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    100 years of Insulin discovery: The ground-breaking innovation in diabetes care

    100 years of Insulin discovery: The ground-breaking innovation in diabetes care

    100 years of Insulin discovery: The ground-breaking innovation in diabetes care
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    By Dr KM Prasanna Kumar   IST (Updated)

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    The number of people with diabetes in India is currently around 77 million and is expected to rise to about 134 million by 2045.

    Insulin discovery by Sir Frederick G Banting, Charles H Best and JJR Macleod in 1921 is one of the greatest medical discoveries ever. Even today, Insulin remains one of the most effective treatments for people with Type 1 diabetes. As we celebrate the 100 years of Insulin discovery, we cannot thank enough the ground-breaking innovations in insulin for diabetes care that have saved countless lives.
    We are blessed today to have improved medicines than ever, yet the number of people living with diabetes continues to rise at an alarming rate, throwing a significant burden on patients, families, and the country. According to the Diabetes Atlas 2019 published by the International Diabetes Federation, the number of people with diabetes in India is currently around 77 million and is expected to rise to about 134 million by 2045. The rising prevalence of diabetes is mainly driven by a mix of factors such as rapid urbanisation, sedentary lifestyles, unhealthy diets, tobacco use, and increasing life expectancy.
    While each type of diabetes has its exclusive characteristics, the distinctive feature of diabetes is either the absence of insulin (Type 1 diabetes) or the insufficient production of insulin, often tied with the body being unable to entirely respond to insulin (Type 2 diabetes). Before the discovery of insulin, the only available treatment for diabetes was a diet that restricted caloric intake so strictly that people were subjected to starvation to control their diabetes. While this did help many to extend their lives as they waited for a cure, it also meant that many people with type 1 diabetes died because of malnutrition rather than diabetes.
    In 1922, the first person with diabetes to be treated with insulin was injected with insulin taken out from the pancreases of cattle. Since then, the therapeutic options available today have come a long way. Although revolutionary in the 1920s, animal-derived insulin came with a lot of risks, which included the possibility of an allergic reaction. After the discovery of insulin, the average life expectancy of a diabetes person improved drastically.
    By 1945, a child diagnosed with type 1 diabetes could expect to live more than 30 years longer than a 10-year-old child diagnosed with type 1 diabetes before the discovery of insulin. This was a significant gain! Human insulin, which became commercially available in 1982, demonstrated significant advantages over animal-derived insulin.  It did not rely on a supply of animal pancreases, production was scalable, and it was identical to the insulin produced by the human body. The first insulin pen created a revolution in diabetes care and paved the way for streamlining administration and diabetes management.
    In recent years, significant advances have been made in insulin therapy. The latest new generation long-acting insulins are capable of releasing medication into the bloodstream slowly over time rather than all at once. This steady release brings insulin therapy one step closer to mimicking the complex insulin action of the body, making it easier for people with diabetes to reduce the risk of low blood glucose (hypoglycemia), without compromising control over blood glucose levels.
    A new generation of ultra-fast-acting insulins has also provided freedom from planning insulin injections around mealtimes. These fast-acting insulins allow people with type 1 diabetes or advanced type 2 diabetes to give themselves an injection just before eating or even after starting a meal, relieving them from the burden of planning what to eat and how much insulin to take before each meal. Each generation of insulin has sought to introduce new freedoms and flexibilities for people with diabetes.
    The COVID-19 pandemic has also made people with diabetes more vulnerable to developing worse outcomes from infection, globally. However, people with well-managed diabetes have a lower risk of worse outcomes from the COVID-19. Therefore, more advancements are necessary to ensure a full and healthy life for people living with diabetes. Sustained innovation is the need of the hour to address the challenges that diabetes has on individuals and society.
    According to a report by Diabetes Technology & Therapeutics, the total number of insulin-requiring patients today is expected to be around 150–200 million (this is an underestimate). The Overall insulin use would increase from 516.1 million 1000IU vials (95 percent CI: 409.0, 658.6 million) to 633.7 million per year (95 percent CI: 500.5, 806.7 million) between 2018 and 2030.
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