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Leonard Thompson was given his first injection of insulin on 11 January 1922 [1] in Canada. He was the first patient to be treated with insulin for Type 1 diabetes. Type 1 diabetes is a disease characterised by a destruction of the body’s own insulin production.

By that time he was 14 years old he weighed only 29kg. Having survived some 2½ years from his diagnosis, he had done better than most people with Type 1 diabetes in the pre-insulin era. The access to insulin saved Leonard from the previous fate of all patients with Type 1 diabetes wasting and death within a matter of months, sometimes even weeks if insulin was not given [2].

During the subsequent months, the Toronto scientists Banting, Best, Collip and Macleod, cooperated with several pharmaceutical companies to expand the capacity for the production of insulin and in 1923 two of them were awarded the Nobel Prize for the discovery of insulin. Taking on the need to supply this life saving drug Nordisk insulin Laboratory was established in Denmark as a non-profit company. The researchers were justly applauded for their recognition that the ethical imperative of accelerating availability of this lifesaving compound should take priority over profit [2].

Three quarters of a century after its discovery, insulin is still not available on an uninterrupted basis in many parts of the developing world [3-5]. A survey in 25 countries in Africa found that in half of them insulin was often unavailable in the large city hospitals, while in only 5 countries was insulin regularly available in rural areas. In some countries, insulin is not included on the national formulary [6].

In consequence, the life expectancy of a child with newly diagnosed Type 1 diabetes in much of sub-Saharan Africa may be as short as one year [7, 8]. In addition, restricted access to insulin will result in debilitating complications such as amputations and blindness and a much reduced life expectancy.

It is estimated that in the 41 nations defined by the World Bank and the IMF as “Highly Indebted Poor Countries” there are 19,000 people with Type 1 diabetes [9], almost all of whom find the availability or expense for insulin a major hazard to life and health. Even when the hormone is available, its purchase may consume as much as half of the family’s weekly income.

Thus the current situation for many patients with Type 1 diabetes in the developing world has many parallels to the time of insulin’s early availability in the industrial world.

It is recognised that the severe financial constraints faced by Ministries of Health in the world’s poorest countries limits spending on pharmaceuticals to as little as $2 per year. This may mean a choice between providing insulin for one child with Type 1 diabetes (at a cost of some $100-$150) and providing essential medicines to as many as 50 to 100 others. Nevertheless there are few other conditions where the replacement of a natural hormone, which the body has stopped producing, can make the difference between death and potentially long term survival.

The establishment of the International Insulin Foundation (IIF), by leading academics and physicians in the field of diabetes, is an attempt to embark on a concerted effort to improve the prospects for people with Type 1 diabetes in the world's poorest countries. The IIF was established with the aim of prolonging the life and promoting the health of people with diabetes in developing countries by improving the supply of insulin and education in its use. (back to top)

References:

1. Burrow, GN, Hazlett, BE and Phillips, MJ. A case of Diabetes mellitus. N Engl J Med 1982; 306: 340-343.

2. Bliss M. The Discovery of Insulin. Paul Harris Publishing, Edinburgh, 1983.

3. McLarty, DG, Swai ABM. and Alberti KGMM. Insulin availability in Africa: an insoluble problem? International Diabetes Digest 1994; 5: 15-17.

4. Savage, A. The Insulin dilemma: a survey of Insulin treatment in the tropics. International Diabetes Digest 1994; 5: 19-20.

5. Deeb, LC, Tan, MH and Alberti, KGMM. Insulin availability among International Diabetes Federation member associations. Diabetes Care 1994; 17: 220-223.

6. Alberti, KGMM. Insulin: availability and cost. World Health Forum 1994; 15: 6 (letter).

7. Makame, M for the Diabetes Epidemiology Research International Study Group, Childhood Diabetes, Insulin, and Africa. Diabetic Medicine 1992; 9: 571-573.

8. Castle, W and Wicks, A. A follow-up of 93 newly diagnosed African diabetics for 6 years. Diabetologia 1980; 18: 121-123.

9. Yudkin, J. Insulin for the world’s poorest countries. Lancet 2000; 355:919-21.