Insulin therapy in type 2 diabetes mellitus: history drives patient care toward a better future.

"Insulin will never be a success in the treatment of diabetics without the aid of the general practitioner."(1) These words, written by Elliott P. Joslin, MD, in 1923, still ring true today. After the first successful insulin injection was administered on January 23, 1922, to Leonard Thompson, a 14-year-old patient with type 1 diabetes mellitus at Toronto General Hospital, it did not take long before a diabetes clinic using insulin treatment was set up.(2) Insulin was subsequently provided to physicians in the United States for clinical trials, although many US patients with diabetes mellitus presented themselves to Sir Frederick Banting, MD, co-discover of insulin, in Toronto for insulin treatment. Within 2 years, insulin was being manufactured by multiple pharmaceutical companies and was available commercially in both the United States and Canada.(2) Almost immediately, health care professionals and others identified the problem of who was going to care for all of these patients. Patients were arriving at diabetes clinics expecting to receive insulin, often overwhelming the few physicians who were educated on the care of diabetic patients. For this reason, the physicians and nurses at the New England Deaconess Hospital in Boston initiated a teaching program so that general practitioners could learn all aspects of the management of diabetes.