By Elsabé Brits
One should be reluctant to talk about “breakthroughs” when science and especially medical science come up for discussion. However, the discovery of insulin in 1921 was a breakthrough which transformed diabetes from a death sentence to a chronic condition.
The Nobel Prize in Physiology or Medicine in 1923 was awarded jointly to Frederick Grant Banting and John James; and Rickard Macleod “for the discovery of insulin.”
They isolated insulin from pancreatic islets and administrated it to patients suffering from type 1 diabetes.
Diabetes mellitus has been known since antiquity. Descriptions have been found in the Egyptian papyri, in ancient Indian and Chinese medical literature, as well as, in the work of ancient Greek and Arab physicians, according to an article in the World Journal of Diabetes.
In the 2nd century AD Aretaeus of Cappadocia provided the first accurate description of diabetes, coining the term diabetes, while in 17th century Thomas Willis added the term mellitus to the disease, in an attempt to describe the extremely sweet taste of the urine. https://www.wjgnet.com/1948-9358/full/v7/i1/1.htm
A century after it was discovered, insulin still remains out of reach for many people living with diabetes, the World Health Organization (WHO) said in a report published recently to commemorate the milestone anniversary. It also makes very good suggestion to improve access https://www.who.int/news/item/12-11-2021-new-who-report-maps-barriers-to-insulin-availability-and-suggests-actions-to-promote-universal-access
Today, it’s estimated that 463 million people are living with diabetes worldwide. However, despite a century of medical advances, around half of those who need insulin still don’t have access to it.
What stands in the way of treatment? According to Doctors Without Borders (MSF) Without reliable refrigeration, many patients end up travelling more than once a day to a healthcare clinic to receive their insulin. Not only can this cost money, but in places suffering from insecurity, it can become incredibly unsafe.
However, from experience, MSF says that guidelines from pharmaceutical companies need updating. In February 2021, the results of a study led by MSF and the University of Geneva proved that insulin could be stored at up to 37°C.
Meanwhile, simple storage solutions, such as basic clay pots, have also been found to be an effective way of keeping insulin at cool and stable temperatures, meaning patients no longer have to travel twice a day to receive their treatment.
Especially patients with Type 1 diabetes have to constantly monitor their blood sugar levels with finger-prick tests and inject themselves with insulin up to six times a day. In many places where MSF works, food insecurity can complicate things even further.
“There are newer tools such as insulin pens that make it much easier to inject, while at the same time, continuous glucose monitoring devices now mean that patients don’t have to prick themselves multiple times a day. These devices are not routinely available in many lower-income places due to their cost, however, improving availability would ultimately reduce a patient’s need for treatment due to complications in the long run. By helping people to safely manage diabetes now, we can stop it from worsening in the future,” says MSF.
The last great barrier is treatment and with only three companies globally controlling 90% of the insulin market; pricing remains a huge barrier.
This cost to produce insulin can be up to R2000 (£102) per patient per year. However, the price of insulin available to MSF projects ranges from R4312 (£220) to R17 641 (£900) per patient, depending on the injection device and type of insulin we need to provide for the patient.
There are several companies working to improve market competition and produce generic unbranded insulin. This would significantly lower the cost for patients and healthcare organisations. However, they face tough regulations to have their insulin approved. MSF is campaigning hard to enable these generic companies to enter the insulin market, and working to improve the package of tools available to diabetic patients around the world.
“The scientists who discovered insulin 100 years ago refused to profit from their discovery and sold the patent for just one dollar,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “Unfortunately, that gesture of solidarity has been overtaken by a multi-billion-dollar business that has created vast access gaps.”
Hospitals can also do their part, via Inpatient Diabetes Management Services in a community hospital setting to reduce the rates of both hypoglycaemia and hyperglycaemias, length of stay, and even hospital costs. Groote Schuur Hospital in Cape Town recenlty launched its state-of-the-art Diabetes Centre. It will offer Diabetes Clinics – specifically focusing on complicated diabetes such as Type 1 diabetes, diabetes in pregnancy, diabetes in special situations (patients with organs transplants, cystic fibrosis, steroid-induced, atypical), preoperative optimization of diabetes. It also has a specialised Diabetes Foot Clinic encompassing a multi-disciplinary team including a podiatrist, endocrinologist, vascular surgeon and plastic surgeon.
A dedicated patient education centre will encouraged patients to attend group sessions and one-on-one education sessions with trained diabetes educators. And a lot of focus will be placed in the education of nurses, doctors, medical students and the next generations of endocrinologists.
The written history of this disease goes back 3 000 years, and it still shows, we are still learning how it manage it. May we dare to dream for a cure in the future.
Guest columnists share their own views that are not necessarily reflective of HASA’s.