Seven in ten people living with diabetes are of working age. This World Diabetes Day we are highlighting the complex and often unseen challenges faced by working people with diabetes in low- and middle-income countries (LMICs); where informal employment, limited support, and gender norms compound the daily struggle for care and inclusion.
13 November 2025 Anna Thabuis
Globally, an estimated 430 million working-age adults live with diabetes, many of whom reside in LMICs. This year, World Diabetes Day draws attention to the daily struggles faced by people with diabetes in the workplace: stigma, discrimination, exclusion, anxiety, and restricted access to care.
The conversation around diabetes and employment is often complex, particularly in LMICs, where informal work, limited institutionalised social support, gendered vulnerabilities, and the burden of unpaid labour create unique and frequently invisible challenges for those managing the condition.
On this World Diabetes Day, we embark on a global journey to examine how diabetes intersects with informal employment, gender, and community resilience in LMICs.
According to the OECD, informal workers account for nearly 60% of the global workforce, rising to 90% in LMICs. These individuals are vital to their economies but often remain unrecognised and unprotected by legal frameworks. For those living with chronic illnesses like diabetes, this lack of protection means missed work for treatment can lead directly to lost income, while untreated complications threaten long-term earning potential.
The consequences of unmanaged diabetes can be severe, increasing the risk of unemployment and financial instability. For many, the challenges of diabetes spill over into family life, deepening poverty and placing further strain on loved ones. In Indonesia, for instance, Mr Ahjar was forced to retire early after being diagnosed with diabetes and tuberculosis; his eldest son became the primary breadwinner, while his wife ran a small home-based food shop. Through WDF-supported project, he has received improved care for both conditions. However, despite better treatment options, his health challenges continue to pose a significant barrier to financial security.
Mr Ahjar’s experience in Indonesia reveals how chronic illness can reshape not only individual livelihoods but entire family dynamics.
Thousands of kilometres away, in Senegal, Dieumbe Seck’s journey echoes similar themes of resilience and adaptation. The cost of ongoing treatment often leads to delayed care and advanced complications, sometimes requiring expensive interventions like amputation.
After managing her diabetes for over 15 years while working as a market merchant, Dieumbe developed a blister on her leg in early 2021. After several visits to a clinic in St Louis, her condition worsened, leading to an amputation in March 2021. Dieumbe has received a prothesis, allowing her to resume her merchant activities, as well as build community, supporting other women living with diabetes in her village.
These intertwined challenges—particularly limited access to healthcare for informal workers in remote or underserved areas—are being addressed through a range of innovative community and workplace-based interventions.
In the Sundarbans, West Bengal, honey hunter Bimal Mandal attended a diabetes awareness camp organised by the Jujersa Women and Child Welfare Organisation. Diagnosed with type 2 diabetes by a mobile medical team, he received follow-up care locally, enabling him to continue working and supporting his family.
Workplace-centred initiatives like Last Mile Care, supported by the WDF’s Diabetes Investment Accelerator’s portfolio, bring health centres to factories and other worksites, offering both in-person and remote digital healthcare tailored to blue-collar workers’ schedules. By integrating services into daily routines, these programmes minimise disruptions to work and income. The ‘OK Tata Horn Please’ initiative in India, for example, delivers onsite screenings and health education for truck drivers, making care accessible without significant time away from work.
When diabetes care is brought closer to workers, it affirms that health is a right, not a privilege reserved for the formally employed.
Nevertheless, while informal work presents unique challenges for people with diabetes, these difficulties are compounded by persistent gender norms and expectations, leaving women overrepresented in both informal and unpaid work. Diabetes not only challenges women’s health but also amplifies existing inequalities and increases vulnerability to poverty. Sandra, a mother in Barranquilla, Colombia, wakes before dawn to prepare meals for her modest lunch business. During pregnancy, she was diagnosed with gestational diabetes, and a month after giving birth to Joshua, persistent high blood sugar was detected, requiring continuous management. Juggling this new responsibility alongside work and childcare, Sandra’s determination to provide for her family often means putting her own health needs last, a story rarely told but not unique.
For women like Sandra, the intersection of informal work, poverty, and chronic illness creates a precarious situation. The absence of formal employment and social protections makes accessing care difficult and undermines the financial security of entire households. This invisible and often undervalued labour places a significant strain on women’s health and prospects, yet their stories and struggles remain largely unrecognised in discussions about diabetes and work.
This invisible burden is accentuated by the fact that, globally, women collectively perform an estimated 16 billion hours of unpaid care work every day in tasks from cooking and cleaning to caring for family members. When a family member is diagnosed with diabetes, it is frequently women who shoulder the additional burden of care, further constraining their economic opportunities and increasing the risk of falling deeper into poverty.
Hiba Suleiman Arwale, a mother in the Nasa-Hablood camp for internally displaced people near Hargeisa, Somalia, exemplifies this care burden. When four of her seven children developed diabetes, Hiba moved to the city to access treatment, facing severe financial hardship and logistical challenges. With no reliable refrigeration for insulin and limited resources, she devised creative solutions: sharing medication among her children and relying on community support for storage. Hiba’s resilience underscores the extraordinary lengths women go to in safeguarding their families’ health, often at great personal and financial cost.
Additionally, women are less likely than men to transition into formal work, and when they leave informal jobs, unemployment is frequent. Tackling these vulnerabilities is vital for advancing gender equity and economic opportunity.
Yet hope and change are possible. Reading Hiba’s story, we are reminded that resilience is not just an individual trait, but a communal resource, one that flourishes when supported by collective action. Her participation in WDF’s 2022 fundraiser empowered her to manage her children’s health and seek vocational training. In Malowle camp, another camp in Somalia, Fadumo also participated in the 2022 fundraiser, she supports diabetes education, teaching maths to help with glucose monitoring, while livelihood grants enable women with diabetic family members to start businesses and build resilience. Such initiatives nurture self-determination and community strength, as Fadumo says, ‘We are human beings with rights and intelligence… WDF and SOS projects give us renewed hope for a better future.’
For many people living with diabetes, their diagnosis becomes a platform for change, a way to empower others, and a means to influence how the condition is treated and understood.
Advocacy allows individuals to move beyond the role of patient and step into roles as educators, organisers, and changemakers, shaping not only their own futures but also that of their communities. Although not reflected in statistic, diabetes advocacy is a form of work, which adds onto the labour of everyday self-management and care.
In Nepal, Tikaram Pandey has turned his diagnosis into a catalyst for community wellbeing, inspiring neighbours and children alike. After being diagnosed at 64, Tikaram embraced a healthier lifestyle and, with the help of a local health volunteer, began sharing his knowledge with his family and neighbours. He encourages healthy habits at home and among tenants, promoting nutritious meals and self-sustainability through gardening. ‘Everybody in the house knows what to eat and what not to eat to stay healthy,’ he confesses.
As a former teacher, Tikaram remains active in the community, raising diabetes awareness. Since his diagnosis, he has joined WDF's Global Diabetes Walk and actively participates in local initiatives. Fondly known as ‘Pandey-Ba’ or ‘knowledgeable grandfather,’ Tikaram inspires children and neighbours alike with his commitment to healthy living and community service.
Drawing on her personal experience of overcoming isolation and stigma after her diagnosis and the loss of her job, Christine Nabatanzi from Uganda, has become a powerful advocate and leader. She champions improved access to care, better healthcare training, and the need to tackle poverty and stigma. Christine’s advocacy highlights how education, community support, and leadership from those with lived experience are fundamental to strengthening T1D care in LMICs.
The voices of those living with diabetes are central to developing effective solutions, and their efforts remind us that the workplace isn’t just where we earn, it can also be where we educate, advocate, and support our communities.
As we mark World Diabetes Day, it is vital to remember that, in LMICs, addressing diabetes in the workplace is more than a health issue; it’s a matter of social justice and economic survival.
By prioritising access to care, promoting equity in employment, and recognising the hidden labour of living with diabetes, we can create working environments that empower individuals, support families, and strengthen societies.