The Access to Medicine Foundation said in its 2026 index, published Nov. 10, that a commercial rush into GLP-1 medicines used for weight loss could leave insulin access weaker in low- and middle-income countries, The Guardian reported^1,2.

The Netherlands-based nonprofit's tenth index scored 20 large drugmakers on access plans for 84 conditions across 113 countries². A diabetes chapter said GLP-1 products dominate the assessed diabetes pipeline while insulin, more than a century old, still does not reach many patients who need it².

The foundation cited an estimate of 589 million adults with diabetes worldwide, 81% of them in low- and middle-income countries^1,2.

Jay Iyer, the foundation's chief executive, told The Guardian that much of the attention on GLP-1 drugs is aimed at the obesity market and that that focus will not help people with type 1 diabetes who still lack insulin¹. The Guardian attributed to Iyer a warning that if Sanofi, Eli Lilly or Novo Nordisk left insulin, supply for type 1 and insulin-dependent type 2 diabetes could be badly hit¹.

The index said Lilly, Novo Nordisk and Sanofi together account for more than 90% of the global insulin market². It said some manufacturers are narrowing insulin portfolios and scaling back older products, which could shrink what is available where access is already thin².

The Guardian said Novo Nordisk has announced plans to phase out some older diabetes products, including insulin pens¹. The index described Novo Nordisk access programs for human and analogue insulin, Sanofi's Global Health Unit analogue expansion, and Lilly's technology-transfer work with Egypt's EVA Pharma, while saying evidence of patient reach is often incomplete².

Of 25 diabetes pipeline projects the index counted at six companies, 18 used incretin or related metabolic approaches, many of them GLP-1-based, and 10 of 25 targeted type 1 diabetes^1,2. Among late-stage projects with access plans, the foundation said most plans were limited to registration in a handful of countries and that only two in 10 included equitable pricing².

The index said GLP-1 medicines remain largely out of reach in poorer countries, with company efforts concentrated in a few middle-income markets². The Guardian said the drugs are unregistered in many lower-income countries and, where listed, high prices and few equitable-pricing measures put them beyond most patients¹.

Novartis ranked first in the 2026 index, with GSK second and AstraZeneca third, according to the foundation and The Guardian^1,2. The report did not include on-record replies from Lilly or Sanofi in the materials reviewed^1,2.

Not medical advice.