Featured ArticleIssueNov 21

100 Years of Insulin

Insulin remains a scarce commodity even after 100 years of its discovery as diabetes grows into a pandemic of epic proportion globally

About 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year. Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. A chronic, metabolic disease characterised by elevated levels of blood glucose (or blood sugar), diabetes leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves. The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesn’t make enough insulin. In the past three decades, the prevalence of type 2 diabetes has risen dramatically in countries of all income levels. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. For people living with diabetes, access to affordable treatment, including insulin, is critical to their survival. There is a globally agreed target to halt the rise in diabetes and obesity by 2025.


Alarming situation
Globally, over 90 per cent of people with diabetes have type 2 diabetes. The rise in the number of people with type 2 diabetes is driven by a complex interplay of socio-economic, demographic, environmental and genetic factors. Key contributors include urbanisation, an ageing population, decreasing levels of physical activity and increasing prevalence of overweight and obesity.

The International Diabetes Federation (IDF) has released new figures showing that 537 million adults are now living with diabetes worldwide — a rise of 16 per cent (74 million) since the previous IDF estimates in 2019. Released in advance of World Diabetes Day on November 14, the new findings highlight the alarming growth in the prevalence of diabetes around the world. The new figures are taken from the upcoming 10th Edition of the IDF Diabetes Atlas, which will be published on December 6.

The latest IDF Diabetes Atlas reports that the global prevalence of diabetes has reached 10.5 per cent, with almost half (44.7 per cent) of adults undiagnosed. IDF projections show that by 2045, 783 million adults will be living with diabetes – or one in eight adults. This would be an increase of 46 per cent, more than double the estimated population growth (20 per cent) over the same period. The centenary of the discovery of insulin presents a unique opportunity to reflect on the impact of diabetes and highlight the urgent need to improve access to care for the millions affected. An estimated one in two people with diabetes across the world who need insulin cannot access or afford it. Diabetes is at higher risk of serious and life-threatening complications, such as heart attack, stroke, kidney failure,blindness and lower-limb amputation, due to not receiving effective treatments in a timely manner. These complications result in reduced quality of life and higher healthcare costs.

Much can be done to reduce the impact of diabetes. Evidence suggests that type 2 diabetes can often be prevented, while early diagnosis and access to appropriate care for all types of diabetes can avoid or delay complications in people living with the condition.

Global Diabetes Compact The World Health Organization’s new Global Diabetes Compact aims to bring a much-needed boost to efforts to prevent diabetes and bring treatment to all who need it – 100 years after the discovery of insulin. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization says, “The need to take urgent action on diabetes is clearer than ever. The number of people with diabetes has quadrupled in the last 40 years. It is the only major non-communicable disease for which the risk of dying early is going up, rather than down.

Dr Ghebreyesus adds, “A high proportion of people who are severely ill in hospital with COVID-19 has diabetes.The Global Diabetes Compact will help to catalyse political commitment for action to increase the accessibility and affordability of life-saving medicines

Urgent action needed for affordable insulin

One of the most urgent areas of work is to increase access to diabetes diagnostic tools and medicines, particularly insulin, in low- and middle-income countries. The introduction of a pilot programme for WHO prequalification of insulin in 2019 has been an important step. Currently, the insulin market is dominated by three companies. Prequalification of insulin produced by more manufacturers could help increase the availability of quality-assured insulin to countries that are currently not meeting demand. In addition, discussions are already underway with manufacturers of insulin and other diabetes medicines and diagnostic tools about avenues that could help meet demand at prices that countries can afford.

Insulin is not the only scarce commodity. Many people struggle to obtain and afford blood glucose metres and test strips as well. In addition, about half of all adults with type 2 diabetes remain undiagnosed and 50 per cent of people with type 2 diabetes don’t get the insulin they need, placing them at avoidable risk of debilitating and irreversible complications such as early death, limb amputations and sight loss.

Innovation will be one of the core components of the compact, with a focus on developing and evaluating lowcost technologies and digital solutions for diabetes care. The compact will also focus on catalysing progress by setting global coverage targets for diabetes care. A “global price tag” will quantify the costs and benefits of meeting these new targets. The compact will also advocate for fulfilling the commitment made by governments to include diabetes prevention and treatment into primary health care and as part of universal health coverage packages.

The theme of this year’s World Diabetes Day was Access to Diabetes Care. IDF is calling on national governments to provide the best possible care for people living with diabetes and develop policies to improve diabetes screening and type 2 diabetes prevention, especially among young people.

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