Occurs in people on average ten years sooner and at a lower body mass index than in populations of European heritage, and is linked to history of famine as well as to current diet and lack of physical activity. MDV3100 Three-quarters of persons with diabetes live in low- and middleincome countries. In LMICs, the impact of DM falls both on individuals and their families: disability or death from DM can lead to family poverty from loss of income and from the expense of medical care, and then to malnutrition, interruption of education, and the loss of a business or a farm. When diabetes prevalence is high, impoverishment at the family level will cumulate to economic stagnation and social instability, which harm entire communities and retards economic and social development nationally. Information on the availability, cost, and quality of medical care for DM is generally not available for LMICs. Documenting access to care is particularly important because complications from DM, which can be devastating, could largely be prevented by wider use of inexpensive generic medicines, such as metformin, sulphonylureas, statins, angiotensin-converting-enzyme -inhibitors, and other classes of blood pressure-lowering medicines. Because serious side effects are rare when these medications are taken at moderate dosages, many of these medications can be given safely and simultaneously without the need for expensive testing and monitoring. In addition, these interventions are often cost saving, even in the poorest countries. To estimate expenditures for medicines, the study team asked detailed questions about each medicine that a person was currently using. Where the person lived, whether the person had DM or NGT, and what class of medicine was purchased. Within each of the resulting strata, we calculated an average daily price, using data about the price paid the most recent time the item was purchased, the number of pills or units of insulin purchased at that time, and the number of pills or units prescribed per day. We then multiplied this result by an adjuster for self-reported adherence, the average number of days per week that the participant indicated that he or she adhered to the prescribed regimen for a given medicine, divided by seven. This gave us a payment per day “as used.” Mean daily payments were multiplied by 30 to obtain a monthly mean expenditure and by 365 to obtain an annual mean expenditure. File S2, Table S2–3 displays the calculated mean annual expenditures for diabetesrelated and non-diabetes-related “Western” medicines by source and by diabetes status, plus expenditure ratios. File S2, Table S2-4 provides a detailed breakdown of annual payments for individual classes of diabetesrelated medicines by urban vs. rural location in public and private pharmacies, also by diabetes status. Payments for glucose testing strips were calculated similarly to payments for medicines except that self-reported testing rates were used in lieu of prescribed usage rates and adherence to obtain mean daily, monthly, and annual usage and expenditure.