Treating the Cause, Not Just the Symptom: The GLP-1 Access Debate

By guest contributors Giridhara Rathnaiah Babu and Abdella Mohammed Habib

The spectacular rise of glucagon-like peptide-1 (GLP-1) receptor agonists and GIP/GLP-1 dual agonists, from once-obscure research to a therapeutic cornerstone for type 2 diabetes mellitus (T2DM) and obesity, has accelerated recently.  Newly published data illustrating the benefits of these agents in obesity, heart failure with preserved ejection fraction, Parkinson’s disease, and other conditions have only amplified enthusiasm for their broader clinical potential. Yet, amid the promise of these discoveries lies a critical public health concern: ensuring that access is expanded in a way that is both sustainable and equitable. Given the chronic nature of T2DM and obesity, universal access to these therapies is unlikely to be feasible, particularly in resource-limited settings where healthcare priorities must be balanced. Moreover, even if access were achieved, these therapies alone cannot resolve the deeper structural drives of obesity and T2DM, such as socioeconomic inequities, food environments, and limited preventive healthcare. To create meaningful and lasting impact, GLP-1 and dual GIP/GLP-1 agonists must be part of a broader strategy that includes policy interventions, lifestyle modifications, and systematic changes that address the root causes of these disease.

Low- and middle-income countries in the global south face a disproportionate burden of type 2 diabetes (T2DM) and obesity, driven by urbanization, lifestyle changes, and inadequate healthcare infrastructure. Indigenous populations also face elevated prevalence due to long-standing systemic inequities. In high-income countries, certain racial and ethnic minorities are similarly at heightened risk, reflecting a host of intersecting social determinants of health. These populations frequently encounter barriers to preventive services, timely diagnosis, and advanced pharmacotherapies, underscoring the urgent need for equity-focused strategies in diabetes and obesity care. However, addressing these disparities requires more than expanding access to advanced pharmacotherapies- it demands a fundamental shift in how healthcare systems, economic policies, and social structures interact to shape chronic disease prevalence. Without tackling the root causes that perpetuate these health inequities, interventions may only offer partial relief while leaving the deeper systemic issues unaddressed.

Despite T2DM’s disproportionate burden on socioeconomically disadvantaged populations worldwide, the newest therapies remain priced out of reach for low-income and uninsured individuals. The cost of such medications, running nearly a thousand US dollars per month till recently, imposes a severe barrier, even in high-income countries with fragmented health insurance systems. This reality starkly contrasts the global mandates for Universal Health Coverage, underscoring an urgent need to rethink not only how these therapies are funded, delivered, and prescribed, but also access is structured within a broader, more equitable healthcare framework.

In developed countries, inequities take a different but no less concerning form, with evidence suggesting that while some benefit directly from new drugs, a more significant number may experience compromised health outcomes due to lack of insurance or the reallocation of resources toward these high-cost innovations. Ongoing drug shortages further compound the concern over cost. This not only undermines therapeutic goals but also complicates the management of complications such as heart failure and kidney disease, ultimately eroding trust in healthcare systems. Given that GLP-1 receptor agonists offer health benefits beyond glucose control, increasing demand policymakers and industry should prioritize these in essential drug lists and formularies for cardiovascular and renal protection in T2DM, with government negotiation or subsidy potentially preventing downstream costs. Yet, while partnership with industry is essential, there is little movement toward a global policy framework that prioritizes affordable supply from generic manufacturers. Shockingly, a concerted effort to expand low-cost production is not prioritized by the regulatory agencies despite the overwhelming health benefits of these drugs – a shortcoming that reflects a fragmented approach to health care, where innovation is prioritized over access. Governmental incentives—such as tax breaks, patent extensions contingent on affordable pricing, or technology-transfer agreements—could foster broader availability in low- and middle-income countries. However, these measures remain underutilized due to structural inertia and the dominance of profit-driven pharmaceutical models.

The transformative potential of these drugs remains largely untapped, not because the science is lacking, but because the global health stakeholders, including WHO and major funders, are limited by several constraints in bridging the gap between innovation and equity; the WHO Independent High-Level Commission on NCDs attributes huge funding gap as the reason. The vulnerable communities grapple with diabetes complications and agonize silently, excluded from therapies that should be within reach. More than a moral imperative, ensuring equitable access requires systematic shifts – moving beyond traditional industry-driven approaches towards collaborative procurement, localized production, and long-term sustainability models. While some advocate for model akin to antiretroviral therapy for HIV, a direct comparison is flawed, as diabetes is a chronic, non-communicable disease and requires an integrated care approach, more than merely an emergency mobilization effort.   

Ultimately, ensuring equitable access involves more than drug pricing. Healthcare systems must be sufficiently resourced to provide the multidisciplinary support these therapies require. Patient education about titration schedules, monitoring for gastrointestinal side effects, and counselling on nutrition and physical activity are crucial components of achieving optimal clinical outcomes. Without addressing these interconnected factors, even affordable therapies will fail to achieve their full impact. Long-term success hinges on a coherent, systemic approach one that prioritizes sustainability, preventive care, and the dismantling of structural barrier that perpetuate health inequities.

The benefits of GLP-1-based therapies are currently limited to those who are super rich, reflecting broader systemic inequity in healthcare access. The continued stigmatization and underinvestment in underserved populations demand an urgent and structural response rather than just expansion of drug access. It necessitates a rethinking of the entire healthcare system to address the root causes of chronic disease, including food environments, economic disparities, and inadequate preventive care. A balanced strategy is needed to expand equitable, universal access to drugs for chronic diseases. Innovation and equity are crucial, but a fundamental shift in approach is needed. Comprehensive actions must address not just drug pricing but the broader health ecosystem, necessitating a fundamental shift in how we approach chronic disease, as expanding drug access alone risks treating symptoms rather than causes.  A truly equitable strategy for diabetes and obesity prevention and care must go beyond pharmaceutical access to incorporate comprehensive preventive measures, nutrition policies, and structural reforms that empower communities to achieving long-term health improvements.

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