World Diabetes Day 14 November (2) The Lancet: 100 years of insulin: a technical success but an access failure

12 November, 2021

Citation, extracts and a comment from me below.

CITATION: 100 years of insulin: a technical success but an access failure

The Lancet Editorial volume 398, issue 10313, p1777, november 13, 2021

Published:November 13, 2021 DOI:https://doi.org/10.1016/S0140-6736(21)02479-X

'The isolation of insulin in 1921 and its subsequent delivery to a 14-year-old boy in a diabetic coma in Toronto in 1922 was a ground-breaking scientific and clinical achievement that has transformed diabetes care and is celebrated in this themed issue of The Lancet. But despite the altruistic sentiments of the discoverers—Banting, Best, Collip, and Macleod—that “insulin belongs to the world”, the lack of access to insulin over the past 100 years reflects an appalling policy and implementation failure.

'Fewer than half of countries in central and east Asia and western sub-Saharan Africa have the necessary policies and registries to account accurately for the numbers and needs of patients with diabetes.

'Globally, an estimated 76% of children with type 1 diabetes are unable to stay within the recommended glycaemic ranges, putting them at risk of life-threatening short-term and long-term complications.

'More than 50% of patients with type 2 diabetes are unable to receive the insulin they need... When it comes to insulin access, cost is a major barrier... Along with difficulty in getting insulin, many patients do not have access to basic blood glucose monitoring, diagnosis continues to be a problem, and access to patient education is limited...'

COMMENT (NPW): The article suggests a failure of national policies on diabetes at a time when type 2 diabetes is exploding in LMICs. On affordability, it points out that the WHO Essential Medicines List expert committee is now creating a working group on highly priced essential medicines such as insulin. For those who can access the drug, optimal use is not assured.

Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org