The GLP-1 Gold Rush Is Cannibalizing Insulin Access for 478 Million People in Poor Countries

Pharma's pivot to lucrative weight-loss drugs threatens the global insulin supply chain. Three companies control the market, and one is already phasing out older diabetes products.

The Access to Medicine Foundation's latest biennial report surfaces a structural conflict at the heart of the GLP-1 boom: the same three companies that dominate global insulin supply — Novo Nordisk, Eli Lilly, and Sanofi — are rapidly reallocating R&D, manufacturing, and commercial attention toward the far more profitable weight-loss market. The foundation's chief executive, Jay Iyer, warns that any one of the three exiting insulin could be "disastrous" for supply.

The numbers frame the stakes. An estimated 589 million adults globally have diabetes, with 81% — roughly 478 million people — living in low- and middle-income countries such as Pakistan, Egypt, and Jordan. These populations depend on affordable insulin, particularly for type 1 diabetes, where there is no GLP-1 substitute. Yet after 105 years of insulin development, basic access remains unresolved in much of the world. Novo Nordisk has already announced plans to phase out some older diabetes products, including insulin pens. The commercial logic is straightforward: GLP-1 weight-loss drugs command dramatically higher prices and margins than insulin. The obesity market in wealthy countries — the US above all — is enormous and growing. For a publicly traded company answering to shareholders, the gravitational pull toward Ozempic and Wegovy over legacy insulin lines is powerful. The foundation's report found that of 25 medications in development for this therapeutic area, only 10 target type 1 diabetes. GLP-1 medications are not even registered in many lower-income countries, and where they are available, companies have not implemented equitable pricing measures. The drugs remain out of reach for most people in those markets. The extraction pattern is clean: wealthy-country obesity demand is pulling investment away from a life-or-death drug for hundreds of millions of people in poorer nations. This is not a conspiracy — it is profit-maximizing behavior in a market with a three-firm oligopoly and no meaningful public backstop. Some positive signals exist. The report notes that nearly two-thirds of cancer drugs now have access plans for poorer countries, and that access considerations have entered some firms' corporate strategy and executive bonus targets. Novartis topped the foundation's global health equity ranking, with AstraZeneca rising to third. But these incremental gains coexist with a structural vulnerability: the insulin supply chain depends on three private firms whose financial incentives are shifting decisively elsewhere. The 20-year trajectory is stark. If the GLP-1 profit differential widens and no new entrants or biosimilar producers scale up, insulin could follow the pattern of other essential medicines abandoned by originator companies — sporadic supply, quality degradation, and preventable deaths concentrated in the global south.