The discovery of insulin in 1921 revolutionised diabetes care. Type 1 diabetes went from being a death sentence to a manageable chronic condition.

To ensure access to this vital medicine to as many people as possible, the researchers who discovered insulin sold the patent to their university for one symbolic dollar. Yet, a century later, a significant proportion of people with diabetes still cannot obtain this essential medicine.

In 2021, the World Health Assembly highlighted the importance of insulin access in its resolution to strengthen diabetes prevention and control. Yet, since then, little has changed at the global level.

The 4th UN General Assembly on the Prevention and Control of Noncommunicable diseases (NCDs) held on the 25th of September 2025 in New York highlighted how crucial governmental action is in ensuring that all people who need insulin can actually access the supplies they need.

Governments play a key role in achieving this and key takeaways from our work are presented below. Some of these conclusions extend beyond the scope of access to insulin and highlight key issues as to what the role of governments is with regards to global health challenges.

A vital medication that is still out of reach

Discovered over a century ago, in 1921, and its first therapeutic use in 1922 to treat a child was hailed as a medical miracle. Since then insulin has transformed the lives of millions of people with diabetes.

Insulin is a hormone synthesised in certain specialised cells of the pancreas (the beta cells of the islets of Langerhans. It regulates blood sugar, in other words glucose levels in the blood. Insulin promotes the entry of this sugar into cells, which decreases its blood concentration.

There are two distinguishable types of diabetes: Type 1 diabetes mellitus – T1DM (which is due to insufficient insulin production) and type 2 diabetes mellitus – T2DM (resulting from reduced insulin sensitivity or β-cell failure).

Lack of access to insulin and treatment results in chronic hyperglycemia (high blood sugar). The consequences of chronic hyperglycemia impact the heart and blood vessels with possible catastrophic complications, such as an increased risk of atherosclerosis, infarction (a three to fivefold increase), stroke or arteritis (inflammation of the arteries) in the lower limbs (which can lead to amputation), severe kidney failure and blindness.

Both types of diabetes may require insulin, but for type 1 it is a matter of survival, because without insulin, this condition constitutes a death sentence. We understand why the discovery of the role of this hormone, then how it could be used as a drug, revolutionised the management of this condition. To the point that, as early as 1923, the team of scientists behind it (Frederick Banting, Charles Best, John Macleod, and James Collip) were awarded........

© The Conversation