Insulin: a momentous transformation of diabetes care from the 1970s to the millennium

Introduction The last three decades of the 20th century witnessed a spectacular and remarkable progression in the delivery of diabetes care. In the 1970s diabetes provision was almost entirely hospital-based but by the millennium the exponential explosion of diabetes numbers necessitated a complete restructuring of diabetes services with a substantial switch to primary care, while hospital diabetes centres focused on more specific specialist and complicated subgroups. This period of time saw a radical transformation of diabetes management from an historical empirical, rigid conformity, overtly didactic and prescriptive in nature, to the guiding principle of a much more patient-centered and flexible approach. In this time, we witnessed dramatic developments with insulin and its usage – new insulins, new delivery devices – and once the importance of good diabetes control was fully accepted and the rational evidence base established, the monitoring of such metamorphosed from indirect and generally inadequate urinalysis to the increasingly sophisticated measurement of blood glucose, both immediate and long-term. With these transformative developments, education for healthcare professionals, and for people living with diabetes, became a prime priority to be integrated into the singularly rewarding domain of diabetes care.