A Century of Insulin: Progress, Promises, and the Persistent Divide
It’s been over a century since insulin was first administered to a dying teenager, a medical breakthrough that should have revolutionized diabetes care forever. Yet, as I reflect on the five-year anniversary of the Global Diabetes Compact (GDC), I’m struck by a sobering reality: millions still lack access to this life-saving medication. What’s even more concerning is the projected 50% global increase in diabetes cases by 2050. This isn’t just a health crisis—it’s a moral imperative.
The Promise of Insulin and the Persistence of Inequality
In 1922, Leonard Thompson became the first person to receive insulin, a moment that should have marked the end of diabetes as a death sentence. Fast forward to today, and 40 million people, mostly in lower- and middle-income countries, still can’t access this essential medication. The South-East Asian region alone needs 170 million vials of insulin annually, yet even the cheapest options remain unaffordable for the most vulnerable. This disparity is not just a failure of healthcare systems—it’s a failure of humanity.
What makes this particularly fascinating is the contrast between the scientific achievement and its uneven distribution. Insulin is a ‘gift from science,’ as Dr. Bente Mikkelsen aptly described it, yet its promise remains unfulfilled for millions. This raises a deeper question: how can we celebrate medical breakthroughs when they’re inaccessible to those who need them most?
The Global Diabetes Compact: A Bold Vision with Mixed Results
The GDC, launched five years ago, set ambitious goals: 80% diagnosis coverage, 80% glycemic control, and 100% access to affordable insulin for type 1 diabetes by 2030. These targets, as Professor Peter Schwarz noted, are ‘brilliant’—but brilliance alone isn’t enough. The Compact has made strides, particularly in raising awareness and fostering collaboration, but the progress is uneven.
One thing that immediately stands out is the inclusion of insulin analogues in the WHO Essential Medicines List, a significant step toward improving access. Yet, the discontinuation of key insulin products by leading manufacturers like Sanofi and Novo Nordisk is alarming. As cases rise, the gap between need and availability seems to be widening. This isn’t just a logistical issue—it’s a systemic failure that requires urgent attention.
The Ethical Dilemma of Undiagnosed Cases
What many people don’t realize is that an estimated 43% of people with diabetes remain undiagnosed, particularly in the Global South. Professor Schwarz highlights a tragic assumption: children in these regions are dying young, undiagnosed and untreated. This isn’t just a data gap—it’s an ethical failure. The stigma surrounding diabetes, compounded by lack of education and access to diagnostics, further exacerbates the problem.
In Africa, for instance, obesity is sometimes seen as a sign of health, contrasting sharply with the stigma of HIV. This cultural nuance underscores the need for tailored education and awareness campaigns. If you take a step back and think about it, addressing diabetes isn’t just about medication—it’s about understanding and challenging societal perceptions.
Innovation vs. Inequality: A Stark Contrast
The rise of innovative treatments like GLP-1 drugs has been a game-changer, particularly in high-income countries where they’re used for weight loss. Yet, in Africa, only 1% of diabetes care investment is directed, despite predictions of a 140% increase in cases by 2050. This disparity is shocking. As Dr. Tom Frieden pointed out, we need to ‘get the basics right’ before celebrating advancements that remain out of reach for most.
South East Asia: A Region in Crisis
South East Asia is on a ‘shocking trajectory,’ with one in five adults living with diabetes. By 2030, this number is expected to reach 320 million. Yet, only one in three adults receives treatment, and less than 15% achieve glycemic control. Health systems are ill-equipped to handle this surge, lacking prevention, early detection, and care infrastructure.
A detail that I find especially interesting is the SEAHEARTS initiative, which has enrolled 43.5 million patients across 180,000 healthcare facilities. This ambitious program aims to place 100 million on protocol-based diabetes management by 2030. While promising, it’s a drop in the ocean compared to the scale of the problem. What this really suggests is that localized efforts, while crucial, need global support and systemic change.
The Role of Partnerships and Cultural Sensitivity
One of the most inspiring aspects of the GDC is its emphasis on partnerships. In Bangladesh, for example, the World Diabetes Foundation is engaging religious leaders to raise awareness and provide community support. This approach leverages cultural trust and influence, offering a model for other regions. Personally, I think this is where the real change begins—at the grassroots level, where communities are empowered to take charge of their health.
Conclusion: A Call to Renewed Commitment
As we celebrate five years of the GDC, it’s clear that progress has been made, but the journey is far from over. The increasing burden of diabetes, particularly in low- and middle-income countries, demands urgent action. We need more than political ambition—we need action on the ground, from improving access to insulin to addressing cultural stigmas and data gaps.
In my opinion, the next five years will be pivotal. Will we fulfill the promise of insulin, or will we continue to fail those who need it most? The answer lies not just in policies and initiatives but in our collective will to bridge the divide. As Dr. Catharina Boehme said, this is an opportunity to renew our commitment to delivering diabetes care at scale, for everyone. The question is: are we up to the challenge?
