Will there be an [email protected]?

As insulin’s centennial year draws to a close, Professor Chantal Mathieu asks what the future holds for medical history’s ‘miracle cure’ – and who might still have cause to celebrate it in another century’s time?

As Professor Chantal Mathieu says in her presentation, 2021 has been a festive year for the centenary of insulin’s discovery. Grateful thanks were warranted – and not only for the sake of people with type 1 diabetes (the principal target of the new treatment back in 1921) but for many more besides: people with type 2, of course (for whom progressive beta-cell degeneration makes the eventual addition of insulin to their treatment almost inevitable). People with pancreatic forms of diabetes too, those with cystic fibrosis – and women with gestational diabetes.  

Celebrations aside, though, there are reasons to hope for better. Chantal sets out compelling reasons to show why injecting insulin is far from ideal. First off, subcutaneous insulin injections can hardly be described as physiological – by rights, insulin should be targeted at the liver first. As it is currently delivered, it over insulinises peripheral tissues, like fat and muscle.

Second, there’s the lack of responsiveness once the insulin enters the blood stream. Says Chantal: “There’s no feedback. Once we inject it, insulin will start working. And so this gives a high risk of hypoglycaemia.”

“When thinking of the future,” she continues, “we want to come to more physiological insulin replacement, with the liver being targeted preferentially. We want to come to insulin replacement that is perhaps not administered in a parenteral way, but can be given via the mouth. We want to have insulin replacement that gives people less hypoglycaemia risk. Also, and more importantly, we want insulin to be administered in such a way that it improves people’s quality of life and reduces the burden of diabetes. And finally, let’s not forget the issue of access to insulin, of affordability of insulin – that will also have to be taken care of in the next 100 years of insulin.”

Will there be an [email protected]? “If you ask me to predict,” says Chantal, “I think we will have an [email protected] anniversary for many, many people living with diabetes. But the face of insulin will be very different, with new products coming into our hands and allowing us to improve the quality of life of people who live with diabetes and need insulin in their therapy.”

So, roll on 2121…

Click here for Professor Mathieu’s contribution to the EASD e-Learning [email protected] series, ‘[email protected]?’.

Any opinions expressed in this article are the responsibility of the EASD e-Learning Programme Director, Dr Eleanor D Kennedy.