Access to Medicine Foundation Warns Weight-Loss Drug Boom Could Put Insulin Supply at Risk

The FDA announced on Monday that it is requiring new safety warnings on all GLP-1 drugs over a potential increased risk of a rare eye condition. A different question about the class has surfaced alongside it: what the weight-loss gold rush is doing to the older diabetes medicines it grew out of. The Netherlands-based Access to Medicine Foundation says the answer could be a squeeze on insulin.

The warning comes from Jay Iyer, the foundation's chief executive, and from the group's biennial report on pharmaceutical access.

The warning on insulin

Iyer said companies are putting most of their GLP-1 attention on obesity. "You have a lot of attention on GLP-1s, but a lot of it is directed towards the obesity market, and that's not going to help people with type 1 diabetes who after 105 years of insulin development still do not have access to the drug," he said.

He also named the firms he is worried about. "There is a risk that any of the three, Sanofi, Lilly or Novo, could leave the insulin market, and that will be disastrous for supply to insulin especially for people living with type 1 diabetes and insulin-dependent type 2 diabetes," Iyer said.

That is a statement of risk. The foundation did not say any of the three has announced an exit from insulin.

The money behind the shift

Companies can charge far higher prices and enjoy greater profit margins on weight-loss injections and pills than on other medication such as insulin. That gap is the commercial pull Iyer describes.

Novo Nordisk, maker of Ozempic, has announced plans to phase out some of its older diabetes products, including insulin pens. Eli Lilly makes Mounjaro.

The foundation also looked at what is in development. Most of the diabetes-related medicines in the pipeline target type 2 diabetes. Only 10 of 25 target type 1.

Who is affected

Diabetes affects an estimated 589 million adults globally. About 81% live in low- and middle-income countries such as Pakistan, Egypt and Jordan.

GLP-1 drugs are only now reaching many of those markets. Iyer said "a lot of the GLP-1 drugs are just starting to enter these LMIC markets for obesity." GLP-1 medications are not registered in many lower-income countries. Where they are available, high prices and a lack of equitable pricing measures put them out of reach for most people.

So the picture has two gaps. Many people cannot get hold of basic insulin, which is critical for people with type 1 diabetes, and many countries are struggling to access GLP-1 medications at all. GLP-1s, by contrast, are taken by millions of people in the US and other wealthy countries.

The drugs were first developed to manage type 2 diabetes by regulating blood sugar, slowing digestion and reducing appetite. Their growing use for obesity has opened up a huge, lucrative market for pharmaceutical companies.

The rest of the ranking

The report also ranks companies on global health equity. Switzerland's Novartis came top again, after knocking the UK's GSK off the top spot last time. AstraZeneca moved up to third place, with access plans for almost all its drugs in late-stage development.

Nearly two-thirds of cancer drugs are covered by measures to make them available in poorer countries.

Looking back over the last 20 years of the access to medicines index, Iyer said progress had been made, and access is now considered a part of corporate strategy at some companies and is sometimes included in executive bonus targets.

The foundation is part-funded by the UK and Dutch governments.

What comes next

Novo's planned phase-out of older diabetes products, including insulin pens, is the concrete step already announced. It is unclear whether Sanofi, Lilly or Novo will narrow their insulin lines further as GLP-1 revenue grows.

The FDA's warning requirement applies to the same drug class. The agency said NAION, the eye condition at issue, is rare and that a causal relationship has not been established. Novo said it "continues to believe the data do not establish a cause-and-effect relationship." The foundation's insulin concern is a separate issue.