Italy's 100-Year Look at Insulin: What Comes Next?

A Study From Italy Charts Insulin's Past — and a Future Without It

A study from Italy, published by researchers at the prestigious San Raffaele Diabetes Research Institute in Milan, takes a sweeping look at insulin's 100-year history — and makes a compelling case that the future of diabetes care may lie not in better insulin, but in replacing the need for it altogether.

Writing in Acta Diabetologica, Dr. Lorenzo Piemonti argues that while insulin has been one of medicine's greatest success stories, its limitations are real — and the scientific community should renew its commitment to developing therapies that restore the body's own insulin-producing beta cells.

A Century of Milestones

The Italian perspective offers a uniquely broad historical lens that helps American patients understand how far diabetes treatment has come — and how much further it could go. Here are the key milestones Piemonti highlights:

• 1921: Insulin is discovered, saving countless lives from what was then a death sentence.
• 1982: Insulin becomes the first therapeutic protein produced through recombinant DNA technology — meaning it no longer had to come from animal sources.
• 1983–1985: The first miniature insulin pump and insulin pen arrive, giving patients more flexible, discreet options.
• 1996: First-generation insulin analogues are introduced, offering faster and longer-acting options than traditional insulin.
• 1999: The FDA approves the first continuous glucose monitor (CGM), allowing patients to track interstitial glucose levels in real time — a tool now widely used across the US.
• 2010s: Ultra-long-acting insulins such as insulin degludec (Tresiba) become available, reducing the risk of nighttime low blood sugar.

Beyond Insulin: The Beta Cell Revolution

What makes this Italian research particularly valuable for US patients is its focus on what's coming next. Piemonti traces a parallel story of beta cell replacement therapies:

• 1966: The first clinical pancreas transplant is performed at the University of Minnesota — now a recognized treatment option for select patients with Type 1 diabetes.
• Late 1980s–1990s: Early human islet transplantations show promise.
• 2000s: Islet transplantation becomes capable of consistently restoring the body's own insulin production.
• 2014: The first clinical trial using stem cell-derived, insulin-producing cells begins — a potential game-changer for millions of Americans living with Type 1 diabetes.

Why This Matters for US Patients

Today, approximately 1.6 million Americans live with Type 1 diabetes and depend on insulin to survive. Current US guidelines from the American Diabetes Association (ADA) support the use of CGMs, insulin pumps, and advanced insulin analogues — all technologies this Italian study helped contextualize historically.

But Piemonti's central message goes further: insulin therapy, while lifesaving, still carries burdens — hypoglycemia risk, dosing complexity, cost, and the constant mental load of glucose management. His rallying cry, "beta is better," reflects a growing global scientific consensus that restoring natural insulin secretion through beta cell therapies is the true long-term goal.

For US patients, this means that stem cell-derived beta cell therapies — already in early clinical trials — could one day eliminate the need for daily insulin management entirely. American researchers and institutions like the JDRF are actively funding similar work, and this Italian perspective reinforces that momentum is building worldwide.

The Bottom Line

Italy's San Raffaele Institute reminds us that insulin's story isn't over — it's evolving. For American patients managing diabetes today, the message is hopeful: the tools available now are better than ever, and the science driving tomorrow's treatments has never been more promising.

Source: Piemonti L. "Felix dies natalis, insulin… ceterum autem censeo 'beta is better'." Acta Diabetologica. 2021. PMID: 34027619. DOI: 10.1007/s00592-021-01737-3