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Doctors Concerned About An Insulin Shortage As Diabetes Cases Grow
STEVE GOLDSTEIN: The incidents of Type-2 diabetes around the world are expanding — and that has researchers and medical professionals concerned about the supply of insulin. A study published in the journal The Lancet: Diabetes and Endocrinology says a shortage could leave nearly half of the people who need insulin without it. That's around 40 million diabetics worldwide. I spoke with the study's lead author Dr. Sanjay Basu, assistant professor of medicine at Stanford, and started by asking about how rapidly diabetes cases are growing and what parts of the world.
SANJAY BASU: Yeah, right now we are seeing a lot of diabetes in China and India, as well as in the United States, as China and India have large populations but are also undergoing a lot of changes in nutrition and physical activity. We are expecting to see a dramatic rise in the number of people, so about over half of the people with diabetes in the world will probably be in China, India and the United States. About 130 million currently in China, and about 100 million in India, and about a little over 30 million in the United States. Over the next 15 years or so, we're expecting that that will rise from about 520 million worldwide to about 634 million worldwide, in terms of insulin use, most of it being in Asia.
GOLDSTEIN: Has there not been an evolution in awareness of the issue? Is there simply not enough focus on nutrition in some places or is this just the direction, as we have more people, this is the direction we're going?
BASU: I think a little bit of both. Part of it is a side effect of people dying later in life. So it's a good thing that people aren't dying of infections but because there are more older adults and because of more urbanization, less physical activity, and the changes in nutrition we're expecting to see quite a bit more Type-2 diabetes.
GOLDSTEIN: Can you just explain how Type-2 arises why people can develop type to a certain point in their lives.
BASU: People can develop Type-2 diabetes in a way that might be thought of as analogous to alcohol. So if we drink alcohol and we drink too much of it we become kind of resistant to the effects. We have to drink more alcohol in order to get the same buzz. The same thing kind of happens with sugar if we keep eating lots of sugar and our blood sugars are high all the time, our body doesn't respond as well to insulin which is our bodies way of using that sugar putting it into cells, using it for energy, storing it for later and our body becomes so-called, 'insulin resistance.' The same amount of insulin doesn't have as much effect and you can think of it as kind of like a candy apple what happens if you just sugar coat an apple becomes kind of hard and crusty as the sugar coats it. The same thing happens on the inside of our bodies to our brains, our hearts or kidneys, our nerves to the small blood vessels in the back of our eye. And those are the diabetes complications. We get strokes, heart attacks, kidney problems, nerve pain, and problems with our vision.
GOLDSTEIN: I'll ask you another sort of two pronged question as far as the amount of insulin available to treat people with diabetes. Are we seeing less insulin available or is that because again we're seeing many more cases and the supply can't keep up, or are there other reasons that there's a shortage?
BASU: I think it's more of an economic problem, that is in theory there's enough insulin available, at least for now, being produced but it's an affordability problem for a lot of people. There isn't a generic insulin still because of weird historical phenomena and because of difficulties with the manufacturing. So many of the people who need insulin can't afford it and tend to “stretch” the insulin, which is really dangerous. If it’s a little bit less than they should or if they run out, they go days without it and that can be really dangerous as well. That happens in the United States as well as in the rest of the world in many developing countries or low income countries. It's also a problem of the supply chain. Insulin needs to be refrigerated. You need to have access to a refrigerator be able to store it well, transport it in a refrigerated manner, and that's another big part of the problem. There's very few insulin manufacturers, only a handful of companies make it worldwide. And so if one of them, or more of them have limited supplies, have a production problem there can be shortages.
GOLDSTEIN: Are there things that make sense that could improve that? Are the ideas that are being tossed around about that? Because some of the things you mentioned are very practical.
BASU: Yeah. One of the things is to learn from more successful drug supply chains so people have successfully delivered refrigerated vaccines around the world. We can learn from those supply chains and piggy back on them in order to deliver refrigerated insulin. Another thing that has been explored, and it seems increasingly likely to be successful, is building up the production capacity in low income countries. Many non-insulin products, for example, can be with good safety, produced in India in a generic form and so similarly we can build up the infrastructure so that those facilities can be used to produce insulin.
GOLDSTEIN: What is the timeframe on this? Are we talking about a decade or so? Does 2030 sound like a sensible year to you based on the projections? Or could it even come faster than that?
BASU: I think unfortunately our projections are pretty conservative and optimistic set of projections. And already people in the United States are having difficulty accessing insulin, not to mention people in lower income countries. I think we should be more proactive than waiting for 2030.
GOLDSTEIN: And that's Dr. Sanjay Basu, assistant professor of medicine at Stanford.