Is the world heading towards a shortage of insulin?

This has been called the scourge of urban life. Bad lifestyle habits and obesity have resulted in an increase in type 2 diabetes, a condition that occurs when the body can not produce enough insulin to regulate blood sugar levels.

Now, scientists say that millions of people with diabetes around the world may no longer have access to insulin over the next decade or more.

Some 400 million people – more than half of them in China, India and the United States – aged 20 to 79, live with type 2 diabetes, which is the most common form of the disease. Their number is expected to reach more than 500 million by 2030. (The other form is type 1 diabetes in which the body attacks its own pancreatic insulin-producing cell.)

A new study published by the journal Lancet Diabetes and Endocrinology indicates that nearly 80 million people with the disease will need insulin by 2030 because the demand for this drug is expected to increase by 20%. 39 here here. But about half of those who need it – perhaps the majority in Asia and Africa – will not be able to get it. Already, one in two people with type 2 diabetes does not have access to the insulin it needs.

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"Access is defined as the combination of availability and affordability," said Dr. Sanjay Basu of Stanford University in the United States, who led the research. . "In addition to prices, it also means that a supply chain must be in place to safely handle and dispense a refrigerated medicine and various accessories such as needles and sterile syringes that need to be used. # 39; support. "

Why is insulin, a 97-year-old drug that has been hailed as one of the first "miracle drugs" of the twentieth century, always been expensive over the years?

One of the reasons, say the scientists, is that three multinationals – Novo Nordisk, Eli Lilly and Company and Sanofi – control 99% of the global insulin market, worth $ 21 billion (£ 16 billion), and 96% by volume. (The same companies control the entire US market.)

Global control

And although more than 90 out of 132 countries do not have an insulin tariff, the drug remains expensive for many: taxes, high mark-ups and other supply-chain costs have driven up the price of the drug and hurt to its accessibility.

Even in the United States, where more than 20 million people have been diagnosed with diabetes, insulin-related expenses have increased by 89% between 2000 and 2010. This is true even for adults covered by insurance. The price of the drug has risen from $ 40 to $ 130 per bottle – each bottle usually lasts up to two weeks.

There are also questions about the availability of the drug.

According to David Henri Beran of the University Hospitals of Geneva and the University of Geneva, global insulin market control means that countries only have a small number of suppliers to choose from. " This has forced people to change the type of insulin they take as companies have withdrawn (some) formulations of the market.

There are different types of insulin and doctors prescribe the most beneficial type for patients based on their drug response, lifestyle choices, patient's age, blood glucose goals and the number of injections to be performed each day.

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Several low- and middle-income countries are particularly vulnerable to supply disruptions. A study on the availability of insulin revealed that stocks were low in six countries: Bangladesh, Brazil, Malawi, Nepal, Pakistan and Sri Lanka. Poor management and inefficient distribution can also cause disruption – in Mozambique, for example, 77% of total insulin supply remained in the capital, causing shortages in the rest of the country.

"Globally, the problems of affordability and insulin availability pose a threat to life and challenge the very concept of the right to health," said Dr. Beran.

So, why is a drug that was invented nearly 100 years ago still not available as a cheap generic? Scientists who invented insulin at the University of Toronto sold the patent to the university for $ 1. And high-demand drugs generally become more accessible after the expiry of their patents, thanks to cheap generic competitors. But that did not happen in this case.

According to Jeremy A Greene and Kevin Riggs, scientists, one of the reasons is that insulin is made up of living cells and is therefore more complex and more difficult to copy. And generic drug companies, they add, have not found it "profitable" to do so. Insulin biosimilars, similar to insulin, are also available on the market and offer more competitive prices, but they are not generic.

Scientists say that insulin should be included in universal health coverage programs and that donors for diabetes should allocate a portion of their funds to innovation in the provision of care and medication.

It is clear that weak health systems, limited access to health facilities, the provision of health care for people with diabetes and the pricing of the disease are all barriers to insulin.

"There is still a lot of things to do, including the price and the infrastructure to distribute," says Dr. Basu. Until then, the insulin vaccine will not become affordable any time soon.

Diabetes – the basics

• There are two main types of diabetes, type 1 and type 2. There are also other types of diabetes, such as gestational diabetes, that develops during pregnancy.
• In type 1, which is usually diagnosed earlier in life but can develop at any age, insulin must be injected manually or with the help of a pump. We can not prevent or cure, and this is not due to the way of life
• People are afflicted with type 2 when the insulin that they produce does not work properly or in insufficient quantities. This may be related to overweight or inactivity, but also to family history. This is much more common than type 1, accounting for about 90% of all people with diabetes. Some people with type 2 take insulin, while others control their blood sugar with the help of medications, exercise and a healthy diet.
• Uncontrolled long-term glucose can lead to complications, including nerve, kidney, eye and foot problems, but the risk of developing them can be reduced with appropriate treatment and care

sources: NHS, Diabetes United Kingdom