The success story of insulin is linked to the generosity of the researchers who isolated it in 1921. Canadian physician Frederick Banting and his assistant Charles Best may have patented the discovery, but they transferred the benefits to the University of Toronto. That altruistic gesture had a great impact on public health. With the patent free, the manufacture of insulin was sped up, facilitating quick access to treatment for patients with diabetes. Richard Welbourn, historian of endocrine surgery, has noted that commercial production from 1922 “was the greatest advance in medical treatments since the advent of antiseptics fifty years earlier.”
A century ago diabetes was no longer a death sentence. An evicted 14 year old boy, Leonard Thompson, was the first patient to save his life. “Insulin was a milestone in the treatment of people with type 1 diabetes who until then had no therapeutic option, except for the famous starvation diets, and their life expectancy was very low,” says Esteban Jódar, head of the Service Department of Endocrinology and Nutrition at the Hospital Quirónsalud Madrid.
The first insulins obtained were derived from pancreas of animals, first from dogs and then from cattle, which were effective for a short time. From there, Esteban Jódar points out, “a race began to better adapt them to the needs of patients and prolong their action”. Having achieved this objective, “the obstacle of allergic reactions caused by some had to be overcome. The next milestone was trying to obtain human insulins, something that was achieved by genetic engineering ”. In parallel, devices were appearing that have facilitated the control of the disease and the quality of life of patients with both type 1 and type 2 diabetes. The latter represents 95% of cases and Its prevalence, soared in recent decades, is already taking on the dyes of a global epidemic.
One 10% of deaths among the 35 and the 64 years is attributed to type 2 diabetes, according to the WHO. The fourth leading cause of premature death among women and the eighth in men is presented as a silent threat. Investigating it and detecting and addressing it early are essential to prevent its progression, but also, it is necessary to tackle its origin: obesity. Domingo Orozco, Vice-Rector for Research at the Miguel Hernández University of Elche and a family doctor, points out that “preventive medicine is as important as curative medicine and we must act to reduce obesity rates, especially in children, where Spain is leader, and also in the general population. ”
The cardiovascular system is the Achilles heel of the disease, given the deterioration that glucose causes in the blood vessels. That is why one of the priority objectives when it has already been diagnosed is to control diabetes to protect the heart. It is estimated that up to 25% of patients have or will develop cardiovascular disease in the future. A person with diabetes has three times the risk of suffering a myocardial infarction than the rest of the population, according to the Spanish Heart Foundation. Hence, one of the lines of research in recent decades has focused especially on developing drugs that prevent these effects. The work of science has paid off, the protection of the cardiovascular system in people with diabetes is one of the areas where more pharmacological advances have been registered in recent years. “The new treatments, in addition to controlling glucose, have the additional effect of preventing cardiovascular events and reducing weight,” points out Domingo Orozco.
The protection of the drug on the heart may go unnoticed by the ill, but not weight loss, which has a very beneficial effect on disease control, in Orozco’s opinion: “He perceives it as something useful and helps him have better adherence to treatment, one of the great problems that we have because half of the patients do not take the medication correctly. ”
The leap forward that has occurred in the treatment and control of the disease has now made many people with diabetes have reasons to smile. Contrary to what happened a few decades ago, today there are many patients who live with this chronic disease and enjoy quality of life for decades thanks to advances in research. But that does not distract science from the goal of curing disease. Regenerative medicine, which promises to restore the functioning of the pancreas, is emerging as a possibility, although it is in the long term.
Research in diabetes so far has not been able to cure it, but throughout the century has been responding to many needs. Esteban Jódar recalls that the old insulins “forced patients to prick themselves and wait 30 or 40 minutes before starting to eat, which it altered their quality of life a lot ”. Now other insulins are being developed that can be given once a week. “Those that will come in the future are intelligent, that is, they will only take effect when glucose is high, which together with technological systems so that the patient is permanently controlled completely changes the perspective of the disease”, points out this specialist.