People with type 1 diabetes must monitor their blood glucose levels and inject precise doses of insulin several times a day to avoid health complications. Now, diabetes researchers are developing smart insulins that could be administered only once a week and manage blood sugar in real time. Medical News Today investigated whether smart insulins really could be life-changing for people with type 1 diabetes.
How
far has research on smart insulin come?
Type 1 diabetes occurs when the body does not produce enough insulin, the hormone that controls blood glucose (sugar). The condition is less common than type 2 diabetes, which affects around 462 million people worldwide. Nevertheless, more than 8 million people around the world live with type 1 diabetes.
Although
the exact cause of this condition is unknown, having a parent or sibling with
the type 1 diabetes may increase a person’s risk of developing it.
Environmental factors, including some viral infections,
can also cause type 1 diabetes by triggering an autoimmune response which destroys the
insulin-producing beta cells in
the pancreas.
A diagnosis of type 1 diabetes, which most commonly happens in
childhood or early adulthood, but can occur at any age, means a lifetime of
monitoring your blood glucose levels and injecting insulin several times a day
to control them.
New
technologies, such as continuous blood glucose monitors, insulin pumps, and smart insulin pens can make the management of blood
glucose easier, but still cannot entirely eliminate the dangers of blood
glucose going too high (hyperglycemia) or too low (hypoglycemia).
Why is
controlling blood sugar a challenge?
The
constant challenge for people with type 1 diabetes is keeping their blood
glucose in the healthy range. Hypoglycemia can lead to unconsciousness and even
death.
Hyperglycemia
increases the risk of many health complications,
including:
- diabetic
retinopathy, which can lead to vision
loss
- diabetic
neuropathy, which affects nerve function
- problems
with wound
healing
- kidney
disease, or diabetic
nephropathy, which can lead to kidney failure
- cardiovascular
disease, heart
attack, stroke,
and peripheral
vascular disease
- dental
problems, including tooth loss and gum
disease
- mental
health problems, such as depression.
If a
person keeps their blood glucose under control, the likelihood of health
complications is greatly decreased, and new technologies make it easier for
people to monitor and regulate their blood glucose levels.
Continuous blood glucose
monitors, which are inserted just under the skin, or implanted in the body, can
connect to smartphones, or to insulin pumps, avoiding the need for people to do
regular finger-prick tests to
check their blood glucose levels.
Insulin pumps, which are attached to the skin, or clothing,
and deliver fast-acting insulin through a very fine tube, are an alternative to
frequent injections.
They
can help people who have problems giving themselves injections or who struggle
to avoid high or low blood glucose, as they deliver tiny amounts of insulin
frequently. However, they can be expensive and are not suitable for everyone
with type 1 diabetes.
An alternative to an insulin pump
is a smart insulin pen.
These reusable injector pens are linked to a smartphone app that calculates and
tracks doses. They can deliver variable doses as needed and send real time data
to a person’s healthcare provider.
Rachel
Connor, Director of Research Partnerships at JDRF UK, explained to Medical News Today:
“It is relentless to live with type 1 diabetes because
you have to try to do the job of a biological organ with imperfect tools.
So-called smart insulins have the potential to respond to changing blood
glucose levels in real time without adjusting insulin pump settings, taking
extra insulin injections or continuously monitoring blood glucose levels.”
What are smart insulins?
Smart
insulins, or “glucose-responsive” insulins, are the latest in a range of novel
insulins being developed in the search for better treatments for type 1
diabetes.
The Type 1 Diabetes Grand Challenge, which is supported by Diabetes UK, JDRF and the Steve
Morgan Foundation, has allocated £2.7 million to fund six research
projects into new diabetes treatments.
Novel insulins under development include:
- Fast-acting
insulins — these are insulins that have been chemically edited so they are
absorbed faster by the body and can reduce blood glucose levels rapidly.
Some ultra rapid insulins can reach the blood in 4-7 minutes, around half the time taken by
currently available insulins.
- Weekly
injections — to try and help remove the chore of daily injections, the
drug company Novo Nordisk is developing a form of
insulin, called insulin icodec, that is injected only once a week.
Although a long way from being a marketable treatment, this has shown
promise in the ONWARDS 6 trial of 582 people
with type 1 diabetes.
- Oral insulin —
researchers from Australia and Norway have developed a capsule that is
taken by mouth and travels through the digestive system to the liver. The
covering of the capsule prevents the insulin being broken down by stomach
acid or digestive enzymes on its journey. Once in the liver, tiny
particles called nanocarriers that are attached to the insulin molecules
detect increased glucose levels and release their insulin as needed.
Clinical trials are due to start in 2025.
- Smart capsules — scientists at the
University of Birmingham in the United Kingdom are developing a capsule
that could be injected once a week. The theory is that the capsule would
slowly degrade, releasing insulin whenever blood glucose gets too high.
However, this treatment is in the early stages of development, so it could
be many years before trails in people can begin.
- Smart, or “glucose-responsive” insulins —
these are administered once a day, and remain inactive in the body until
blood glucose levels rise. When this happens, they respond rapidly to
bring the level down before returning to the inactive state.
According to the JDRF,
smart insulins could greatly reduce the burden of type 1 diabetes by offering
tight glucose management, eliminating hypos [hypoglycemia], reducing the risk
of complications and freeing people from glucose monitoring.
Mimicking
the body’s natural responses
But
how can a synthetic insulin respond to blood glucose levels in the same way as
a healthy person’s pancreas?
One
development is a cage-like structure surrounding the insulin that can detect
varying glucose levels. When high levels are detected, the ‘cage’ releases the
appropriate amount of insulin in response.
Researchers
are also exploring ways to chemically edit insulin so it can sense glucose,
or change shape in response to glucose. In a low-glucose
environment, the molecule would be tightly closed, but rising glucose levels
would make it open up so it could react to bring the levels back down.
“We
hope new forms of insulins will do more of the work of managing type 1 diabetes
to alleviate some of this burden and make it much easier to live life with type
1 diabetes with less worry about managing the condition,” Connor commented.
A crucial
step forward in diabetes treatment
Elizabeth Robertson, MD, Director of Research at Diabetes UK,
noted in a press release:
“By supporting these groundbreaking research projects,
we are aiming to develop new insulins that more closely mimic the body’s
natural responses to changing blood sugar levels. This could significantly
reduce the daily challenges of managing type 1 diabetes, and improve both the
physical and mental health of those living with the condition. We are hopeful
that this research will lead to life-changing advancements in type 1 diabetes
care.”
However,
Connor cautioned that it may be some years before smart insulins are available
for people with type 1 diabetes.
“No glucose responsive insulins
are yet available in the clinic. The scientists we’re funding are at a
relatively early stage of their research, and the products they are trying to
develop aren’t yet ready for clinical testing,” she told us.
“It’s
really hard to give timescales in drug development – things can sometimes go
very rapidly and get accelerated, like we saw happen with covid vaccines. Or,
as often happens, we could hit hurdles along the way that make the process take
longer. This funding will push us closer to first in man clinical trials, where
small numbers of people with type 1 diabetes would try the products to assess
their safety,” she added.
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