Global assessment of insulin and oral hypoglycaemic agent accessibility and affordability: A cross-sectional survey of international diabetes federation member countries.

AIMS: To examine global stakeholder perspectives on the availability, affordability, and access barriers to insulin and oral hypoglycaemic agents (OHAs), based on a cross-sectional survey of International Diabetes Federation (IDF) member associations.

METHODS

A mixed-methods online survey was conducted among designated informants from 86 IDF member associations across 131 responses. The questionnaire covered medicine availability, reimbursement mechanisms, affordability, and access constraints. Quantitative data were analysed descriptively, and open-ended responses were thematically analysed. In cases of multiple responses from the same country, all were included to capture diverse perspectives.

RESULTS

Insulin analogues were reported as available in 68.8% of settings, with full reimbursement in 63.5%. Biguanides and sulfonylureas were the most available OHAs. Major access barriers included high out-of-pocket costs, limited insurance coverage, supply disruptions, and insufficient patient education. Regional representation was uneven, with over-representation from South and Central America and under-representation from South-East Asia; thus, subgroup comparisons should be interpreted with caution.

CONCLUSIONS

Substantial perceived disparities in access to diabetes medicines persist across countries, particularly in low- and lower-middle-income settings. These findings reinforce the urgent need for improved financing, strengthened supply chains, and integrated patient-centred strategies. This study contributes to the global evidence base by providing a contemporary, policy-relevant snapshot of diabetes medicine access challenges in 2024-2025, supporting national and international efforts to close equity gaps.