Background

Long-acting insulin analogues have become a de-facto standard of care for patients with Type 1 Diabetes (T1D) living in high-income countries. Unfortunately, insulin analogues remain unavailable or unaffordable for much of the global population. In both 2017 and 2019, applications to add long-acting insulin analogues to the World Health Organization’s Model List of Essential Medicines were rejected due to insufficient evidence of superiority and an unfavorable cost-effectiveness profile when compared against older, less expensive, human insulins (e.g., NPH insulin and premixed 70/30 insulin). While it did eventually make the list in October 2021, experts remain divided on the decision and have called for more data about long-acting insulin’s effectiveness both in terms of cost and clinical impact. Moreover, studies conducted in high-income settings may not generalize to children and young adults living with T1D in very low-resource settings.