Bridging the Gaps in Type 1 Diabetes Care: Reflections from the Copenhagen Meeting

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A couple of weeks ago, the World Diabetes Foundation, East Africa Diabetes Study Group, University of Geneva, and Danish Diabetes and Endocrine Academy coordinated an international meeting on type 1 diabetes (T1D) in low- and middle-income countries (LMICs). The meeting brought together people living with T1D, early-career and seasoned researchers, and policymakers at the forefront of diabetes care across different regions.

People with diabetes were included in most sessions of the meeting. While we’d like to think that clinicians and researchers don’t need constant reminders that there are people behind the statistics and data, it never hurts to put a human face and lived experience front and centre. These perspectives reinforce how diabetes impacts real lives beyond the numbers.

People with Diabetes at the Copenhagen Meeting

Throughout the meeting, people with diabetes spoke on panels and gave presentations about initiatives driving real change in diabetes care. The message was clear: community-led programs can (and do) bridge gaps that health systems struggle to fill.

  • Christine Nabatanzi (Sonia Nabeta Foundation, Uganda): Highlighted how Warrior Coordinators use their own lived experience expertise to support younger people with T1D.
  • Sana Ajmal (Meethi Zindagi, Pakistan): Shared how they delivered insulin directly to children and adults with T1D during the devastating floods.
  • Nupur Lalvani (Blue Circle Diabetes Foundation, India): Spoke about the vital education programs that empower people with T1D.
  • Mark Barone (The CCNTs Forum, Brazil): Showcased how grassroots diabetes advocacy movements have led to tangible policy changes in Brazil.

By the end of the two-day meeting, it wasn’t just people with diabetes who understood the power of community involvement—everyone at the meeting recognized the urgent need for meaningful engagement of people with diabetes to improve health outcomes.

Copenhagen Call to Action on Type 1 Diabetes

A key outcome of the meeting will be the launch of the 2025 Copenhagen Call to Action on Type 1 Diabetes, a document that will:

  • Highlight persistent global inequities in diabetes care, particularly in low-resource settings.
  • Address the systemic neglect of T1D within global health agendas.
  • Underscore the consequences of limited access to insulin, glucose monitoring devices, and integrated care.
  • Emphasize the need for robust epidemiological data to close knowledge gaps in LMICs.
  • Call for people with lived experience to be at the centre of decision-making, education delivery, and policy development.

Key Takeaways from the Conference

WHOGlobal Diabetes Compact

Sanjana Marpadga, WHO, Technical Officer

A major discussion focused on Resolution 74.4, which led to the launch of the WHO Global Diabetes Compact in 2021. The Compact prioritizes six core areas:

1. Access to essential diabetes medicines & technologies

2. Technical product innovation

3. Prevention, health promotion & health literacy

4. Country-level support

5. Research & innovation

6. Governance

Next Steps:

  • Strengthen health systems by integrating diabetes care into universal health coverage (UHC) and national policies.
  • Empower people with diabetes by promoting self-management and health literacy.
  • Integrate diabetes into national NCD registries to improve data collection and track progress.
  • Advance research on barriers to care and drive sustainable solutions.
  • Align global, regional, and national efforts under the WHO Global Diabetes Compact.

Global Epidemiology of Type 1 Diabetes

Accurate epidemiological data is critical to ensuring T1D remains a global health priority.

Key Findings:

  • There is some data on T1D incidence in children, but very little on T1D in adults.
  • Across all age groups, we need better data on:
  • Prevalence
  • Age-specific trends in mortality and complications
  • Variability in T1D phenotype across regions
  • Improvements in global T1D metrics

Conclusions:

  • T1D incidence varies by country and over time and is expected to increase slightly.
  • The prevalence varies even more due to differences in survival rates and is projected to increase significantly.
  • Although T1D in low-income countries (LICs) currently contributes little to global epidemiology, its prevalence will rise as access to insulin and care improves.
  • More real-world data is needed, particularly for adults with T1D.

Access to Insulin & Diabetes Technology (ACCISS Study)

The ACCISS Study, led by Health Action International, investigates global access to insulin and glucose monitoring technology.

Key Challenges Identified:

Manufacturing & Registration:

  • The $24 billion insulin market is controlled by just three companies, limiting competition.
  • Biosimilar insulin manufacturers have underused capacity, but regulatory barriers prevent wider availability.

Selection, Pricing & Reimbursement:

  • Analog insulin is expensive, making it inaccessible for many in low-income settings.
  • Biosimilars are more affordable, but pricing is still a barrier.
  • High costs of diagnostic tools (CGMs, test strips) add to the financial burden.

Procurement & Supply Chain:

  • Lack of transparency in insulin procurement.
  • VAT and markups significantly increase costs.
  • Insulin availability remains below WHO’s 80% target, particularly in rural areas.

Prescribing & Use:

  • Some countries lack clinical guidelines for T1D.
  • Limited healthcare provider training, particularly in LMICs.
  • Stigma & discrimination remain barriers to care.

Other Key Discussions & Programs

#dedoc°Scholarship

Bastian Hauck highlighted the #dedoc° scholarship, which supports people living with diabetes and their families to attend global diabetes conferences.

DIAMOND 2A Collaboration

This initiative aims to improve global T1D data collection and research through:

  1. Data & Research: Prevalence, mortality, and adult T1D trends.
  2. Capacity Development: Building research and advocacy networks.
  3. Guidelines & Reports: Strengthening national and global diabetes policies.
  4. Advocacy: Engaging stakeholders for better T1D care and research.

Regional & Country Highlights

Bangladesh

  • Over 1.2 million children and adolescents have T1D globally.
  • The government is expanding the national T1D registry and providing free insulin.

Rwanda

Achievements:

  • Decentralized diabetes care across 123+ health centres.
  • 12,000+ community health workers trained.
  • Insulin delivery via drones (Zipline partnership).

Challenges:

  • Only four endocrinologists in the entire country.
  • Limited public awareness & funding.

Pakistan & Uganda

Sana Ajmal x Christine Nabatanzi  

Sana Ajmal and Christine Nabatanzi shared powerful experiences from their countries' advocacy efforts.

Senegal (Changing Diabetes in Children Programme)

  • DKA rates dropped from 68.3% to 6%.
  • Mortality reduced from 6.7% to 2.6%.

Brazilian Perspective

Karla Melo, MD, PhD Endocrinology

Dr. Karla Melo and the Brazilian Diabetes Society (SBD) emphasize the importance of accessible and equitable care for people with type 1 diabetes, especially in low-income regions. SBD advocates for easier access to essential medications and supplies through streamlined processes at primary healthcare centers and the use of teleconsultation to overcome barriers. The Society is also working on improving diabetes education through innovative digital tools to reach underserved communities, empowering individuals and their families to better manage T1D and improve their quality of life.

Reflections from People Living with T1D

  • Nupur Lalvani (India): Shared experiences from LMICs.
  • Mark Barone (Brazil): Advocated for meaningful engagement of people with diabetes in decision-making.
  • Tinotenda Dzikiti (Zimbabwe): Raised questions about the sustainability of aid programs.
  • Renza Scibilia (Australia): Urged for lived experience expertise to be compensated on par with clinical and research expertise.
  • Sana Ajmal (Pakistan): Spoke about Meethi Zindagi’s advocacy.

The Copenhagen meeting reinforced a critical truth: type 1 diabetes care is not a privilege but a fundamental right that must be accessible to all, regardless of geography or income. The upcoming 2025 Copenhagen Call to Action on Type 1 Diabetes must serve as more than a declaration—it must drive concrete, systemic change. Now is the time to move beyond discussions and ensure that commitments translate into sustainable solutions, policy reforms, and meaningful engagement of people with diabetes. The momentum from this gathering must not fade; it must fuel lasting action to close the global gaps in care, access, and equity.

Disclosure: 

Renza Scibilia attended this meeting as part of her role in the Global Responsibility team at Breakthrough T1D, which covered her flights and accommodation. Tinotenda Dzikiti attended as a person with lived experience of type 1 diabetes, representing the Zimbabwe Diabetes Association, with his flights and accommodation covered by the World Diabetes Foundation.

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