… As prevalence projected to hit 8m by 2045 in Nigeria

By Chioma Obinna

Despite huge advances in diabetes treatments, people living with the disease in poorer countries still miss out on access to insulin and other treatment choices. 

Unfortunately, a report on diabetes care published by the Access to Medicine Foundation (ATMF), a Netherlands-based nonprofit Organisation showed that the number of people with diabetes worldwide is expected to reach 643 million by 2030, and 783 million by 2045. 

Findings by Vanguard have shown that in LMICs, many people who need insulin currently do not have access to this essential, life-saving drug and many more do not have the choice of products that all patients deserve.

According to medical experts, Insulin is a hormone made in the pancreas, a gland located behind the stomach. Insulin allows the body to use glucose for energy. Glucose is a type of sugar found in many carbohydrates.

Injections of insulin can help manage both types of diabetes as it acts as a replacement for or a supplement to the body’s natural insulin.

People living with type 1 diabetes can’t make insulin, so they must inject insulin to control their blood glucose levels.

Many people living with type 2 diabetes can manage their blood glucose levels with lifestyle changes and oral medication. However, experts say, if these treatments don’t help control glucose levels, people living with type 2 diabetes may also need supplemental insulin.

However, in Nigeria, the prevalence of the disease is projected to rise to 8 million by 2045.

The rise, according to the ATMF report, will be most rapidly in low- and middle-income countries, LMICs, like Nigeria as the burden of non-communicable diseases continue to skyrocket.

Reacting to the study, the Chief Executive of Officer of Access to Medicine Foundation, Dr Jayasree Iyer, the number of people living with diabetes is expected to grow by over 100 per cent in Africa by 2045.

She said the current estimate of 3.5 million living with the disease in Nigeria may be underestimated due to poor diagnosis.

To break these inequalities in treatment and ensure easy access to treatment, the World Health Organisation, WHO added several analogue insulins to its Model List of Essential Medicines, with analogues joining the human insulins that were already listed – demonstrating an increasing recognition by global health stakeholders that both types of insulin are needed for patients in all countries.

Still in Nigeria and other low-income countries, the burden of treatment of diabetes remains significantly greater, according to the ATMF. 

The report also showed that the 3.5 million Nigerians living with diabetes are facing challenges accessing treatment.

However, “costs associated with the prevalence of the disease are not only social but economic,” says Iyar

She said:” The health expenditure related to diabetes care in Africa is about $12.5 billion and this reflects the fact that most people pay for relatively expensive and unaffordable insulin treatment. For example, the average diabetes-related health expenditure per person amounts to approximately 500 dollars a year, which is a huge financial burden if the patient has to pay it all or partially out-of-pocket.”

The report also indicates that 35 per cent of patients in LMIC pay out-of-pocket for healthcare, compared to 13.6 per cent in high-income countries, where the public sector is more likely to be involved.

However, to ensure access to insulin and treatment, organisations are seeking more sustainable, systemic approaches to expanding access to insulin in countries like Nigeria and other LMICs.

The ATMF report examined the activities of three prominent pharmaceutical manufacturers. It showed that Eli Lilly, Novo Nordisk, and Sanofi, produce 83 per cent of the insulin sold in LMICs, where they also hold around 95 per cent of the market share. Insulin supplied by these firms is sold at higher median prices in LMICs than in high-income countries.

According to the report, the reasons for this include the manufacturer’s selling price, wholesale and retail mark-ups, taxes, and other tariffs.

These companies are however taking action to address the inequity in access to this essential medicine.

Iyer explained that in Nigeria, Novo Nordisk has signed a memorandum of understanding with the Federal Ministry of Health, and that serves as a base for the rollout of a programme called I-Care.

The idea of the programme was to provide affordable access to diabetes care, especially for children with type one diabetes. Another large insulin producer, SANOFI, has pushed for the listing of insulin in the National Health Insurance Authority, NHIA, and the State Health Insurance Scheme for two of Nigeria’s 36 states.

Iyer stated that these actions help to make insulin more affordable and accessible to more people, adding that the company is planning to expand the strategy to two more states in 2022.