Objective
The objectives of this project are to:
- Document current knowledge on health system and societal responses to type 1 diabetes globally
- Identify existing challenges and prioritize solutions using different research approaches
- Develop practical recommendations to improve the lives of people with type 1 diabetes globally
Background Rationale
The year 2022 marked the Centenary of insulin’s first clinical use. The discovery of insulin by a team of researchers at the University of Toronto represented a true medical miracle that changed a diagnosis of what we now term type 1 diabetes from a death sentence to what, for many, represents a manageable yet chronic disease.
Type 1 diabetes is widely considered an autoimmune disease having an unknown etiology. While estimates vary, it likely affects approximately 9 million people globally. Whereas in high-income countries the life expectancy for people with type 1 diabetes is almost the same as people without this disease, in low- and middle-income countries people with the disorder might have less than one year to live. Indeed, issues of insulin availability and affordability, fragile health systems, lack of access to diabetes management tools (e.g., routine metabolic testing, educational materials), geographic constraints (e.g., travel related difficulties), and social determinants preclude the adequate management of type 1 diabetes in many resource-challenged settings and vulnerable populations.
Although global interest in improving this unacceptable situation has recently increased for type 1 diabetes, represented in part with the World Health Organization’s Global Diabetes Compact and a World Health Assembly Resolution on diabetes in 2021, many challenges persist. In order to operationalize these global commitments, a comprehensive type 1 diabetes strategy is needed to provide a roadmap for policy makers, health systems, healthcare workers, diabetes advocates and researchers to improve the outcomes for people with type 1 diabetes.
Description of Project
The year 2022 marked the centenary of insulin’s first clinical use. The discovery of insulin by researchers at the University of Toronto, Canada, is a true medical miracle that changed type 1 diabetes from a death sentence to a manageable chronic disease. Type 1 diabetes, an autoimmune disease of unknown etiology, affects approximately 9 million people globally. Whereas in high-income countries the life expectancy for people with type 1 diabetes is almost the same as people without type 1 diabetes, in low- and middle-income countries people with type 1 diabetes might have less than one year to live. Issues of insulin availability and affordability, fragile health systems, and social determinants preclude the adequate management of type 1 diabetes in resource-challenged settings and vulnerable populations. Although global interest has increased for type 1 diabetes with the World Health Organization’s Global Diabetes Compact and a World Health Assembly Resolution on diabetes in 2021, many challenges persist including: access to insulin; weak health systems; need for new models of management; inequity in access to insulin and technologies for diabetes self-management; the wide-ranging factors impacting the lives of people with diabetes; and a lack of propitious holistic policy environment. To address these complex challenges, it has been proposed to develop a Commission Report for the the Lancet Diabetes & Endocrinology, the leading medical journal in diabetes, focusing on describing the current situation and providing innovative solutions for a variety of audiences. This landmark document will have as its aim to pave the way for defining the future of type 1 diabetes 100 years after insulin’s discovery and first use. This Commission will bring together leading experts in diabetes, people with diabetes, and decision makers to document barriers and solutions at health system and societal levels impacting people with type 1 diabetes to propose practical solutions.
Anticipated Outcome
Overall this Commission will provide a "Grand Strategy" for the future of type 1 diabetes addressing health systems and the environments in which people with type 1 diabetes live building off lessons from the past and innovative research. This report will document current global challenges to the management of type 1 diabetes using existing data and new research. However, its main focus and aim will be to provide a holistic set of recommendations by engaging a variety of stakeholders, including people living with type 1 diabetes. The results of this work and the recommendations will be shared through different events and with various actors in order for these to be used to shape policy and practice globally. These activities will benefit from the networks that the individuals leading this work are part of. It is hoped that this will then lead to concrete actions at global, national and local levels to benefit all people living with type 1 diabetes.
Relevance to T1D
This project will address one of the largest and likely addressable health care inequities for a treatable chronic disease of our time: access to life-saving insulin and care. Access to insulin, self-monitoring technologies, and a wide range of quality health care and community services are guaranteed in many high-income countries, yet remain limited for a vast majority of low- and middle-income countries. Indeed, in far too many low and middle-income countries, the prospects for people with type 1 diabetes are similar to those living with the disease in 1922. Beyond this, in some of the wealthiest nations of the world, perhaps most notability the United States, glaring voids exist in systems designed to optimize type 1 diabetes care including access to insulin.
Hence, regardless of region and despite groundbreaking advances in medicine, technology and health management, millions of people with type 1 diabetes suffer due to limited resources and lack of a plan to address their needs. The aim of this landmark Commission is to provide a unique ‘Roadmap’ for the future; this, in order to promote the translation of identifiable challenges to solutions for those most in need.