A century of insulin: from lifesaving discovery to a journey of scientific evolution!

Abstract

AbstractBefore 1922, treatments for type 1 diabetes were limited, including the Allen plan (a diet based on minimising calorific intake), and the prognosis was bleak. Although the pancreas was already thought to produce a substance that, when lacking, resulted in diabetes it was not until the unlikely combination of an orthopaedic surgeon, Frederick Banting, and a medical student, Charles Best, came together with the guidance and support of physiologist Prof John Macleod that progress into clinical practice became a reality. Initial laboratory work in dogs confirmed the biological effect of the endocrine function of the pancreas. The realisation that insulin could be extracted from bovine pancreas made it a realistic prospect for treatment, but only after the involvement of James Collip, a biochemist who helped refine the purification process. The first injection of insulin as a treatment happened on 11 January 1922. Since then, it has been a scientific journey driven by the need for large‐scale production, processes allowing initially for better extraction and purification of bovine, then porcine insulin, before recombinant DNA technology allowed for the production of human insulin from 1978. Throughout the use of animal and human insulins, research efforts have concentrated on finding ways of prolonging the insulin time‐action profile to meet basal insulin requirements while at the same time shortening it to be more convenient for prandial insulin needs. The development of insulin analogues from 1996 has allowed an even better ability to mimic normal physiological function with longer‐acting basal insulins and shorter‐acting prandial insulins. This approach will continue to be a driver for evolution in addition to exploring the possibility of different routes of delivery. Copyright © 2021 John Wiley & Sons.