Insulin at 100: Is diabetes management promising?

By Shimbo Pastory and Johnson Mwamasangula

World Diabetes Day is an international observance created by International Diabetes Federation (IDF) in collaboration with World Health Organization (WHO) in 1991, in response to growing concerns about the escalating threat posed by diabetes. It became an official United Nations day in 2006 under the resolution 61/225.

World Diabetes Day is marked every year on November 14, the birthday of Sir Frederick Banting who discovered insulin along with Charles Best in 1922. As the world gathers together to observe the importance of this day we are also gathered to review a historic milestone in the history of diabetes, Insulin at 100. Now it has been 100 years and nine months since the discovery and we cannot deny that insulin has been a life-saving discovery but more remains to be done. Insulin still remains beyond the reach of many who need it.

Need for diabetes education

On this day we are calling on global policy makers to increase access to diabetes education to help safeguard the lives of more than half a billion people (537 million) living with diabetes worldwide, a number that is expected to rise to 643 million by 2030. With China hosting highest numbers of diabetics worldwide, followed by Pakistan, still more than 3 in 4 people with diabetes live in low and middle income countries.

The disease has been responsible for at least $966 billion in health expenditure in 2021 which is 9 percent of the global total spent on healthcare. There is need for global action to promote importance of taking coordinated and concerted actions to confront diabetes as a critical global health issue.

The theme for World Diabetes Day 2021-2023 campaign is “Access to Diabetes Care” but for the second year (2022) is “Education to Protect Tomorrow.” People with diabetes require ongoing care and support to manage their condition and avoid complications but still millions of people around the world do not have access to health care.

More than 530 million people live with diabetes and the millions more are at risk which is the call of the wild for governments to increase investment in diabetes care and prevention. In developing countries, the condition is worse due to lack of health education regarding diabetes thus leaving them behind undiagnosed and battling diabetes in lay way or worst means. But maybe the real question on this day is what diabetes is.

What is diabetes?

According to WHO, diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is the hormone that regulates blood glucose. When the blood glucose level rises it leads to condition called Hyperglycemia which is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body systems especially the nerves and blood vessels.

There are two types of diabetes, type 1 and type 2. Type 1 diabetes which previously was known as insulin dependent or childhood-onset, is characterized by deficient insulin production and requires daily administration of insulin., neither its cause nor the means to prevent it are known.

Type 2 diabetes formerly called non-insulin dependent or adult on-set results from the body’s ineffective use of insulin. More than 95 percent of people with diabetes have type-2 diabetes, which is largely caused by excess body weight and physical inactivity. The symptoms may be similar to those of type 1 diabetes but often less marked resulting to late diagnose of the disease after complications have already rise.

The local situation

In Tanzania, according to International Diabetes Federation (IDF) in 2017 the country was hosting 897,000 cases of diabetes. The government, after recognizing the threat of disease, has established diabetes clinics across the country to ensure diabetes healthcare services are available and the communities become aware but they are not enough to cover the whole rapid increasing population.

World Bank data in 2021 shows that diabetes prevalence in Tanzania is at 12 percent on people aged 20-79. Many people especially in rural Tanzania are unaware of the disease symptoms and treatment thus led them to delay seeking medical care which escalates health risks and life-threatening complications. Still, many people are opting treatment to folk healers and religious leaders believing that they have been bewitched or an evil force is following them. Lack of understanding leads to increase in mortality rate caused by diabetes and hence negatively impacting the economy, healthcare system and production workforce for sustainable development that we need.

Diabetes is a serious, potentially debilitating, and a life-threatening non-communicable disease that imposes heavy impact on individuals and their families as well as on healthcare systems and national economies. Left untreated with insulin, type 1 diabetes is fatal. According to WHO resources, diabetes is a major cause of heart attacks, stroke, kidney failure, blindness and lower limb amputation especially on type 2 diabetics if go un treated or not sufficiently supported.

Many are diagnosed with type 2 diabetes because they enter clinical environment with a significant pre-existing problem, unaware that the problem will have been caused by diabetes. On this day, we are reminded that we are living in extraordinary difficult times in which people with diabetes are facing major health threats such as COVID-19 of which they are among more susceptible to the worst complications thus increasing fatalities in people with diabetes.

We recommend for the governments and development stakeholders to increase investment in provision of diabetes healthcare services and education such as distribution of mobile clinics in rural areas and establishment of clinics and deployment of medical personnel for diabetics in dispensaries as many people depend seeking care and diagnose in town areas which leaves behind the rural people with few choices.

As Sustainable Development Goal number 3 states: Good Health and Well Being, ensuring healthy lives and promoting well-being for all at all ages, we are ought to ensure our people are free from diabetes as possible as it needs to be because healthy people are the foundation for healthy economies.

Shimbo Pastory and Johnson Mwamasangula are Tanzanian social development analysts [email protected]