| You might think we've gotten better at helping people with diabetes keep their blood sugar in check. After all, over the past 30 years there's been plenty of technological advances in the way insulin is given. Diabetes interferes with the body's ability to produce and use insulin. Insulin transports sugar from the bloodstream to the rest of the body. When that system doesn't work, too much sugar accumulates in the blood, damaging the body. Many people with diabetes need to take insulin daily. New medical advances and commercial technologies are making it easier for the more than 8 million people who need insulin to complete that essential task. Modern insulin pens and pumps are simpler to use than older vials and syringes. Newer formulations of insulin are less risky and more convenient. And continuous glucose monitors can help people and their doctors better track how much insulin they need and when. But despite all that progress, people in the US with diabetes who take insulin are just as likely to have dangerously high levels of blood sugar now as they were about 30 years ago, according to research published earlier this month in JAMA Open Network, an American Medical Association journal. "There still isn't any improvement, which is not a promising trend," says Michael Fang, who's an assistant professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health and a senior author on the paper. Fang and his colleagues analyzed data from the US Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey and found the percentage of adults in the country using insulin who had hemoglobin A1C levels below 7% — the standard target for treatment — was 29.2% in the period of time from 1988-1994, and 27.5% from 2013-2020. The difference wasn't statistically significant. "Why aren't things improving? Why aren't things getting better?" Fang says. "It may be that a lot of these advances aren't getting into the hands of people who need them." The reasons may vary but could stem from a combination of doctors not starting patients on insulin quickly enough, patient reluctance to taking the medicine, and the soaring price of insulin. Insulin is notoriously expensive in the US. Monthly outlays for one person buying insulin can top $1,000. And new technologies such as continuous glucose monitors can also be expensive, Fang says. Meanwhile, nearly 30 million Americans don't have any health insurance to help pay for treatments and equipment. High prices drove 17% of adults with diabetes to ration their medicine in 2021, according to a study in the Annals of Internal Medicine. People who need insulin and can't get it might die. Fang's research didn't directly address these potential causes and he says more inquiry is necessary. "We need to have a better understanding of why there's no progress," Fang says. — Ike Swetlitz | 
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