A century past the discovery of insulin: global progress and challenges for type 1 diabetes among children and adolescents in low-income and middle-income countries.

Type 1 diabetes is on the rise globally; however, the burden of mortality remains disproportionate in low-income and middle-income countries (LMICs). As 2021 marks 100 years since the discovery of insulin, we revisit progress, global burden of type 1 diabetes trends, and understanding of the pathogenesis and management practices related to the disease. Despite much progress, inequities in access and availability of insulin formulations persist and are reflected in differences in survival and morbidity patterns related to the disease. Some of these inequities have also been exacerbated by health-system challenges during the COVID-19 pandemic. There is a clear opportunity to improve access to insulin and related essential technologies for improved management of type 1 diabetes in LMICs, especially as a part of universal health coverage. These improvements will require concerted action and investments in human resources, community engagement, and education for the timely diagnosis and management of type 1 diabetes, as well as adequate health-care financing. Further research in LMICs, especially those in Africa, is needed to improve our understanding of the burden, risk factors, and implementation strategies for managing type 1 diabetes.

"Couldn't live without it": diabetes, the costs of innovation and the price of insulin in Canada, 1922-1984.

This article traces insulin prices in Canada from 1922, just after its discovery at the University of Toronto, to 1984 when production fell out of Canadian control. Connaught Laboratories (part of the University of Toronto from 1914 to 1972) was the first to manufacture insulin and remained the sole Canadian producer. As a public trust, Connaught remained committed to providing insulin at the lowest possible price despite increasing economic pressures. This article analyzes the context surrounding the price of insulin preparations and how they fell from 1922 to 1942, remained unchanged until 1967, and rose during the 1970s.

Antidiabetic drugs used in Europe prior to the discovery of insulin.

Many therapeutic agents had been used for the treatment of diabetes mellitus before insulin was discovered and several hundred plants have shown some extent of antidiabetic activity. This study tries to explore which agents were most widely used in Europe in the pre-insulin era. According to the scientific literature and the proprietary drug industry around 1900, more than 100 agents were considered to have hypoglycemic activity. Most of them seem to have been used only occasionally while some others were recommended and marketed to a large extent. Among the medicinal plants, Syzygium cumini (syn. S. jambolanum, Eugenia jambolana), Vaccinum myrtillus and Phaseolus sp. were most common, and other frequently used agents were opium, opium alkaloids, other alkaloids like quinine or Belladonna alkaloids, salicylates, alkaline substances like sodium (bi)carbonate and even strong poisons like arsenic or uranium salts. Syzygium jambolanum seed powder seems to be one of the most intensively studied antidiabetic agents of plant origin.

Making the unit of insulin: standards, clinical work, and industry, 1920-1925.

The standardization of insulin is generally considered by historians to have been a process conducted by physiologists under the direction of Henry Dale. This article shows that it actually involved many actors and began with the earliest administration to patients in Canada and the United States. During this first phase, the drug company Eli Lilly also contributed actively to the standardization, under the scientific direction of George Clowes. This is not to undermine the role of Dale, whose political leadership was paramount for the international phase of the standardization. His scientific contribution, however, was a continuation of previous work led by physiologists, clinicians, and pharmacists. The production and packaging of insulin in standardized units thus appears to be the result of the impressive working of a transdisciplinary and transnational network. It also highlights how new modes of drug regulation were elaborated by state bodies in the early 1920s and paved the way for more extensive reforms.