A person with type 2 diabetes needs more than a medicine to achieve the best possible health. They need a timely diagnosis, follow-up, food they can access and afford, education that makes sense in their daily life, a safe place and time to move, support for sleep and stress, monitoring, treatment for blood pressure and cholesterol when indicated, and care for complications. They also need medicines to be reliably available and affordable when medicines are part of their plan.

That is why diabetes equity cannot be measured by a product registration, a donation, a company target, or the number of prescriptions written. Those can matter. But they are not the same as sustained access, safe use, continued treatment, or better health outcomes.

The World Health Organization reports that diabetes treatment coverage is lowest in low- and middle-income countries (LMICs). WHO describes diabetes care as a package that includes lifestyle measures, medication, regular screening, and prevention or treatment of complications. This is a useful starting point because it shifts the question from “Can a medicine enter a market?” to “Can a person receive comprehensive care over time?”

The gap is wider than one missing prescription

A cross-sectional analysis of 55 nationally representative LMIC surveys pooled information from 680,102 adults, including 37,094 adults with diabetes. The researchers estimated that only 4.6% of adults with diabetes met need for all recommended treatments. Estimated coverage varied by care component: 50.5% reported glucose-lowering medication, 41.3% antihypertensive medication, 6.3% cholesterol-lowering medication, 32.2% diet counseling, 28.2% exercise counseling, and 31.5% weight-loss counseling.

Those figures do not describe every country or every person. They are largely self-reported, cross-sectional estimates rather than proof that one intervention caused a gap or closed it. But they make the core point clear: diabetes care breaks down at multiple points. Increasing one component without addressing the others may leave people unable to benefit fully.

A person may receive a diagnosis but not have access to laboratory follow-up. They may be prescribed a medicine but face cost barriers, unreliable supply, travel distance, lack of refrigeration or storage, limited clinician access, side effects without follow-up, or food insecurity that makes nutrition guidance difficult to put into practice. They may receive counseling once but not have time, safe spaces, family support, or local resources to sustain the plan.

None of these obstacles is a personal failure. They are features of the systems in which people are asked to manage a long-term condition.

A corporate pledge should be judged by outcomes, not aspiration

Lilly recently announced a goal to treat as many people in resource-limited settings with its diabetes and obesity medicines as in high-income countries before 2040. The company’s official release describes future work on product development, registration and access, and health-system collaboration.

It is reasonable to welcome attention to treatment gaps. But this remains a corporate commitment and projection, not evidence that access, affordability, adherence, safety, or health outcomes have improved. The release does not provide independently audited country-by-country data on registration, price, reimbursement, reliable supply, treatment initiation, persistence, adverse events, HbA1c, complications, or patient experience.

That does not mean the pledge is meaningless. It means it should be evaluated with the same rigor applied to any health-equity initiative. Future reports should make clear which countries are included, what “access” means, which products are registered and available, what patients pay, how often treatment is interrupted, who is left out, and whether outcomes improve across income, geography, gender, age, and rurality where relevant.

Without those details, a promise of “reach” can hide important differences between product availability and meaningful care.

Registration is not access, and access is not an outcome

The path from a medicine’s development to a patient’s health is long. A product may be studied but not registered in a country. It may be registered but not covered. It may be covered but unavailable at a local pharmacy. It may be available but unaffordable. It may be affordable but not prescribed because trained staff, diagnostic testing, or follow-up systems are limited.

Even once treatment begins, patients need education, monitoring, help with adverse effects, and a plan that fits food access and daily life. Treatment persistence is not only about motivation. It can be shaped by income, travel, stigma, trust, supply interruptions, caregiving, mental health, and whether the care system respects people’s priorities.

This is especially important in discussions of newer medicines. The FDA notice for Foundayo, orforglipron concerns a specific U.S. approval for chronic weight management in qualifying adults. It does not establish approval in LMICs, affordability, reliable supply, or an approved type 2 diabetes indication elsewhere. A product’s label in one country cannot stand in for global access.

Medicine is one tool. It should not be framed as a failure to use food, movement, sleep, stress support, or community care. Nor should whole-person care be used to dismiss the importance of evidence-based treatment when it is indicated and available.

What comprehensive, equitable care looks like

The American Diabetes Association’s Standards of Care describe person-centered diabetes care that includes medical nutrition therapy, physical activity, adequate sleep, psychosocial care, diabetes self-management education and support, medication-taking support, and shared monitoring. The ADA also emphasizes identifying food insecurity and connecting people with resources.

In an equitable system, these components are not luxury additions. Nutrition support should be culturally relevant and workable with local foods, budgets, work schedules, and family structures. Movement options should fit safety, disability, climate, and space. Sleep and mental-health support should be available without stigma. Diabetes education should be understandable and repeated over time, not delivered once as a test of compliance.

Clinical care also needs continuity. A person should be able to check glucose or HbA1c when clinically appropriate, monitor blood pressure and kidney risk, receive eye and foot care, and discuss side effects or treatment changes with qualified professionals. Community health workers, pharmacists, nurses, dietitians, and peer-support networks can all help make this care more reachable when they are resourced and integrated into a health system.

Whole-person care is also equity work

At Diabetes Reversal Group, we believe type 2 diabetes care should be both evidence-based and realistic. Food, movement, sleep, stress support, social connection, medical monitoring, and clinician-directed medication are interconnected. Making only one component available is not the same as delivering comprehensive care.

For some people, type 2 diabetes remission may be possible with sustained changes and clinical support. Remission is not a cure and requires continued monitoring. It should never become a standard used to blame people who face structural barriers or who appropriately need ongoing medication.

Equity means expanding the real conditions that make care possible—not merely announcing that a medicine exists.

By: Dr. Jeffrey Hockings, CEO / Founder & Kristine Burke, MD, Chief Operating Officer

This article is educational and does not replace individualized medical care. Do not start, stop, ration, or change diabetes medication without guidance from the clinician managing your care.