---
title: "Global access to diabetes medicines: TARGET-DM framework for targeted policy actions"
id: "nature-0-global-access-to-different-classes-of-diabetes-medicines-a-framework-for"
canonical_url: "https://medichelpline.com/clinical-feed/nature-0-global-access-to-different-classes-of-diabetes-medicines-a-framework-for"
content_type: "clinical_feed_article"
specialty: "Endocrinology"
source_name: "Nature Medicine"
source_url: "https://www.nature.com/articles/s41591-026-04579-0"
published_at: "2026-08-10T10:04:30.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Global access to diabetes medicines: TARGET-DM framework for targeted policy actions
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/nature-0-global-access-to-different-classes-of-diabetes-medicines-a-framework-for
- **Specialty:** [Endocrinology](https://medichelpline.com/clinical-feed/endocrinology.md)
- **Primary Source:** Nature Medicine
- **Source URL:** [Original Journal Publication](https://www.nature.com/articles/s41591-026-04579-0)
- **Published At:** 2026-08-10T10:04:30.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- Around **530 million** people worldwide have **type 2 diabetes**, generating large health burdens and major economic losses estimated in the trillions of US dollars over coming decades. - Only about **one in five** people with diabetes currently achieve glycemic control, with the largest care gaps concentrated in **low- and middle-income countries (LMICs)**. - Limited access to **diabetes medicines** is a central barrier in preventing complications, and affordability remains a problem even for off‑patent products such as **human insulin**. - Newer therapeutic classes and delivery devices, for example certain **GLP-1 receptor agonists (GLP-1RAs)**, are expected to remain patent-protected in many countries for several years, limiting broad access. - Medicine prices typically fall over time through competition, manufacturing efficiencies and post‑patent market effects, but these mechanisms have not ensured affordable access globally for diabetes drugs. - The authors argue proactive, targeted policy interventions are needed to accelerate and sustain access to different classes of diabetes medicines, especially in LMICs. - Policy lessons from the global HIV response provide a general toolkit (availability, accessibility, affordability) but must be adapted to the much larger scale of the diabetes epidemic and the absence of comparable international coordination and financing mechanisms. - The article proposes the TARGET‑DM framework, which categorizes diabetes medicines by access‑related characteristics and maps corresponding policy actions to improve equity in treatment. - Responsibility for expanding access falls largely to national governments and health systems given the current lack of coordinated global financing for diabetes; the article highlights the need for tailored national policies. - A visual summary is provided as Fig. 1 in the article showing targeted actions for global equity in diabetes treatment (TARGET‑DM).
## Clinical Analysis & Structured Key Points
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[correspondences](https://www.nature.com/nm/articles?type=correspondence) 4. article * Correspondence * Published: 10 August 2026 # Global access to different classes of diabetes medicines: a framework for targeted policy actions * [Felix Teufel](https://www.nature.com/articles/s41591-026-04579-0#auth-Felix-Teufel-Aff1-Aff2)[1](https://www.nature.com/articles/s41591-026-04579-0#Aff1),[2](https://www.nature.com/articles/s41591-026-04579-0#Aff2), * [Nomathemba Chandiwana](https://www.nature.com/articles/s41591-026-04579-0#auth-Nomathemba-Chandiwana-Aff3)[3](https://www.nature.com/articles/s41591-026-04579-0#Aff3), * [Roopa Shivashankar](https://www.nature.com/articles/s41591-026-04579-0#auth-Roopa-Shivashankar-Aff4)[4](https://www.nature.com/articles/s41591-026-04579-0#Aff4), * [Jennifer Manne-Goehler](https://www.nature.com/articles/s41591-026-04579-0#auth-Jennifer-Manne_Goehler-Aff5-Aff6)[5](https://www.nature.com/articles/s41591-026-04579-0#Aff5),[6](https://www.nature.com/articles/s41591-026-04579-0#Aff6), * [Mohammed K. Ali](https://www.nature.com/articles/s41591-026-04579-0#auth-Mohammed_K_-Ali-Aff1-Aff2-Aff7) [ORCID: orcid.org/0000-0001-7266-2503](https://orcid.org/0000-0001-7266-2503)[1](https://www.nature.com/articles/s41591-026-04579-0#Aff1),[2](https://www.nature.com/articles/s41591-026-04579-0#Aff2),[7](https://www.nature.com/articles/s41591-026-04579-0#Aff7) & * … * [Till Bärnighausen](https://www.nature.com/articles/s41591-026-04579-0#auth-Till-B_rnighausen-Aff8-Aff9-Aff10) [ORCID: orcid.org/0000-0002-4182-4212](https://orcid.org/0000-0002-4182-4212)[8](https://www.nature.com/articles/s41591-026-04579-0#Aff8),[9](https://www.nature.com/articles/s41591-026-04579-0#Aff9),[10](https://www.nature.com/articles/s41591-026-04579-0#Aff10) Show authors [_Nature Medicine_](https://www.nature.com/nm) (2026) [Cite this article](https://www.nature.com/articles/s41591-026-04579-0#citeas) [ Save article ](https://www.nature.com/articles/s41591-026-04579-0/save-research?_csrf=62b6Q1DWxy2xpNa8lvGgQXLrlzsgkmFH) [ View saved research ](https://www.nature.com/saved-research) Around 530 million individuals globally have type 2 diabetes[1](https://www.nature.com/articles/s41591-026-04579-0#ref-CR1 "Stafford, L. K. et al. Lancet Diabetes Endocrinol. 13, 924–934 https://doi.org/10.1016/S2213-8587\(25\)00217-7 \(2025\)."), leading to substantial health burdens, as well as economic losses estimated at US $10.2 trillion between 2020 and 2050[2](https://www.nature.com/articles/s41591-026-04579-0#ref-CR2 "Chen, S. et al. Nat. Med. 32, 126–138 https://doi.org/10.1038/s41591-025-04027-5 \(2026\)."). Yet, only one in five individuals with diabetes attain glycemic control[1](https://www.nature.com/articles/s41591-026-04579-0#ref-CR1 "Stafford, L. K. et al. Lancet Diabetes Endocrinol. 13, 924–934 https://doi.org/10.1016/S2213-8587\(25\)00217-7 \(2025\)."). The largest diabetes care gaps are in low- and middle-income countries (LMICs)[1](https://www.nature.com/articles/s41591-026-04579-0#ref-CR1 "Stafford, L. K. et al. Lancet Diabetes Endocrinol. 13, 924–934 https://doi.org/10.1016/S2213-8587\(25\)00217-7 \(2025\)."), where limited access to medicines is a major barrier in averting diabetes complications[3](https://www.nature.com/articles/s41591-026-04579-0#ref-CR3 "Chow, C. K. et al. Lancet Diabetes Endocrinol. 6, 798–808 https://doi.org/10.1016/s2213-8587\(18\)30233-x \(2018\)."). Policy lessons from the HIV response offer a general toolkit for increasing the availability, accessibility and affordability of chronic disease medicines, but these approaches must be adapted to the far larger scale of the diabetes epidemic[4](https://www.nature.com/articles/s41591-026-04579-0#ref-CR4 "Teufel, F., Bulstra, C. A., Davies, J. I. & Ali, M. K. Lancet Diabetes Endocrinol. 12, 88–90 https://doi.org/10.1016/S2213-8587\(23\)00359-5 \(2024\)."). Here, we propose a framework that categorizes diabetes medicines based on key access-related characteristics and outline corresponding health policies that could help achieve and sustain access, particularly in LMICs. Medicine prices decrease over time through market mechanisms, such as increasing competition and manufacturing efficiencies, followed by further declines after patent expiry. However, even off-patent diabetes medicines (for example, human insulin) currently remain unaffordable for many patients globally[3](https://www.nature.com/articles/s41591-026-04579-0#ref-CR3 "Chow, C. K. et al. Lancet Diabetes Endocrinol. 6, 798–808 https://doi.org/10.1016/s2213-8587\(18\)30233-x \(2018\)."), and newer medicines such as certain glucagon-like peptide-1 receptor agonists (GLP-1RAs) and their delivery devices will stay patent-protected for several years in many countries. To gain the population health benefits of diabetes medicines, proactive policies are thus needed that accelerate access globally. Unlike HIV, diabetes lacks international coordination and financing mechanisms, shifting responsibility for medicine access even more fully to national governments and health systems. This is a preview of subscription content, [access via your institution](https://wayf.springernature.com?redirect_uri=https%3A%2F%2Fwww.nature.com%2Farticles%2Fs41591-026-04579-0) ## Access options [ Access through your institution ](https://wayf.springernature.com?redirect_uri=https%3A%2F%2Fwww.nature.com%2Farticles%2Fs41591-026-04579-0) Access Nature and 54 other Nature Portfolio journals Get Nature+, our best-value online-access subscription 27,99 € / 30 days cancel any time [Learn more](https://shop.nature.com/products/plus/?region=ROW) Subscribe to this journal Receive 12 print issues and online access 251,40 € per year only 20,95 € per issue [Learn more](https://www.nature.com/nm/subscribe) Buy this article * Purchase on SpringerLink * Instant access to the full article PDF. 39,95 € Prices may be subject to local taxes which are calculated during checkout ### Additional access options: * [Log in](https://idp.nature.com/authorize/natureuser?client_id=grover&redirect_uri=https%3A%2F%2Fwww.nature.com%2Farticles%2Fs41591-026-04579-0) * [Learn about institutional subscriptions](https://www.springernature.com/gp/librarians/licensing/license-options) * [Read our FAQs](https://support.nature.com/en/support/home) * [Contact customer support](https://www.springernature.com/gp/contact) **Fig. 1: Targeted actions for global equity in treatment with diabetes medicines (TARGET-DM) framework.** ![](https://media.springernature.com/m312/springer-static/image/art%3A10.1038%2Fs41591-026-04579-0/MediaObjects/41591_2026_4579_Fig1_HTML.png) ## References 1. Stafford, L. K. et al. _Lancet Diabetes Endocrinol._ **13** , 924–934 (2025). 2. Chen, S. et al. _Nat. Med._ **32** , 126–138 (2026). 3. Chow, C. K. et al. _Lancet Diabetes Endocrinol._ **6** , 798–808 (2018). 4. Teufel, F., Bulstra, C. A., Davies, J. I. & Ali, M. K. _Lancet Diabetes Endocrinol._ **12** , 88–90 (2024). 5. Global Health & Population Project on Access to Care for Cardiometabolic Diseases (HPACC). _Lancet Diabetes Endocrinol._ **9** , 825–836 (2021). 6. World Health Organization. _Energizing Health: Accelerating Electricity Access in Health-care Facilities_ (WHO, 2023). 7. Pillarisetti, A. et al. _Lancet Glob. Health_ **14** , e612–e625 (2026). 8. Sturchio, J. L. & Cohen, G. M. _Health Aff._ **31** , 1450–1458 (2012). 9. Chokshi, M., Farooqui, H. H., Selvaraj, S. & Kumar, P. _WHO South East Asia J. Public Health_ **4** , 78–85 (2015). 10. Beran, D., Lazo-Porras, M., Mba, C. M. & Mbanya, J. C. _Diabetologia_ **64** , 954–962 (2021). [Download references](https://citation-needed.springer.com/v2/references/10.1038/s41591-026-04579-0?format=refman&flavour=references) ## Author information ### Authors and Affiliations 1. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA Felix Teufel & Mohammed K. Ali 2. Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, GA, USA Felix Teufel & Mohammed K. Ali 3. Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa Nomathemba Chandiwana 4. Division of Delivery Research, Indian Council of Medical Research - Headquarters (ICMR-HQ), New Delhi, India Roopa Shivashankar 5. Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, USA Jennifer Manne-Goehler 6. Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Jennifer Manne-Goehler 7. Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA Mohammed K. Ali 8. Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany Till Bärnighausen 9. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA Till Bärnighausen 10. Africa Health Research Institute (AHRI), Durban, South Africa Till Bärnighausen Authors 1. Felix Teufel [View author publications](https://www.nature.com/search?author=Felix%20Teufel) Search author on:[PubMed](https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&term=Felix%20Teufel)[Google Scholar](https://scholar.google.co.uk/scholar?as_q=&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=any&as_sauthors=%22Felix%20Teufel%22&as_publication=&as_ylo=&as_yhi=&as_allsubj=all&hl=en) 2. 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Till Bärnighausen [View author publications](https://www.nature.com/search?author=Till%20B%C3%A4rnighausen) Search author on:[PubMed](https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&term=Till%20B%C3%A4rnighausen)[Google Scholar](https://scholar.google.co.uk/scholar?as_q=&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=any&as_sauthors=%22Till%20B%C3%A4rnighausen%22&as_publication=&as_ylo=&as_yhi=&as_allsubj=all&hl=en) ### Corresponding author Correspondence to Felix Teufel. ## Ethics declarations ### Competing interests J.M.-G. works as a consultant for the World Health Organization Diabetes Unit. M.K.A. has previously served on advisory boards for Siemens, Novo Nordisk and Eli Lilly, all outside the scope of the current manuscript. 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