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What’s next in diabetes care - 100 years since the lifesaving discovery of insulin (Guest blog)

The discovery of insulin in 1921 marked the start of a medical journey that has fundamentally changed the lives of people with diabetes. Since then, each new understanding and innovation has brought fresh hope of a full and healthy life to those living with diabetes.

  • The introduction of human insulin in the ‘80s, brings an end to the reliance on animal-derived insulin and means a limitless supply of highly purified insulin (1,2).
  • First- generation analogue insulin introduced in late 90’s, and new generation insulin introduced in 2010s bring improved convenience while countering some of the short-term complications, such as weight gain and  risk of hypoglycaemia (3-6).
  • New classes of therapeutics have been shown to not only improve glucose control, but also to have other beneficial effects on vital organs such as the heart (7,8).

With each step on the journey of innovation, the complexity of diabetes management and seriousness of this disease became more and more apparent. Today, with diabetes prevalence on the rise(9), recent learnings showing that people with diabetes are at higher risk of more severe complications and death with COVID-19(10), and the understanding that 50% of all people receiving diabetes care do not achieve their treatment targets and are at risk of developing diabetes-related complications (11) – one thing remains clear: there is more to be done to ensure people with diabetes can live their lives to the fullest. So the key question is: what is next in diabetes care?

To answer that question, let us think forward. As the EFPIA Diabetes Platform, we envision an environment where people with diabetes are diagnosed earlier and provided with the tools and education to self-manage their diabetes effectively. Continued innovation across the healthcare system in terms of approach to care, digital and therapeutic innovation, and a focus on reducing preventable and serious short- and long-term complications that impede people from living a healthy life with diabetes –are paramount to this vision.

The first step is to recognise the seriousness of the disease not just in terms of its prevalence across Europe – but its impact on individuals day-to-day, long-term, and on overall quality of life. With  every 8 seconds somebody dying from a diabetes related complication(9), of which many due to cardiovascular complications(12), the recognition of diabetes as a debilitating and deadly disease is critical. Prevention, early diagnosis, and improvements in how the disease is managed make a significant difference to people with diabetes.

What is also crucial to recognise is that 75% of cost spent on diabetes is linked to complications which could be preventable(13). The connection of diabetes to various complications calls for a multi-disciplinary approach; amongst specialists, but also certainly in relation to primary care. Healthcare focused on preventing complications, reducing the burden of diabetes management as well as ensuring psychosocial support for people with diabetes – will be better positioned to utilise resources more efficiently.

The individual living with diabetes plays a central role in the care team. Recognising that less than 1% of the time that a person with diabetes spends managing their disease involves contact with healthcare professionals(14). Therefore, the support to self-manage is critical to successful diabetes care. Patient education as well as innovation within medicines, digital tools and care technologies are vital to enable people living with diabetes to take better control of their disease and improve wellbeing.

The discovery of insulin has saved millions of lives (9), yet it is clear much is still to be done for people living with diabetes. The European Commission and Parliament, as well as Member States can play a central role in tackling the silent pandemic diabetes is. The launch of The Blueprint for Action on Diabetes in the European Union by 2030, by the MEPs Mobilising for Diabetes (MMP) on 25 February will be an important milestone in this journey. The EFPIA Diabetes Platform is committed to continue to be a partner and work on improving diabetes diagnosis and management, focusing on delivering better healthcare for people living with diabetes, within and beyond treatment innovation.

 
Find out more:

Mind the gap: implementing integrated diabetes systems in Europe
Improving outcomes for people with diabetes

Are we doing the best we can for people living with diabetes?
European Diabetes Forum
IDF 
Register for the event: MEPs Mobilising for Diabetes Webinar: Blueprint for Action on Diabetes in the European Union by 2030, which will take place on 25 February

 

[1] Tattersall RB. The History of Diabetes Mellitus. In: Textbook of Diabetes.2010:1–23.
[2] Richter B, Neises G. 'Human' insulin versus animal insulin in people with diabetes mellitus. The Cochrane database of systematic reviews. 2005(1):CD003816.
[3] Gough S, Narendran P. Insulin and Insulin Treatment. In: Textbook of Diabetes.2016:399–413.
[4] Evans M, Schumm-Draeger PM, Vora J, King AB. A review of modern insulin analogue pharmacokinetic and pharmacodynamic profiles in type 2 diabetes: improvements and limitations. Diabetes, obesity & metabolism. 2011;13(8):677–684.
[5] Russell-Jones D, Danne T, Hermansen K, et al. Weight-sparing effect of insulin detemir: a consequence of central ner­vous system-mediated reduced energy intake? Diabetes, obesity & metabolism. 2015;17(10):919–927.
[6] Davis CS, Fleming JW, Malinowski SS, Brown MA, Fleming LW. Ultra-long-act­ing insulins: A review of efficacy, safety, and implications for practice. J Am Assoc Nurse Pract. 2018;30(7):373–380.
[7] Sandoval DA, D’Alessio DA. Physiology of proglucagon peptides: role of gluca­gon and GLP-1 in health and disease. Physiological reviews. 2015;95(2):513– 548.
[8] Campbell JE, Drucker DJ. Pharmacol­ogy, physiology, and mechanisms of incretin hormone action. Cell Metab. 2013;17(6):819–837.
[9] IDF Atlas 9th Edition 2019
[10] Kubjane M, McCreedy N, Cariou B, et al. Association of Diabetes and Severe COVID-19 Outcomes: A Rapid Review and Meta-Analysis. 2020.
[11] Hart JT. Rule of halves: implications of increasing diagnosis and reducing dropout for future workload and pre­scribing costs in primary care. Br J Gen Pract. 1992;42(356):116–119.
[12] Roger et al. Circulation 2011;123:e18-e209
[13] Martin S, et al. Exp Clin Endocrinol Diabetes. 2007;115:495-501
[14] Barnard KD, Holt RI. The aims of diabetes care. Textbook of Diabetes. 2017:314–325.

 

Elvera Laanen Larsen

Elvera Laanen Larsen is a member of the EFPIA Diabetes Platform and Head of Diabetes and Cardiovascular Policy...
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Yulia Ivanova

Yulia Ivanova is Public Affairs Lead in Global Public Affairs and Patient Relations at Novo Nordisk. In her current...
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