A century later, insulin remains ‘truly a gift to the world’

Dr. Minna Woo says it has been a privilege to witness so many advances in diabetes care, but highlights that there are still challenges in equitable access to insulin and other therapies. (Photo: UHN)

It was a century ago, on Jan. 23, 1922 at Toronto General Hospital, when 14-year-old Leonard Thompson became the first person in the world to receive a purified extract of insulin.

A Canadian discovery that has saved the lives of millions globally, insulin came from the work of Drs. Frederick Banting and Charles Best at the University of Toronto, providing hope for people with diabetes, which had previously been a death sentence. Read more about this historic discovery at University of Toronto’s Insulin 100 page.

To mark the centenary of this milestone, UHN sat down with Dr. Minna Woo, Director of the Division of Endocrinology and Metabolism at UHN and Sinai Health, to discuss the impact the discovery of insulin has had on the clinical care of people with diabetes, and what challenges still remain.

Dr. Woo says it has been a privilege to witness recent advances in care and research, including development of insulin pumps and work with stem cells – the biggest hope to achieve an actual cure for diabetes.

However, she says it is important to realize there are still issues with access and proper use of insulin.

“This is particularly true for marginalized groups including Indigenous populations, racialized groups and those affected by socioeconomic disparities,” she says. “Many of the newer therapies for diabetes are not widely available despite their efficacy.

“More investments in patient education and strong advocacy are needed to overcome these barriers in care,” adds Dr. Woo, who is also a Professor of Medicine at University of Toronto, and the Canada Research Chair in Signal Transduction in Diabetes Pathogenesis and the Soham & Shaila Ajmera Family Chair in Molecular Diabetes Research.

Dr. Woo also discusses how the pandemic has affected in-person services, which are so critical in diabetes care. The full interview, which has been edited of length, is below.

Q: One hundred years after the first clinical use of insulin, what is the impact you see for patients living with diabetes?

A: Insulin is truly a gift to the world. It has saved millions of people living with diabetes in this past century. The spirit of research and discovery has since continued and as a clinician and researcher, it has been gratifying to see so many advances in diabetes care.

The landscape has changed dramatically even in the last two decades. The days when we would frequently see patients blinded or amputated by the disease are largely behind us. We have new drugs and monitoring technologies that allow for much more effective care and improved quality of life. It is truly an exciting time to provide care for those with diabetes with many more choices of drug therapies, newer formulation of insulin and other treatment modalities in the pipeline to improve lives of those living with diabetes. It is also important to remember that there is still a lot of work to be done, as diabetes continues to burden people in epidemic proportions around the globe.

Q: What challenges remain in access to this life-saving hormone, and in education around proper use?

A: Access and proper use of insulin and other drugs for diabetes continue to be a significant limitation to overcome the disease. This is particularly true for marginalized groups including Indigenous populations, racialized groups and those affected by socioeconomic disparities. Many of the newer therapies for diabetes are not widely available despite their efficacy. More investments in patient education and strong advocacy are much needed to overcome these barriers in care. There needs to be heightened awareness and effort in all facets of our society, from all levels of government, policy makers, advocates, associations and frontline health care workers to prioritize care for everyone living with diabetes.   

Q: How has the COVID pandemic impacted the care for patients with diabetes?

A: COVID has been especially challenging for our patients, for those with new diagnosis in particular, but also for those requiring ongoing support. COVID has significantly limited access to in-person care, which is highly valuable for effective teaching around proper use of insulin and other interventions. Again, socioeconomic disparities and language barriers have been particularly difficult to navigate in the era of COVID. Virtual care has been a very important tool, however not everyone may have access or be familiar with virtual platforms on tablets or smartphones. Lastly, the impact of COVID on mental health has been significant for patients and staff in our clinic.

Q: What is the next clinical breakthrough that patients living with diabetes would benefit from?

A: One hundred years have passed since the discovery of insulin and we continue the Holy Grail quest for a cure to diabetes. For type 1 diabetes, there is much excitement around cutting-edge work with stem cells. The hope is to get to a point where we can generate functioning insulin producing cells for all patients. Until then, insulin pumps that can respond to glucose levels and automatically deliver insulin in precise amounts is the latest technology to provide improved quality of life for patients. An important step would be to distribute with wide access to this technology. For type 2 diabetes, new classes of drugs are also in the pipeline along with outlook for personalized care, giving us hope to minimize the burden of this disease to people living with it.

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