As household incomes in developing countries increase, so has the prevalence of diabetes. Growing economies in China and India, for example, have been accompanied by increases in the number of cases of diabetes that is expected to double by 2025. Health care in developing countries is not equipped to handle the swelling numbers of people with diabetes, leaving many without essential medication to prevent serious complications, according to Stanford University researchers. “Public and private health insurance programs aren’t providing sufficient protection for diabetics in many developing countries,” says lead researcher Jeremy Goldhaber-Fiebert. “Health insurance and health systems need to be re-oriented to better address chronic diseases like diabetes.” The researchers found that people are spending much of their household income paying for diabetes treatment, despite having insurance. The team analyzed data from 35 low- and middle-income countries in Asia, Latin America, Africa, and Eastern Europe to determine whether people with insurance were more likely to get medication than those without insurance. “Surprisingly, [people with diabetes] with insurance were no more likely to have the medications they need than uninsured [people with diabetes],” says Goldhaber-Fiebert. “They were also no less likely to suffer catastrophic medical spending.” Poorly managed diabetes can lead to serious health problems. Because diabetes is often diagnosed in middle age, a time when people are more likely to be primary caretakers of their children and aging parents, the toll of poorly managed diabetes on public health can be enormous. The team identified several factors that make receiving care for diabetes even for those with health insurance, so expensive, such as insufficient supplies of insulin, high co-pays and deductibles, and doctors and hospitals that do not accept insurance.