Professor Andrew Boulton, President & Professor Akhtar Hussain, President-Elect of the International Diabetes Federation, argue that while there has been a century of saving lives, more must be done to tackle diabetes
This year marks an important milestone in the history of diabetes as we mark 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. The centenary of this landmark breakthrough in the history of medicine is of considerable significance for many in the global diabetes community.
This pioneering discovery, and the subsequent and continued advances in diabetes care and treatment, have saved and improved the lives of millions. However, it is a sad fact that insulin and other fundamental components of diabetes care – monitoring equipment and supplies, oral medicines, education and psychological support – remain beyond the reach of many people with diabetes who need them.
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.
Living with diabetes
Worldwide, close to half a billion people live with diabetes. Without significant action to address the global impact of the condition, the International Diabetes Federation anticipates that the number will rise to more than 700 million over the next 25 years.
Diabetes is a serious, potentially debilitating, and life-threatening condition 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.
In many cases, if diabetes is detected and treated early and managed with uninterrupted care, people affected can prevent or delay the often devastating complications associated with the condition. Worryingly, approximately half of people estimated to be living with diabetes remain undiagnosed. Many will be diagnosed with type 2 diabetes, which accounts for up to 90% of all diabetes, because they enter a clinical environment with a significant pre-existing problem, unaware that the problem would have been caused by diabetes. Left untreated with insulin, type 1 diabetes is fatal.
The additional health threat of COVID-19
We are living in extraordinarily difficult times, in which people with diabetes are facing the additional health threat posed by COVID-19. We have seen that people living with diabetes can be more susceptible to the worst complications of the virus and share a concern with many colleagues that the current situation may increase 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.
A call for coordinated global action
Action to address the diabetes pandemic must include access to affordable and uninterrupted care for every person living with diabetes, regardless of where they live or economic circumstance. This should be complemented by investment in policies to improve the prevention of type 2 diabetes and screening to ensure timely diagnosis and help people delay or avoid diabetes-related complications.
Earlier this year, the World Health Organization launched the Global Diabetes Compact and United Nations Member States adopted a Resolution that calls for urgent coordinated global action to tackle diabetes. These are positive steps. It is now up to governments and policymakers to transform words into meaningful action. The centenary of the discovery of insulin provides the ideal timing for action on diabetes. In a world where children with diabetes still die because they cannot access the care they need to survive; action is long overdue. Taking action on diabetes is a moral imperative now, and if not now, when?
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.