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Is the World Running Out of Insulin? Shortages Could Leave Millions of Diabetics Without Treatment

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Insulin is crucial for the treatment of people with type-1 diabetes and some patients with type-2. However, with rates of type-2 expected to rise by more than 20 percent worldwide in the next 12 years, we may reach a point where insulin will be beyond the reach of around half of the 79 million adults who will need it by 2030. That’s according to a study published in the journal The Lancet: Diabetes & Endocrinology.

The findings are of particular concern for Africa, Asia and Oceania—regions the study predicts will have significant shortages of insulin if access remains at current levels. In light of the findings, the authors warn that strategies to make insulin more widely available and affordable will be critical to ensure that demand is met.

“These estimates suggest that current levels of insulin access are highly inadequate compared to projected need, particularly in Africa and Asia, and more efforts should be devoted to overcoming this looming health challenge,” Sanjay Basu, lead author of the research from Stanford University, said in a statement.

“Despite the U.N.’s commitment to treat non-communicable diseases and ensure universal access to drugs for diabetes, across much of the world insulin is scarce and unnecessarily difficult for patients to access,” he said. “The number of adults with type-2 diabetes is expected to rise over the next 12 years due to aging, urbanization, and associated changes in diet and physical activity. Unless governments begin initiatives to make insulin available and affordable, then its use is always going to be far from optimal.”

For people with Type-1 diabetes and some of those with Type-2, insulin is used to reduce the risk of complications such as blindness, amputation, kidney failure and stroke. As rates of type-2 diabetes soar around the world, the researchers wanted to paint a comprehensive picture of global insulin need.

To do this, they use data from the International Diabetes Federation and 14 cohort studies to estimate the burden of type-2 diabetes in 221 countries between 2018 and 2030. They determined the potential number of insulin users and the burden of diabetes complications under varying levels of insulin access and treatment targets, in adults aged 18 and over.

A high speed production line of insulin is pictured at the factory of Novo Nordisk, a global healthcare company, on February 17, 2014, in Chartres. JEAN-FRANCOIS MONIER/AFP/Getty Images

The findings showed that the number of adults with type-2 diabetes is expected to rise by more than a fifth, from 406 million in 2018 to 511 million in 2030, with over half of sufferers living in just three countries—China (130 million), India (98 million) and the United States (32 million).

Over this period, global insulin use is predicted to rise from 526 million 1000-unit vials in 2018 to 634 million in 2030. The demand is expected to be highest in Asia (322 million vials in 2030) and lowest in Oceania (4 million vials). The authors then calculated that the number of people with type-2 diabetes using insulin worldwide in 2030 would double from around 38 million to 79 million.

It is important to note that there are several limitations to the study, however. Firstly, the projections of type-2 diabetes prevalence do not account for dietary and physical activity changing over time, meaning that the disease could have a much larger or smaller impact in the future.

Furthermore, the methodology used assumes that the relation between underlying demographics, treatment targets and complications are similar across countries, which overlook some variations between ethnicities.

“These comprehensive analyses explicitly accounted for a variety of circumstances,” Hertzel Gerstein from McMaster University, who was not involved in the study, said. “Nevertheless, they are based on mathematical models that are in turn based on other mathematical models. They are also based on a variety of assumptions. Such considerations suggest that predictions about the future need to be viewed cautiously.”

“Regardless of these uncertainties, insulin is likely to maintain its place as a crucial therapy for type-2 diabetes, and as such a sufficient global supply needs to be estimated and ensured,” he added. “Ongoing updates to models such as these that incorporate new data and trends as they accrue, may be the most reliable way of assuring their reliability and relevance to evidence-based care.”

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