An in-depth report on the effects of conflict in the region and what this could mean for diabetes technology and insulin supply across the Middle East and Europe.
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Headlines
- Omnipod 5 launched in Middle East countries in February
- Insulin supplies in Europe come from US, Ireland, Switzerland, Germany, or Asia
- Delays & disruption in the Strait of Hormuz could affect flow of CGM sensors, insulin pump components, infusion sets
- Israel plays a key role in technology involved in diabetes management
- Iran has one of the largest type 1 diabetes populations in the Middle East
- Use of CGMs in Middle East (except Israel) is low, but expanding
- High energy costs could affect prices of diabetes supplies
- FreeStyle Libre is widely available and most used CGM in Middle East
In Detail
Just weeks before War erupted in the Middle East, Insulet – owner of Omnipod – announced their launch of Omnipod 5 and the Omnipod Discover data platform in the region, making it available in Saudi Arabia, the United Arab Emirates, Kuwait and Qatar.
The timing may provide the company with difficulties – though none have been reported yet - but they’re unlikely to be alone as conflict in the Middle East will bring forward other consequences that go beyond the region itself. For people with diabetes in the affected areas and within Europe, the main concern is whether global supply chains for insulin, medicines and diabetes technology could be disrupted.
Shipping routes and logistics
There are very few diabetes medicines and devices actually manufactured in the Middle East and shipped to Europe as finished products. Most diabetes med-tech used in Europe is manufactured in the US, Ireland, Switzerland, Germany, or Asia.
However, medtech companies often have complex manufacturing networks that depend on international shipping routes being able to move raw materials, components and finished products. Any disruption to part of this system e.g. security risks or blockages in shipping channels, can have knock-on effects to delivery times and increase transport costs for CGM sensors, insulin pump components, infusion sets and other consumables.
Manufacturing materials
Many diabetes devices rely on specialised materials sourced globally. These include semiconductor chips, medical-grade plastics, adhesives and batteries.
Medical plastics used in devices such as CGM sensors, infusion sets and insulin pump cartridges are derived from petrochemicals and the Middle East is one of the world’s largest producers of petrochemical materials. Disruption and instability in the region is therefore likely to affect the wider manufacturing supply chain.
Higher energy prices, as we’re currently seeing, can also increase production costs for medical devices, packaging and transport and these costs are, in time, likely to be passed on to consumers – often healthcare providers such as the NHS.
Insulin supply
Most insulin used in Europe is manufactured within Europe or North America by one of 3 companies; Novo Nordisk, Eli Lilly and Sanofi and large insulin production facilities are located in Denmark, France, Germany and the United States.
Because insulin manufacturing is concentrated in these regions, direct disruption from conflict in the Middle East is unlikely. However, insulin production still relies on global supply chains. Raw materials used in pharmaceutical manufacturing, packaging materials, transport logistics and refrigeration systems all depend on stable global trade.
If shipping routes become slower or more expensive, the distribution of insulin between manufacturing sites, warehouses and pharmacies could take longer. In practice, pharmaceutical companies usually maintain large safety stocks of insulin to reduce the risk of shortages, but if war or disruption is lengthy, the impact is likely to be felt by companies involved in diabetes in all sorts of ways.
Suppliers to the NHS are required to hold 8 weeks supply of medications and related components.
Technology development
The Middle East also contributes to diabetes technology development, particularly through Israel’s medical technology sector.
Several companies based there focus on artificial intelligence, digital health platforms and automated insulin delivery algorithms. And there are others researching non-invasive glucose monitoring and digital health platforms designed to support diabetes management. These companies contribute to the development of next-generation diabetes technologies.
Companies involved in medtech development
DreaMed Diabetes (Israel) - technology used in MiniMed 780G insulin pump system
DreaMed, an Israeli company, develops artificial intelligence algorithms used in automated insulin delivery systems/hybrid-closed loop. Its algorithm work has been integrated into pump platforms used internationally, including Medtronic systems.
If the Israeli technology sector were disrupted, it could affect development or software support for closed-loop insulin delivery systems used in Europe.
DreaMed’s Advisor Pro platform is also used by clinics to analyse insulin pump and CGM data to help adjust therapy settings.
CamAPS FX (UK-Israel research links) – algorithm used with: mylife YpsoPump, FreeStyle Libre 3 and Dexcom G6
While the commercial company is UK-based, parts of the algorithm research ecosystem and software development networks involve global collaborations including Israel. Disruptions in the region can affect software engineering supply chains.
ViCentra Kaleido patch pump (Europe–Middle East logistics) – used with Kaleido insulin patch pump
The Kaleido system is manufactured in Europe but distributed globally. Devices shipped between Europe and Asia frequently pass through the Red Sea–Suez shipping corridor, a major trade route connecting Europe with manufacturing regions. Although not involved at the moment, it’s worth noting that if that corridor became difficult, deliveries of pump components or accessories could be delayed as global diabetes device shipments rely heavily on this route.
Product supplies that could be affected
Infusion set manufacturing networks –
Delays to components could affect pumps, such as -
- Omnipod 5
- t:slim, X2
- MiniMed 780G.
Infusion sets, plastics, electronics and adhesives are often sourced from multiple countries and assembled globally. Any disruption to shipping routes linking Asia, the Middle East and Europe can slow the movement of these materials.
Pharmaceutical and chemical inputs used in diabetes devices
Some chemical inputs and industrial materials used in diabetes device manufacturing are produced in the Middle East, including petrochemical-derived plastics and polymers used in medical devices.
Materials used iinclude -
- CGM sensor housings
- insulin pump cartridges
- infusion tubing
- disposable medical plastic components
The global diabetes device market is large and relies on complex manufacturing supply chains involving multiple regions.
Diabetes technology in Israel
Israel’s technology sector contributes strongly to the development of medical algorithms, sensors and digital health platforms. Many global diabetes technology companies collaborate with Israeli software and engineering teams, particularly in areas such as artificial intelligence, monitoring technologies and data analytics which are used internationally.
Here are 3 examples that are particularly relevant.
GlucoTrack
https://glucotrack.com/cbgm-technology
GlucoTrack develops non-invasive glucose monitoring technology designed to measure glucose without using a sensor inserted under the skin. The system uses a combination of ultrasound, electromagnetic and thermal measurements. While the technology is still developing commercially, it represents one of several attempts to create non-invasive glucose monitoring.
Hagar
Hagar develops wearable sensors that analyse chemicals in sweat. The technology has been explored for continuous metabolic monitoring and may eventually contribute to non-invasive glucose monitoring approaches. Although still in the research and development stage, it reflects the broader trend toward alternative sensing technologies.
Sweetch
Sweetch develops digital health software that uses artificial intelligence to analyse behaviour patterns and support people at risk of developing type 2 diabetes. The platform is used in prevention programmes in several countries and focuses on behavioural change rather than glucose monitoring devices.
Diabetes management in the Middle East
The prevalence of diabetes in Gulf countries is particularly high, with Kuwait having a frequency of 40.8%. Saudi Arabia and Qatar also have significant rates. The International Diabetes Federation (IDF) have reported a surge in type 2 diabetes and that this is apparent in older persons with a high body mass index, often poorly educated.
Surprisingly, the growth in diabetes in these countries has been attributed to the discovery of large oil reserves in the 1930s. While the countries profited from oil extraction and export, higher standards of living have led to a shift in eating habits, moving away from natural, locally grown food to western style diets. Thus, it be reasonably stated, that getting rich off oil has led to poorer health for large populations across the Middle East.
Type 1 Diabetes
In the Gulf states, most type 1s still rely on finger-prick glucose meters because of cost and access barriers, and adoption of CGM is still relatively low compared with Europe or the US. However, adoption is expected to grow rapidly over the next decade, as awareness and access improve. In particular, automated insulin delivery/hybrid-closed loop systems are likely to become more widely available.
People with type 1 diabetes often get care through government hospitals if they are citizens, while expatriates depend more on employer-linked or private insurance.
In terms of advanced diabetes technology, the countries with the most use are Israel, Qatar, Saudi Arabia and UAE. Jordan, Lebanon, and Iran have more mixed or limited coverage - CGMs are more often self-funded there.
As shown in the below table, CGM use is still low in the majority of Middle Eastern countries.
|
Country |
Estimated population of country |
Estimated people with type 1 diabetes |
Estimated CGM adoption by type 1s |
|
Bahrain |
1.7 million |
7,700 |
20-30% |
|
Iran |
89 million |
Bet. 110,000-120,000 |
5-10% |
|
Israel |
9.7 million |
23,000 |
70-80% |
|
Jordan |
11.6 million |
26,000 |
5-15% |
|
Kuwait |
5.2 million |
29,000 |
20—30% |
|
Lebanon |
5.8 million |
12,000 |
5-15% |
|
Oman |
5.3 million |
34,000 |
10-20% |
|
Qatar |
3.1 million |
13,000 |
25-35% |
|
Saudi Arabia |
36.7 million |
Bet. 80,000-120,000 |
30-50% |
|
United Arab Emirates |
11.6 million |
79,000 |
20-30% |
|
TOTAL across these countries |
179.7 million |
413,700 - 463,700 |
|
Sources: UN / IMF / World population datasets and global population estimates for 2024–2026. Estimated number of people with type 1 diabetes from IDF Diabetes Atlas.
Which CGMs are used in the Middle East?
FreeStyle Libre (Abbott) has the largest market share of CGM use in the Middle East but Dexcom G6 / G7 and Medtronic Guardian sensors are also marketed there, with Omnipod just launching.
Across the Middle East:
- FreeStyle Libre is the most widely used CGM
- Dexcom is common in pump users and private clinics
- Medtronic Guardian is used mainly with Medtronic pumps
- Eversense has limited but growing use
The region currently represents a small share of the global CGM market, but adoption is expected to increase significantly over the next decade as healthcare systems invest in diabetes technology.
In Summary
The Middle East is not a major manufacturer of finished diabetes devices, but it still affects the European diabetes technology ecosystem through:
- technology companies and software development (especially Israel)
- shipping routes connecting Europe and Asia
- petrochemical materials used in device manufacturing
- global logistics networks
In Europe, the most likely effects of war on diabetes would be indirect. Possible impacts include longer delivery times for devices and components, higher manufacturing costs and some pressure on global supply chains if disruption continues.
Most insulin pumps, CGM sensors and diabetes devices used in Europe are manufactured elsewhere. However, software development, algorithms and digital health platforms often involve global teams, including companies based in Israel which plays an important role in the global diabetes technology ecosystem.
In practical terms, the main impact of geopolitical disruption would be on research collaboration, software development and investment in medical technology rather than on the physical supply of diabetes devices to Europe.
The wider diabetes ecosystem depends on global cooperation. Research, manufacturing, logistics and software development all rely on international networks. Events in one region can therefore influence supply and innovation elsewhere.
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Disclaimer
Blogs and publications on this website are independent of any involvement by medtech companies or diabetes related charities. To ensure there is no bias, we do not accept any products, freebies or other material from any medtech provider. Except where credited otherwise, all materials are copyright ©️Love My Libre Ltd.
What CGM is not associated or affiliated with Abbott or FreeStyle Libre. Content here and on our website what cgm.com does not constitute medical advice or replace the relationship between you and healthcare professionals nor the advice you receive from them.
The author of this blog has type 1 diabetes and uses a CGM on NHS prescription.
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