Insulin at 100: a life-saving discovery but more remains to be done
We are fast-approaching some historic milestones in the history of diabetes. In May 1921, the experiments that would culminate in the synthesis of commercially available insulin first began in Toronto, Canada. Frederick Banting and Charles Best experimented on a number of diabetes-induced dogs with limited success. A breakthrough came when one of the dogs, named Marjorie by the Toronto team, survived for 70 days with injections of the pancreatic extract, or ‘Isletin’ as the team were calling it. On January 23rd of the following year, the first successful injection of insulin was administered to a person living with diabetes.
There are other key milestone events in the timeline of the discovery of insulin, taking us from the initial idea that led to the research, through to mass production and the wider distribution of insulin beyond North America. Of course, the work in Toronto in late 1920 and early 1921 did not happen in a vacuum. We will take the opportunity to mark many relevant dates and themes in the history of diabetes, including pioneering work that took place prior to the discovery and the subsequent developments that have transformed diabetes care over the past 100 years.
Worldwide, close to half a billion people live with diabetes. Without significant action to address the global impact of the condition, we anticipate the number will rise to more than 700 million over the next 25 years.
Diabetes is a serious, potentially debilitating and life-threatening non-communicable disease that can impose a heavy impact on individuals and their families, as well as on healthcare systems and national economies. This is particularly the case in low and middle-income countries, home to almost four in five (79%) of all people currently living with diabetes.
Approximately half of people estimated to be living with diabetes remain undiagnosed. Left untreated with insulin, type 1 diabetes is fatal.
When people with type 2 diabetes go untreated or are not sufficiently supported, they are at risk of serious and life-threatening complications such as heart attack, stroke, kidney failure, blindness and lower-limb amputation. Many will be diagnosed with type 2 diabetes because they enter a clinical environment with a significant pre-existing problem, unaware that the problem will have been caused by diabetes. Some will be misdiagnosed. Tragically and avoidably, some will be diagnosed post-mortem.
In many cases, if diabetes is detected early, people affected may well be able to prevent or at least delay any serious problems from arising. More must be done to prevent type 2 diabetes in people at high risk of developing the condition and greater effort must be made to diagnose all forms of diabetes early and prevent its complications. Action to address the diabetes pandemic should include access to affordable and uninterrupted care for every person living with diabetes, regardless of where they live or their economic circumstances.
We are living extraordinarily difficult times in which people with diabetes are facing an additional major health threat. Regretfully, we have seen that people living with diabetes can be more susceptible to the worst complications of Covid-19. The evidence suggests fatalities are markedly higher among people with underlying health conditions such as diabetes. This is particularly the case among the elderly (an estimated one in five people over the age of 65 have diabetes) and when diabetes is not under control. We share a concern with many colleagues that the current situation may lead to an increase in diabetes complications over the coming years. Moreover, we should worry that the legacy of the pandemic will see resources and attention focused on infectious diseases to the detriment of all non-communicable diseases, including diabetes.
In the current climate, the global diabetes community needs to come together and raise its voice to make sure diabetes, a leading cause of global disability and mortality, receives the attention required.
If ever there were a time to focus attention on diabetes, that time is now.
The centenary of the development of therapeutic insulin in 1921 by Frederick G. Banting and Charles H. Best, under the supervision of John J. R. Macleod and with the collaboration of James B. Collip is a milestone of considerable significance for many in the global diabetes community and a landmark breakthrough in the history of medicine.
The coming years present an opportunity to raise awareness of diabetes to an unprecedented level as a number of key dates related to the discovery of insulin come to pass. While these historic events have saved and improved the lives of millions living with diabetes, it is important to remind ourselves that insulin still remains beyond the reach of many who need it.
Securing universal access to insulin for all who require it remains a global challenge. The barriers to access and affordability are myriad and complex, reflecting the multiple steps involved in the production, distribution and pricing, as well as the infrastructure required to ensure the appropriate and safe use of insulin.
United, the global diabetes community has the numbers, the influence and the determination to bring about meaningful change. We need to take on the challenge. We owe it to the millions of families affected by diabetes and we owe it to the legacy of Banting and Best. Collectively, we must address the burning question on the lips of many who may not be able to ask it for themselves: “how much longer?”
Prof. Andrew Boulton
President, International Diabetes Federation
Prof. Akhtar Hussain
President-Elect, International Diabetes Federation