A new report from the Access to Medicine Foundation has revealed a deepening crisis in access to diabetes care for children and young people (CYP) living with type 1 diabetes (T1D) in low- and middle-income countries (LMICs).
Despite the presence of 11 company-backed initiatives in over 70 countries, fewer than 10% of the 825,000 children estimated to need care in these regions received it in 2023.
Released on 13 May 2025 in Amsterdam, the report evaluates efforts by major insulin manufacturers Eli Lilly, Novo Nordisk, Sanofi, and biosimilar producer Biocon.
These companies dominate 95% of the global insulin market and produce 83% of the insulin used in LMICs.
The initiatives they support remain the only source of insulin and diabetes care for many CYP in LMICs.
Global cases of T1D among children are rising rapidly. In 2024, 219,000 new cases were reported globally in individuals under 20.
That same year, 30,113 preventable deaths occurred in people under 19, with nearly 40% of those deaths recorded in sub-Saharan Africa.
In high-income countries, children with T1D can expect to live beyond 75 years.
In some parts of Africa, life expectancy for a 10-year-old with T1D is as low as 19 years.
The report analyzed initiatives specifically focused on CYP, which require lifelong insulin therapy and constant monitoring from the moment of diagnosis.
Without consistent access to insulin and proper care, children face severe complications or death.
Claudia Martínez, Director of Research at the Access to Medicine Foundation, said: “Hundreds of thousands of children and young people in low- and middle-income countries face significant barriers to accessing essential insulin, supplies, and care for managing type 1 diabetes.
While the pharmaceutical industry is engaged in the effort to bridge access gaps, as needs grow, initiatives must prioritise widespread coverage, sustainability, and affordability to save lives.”
The 11 initiatives are supported to varying degrees by the four pharmaceutical companies through donations of insulin, delivery devices, and funding. They include Lilly’s HelloType1 and Life for a Child programs, Novo Nordisk’s Changing Diabetes in Children (CDiC), Sanofi’s KiDS and ThriveT1D, and Biocon’s BRIDGE-1 initiative.
These programs operate in 71 of the 113 LMICs reviewed in the report, offering a range of diabetes-related products and education.
The report’s key findings include the following:
First, while over half of LMICs are covered by at least one initiative, the actual reach remains extremely limited.
Less than 10 percent of children needing care in these countries were reached in 2023.
Second, although some companies have begun expanding their product range to include insulin analogues and pens, access to these more advanced options remains limited.
Insulin analogues, which are listed on the WHO Essential Medicines List, offer better glucose control and quality of life but cost up to seven times more than human insulin.
Third, all four companies contribute to capacity building through education, training, and infrastructure.
Sanofi’s KiDS program is notable for its focus on educating teachers and school staff in addition to patients and families.
Lilly and Novo Nordisk have supported improvements in healthcare infrastructure in resource-poor areas.
Fourth, most initiatives rely heavily on corporate donations. Ten out of the 11 initiatives have fixed end dates or target goals, some set to conclude by 2030.
This reliance on short-term funding presents significant risks to continuity of care for thousands of CYP.
Fifth, affordability continues to be a critical barrier to sustainable diabetes care. Although companies such as Lilly and Novo Nordisk are supporting efforts to shift T1D care toward government-led models, progress is slow, and many children still face overwhelming barriers to care access.
The report makes clear recommendations to the pharmaceutical industry.
It calls for a shift away from donation-based programs toward sustainable, government-integrated care models.
It urges companies to ensure diabetes products tailored for children—such as insulin analogues and pens—are accessible and affordable where they are needed most.
It also emphasizes the importance of scaling up access and supporting country-level systems to take ownership of T1D care delivery.
Without addressing affordability and availability, efforts will remain fragile and insufficient to meet the growing needs.
The number of children and young people living with T1D is expected to rise to 2.2 million by 2040.
The Access to Medicine Foundation warns that if current access gaps remain unaddressed, more children will continue to die from preventable causes.
The report challenges the pharmaceutical industry to use its influence and resources to close these gaps and ensure no child with diabetes is left behind simply because of where they were born.