Pharma firms’ focus on weight-loss drugs could put insulin supply at risk, experts warn

GLP-1 products such as Ozempic and Mounjaro spread but many in poorer countries struggle to get basic diabetes treatment

The gold rush into GLP-1 weight-loss drugs risks diverting pharmaceutical firms’ attention away from diabetes treatments such as insulin, the head of the Access to Medicine Foundation has warned.

GLP-1 blockbuster medications such as Novo Nordisk’s Ozempic and Eli Lilly’s Mounjaro have revolutionised obesity and diabetes treatment but there has been a greater focus by companies on weight loss, according to a report from the Netherlands-based non-profit group.

The group warned that many people cannot even get hold of basic insulin, critical for people with type 1 diabetes, and many countries are struggling to access GLP-1 medications at all – as the explosion in their popularity continues since the weight-loss jab Wegovy launched in 2021.

Diabetes affects an estimated 589 million adults globally, 81% of whom live in low- and middle-income countries (LMICs) such as Pakistan, Egypt and Jordan.

“A lot of the GLP-1 drugs are just starting to enter these LMIC markets for obesity,” said Jay Iyer, the foundation’s chief executive, adding: “You have a lot of attention on GLP-1s, but a lot of it is directed towards the obesity market, and that’s not going to help people with type 1 diabetes who after 105 years of insulin development still do not have access to the drug.

Companies are able to charge far higher prices and enjoy greater profit margins on weight loss injections and pills, compared with other medication such as insulin.

“There is a risk that any of the three – Sanofi, [Eli] Lilly or Novo [Nordisk]– could leave the insulin market, and that will be disastrous for supply to insulin especially for people living with type 1 diabetes and insulin-dependent type 2 diabetes.”

Novo Nordisk has announced plans to phase out some of its older diabetes products, including insulin pens.

GLP-1 medications are not registered in many lower-income countries and even where they are available, their high price and companies’ lack of equitable pricing measures mean they are out of reach for most people in those places.

The drugs were initially developed to manage type 2 diabetes by regulating blood sugar, slowing digestion and reducing appetite, but their growing use for obesity has opened up a huge, lucrative market for pharmaceutical companies. GLP-1s are taken by millions of people in the US and other wealthy countries.

The biennial report by the Access to Medicine Foundation – which is part-funded by the UK and Dutch governments – found that most of the medications being developed in this area focus on type 2 diabetes, and only 10 of the 25 target type 1 diabetes.

Switzerland’s Novartis came top of its global health equity ranking again after knocking the UK’s GSK off the top spot last time, while fellow British drugmaker AstraZeneca moved up to third place, with access plans for almost all its drugs in late-stage development.

Nearly two-thirds of cancer drugs are covered by measures to make them available in poorer countries. Looking back over the last 20 years of the access to medicines index, Iyer said progress had been made and access is now considered a part of corporate strategy at some companies, and is sometimes included in executive bonus targets.