This marks a critical step in advancing access to effective diabetes treatments in low- and middle-income countries (LMICs) like India
The World Health Organisation's (WHO) has announced the inclusion of rapid-acting insulin analogues and GLP-1 receptor agonists (GLP-1 RAs) in the updated Model List of Essential Medicines (EML).
People living with type 2 diabetes also need access to insulin-sparing regimens and medicines that have been demonstrated to reduce mortality. The addition of GLP-1 receptor agonists -- semaglutide, dulaglutide, liraglutide, and the dual GLP-1/GIP receptor agonist tirzepatide is a welcome move. By including GLP-1s in the WHO EML, countries are now guided to expand treatment options for people with type 2 diabetes with established cardiovascular or chronic kidney disease, and with obesity.
Submissions and letter of support and statement to the 25th WHO Expert Committee on the Selection and Use of Essential Medicines for inclusion were made by people living with diabetes in India, T1 International, International Alliance for Diabetes Action (IADA), MSF, and other organisations working on NCDs, chronic diseases, and diabetes.
This marks a critical step in advancing access to effective diabetes treatments in low- and middle-income countries (LMICs) like India.
Human insulin has been part of the WHO EML since its inception in 1977, and long-acting insulin was added in 2021. Long-acting insulin, such as glargine, has been essential for both people living with type 1 and insulin-dependent type 2 diabetes patients. But people living with type 1 diabetes need access to a basal-bolus regimen, which includes both long- and rapid-acting insulin -- the global standard of care for people with type 1 diabetes. This inclusion in the EML is essential to significantly improving the quality of treatment and life.
The Ministry of Health and Family Welfare (MoHFW) should now prioritise adding rapid-acting insulin analogues to the national EML, complementing long-acting analogues for use in basal- bolus regimens. Basal-bolus regimens provide greater flexibility in dosing, improving the daily lives of people living with type 1 diabetes.
With some long- and rapid-acting analogues -- such as glargine and aspart -- already off-patent and available as biosimilars, the MoHFW, the National NCD Programme, and state governments have an opportunity to leverage pooled procurement and competitive tendering to secure affordable access for both people living with type 1 and insulin-dependent type 2 diabetes patients.
People living with diabetes and caregivers deserve choices -- between human and analogue insulin, and between syringes and pens. For children, older persons, and those with visual or physical impairments, pens offer ease, precision, and dignity. The Indian EML should reflect these practical realities and help the health system move closer to patient needs.
"We've waited too long, and every delay has cost lives. The inclusion of both long-acting and
rapid-acting insulin is a milestone for people with type 1 diabetes, but it must not be mistaken for the finish line. What we now demand is inclusion in India's national and state essential medicines lists, assured procurement, and zero out-of-pocket costs for every person who needs it," said Mridula Kapil Bhargava of the Diabetes Fighters Trust.
Recent cost-of-production estimates suggest that substantial price reductions are possible -- particularly with the entry of generic semaglutide expected from March 2026. The Indian government must act to translate these WHO recommendations into generic production, inclusion in the NCD programme and procurement, ensuring equitable access for all people living with diabetes.
"We call on the Government of India to urgently make GLP-1 receptor agonists, particularly in pre- filled syringe formulations, available to diabetes patients who need them most," said Deeksha Dev, who is working with type 2 diabetes patients. "But safeguards are equally critical. GLP-1s must not become lifestyle drugs for the wealthy but remain accessible to those with diabetes and obesity who face the highest health risks. Ensuring rational prescribing and strong regulatory safeguards against irrational use must be part of India's strategy for scaling up access."