By Lisa Rapaport

(Reuters Health) – People who live in low-income and middle-income countries may have a harder time finding and affording essential medicines for diabetes than residents of wealthier nations, a recent study suggests.

Metformin, an older generic drug to help lower blood sugar, was available in all of the pharmacies researchers checked in high-income countries and in India, for example. But it was stocked in just 65 percent of other low-income countries excluding India.

And metformin was affordable for more than 99 percent of patients in wealthier nations, compared with 73 percent in poor countries, researchers report in Lancet Diabetes & Endocrinology.

“The actual price of diabetes medicines are pretty similar across countries, and the key reason for them being unaffordable in lower income countries is that people’s incomes in absolute terms in these countries is lower,” said lead study author Clara Chow of the University of Sydney in Australia.

“Health insurance plans can help cover poor people in high-income countries, but they may not exist to protect the poor in low-income countries,” Chow said by email.

Researchers considered drugs affordable when patients spent less than 20 percent of their household income available after food expenditures on medications.

To assess how often drugs were affordable or available, researchers examined data collected in pharmacies and from surveys of more than 156,000 people, ages 35 to 70, in 604 communities across 22 countries.

In addition to metformin, they also looked at insulin and combination therapy with these drugs and other diabetes pills.

Insulin was available in 94 percent of pharmacies in high-income countries, in 76 percent of pharmacies in India, and in only about 10 percent of pharmacies in low-income countries excluding India.

About three percent of households in high-income countries and 63 percent of households in low-income countries could not afford insulin, the study found.

Among the roughly 14,000 people in the study with diabetes, 74 percent of patients in high-income countries took medications to manage the condition, compared with just 30 percent of patients in low-income countries.

Globally, almost one in 10 adults has diabetes, according to the World Health Organization. Most have type 2 diabetes, which is associated with obesity and aging.

The study wasn’t a controlled experiment designed to prove whether or how issues with medication access and affordability might directly impact health outcomes for people with diabetes.

Still, it provides fresh evidence of the need to improve global access to diabetes medicines, particularly with insulin, said Alessandra Ferrario, author of an accompanying editorial and a researcher at Harvard Pilgrim Health Care Institute and Harvard Medical School in Boston.

“Poor treatment of diabetes can lead to increased (complications) and mortality, hence poor access contributes to increased burden of disease,” Ferrario said by email.

“Medicines are a key component in the treatment of diabetes, however, patients also need to be diagnosed on time, and under-diagnosis is common in developing countries,” Ferrario added.

“And medicines are not the only cost for diabetes patients,” Ferrario noted. “Glucose monitoring and visits to the doctor should also be taken into account when analyzing the financial burden of diabetes treatment for patients.”

SOURCE: Lancet Diabetes & Endocrinology, online August 28, 2018.