Research Articles

  • Rethinking and redefining the definitions and how we measure availability and affordability of medicines and technologies for non-communicable diseases

    Rethinking and redefining the definitions and how we measure availability and affordability of medicines and technologies for non-communicable diseases

    Non-communicable diseases (NCDs) — such as cancer, cardiovascular disease, diabetes, and chronic respiratory conditions — account for 74% of global deaths (1). While prevention is critical, ensuring access to essential medicines and technologies remains a major challenge. The Sustainable Development Goals (SDGs) emphasize both availability and affordability as key to achieving universal health coverage (UHC) (2). However, defining and measuring these concepts remains complex. Studies have shown the importance of looking at availability and affordability together, as both factors must be combined for people to access the medicines and technologies they need (3). Drawing from other sectors like food and housing, it is clear that availability without affordability still limits access. As NCD burdens grow, there is an urgent need to rethink and redefine how we understand and measure access to medicines and technologies.

    (1)World Health Organization. Non communicable diseases geneva: world health organization. 2025 (2)World Health Organization. Monitoring health for the SDGs Geneva: World Health Organization. 2024 (3)Ewen M, Joosse H-J, Beran D, et al. Insulin prices, availability and affordability in 13 low-income and middle-income countries. BMJ Glob Health 2019; 4

    Authors: Céline Mettraux, Andrew Gilmoor, Margaret Ewen, Stéphane Besançon, Marina Giachino, Joanna-Laurson Doube, Molly Lepeska, Cécile Macé, Christophe Perrin, Janeth Tenorio Mucha, Rosalind Turkie, David Beran

    Aug 4, 2025

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  • The need for a type 1 diabetes scorecard

    The need for a type 1 diabetes scorecard

    As the global burden of type 1 diabetes continues to rise, disparities in access to care, insulin, and monitoring technologies remain a critical challenge—particularly in low- and middle-income countries. Strengthening data systems and standardised outcome tracking is essential to drive equitable, evidence-based interventions. This article examines the WHO’s Global Diabetes Compact and proposes a multidimensional scorecard to integrate clinical, patient-reported, and system-level indicators—offering a robust framework for monitoring progress and informing global diabetes policy and care.

    Authors: Carine de Beaufort, David Beran, Sana Ajmal, Kaushik Ramaiya, Jessica Hanae Zafra-Tanaka, Mark Atkinson

    Apr 7, 2025

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  • Type 1 diabetes screening: need for ethical, equity, and health systems perspective

    Type 1 diabetes screening: need for ethical, equity, and health systems perspective

    In October 2024, the ICD-10 codes were updated to include presymptomatic stages of type 1 diabetes, prompting recommendations for population screening. The use of teplizumab to delay progression to clinical diabetes offers new possibilities, but raises concerns about medicalizing early stages, psychological impacts, access to treatment, and healthcare equity. This article explores the challenges of integrating population screening and disease-modifying therapies into clinical practice, considering ethical, financial, and health system factors.

    Authors: David Beran, Aude Bandini, Emanuele Bosi, Claudia Boettcher, Marie-Anne Burckhard, Matthieu Colange, Nina Tousch, Valérie Schwitzgebel

    Mar 1, 2025

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  • The Lancet Diabetes & Endocrinology Commission on type 1 diabetes: From research to policy: still a long way to go

    The Lancet Diabetes & Endocrinology Commission on type 1 diabetes: From research to policy: still a long way to go

    Critical issues in diabetes and endocrinology research include the prevalence of research waste and the lack of impact from transformative studies that fail to reach policymakers. Many medical studies are poorly designed or reported, which limits their clinical and public health relevance. Even high-quality research, such as systematic reviews, can be misleading when based on flawed data. Despite efforts to improve research transparency, the translation of research into policy remains limited, particularly for conditions like diabetes, which are often deprioritized by policymakers. This article highlights the need for stronger engagement between researchers and policymakers, as well as greater accessibility of research findings to ensure their influence on health policies.

    Author: The Lancet Diabetes & Endocrinology

    Jan 1, 2024

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  • The Lancet Diabetes & Endocrinology Commission on type 1 diabetes: looking back to move forward

    The Lancet Diabetes & Endocrinology Commission on type 1 diabetes: looking back to move forward

    Type 1 diabetes care has evolved significantly since the discovery of insulin in 1921, improving life expectancy, particularly in high-income countries. However, global disparities in access to insulin and care persist, especially in low- and middle-income countries, where limited resources result in poorer outcomes. Despite global initiatives like the WHO’s Global Diabetes Compact, a comprehensive, person-centered approach for type 1 diabetes is still lacking. This article examines these challenges and introduces a new Lancet Diabetes & Endocrinology Commission aimed at developing a global plan to improve equitable care and quality of life for people with type 1 diabetes worldwide.

    Authors: David Beran, Marta Koch, Sana Ajmal, Carine de Beaufort, Kaushik Ramaiya, Jessica Hanae Zafra-Tanaka, et al.

    Nov 13, 2023

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  • Accès à l'insuline : le(s) rôle(s) des gouvernements

    Accès à l'insuline : le(s) rôle(s) des gouvernements

    Access to insulin is complex requiring global and national factors to be considered. The World Health Organization (WHO) proposes a framework to disentangle this. This includes: research & development and innovation; manufacturing; regulatory aspects; selection, pricing and reimbursement; procurement and supply; prescribing; dispensing; and use. For each of these, governments can play an essential role in guaranteeing an adequate allocation of resources as well as ensuring that diabetes care is properly structured within health systems. Concerted action is needed to guarantee access to affordable insulin and care and to ensure that the various needs of people with diabetes are included in government programs and interventions. Governments also have a role to play in being a counterweight to the private sector, working closely to establish networks and possibilities for exchanges between different actors including the civil society.

    Authors: David Beran, Stéphane Besançon

    Jun 1, 2023

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  • Pénuries de médicaments : augmenter les prix pénalisera les pays les plus pauvres

    Pénuries de médicaments : augmenter les prix pénalisera les pays les plus pauvres

    This joint op-ed, spearheaded by Pauline Londeix and Jérôme Martin of OTMeds, along with Stéphane Besançon from the NGO Santé Diabète, was published in the print edition of Libération and is also available online. It argues that increasing drug prices is not a suitable solution to the structural shortages of these products and will, in fact, have harmful effects on global access to treatment. This price hike is being advocated by pharmaceutical companies and supported by many political leaders.

    Authors: David Beran, Stéphane Besançon, Charlotte Brives, Sophie Crozier

    May 5, 2023

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  • Prequalification of insulin: what is missing?

    Prequalification of insulin: what is missing?

    In 2019, the World Health Organization (WHO) launched a project to make insulin more affordable and accessible by encouraging more manufacturers to enter the market. With just a few companies controlling insulin production and driving up prices, this initiative could be a game-changer for people with diabetes. However, progress has been slower than anticipated. This article explores the challenges holding it back and highlights potential solutions that could make life-saving insulin available to millions of people worldwide.

    Authors: David Beran, Marina Giachino, Christophe Perrin, Cécile Macé

    Dec 1, 2022

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