Stilled progress in Diabetes Care
2021 marks the 100th anniversary of discovery of insulin, which transformed the treatment of diabetes from a death sentence to a chronic condition. The first insulin preparation developed in 1921 was capable of consistently lowering blood glucose. But even now, blood glucose control with insulin in diabetics is nearly universally suboptimal, with essentially the same molecule still delivered by the same inappropriate subcutaneous injection route.
A century after it was discovered, insulin still remains out of reach for many people living with diabetes, the World Health Organisation (WHO) said in a report published on November 12 to commemorate the milestone anniversary. Insulin is the ‘bedrock’ of diabetes treatment, and the WHO is working with countries and manufacturers to expand access to everyone who needs it.
“The scientists who discovered insulin 100 years ago refused to profit from their discovery and sold the patent for just one dollar,” said Tedros Adhanom Ghebreyesus, Director-General, WHO and added “Unfortunately, that gesture of solidarity has been overtaken by a multi-billion-dollar business that has created vast access gaps.”
According to a paper published on PubMed.gov, current research and development in diabetes has seen some innovations, but none of these have truly been game-changing. Currently, three multinational companies control over 95 per cent of global insulin supply. The inclusion of insulin on the WHO’s Prequalification Programme is an opportunity to facilitate entry of new companies into the market. Many governments lack policies on the selection, procurement, supply, pricing and reimbursement of insulin. Moreover, mark-ups in the supply chain also affect the final price to the consumer.
On November 2, 2021, the International Diabetes Federation (IDF) released new figures showing that 537 million adults are now living with diabetes worldwide - a rise of 16 per cent (74 million) since the previous IDF estimates in 2019. Released in advance of World Diabetes Day on November 14, these new findings highlight the alarming growth in the prevalence of diabetes around the world. The new figures are taken from the upcoming 10th Edition of the IDF Diabetes Atlas, which will be published on December 6.
The latest IDF Diabetes Atlas reports that by 2045, 783 million adults will be living with diabetes – or one in eight adults. This would be an increase of 46 per cent, more than double the estimated population growth (20 per cent) over the same period. The report estimated the number to be 74 million adults in India or one in 12 adults suffering from diabetes. This takes India to second place just behind China (141 million) in terms of people diagnosed with diabetes across the globe.
Considering the alarming situation, on November 28, China’s latest centralised drug procurement work has preliminarily selected 42 insulin products, resulting in an average price cut of 48 per cent, according to the National Healthcare Security Administration. The products, from 11 domestic and foreign-invested companies, cover 16 varieties of second and third-generation insulin commonly used in clinical treatment. The first batch of approximately 210 million doses of insulin ordered by medical institutions across the country will be purchased under the programme, saving an estimated 9 billion yuan (about $1.4 billion) in costs.
It is the first time by any country in the world where the national centralised drug procurement programme has included biopharmaceuticals, marking a milestone in the reform of the programme. The centralised procurement of insulin will bring tangible benefits to diabetics by lowering medicine prices, as they require the long-term use of insulin to control their blood sugar. India, with 102 insulin brands from both local and global companies in the market, should also look at implementing such programmes to support diabetes patients.
On October 25, the Indian drug price regulator National Pharmaceutical Pricing Authority (NPPA) fixed the ceiling prices for 12 anti-diabetic generic medicines, including Glimepiride tablets, glucose injection and intermediate acting insulin solution to make it possible for every Indian to afford medical treatment against diabetes.
The challenges affecting access to insulin are complex and require a wide range of solutions. Given that 2021 marks the centenary of the discovery of insulin, there is a need for global advocacy to ensure that the benefits of insulin and innovations in diabetes care reach all those suffering from diabetes.