We are a collective of civil society organizations dedicated to driving urgent global action to address the critical challenges faced by people living with type 1 diabetes (T1D) across low- and middle-income countries (LMICs). Thirty organizations from The Type 1 Diabetes Community Fund, representing 23 countries, co-developed this Global Call to Action at the 2025 NCDA Forum. The T1D Community Fund partners represent community leaders, people living with T1D or other noncommunicable diseases (NCDs), and caregivers.  

In response to the growing burden of T1D, we believe that civil society, including individuals living with and affected by T1D, must play an integral role in planning, decision-making, and actions that lead to effective, sustainable, and lasting solutions. Meeting the needs of people living with T1D cannot be achieved by civil society organizations alone. It requires collaboration with key influencers at national, regional, and global levels, including government, healthcare institutions, multilateral organizations, the private sector, patient associations, researchers, and others working to drive meaningful change.

We unite our voices to urge these key influencers to:

1. Increase evidence and data on the prevalence of T1D and ensure widespread utilization of T1D registries.
2. ‍Mobilize financing and reduce costs of care and medicines to increase equitable access.‍
3. Integrate T1D and other NCD services into primary healthcare systems.‍
4. Raise community awareness and enhance knowledge of T1D to drive early detection and management.‍
5. Strengthen delivery of essential medicines in crisis settings, ensuring people living with T1D continue to receive critical care.

By prioritizing these interconnected actions—evidence generation, financing mobilization, health system strengthening, community engagement, and crisis response—we can make significant progress toward addressing T1D. These priorities will guide our collective efforts toward improved care, access, and outcomes for people living with T1D (PLWT1D) globally, especially in LMICs.

The Urgency of Addressing T1D

NCDs are responsible for 74% of global deaths, with disproportionate impacts in LMICs.¹ Nevertheless, NCDs—including diabetes—remain underfunded and underprioritized. Despite their massive health burden, NCDs only receive around 1-2% of global financing investment for health.^2,3 Addressing the burden of T1D—a life-threatening autoimmune condition affecting at least nine million individuals globally—is increasingly urgent, especially given its rising prevalence in LMICs and the lifelong need for insulin therapy.⁴ Without insulin, survival is limited to just days or weeks, making uninterrupted access a matter of life and death.^5,6

Managing T1D is a constant challenge that demands precision and care, placing significant emotional, mental, and financial burdens on individuals and families and increasing the risk of premature death. For example:

• In LMICs, 50% to 80% of people living with diabetes lack consistent access to insulin or essential supplies, leading to preventable deaths.⁷
• Misdiagnosis and underdiagnosis contribute to delays in life-saving treatment, resulting in high rates of complications like diabetic ketoacidosis, kidney failure, blindness, and amputations.⁸
• In most LMICs, individuals must pay for insulin, although there are sometimes subsidies or countries that provide insulin free of charge.⁹ In countries where individuals must pay out of pocket, the cost of insulin can equate to several days' wages for those earning low incomes.⁷
• The stress and anxiety associated with managing T1D increases the risk of mental health disorders, making access to psychosocial support essential.^{10, 11}

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Alarmingly, the prevalence of T1D is rising, particularly among children and young adults.¹² By 2040, the global number of PLWT1D is projected to increase by 66%, affecting more than 13 million people worldwide,¹³ with the majority of this increase occurring in LMICs.¹⁴ Estimates indicate that the total average life expectancy for an individual diagnosed with T1D at age 10 varies widely, ranging from as low as 19 years in some sub-Saharan African countries to over 75 years in certain high-income countries.¹⁵ Without urgent action, the burden of T1D will continue to escalate, straining health systems and threatening lives. Unlike type 2 diabetes (T2D), no widespread prevention options exist, making it essential to strengthen health systems to ensure timely diagnosis, guarantee uninterrupted access to insulin and essential care, and provide equitable treatment for all PLWT1D.

A Global Call to Action

Addressing type 1 diabetes is vital to achieving UN Sustainable Development Goal (SDG) 3.4, which aims to reduce premature mortality from noncommunicable diseases (NCDs) by one-third by 2030. The 4th UN High-Level Meeting on NCDs reinforces this priority, calling for urgent global action to tackle chronic diseases like T1D. These efforts align with the World Health Organization (WHO) Global Diabetes Compact, which advocates for universal access to affordable, high-quality diabetes care for all.

Confronting the challenges of T1D in LMICs requires coordinated engagement across diverse stakeholders, including government, healthcare institutions, multilateral organizations, the private sector, patient associations, researchers, community and civil society groups, pharmaceutical companies, and the general public. Importantly, the voices and experiences of PLWT1D provide invaluable insights that must inform policies, program design, and service delivery from initial planning through implementation to ensure solutions are truly responsive to their needs. Achieving NCD targets and ensuring sustainable T1D care depends on a collaborative and aligned approach at local, national, and global levels. By working together and prioritizing patient-centered approaches, we can strengthen health systems, expand access to care, and improve outcomes for millions affected by T1D worldwide.  

Accelerating Progress: Key Actions to Strengthen T1D Care in LMICs

To address the growing burden of T1D in LMICs, we must tackle the systemic barriers that hinder the effective management of the condition. Barriers include limited access to essential medicines, high treatment costs, inadequate healthcare infrastructure, and insufficient community awareness of T1D symptoms or management. As a network of civil society organizations, we propose collective strategies to improve T1D care in LMICs: increase evidence and data, mobilize financing, integrate T1D into primary health systems, raise community awareness, and strengthen delivery in crisis settings. By prioritizing these areas, we can reduce preventable deaths and drive long-term health outcomes for PLWT1D.  

1. Increase evidence and data on the prevalence of T1D and ensure widespread utilization of T1D registries

Accurate data on the prevalence and distribution of T1D is essential for ensuring high-quality continuous patient care and shaping effective health policies, driving targeted interventions, and mobilizing financing. However, in many LMICs, diagnosing and reporting T1D remains a challenge due to fragmented data collection systems and a lack of national tracking systems.^16,17,18,19 When data on diabetes is collected, T1D and T2D are often grouped together, leading to discrepancies in reporting and dangerous gaps in clinical management.²⁰ Strengthening the evidence base and ensuring the proper use of T1D data and registries are key to understanding the true burden of disease and guiding policy and resource allocation.  

Key InfluencersGovernments, Ministries of Health, healthcare institutions, universities, research organizations, public and private stakeholders

Priority Actions to Enhance Data Accuracy

• Integrate T1D and NCD data into national health information systems to improve visibility and tracking and inform policy decision-making.
• Develop standardized T1D data collection tools and methods that align with global and regional diabetes surveillance frameworks (e.g., WHO Global Diabetes Compact, IDF Atlas).
• Establish infrastructure for national T1D registries to track prevalence, trends, and outcomes, ensuring interoperability between registries and electronic medical records, national health information systems, and NCD programs.
• Invest in research focused on T1D prevalence, risk factors, and the effectiveness of interventions to build a stronger evidence base for policy action.
• Provide continuous training to healthcare institutions and public health agencies on T1D prevalence, risk factors, data collection methods, and analysis and reporting systems in line with national T1D registries.
• Foster partnerships between public and private stakeholders—including pharmaceutical companies and technology partners—to enhance data sharing and innovation, enabling the development of more efficient, accessible, and sustainable data systems.
• Engage civil society organizations in data collection efforts to enhance insights into the experiences and needs of PLWT1D.

2. Mobilize financing and reduce costs of care and medicines to increase equitable access  

Access to quality insulin and continuous glucose monitoring (CGM) devices is recognized as an important global target by the World Health Organization.²¹ The WHO Global Diabetes Compact aims for 80% of people with diabetes to have access to affordable essential medicines and technologies by 2030. The high cost of insulin, diagnostics, and other essential components of T1D treatment, such as glucometers and CGMs, remains a significant barrier to care. In many settings, people living with diabetes must cover the cost of insulin out-of-pocket, and the price of insulin is often higher in the private market than in the public market.²² Depending on the location, insulin can cost up to 10 times the price in LMICs than in higher-income countries,⁷ with the highest median prices found in LMICs.²³ In some countries, such as Kyrgyzstan and Vietnam, insulin is provided free of charge through social insurance or benefits packages, but CGMs must be purchased out-of-pocket.²⁴ Lowering these costs and securing sustainable financing are critical to improving access in LMICs.  

Key InfluencersGovernments, pharmaceutical companies, international organizations, bilateral and multilateral funding agencies

Priority Actions to Lower Costs of T1D Care

• Advance sustainable manufacturing and procurement strategies that drive down insulin and CGM costs for patients, such as local production, coordinated procurement, and aggregated price negotiations with manufacturers.
• Pursue voluntary licensing for NCD products in LMICs to expand technology transfers to local manufacturers, enabling the introduction of lower-cost, quality-assured medicines.
• Expand national health insurance and subsidy programs to cover insulin, glucose monitoring devices, and other essential T1D treatments.
• Eliminate taxes on essential medicines, insulin, and medical devices to reduce costs for patients and healthcare systems.
• Establish innovative financing mechanisms, such as social impact bonds, diabetes care trust funds, and results-based financing models, to ensure sustainable and equitable access to insulin, diagnostics, and other essential T1D treatments.
• Mobilize bilateral and multilateral funding for integrated health systems to support domestic financing models that prioritize NCDs, including T1D.²⁵
• Adopt access strategies to ensure the affordability and availability of essential NCD products, including increasing registration efforts, and supporting out-of-pocket affordability through co-payment models, patient programs, microfinancing solutions, and second-brand options.
• Increase the uptake of clinical trials in LMICs as a critical tool to boost the efficacy and availability of products.

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3. Integrate T1D and other noncommunicable diseases (NCDs) services into primary healthcare systems  

Integrating services, training, and resources for T1D and other NCDs into primary healthcare systems is important to ensure consistent, high-quality care for all patients. This means ensuring systems are equipped to consistently diagnose, manage, and treat T1D and NCDs as part of routine healthcare.²⁶ Healthcare workers (HCWs) are essential in managing T1D, yet many lack training in recognizing and treating the condition. This results in underdiagnosis or misdiagnosis, impacting the quality of care and increasing the risk of complications. Incorporating T1D care into primary healthcare frameworks enables HCWs to diagnose and manage the condition as part of their routine practice, ensuring consistent and continuous care.  

Key InfluencersMinistries of Health, healthcare providers, hospitals, universities, NGOs, WHO

Priority Actions to Integrate T1D Care into Primary Healthcare

• Establish strong national guidelines, including standardized diagnostic criteria, treatment guidelines, and patient follow-up strategies to ensure consistent T1D care in primary health settings.
• Embed T1D management into primary care protocols by ensuring access to essential medicines, integrating T1D monitoring into routine health checkups, and incorporating referral pathways for specialized care.
• Establish community-based screening programs to detect undiagnosed cases and provide data on trends—especially in rural and underserved populations where T1D cases often go unreported.
• Integrate T1D monitoring and management, alongside other NCD services, into existing mobile primary healthcare services.
• Develop and implement training and mentorship programs on T1D diagnosis, management, and follow-up care for healthcare workers. Integrate these materials into national health curricula and community health worker training programs, to ensure they are equipped to recognize and respond to the condition.
• Partner with hospitals and universities to offer specialized training programs for HCWs, enhancing education and expertise in managing T1D and NCDs.
• Ensure sustainable funding for the implementation of care and training programs, including the provision of essential supplies and access to adequate treatment.

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4. Raise community awareness and enhance knowledge of T1D to drive early detection and management  

Raising awareness at the community level is vital for improving T1D detection and management. A lack of information and myths about T1D makes it difficult to recognize early symptoms. Additionally, misunderstanding and fear of stigma often prevent individuals from disclosing their symptoms or diagnosis to family, friends, and communities.¹⁹ Educating communities, caregivers, and healthcare providers about T1D ensures better recognition of symptoms, accurate diagnosis, timely treatment, and stronger patient support systems. Community engagement and awareness will play a critical role in encouraging individuals to seek proper care.  

Key InfluencersMinistries of Health, Ministries of Education, NGOs, faith-based community organizations, leaders, schools, media, pharmaceutical companies

Priority Actions to Enhance Public Knowledge of T1D

• Incorporate T1D education into national health strategies and primary and school curricula to promote early awareness and management.
• Conduct public awareness campaigns in collaboration with media outlets and NGOs to reduce stigma and increase public knowledge.
• Train community health workers to effectively disseminate T1D symptomatic screening information, considering health literacy levels and cultural context at the community level.
• Expand investment in community education initiatives to improve T1D awareness and reach broader audiences.
• Foster peer education through community groups and peer coordinators to share personal experiences, dispel myths, and build local support networks.

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5. Strengthen delivery of essential medicines in crisis settings, ensuring people living with T1D continue to receive critical care  

Crisis and humanitarian settings significantly compound the challenges PLWT1D face. In these environments, food insecurity, limited access to essential medicines, and a shortage of healthcare providers with sufficient expertise in diabetes can exacerbate the difficulties of managing the condition.^19,27 Access to insulin and glucose monitoring devices becomes especially critical, as any disruption in supply can be life-threatening. Innovative solutions, such as mobile clinics and improved cold chain systems, are essential to ensure that insulin and other treatments reach remote and vulnerable populations. Strengthening health delivery in these areas requires multi-stakeholder cooperation and urgent action.

Key InfluencersMinistries of Health, international organizations, humanitarian agencies, mobile clinic providers, healthcare institutions, logistics companies, local governments, patient networks

Priority Actions to Ensure Uninterrupted Care in Crisis Settings

• Integrate T1D and NCD care into the minimum service package across all phases of humanitarian response.²⁸
• Strengthen cold chain systems, deploy mobile clinics, train the health workforce, and integrate the needs of people living with T1D into early warning systems to ensure uninterrupted T1D care in emergencies.
• Facilitate donations of insulin and essential supplies in fragile settings through collaboration with pharmaceutical and humanitarian partners to ensure continued access to care.
• Develop comprehensive policies that guarantee last-mile delivery of insulin and essential medical supplies, including contingency planning for logistical disruptions, such as insulin banks.
• Advance technological innovations, such as drone delivery, to improve access to insulin and other supplies.
• Ensure that people living with T1D are prioritized in the distribution of food and supplies in crisis contexts, ensuring access to adequate nutrition.