National evidence on glucose-lowering medication use for diabetes from 62 low- and middle-income countries

Given rising diabetes prevalence globally, access to diabetes treatments is gaining urgency. Yet, it remains unknown which glucose-lowering medication types people with diabetes across low- and middle-income countries (LMICs) use. In this cross-sectional analysis, we pooled nationally representative data of 223,283 adults aged ≥25 years in 62 LMICs from 2009 to 2019. We found that 51.9% [95%-CI: 49.6%, 54.2%] of 21,715 individuals with diabetes were undiagnosed. Among individuals with diagnosed diabetes, 18.6% [95%-CI: 14.5%, 23.4%] reported using no glucose-lowering medication, 57.3% [95%-CI: 53.1%, 61.4%] only used oral medication, 19.5% [95%-CI: 17.6%, 21.5%] used oral medication and insulin, and 4.7% [95%-CI: 3.9%, 5.6%] used insulin alone. In low-income countries, fewer individuals with diabetes were diagnosed and treated than in middle-income countries. Yet, among individuals who did get diagnosed, insulin use was two-thirds higher in low-income countries (38.9% [95%-CI: 31.6%, 46.7%]) compared to middle-income countries (23.2%; 95%-CI: 21.0%, 25.5%]). This finding could suggest a need for earlier diagnosis and treatment initiation. Our results can inform national and regional drug procurement efforts across LMICs.

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Publication Details

Journal
Nature Communications
Published
2025-08-04
DOI
https://doi.org/10.1038/s41467-025-59123-4
Citations
1
Primary Topic
Diabetes Treatment and Management
Type
article
Field-Weighted Citation Impact
1.29

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article

National evidence on glucose-lowering medication use for diabetes from 62 low- and middle-income countries

Till Bärnighausen, Kibachio Joseph Mwangi, Maja E. Marcus, Justine Davies et al.
1 citations
Nature Communications
Diabetes Treatment and Management
1.29
article

National evidence on glucose-lowering medication use for diabetes from 62 low- and middle-income countries

Till Bärnighausen, Kibachio Joseph Mwangi, Maja E. Marcus, Justine Davies, Michaela Theilmann, Mongal Singh Gurung, Krishna Kumar Aryal, Lela Sturua, Farshad Farzadfar, David Flood, Corine Houéhanou, Felix Teufel, Andrew Stokes, Sina Azadnajafabad, Sahar Saeedi Moghaddam, Pascal Geldsetzer, Glennis Andall‐Brereton, Jennifer Manne‐Goehler, Jutta M Adelin Jorgensen, Demetre Labadarios, Abla Mehio Sibai, Pascal Bovet, Khem Bahadur Karki, Nuno Lunet, Sebastián Vollmer, Caroline A. Bulstra, Albertino Antonio Moura Damasceno, Maria Dorobanţu, Mohammed K. Ali, Pia Roddewig
article en
1 citations

Abstract

Given rising diabetes prevalence globally, access to diabetes treatments is gaining urgency. Yet, it remains unknown which glucose-lowering medication types people with diabetes across low- and middle-income countries (LMICs) use. In this cross-sectional analysis, we pooled nationally representative data of 223,283 adults aged ≥25 years in 62 LMICs from 2009 to 2019. We found that 51.9% [95%-CI: 49.6%, 54.2%] of 21,715 individuals with diabetes were undiagnosed. Among individuals with diagnosed diabetes, 18.6% [95%-CI: 14.5%, 23.4%] reported using no glucose-lowering medication, 57.3% [95%-CI: 53.1%, 61.4%] only used oral medication, 19.5% [95%-CI: 17.6%, 21.5%] used oral medication and insulin, and 4.7% [95%-CI: 3.9%, 5.6%] used insulin alone. In low-income countries, fewer individuals with diabetes were diagnosed and treated than in middle-income countries. Yet, among individuals who did get diagnosed, insulin use was two-thirds higher in low-income countries (38.9% [95%-CI: 31.6%, 46.7%]) compared to middle-income countries (23.2%; 95%-CI: 21.0%, 25.5%]). This finding could suggest a need for earlier diagnosis and treatment initiation. Our results can inform national and regional drug procurement efforts across LMICs.

Nature CommunicationsVol. 16(1)
National Center for Disease Control and Public Health (GE), Boston University (US), University of Copenhagen (DK), Brigham and Women's Hospital (US), Kiel Institute for the World Economy (DE), Harvard University (US), Emory University (US), Tribhuvan University (NP), Carol Davila University of Medicine and Pharmacy (RO), Eduardo Mondlane University (MZ), Universidade do Porto (PT), Heidelberg University (DE), Stellenbosch University (ZA), University of Michigan (US), University Hospital Heidelberg (DE), Woodruff Health Sciences Center (US), Ministry of Health (KE), Université d'Abomey-Calavi (BJ), Chan Zuckerberg Initiative (United States) (US), Centre universitaire de médecine générale et santé publique, Lausanne (CH), Ministry of Health (SC), Caribbean Public Health Agency (TT), Harvard Global Health Institute (US), University of Bergen (NO), Tehran University of Medical Sciences (IR), University of Göttingen (DE), Charité - Universitätsmedizin Berlin (DE), University of Birmingham (GB), Stanford University (US), American University of Beirut (LB)
World Health Organization, Nederlandse Organisatie voor Wetenschappelijk Onderzoek, National Institute of Diabetes and Digestive and Kidney Diseases
No poverty
Openalex Percentile: Top 17%
Diabetes Treatment and Management
1.29
DOIOpen Access PDFOpenAlex
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