Diabetes: A comprehensive review of the Indian landscape in contrast with global trends

Table 10 Availability and cost of essential diabetes treatments across health sectors in India

Diabetes prevention, treatment options, and management stratigies
Ref.	Government of India[126], 2023; Anjana et al[127], 2023; International Diabetes Federation[128], 2023; Prasanna Kumar et al[154], 2024
Aspect	Details
Essential drugs	Metformin, glimepiride, insulin (human), and pioglitazone are included in the National List of Essential Medicines (NLEM)
Generic drug access	Available via Jan Aushadhi Kendras (government-run generic medicine outlets) at 50%-90% lower cost than branded versions
Insulin access	Human insulin is widely available; analogs (e.g., glargine, lispro) are expensive and less accessible in rural Primary Health Centers (PHCs)
Cost burden	Monthly cost [branded insulin + oral antidiabetic drugs (OADs)]: Approximately 1500-3000; generics: 300-800
Public sector availability	State-run hospitals provide free/basic medications; stockouts and geographic variation are common
Private sector access	Full range of medications available, but high out-of-pocket (OOP) expenses; patients often switch to cheaper or irregular treatment
Innovative treatments	Newer classes like sodium-glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1 RA), and dipeptidyl peptidase-4 inhibitors (DPP-4i) are limited to metropolitan areas and private hospitals due to cost and awareness gaps
Insurance coverage	Partial under Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY); many private plans do not cover chronic outpatient department (OPD) care
Policy recommendations	Expand NLEM to include newer drugs - ensure insulin cold chain in rural areas- Subsidize analog insulins

NLEM: National List of Essential Medicines; PHCs: Primary health centers; OADs: Oral antidiabetic drugs; OOP: Out-of-pocket; SGLT2i: Sodium-glucose cotransporter 2 inhibitors; GLP-1 RA: Glucagon-like peptide-1 receptor agonists; DPP-4i: Dipeptidyl peptidase-4 inhibitors; OPD: Outpatient department; AB-PMJAY: Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana.