The prevalence of type 1 diabetes among children and young people under the age of 20 in Kenya is 23 cases per 100,000.
Kenya is among the low- and middle-income countries (LMICs) whose children
and young people (CYP) face gross inequities when it comes to the diagnosis and
treatment of type 1 diabetes (T1D).
These are some of the key findings of a new Access to Medicine
Foundation report. Without sustainable access to diabetes care, such countries
are unable to manage this chronic condition, leading to severe outcomes that
are entirely preventable, even as global cases of T1D among CYP are expected to
reach 2.2 million by 2040.
In 2024, Kenya had approximately 6,500 children and young people (CYP)
under the age of 20 living with type 1 diabetes (T1D). In the same year, approximately
570 CYP under the age of 20 in Kenya lost their lives due to T1D, while an
estimated 1,380 were newly diagnosed.
“Hundreds of thousands of children and young people in low- and
middle-income countries face significant barriers to accessing essential
insulin, supplies and care for managing type 1 diabetes. While the
pharmaceutical industry is engaged in the effort to bridge access gaps, as
needs grow, initiatives must prioritise widespread coverage, sustainability and
affordability to save lives,” said Claudia Martínez, director of research,
Access to Medicine Foundation.
The report analyses 11 initiatives that have been specifically
established to provide diabetes care for CYP, which are varyingly backed by
major insulin producers Lilly, Novo Nordisk and Sanofi, as well as biosimilar
insulin manufacturer Biocon. These four companies offer diverse portfolios of
insulins and delivery devices, all of which are crucial for managing T1D
effectively. Together, their strength in the market and unique portfolios
position them to redefine access to essential products for millions worldwide.
While each of these four companies are also undertaking broader
commercial initiatives and access strategies to expand the availability and
affordability of diabetes care in LMICs, the needs of CYP living with T1D are
particularly complex. Children especially face unique challenges, and they
often require, specific, tailored support to effectively manage this chronic
condition. For this reason, it is essential to look at dedicated initiatives
targeting CYP apart from broader diabetes care programmes to determine where
gaps persist and develop actionable solutions.
The prevalence of T1D among CYP under the age of 20 in Kenya is 23 cases
per 100,000— lower than the average
prevalence of 42.3 per 100,000 across the 113 low- and middle- income countries
(LMICs) analysed.
Out of the 113 LMICs included in the analysis, Kenya ranks 44th in the
prevalence of T1D among CYP under the age of 20.
Today, insulin remains out of reach for half of those who need it,
meaning that for many CYP living with T1D in low-resource settings, diabetes
care is not about effective management but mere survival. Even when they do
gain access to treatment, it often falls below the standard of care offered
elsewhere, highlighting stark disparities.
Despite the challenges, five main findings highlight positive
developments in expanding access to diabetes care for CYP living with T1D in
LMICs while also identifying critical areas of improvement for companies moving
forward.
One of the findings is that while over 50 per cent of LMICs in scope are
being covered by company-supported initiatives, only a limited number of CYP
are being reached across these countries.
This represents impressive coverage, and the initiatives are offering
critical support by supplying a range of products and delivery devices, but
many CYP in LMICs – both in the countries not covered and even in those that
are – still lack access to diabetes care. Only a small fraction (less than 10%)
of the estimated 825,000 CYP in need of T1D care living in the 71 LMICs
collectively covered by the initiatives were reached in 2023, for example.
Secondly, report says that three companies are taking steps to broaden the
types of products they provide to initiatives, including the provision of
insulin analogues and pens in certain LMICs. Companies’ diabetes care
initiatives in LMICs have historically focused on providing human insulin in
vials. But as the standard of care has evolved over time, companies that supply
or donate insulin to these initiatives have started to offer a broader range of
products.
For instance, Biocon, Lilly and Novo Nordisk now provide insulin
analogues as well as insulin pens through at least one CYP-focused initiative.
Partnerships with device manufacturers have also made some diabetes monitoring
tools more accessible via these initiatives in certain regions. However, these
changes are still relatively new, and only a small number of CYP have access to
these products so far.
All four companies contribute to capacity building initiatives –
including educational efforts – within the CYP-focused initiatives they
support. Most initiatives backed by these companies integrate multiple elements
of capacity building to help the diverse needs of CYP with T1D and their
families, ensuring more comprehensive support.
Sanofi’s KiDS stands out as the
only programme educating not just children and families, but also teachers and
school staff. Notably, Lilly and Novo Nordisk support investments in
infrastructure and equipment, ensuring CYP have better access to care in areas
where resources have long been limited.
All four companies also provide donations to at least one of the 11
initiatives, which can pose risks to the long- term certainty of an initiative.
While these contributions are meaningful and vital to the success of the
initiatives, the heavy reliance on donations from industry partners creates
long-term uncertainty; the lives of CYP depend on these initiatives, and any
reduction or withdrawal of support could result in a sudden loss of access to
critical products for hundreds of thousands of CYP.
Compounding this issue, ten
of the 11 initiatives have set end dates or specific goals, with several
scheduled to conclude by or before 2030. While this does not necessarily mean
they will end, it underscores the uncertainty of sustained access.
The report says CYP’s access to long-term, affordable diabetes care
remains a critical challenge. To ensure continuity of care for CYP living with
T1D in LMICs, Lilly and Novo Nordisk are backing initiatives that are working
to adapt initiative models to better align with local needs and are
collaborating with partners to transition T1D care towards government
ownership.
Notably, although still in the early stages of implementation, Lilly
and Life for a Child are working on improving the continuity of care for young
people who age out of initiatives by extending age eligibility for support in
specific countries. Despite these developments, efforts to scale and sustain
access to diabetes care will not be future-proof if the issue of cost is not
addressed.
Kenya is one of the 19 LMICs in scope that receive insulin from Lilly
through the ‘Life for a Child’ initiative. Through the Changing Diabetes in Children
(CDiC) initiative, Kenya stands out among 30 LMICs—ranking in the top three for both the number of children reached
(6,100) and the number of clinics refurbished (41) since the initiative
launched in 2009. Kenya is also one of the two countries where the CDiC
initiative, was assessed through a commissioned third-party review to measure
and publicly disclose the outcomes of its work.
The recommendations in the Foundation’s report provide practical
solutions whereby companies can bring about the fundamental shift that is
required to truly scale up access and reach CYP with unmet needs.
This includes
ensuring that the diabetes treatments and technologies best suited to CYP are
available where they are needed most; moving away from the donation-based
models that largely define current efforts to support CYP; and addressing
affordability and product availability to help facilitate the successful
transition to government-owned T1D care in LMICs. This way, all CYP, regardless
of where they live, can have access to lifesaving diabetes care products.