Around 530 million people globally live with type 2 diabetes, producing substantial morbidity and mortality and imposing very large economic costs. The authors note that current health-system performance falls short: only about one in five people with diabetes achieve glycaemic control. The article frames access to medicines as a central determinant of outcomes and proposes a policy-oriented framework to accelerate equitable access to different classes of diabetes medicines, with particular attention to low‑ and middle‑income countries (LMICs).
The global burden of type 2 diabetes is large and growing. Economic estimates cited in the article place long‑term losses at very high levels, underscoring the population‑level stakes of improving prevention and treatment. The authors use these scale considerations to justify that access strategies for diabetes must be more expansive than those developed for smaller epidemics.
Despite advances in therapeutics, only approximately one in five people with diabetes attain recommended glycaemic targets. The largest gaps in diagnosis, treatment and control occur in LMICs, where constrained health‑system capacity and limited medicine access are prominent barriers to preventing diabetes complications. The article identifies limited availability, high prices and supply barriers as key contributors to these disparities.
The authors describe typical market dynamics: medicine prices often decline over time through increasing competition, manufacturing efficiencies and further reductions after patent expiry. However, these automatic market processes have not reliably produced affordable access to essential diabetes medications worldwide. Even off‑patent products such as insulin remain unaffordable for many people in numerous settings. At the same time, newer medicine classes and associated delivery devices — for example certain GLP‑1 receptor agonists (GLP‑1RAs) — are expected to remain under patent protection for several years in many countries, constraining timely population access.
The article draws lessons from the global HIV response, which generated a toolkit of policy actions to increase the availability, accessibility and affordability of chronic‑disease medicines. The authors caution that HIV‑era approaches cannot be copied wholesale: the diabetes epidemic is far larger in scale and currently lacks comparable international coordination and financing mechanisms. Thus, approaches successful in HIV must be adapted, scaled and integrated into national health systems to meet the broader needs of diabetes care.
To guide policy choices, the authors propose a framework named TARGET‑DM that categorizes diabetes medicines based on key access‑related characteristics and links each category to targeted health‑system and policy actions. The framework is intended to help countries prioritise interventions that improve availability, affordability and appropriate use of medicines across classes, from long‑standing off‑patent agents to newly patented therapies and devices.
The article highlights that proactive policy measures are needed to capture population health benefits of diabetes medicines rather than relying solely on passive market adjustments. Specific categories and matching policy levers are presented in the framework figure (Fig. 1), which synthesises targeted actions for global equity in treatment with diabetes medicines.
Given the absence of broad international financing or coordination mechanisms analogous to those developed for HIV, the responsibility for expanding access to diabetes medicines rests largely with national governments and health systems. The authors emphasise the need for national strategies that adapt international lessons to local contexts and that address supply chain, procurement, pricing and regulatory barriers. They also note that scaling actions for diabetes requires attention to the larger number of patients and diverse therapeutic classes involved.
The article includes Fig. 1, titled “Targeted actions for global equity in treatment with diabetes medicines (TARGET‑DM) framework,” which visually summarises the categorisation of medicines and the corresponding policy actions. The text in this summary references that figure as the core illustration of the proposed approach.
The authors conclude that achieving and sustaining equitable global access to diabetes medicines will require proactive, targeted policy interventions tailored to medicine class and country context. While lessons from the HIV response offer useful tools, diabetes demands adaptation to a far greater scale and direct engagement by national health systems. The TARGET‑DM framework is presented as a policy roadmap to guide these efforts.