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Celebrating 100 years of insulin

Insulin cover

As summarised in an Editorial by our Guest Editor and previous Editor-in-Chief, Sally Marshall (, our 2021 special issue ( celebrates 100 years since the discovery of insulin. Fralick and Zinman ( begin by recounting the story of insulin’s discovery in Toronto, Canada, in 1921/1922. This discovery meant that type 1 diabetes went from being a death sentence to a chronic condition. Despite this, globally, only one in two people currently have access to the insulin they require; Mbanya and colleagues ( outline the barriers to insulin access and suggest ways to overcome these. For those fortunate enough to have insulin access, hypoglycaemia remains a frequent complication of insulin therapy. Stephanie Amiel ( describes the immediate and cumulative consequences of hypoglycaemia, whilst Rory McCrimmon ( summarises the impact of recurrent hypoglycaemia on brain function. Chantal Mathieu ( suggests options for minimising hypoglycaemia risk, including patient education, insulin analogues, novel technologies and adjunct therapies. To help us understand how insulin therapies work, Yoon and Diano ( describe the central glucose-sensing mechanisms involved in the regulation of glucose metabolism, whilst Kahn et al ( outline current and evolving concepts of insulin action/resistance in type 2 diabetes. The authors state that understanding the primary source of metabolic disturbances and drivers of disease will offer important new avenues for the development of novel therapies. Boughton and Hovorka ( outline an excellent example of a novel therapeutic approach for diabetes, the closed-loop insulin-delivery system, summarising the supporting evidence and limitations of these devices. On a similar note, Weiss and colleagues ( introduce us to ‘smart’ insulin-delivery devices and molecular technologies designed to exploit feedback regulation. As an alternative approach, Douglas Melton ( explores the promise of stem cell-derived islet replacement therapy, whilst von Herrath and colleagues ( give an overview of therapeutics that may help to prevent the destruction of beta cells in the first place. Turning to diabetes complications, David Nathan ( demonstrates that insulin therapy ameliorates the long-term complications of type 1 diabetes, using findings from the DCCT and Epidemiology of Diabetes Interventions and Complications (EDIC) study. To complete this special series, Daniel Drucker ( looks to the future, highlighting the potential of smart insulins, fully automated insulin delivery, reprogramming of the immune system and stem cell-derived islets to alter the natural history and treatment of type 1 diabetes. This special series is in collaboration with the University of Toronto’s Insulin 100 Scientific Symposium (

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