Background: The burden of diabetes is overwhelming worldwide and more important in low- and middle-income countries (LMICs). Preventing cardiovascular morbidity and mortality by providing essential medicines for diabetes and its associated risk factors is a major concern in a context of scarcity of resources and weak health systems. We conducted a systematic review from the recent literature to assess and synthesize the gap and needs for access to essential diabetes medicines in LMICs.

Methods: We selected the recently published literature on essential medicines for diabetes in LMICs using the PubMed database. Articles were found using the following keywords: "Diabetes AND Essential Medicines" and "Diabetes AND Access to Insulin." Relevant studies conducted in one or more LMICs, as defined by the World Bank, were selected for analysis.

Results: Availability and affordability of essential medicines for diabetes is poor in LMICs. Availability of insulin was as low as 10.3% in low income countries while 63% of households could not afford insulin in the PURE study conducted in 22 countries (18 LMICs). In two national surveys conducted in Uganda and Zambia, none of the heathcare facilities was meeting the WHO Standards for essential tools and medicines in Uganda and few (6 out of 46) in Zambia, with only 11% availability of insulin in rural area.

Conclusions: The LMICs include a wide range of countries with varying levels of health care resources and quality. To meet the challenge of access to essential medicines for diabetes and other noncommunicable diseases, it is necessary to categorize needs by region and by country in order to prioritize interventions.


A.M. Diallo: None. M.K. Ali: None. K. Narayan: None.

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