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Multiple innovations over a century have improved the safety, tolerability and clinical acceptability of insulin. From a therapeutic option that required multiple injections a day, often with a poor predictability, insulin has evolved into a treatment approach that an empowered patient can self-administer safely. It is the most potent glucose-lowering therapy and has hence seen widespread clinical adoption in the last two decades in the treatment of type 2 diabetes. At the same time, the unit-costs of insulin have not declined as is often the case with long established therapies. We review the history of insulin as a drug, charting its course from early experiments to modern insulin therapies. We consider the need (or lack thereof) for novel insulin from the perspectives of patients, healthcare professionals and healthcare payers. Whilst there are many valid arguments to support the development of novel insulins, healthcare systems and payers will require a clear demonstration of value for any novel insulin product. If a premium price (i.e. a higher price than comparable products) is demanded by manufacturers, healthcare payers would rightly seek evidence of added value – this could involve clear markers of increased safety and efficacy and/or the offsetting of other diabetes-related costs.

Novel insulin products: Why would patients, professionals and industry want them?