obesity has created a major commercial opportunity for drugmakers. However, the foundation warned that the focus on weight management could leave patients who depend on basic diabetes treatments underserved.
An estimated 589 million adults globally live with diabetes, with 81 per cent residing in low- and middle-income countries (LMICs). Many of these countries continue to struggle with access to essential medicines, including insulin, which is critical for people with type 1 diabetes and some patients with type 2 diabetes.
Jay Iyer, chief executive of the Access to Medicine Foundation, said the growing attention on GLP-1 medicines was largely directed towards the obesity market rather than addressing gaps in access to diabetes treatment.
He highlighted the continuing challenges faced by people with type 1 diabetes, noting that access to insulin remained inadequate more than a century after its development.
Why is the insulin supply under pressure?
The foundation warned that pharmaceutical companies could reconsider their involvement in the insulin market as commercial opportunities shift towards newer medicines.
Iyer identified Sanofi, Eli Lilly and Novo Nordisk as companies whose potential withdrawal from insulin production could have serious consequences for global supplies, particularly for people with type 1 diabetes and insulin-dependent type 2 diabetes.
Novo Nordisk has announced plans to phase out some older diabetes products, including certain insulin pens. However, other manufacturers are continuing to invest in production.
Sanofi has begun construction of a new insulin production facility at its BioCampus in Frankfurt. The company supplies insulin to around 15 million people across more than 100 countries each year.
Eli Lilly, meanwhile, received US approval in September for a once-weekly insulin injection for adults with type 2 diabetes.
Responding to the report, Novo Nordisk said it would review the findings, including opportunities to broaden access to analogue insulins and extend access programmes to more low- and middle-income countries.
The foundation also highlighted the affordability and availability challenges surrounding GLP-1 medicines themselves. Many of these treatments are not registered in lower-income markets, while high prices and limited equitable pricing arrangements can put them beyond the reach of most patients even where they are available.
What does the report say about diabetes drug development?
The report found that most medicines in development within the area focused on type 2 diabetes, while only 10 of the 25 medicines assessed targeted type 1 diabetes.
The imbalance raises questions about whether pharmaceutical research is adequately addressing the needs of patients who have fewer treatment options and rely on long-term insulin therapy.
The foundation's findings also form part of a wider assessment of how pharmaceutical companies approach access to medicines in lower-income countries.
Swiss drugmaker Novartis topped the latest global health equity ranking, reclaiming the leading position from Britain's GSK. AstraZeneca moved up to third place, with access plans covering almost all its medicines in late-stage development.
The report also found that nearly two-thirds of cancer medicines were covered by measures intended to improve availability in poorer countries.
Looking back over the 20-year history of the Access to Medicine Index, Iyer said progress had been made in making access to medicines part of corporate strategy. Some companies have also incorporated access targets into executive performance and bonus structures.
However, the foundation's warning highlights a continuing challenge for the industry: ensuring that the commercial success of newer medicines does not come at the expense of access to established treatments that millions of patients depend on.
