Scientists praise ‘smart’ insulin that responds to changing blood sugar levels in real time
Scientists have developed a ‘holy grail’ insulin that responds in real time to changing blood sugar levels and could revolutionise treatment for millions of people with type 1 diabetes worldwide.
Patients currently have to self-administer synthetic insulin up to 10 times a day to survive. Constant swings between high and low blood sugar levels can lead to short- and long-term physical health problems, and the struggle to keep levels stable can also affect their mental health.
Scientists have found what experts say is the closest any drug therapy has come to a cure for type 1 diabetes: smart insulin that lies dormant in the body and only kicks in when needed. Researchers in the U.S., Australia and China have successfully designed new insulins that mimic the body’s natural response to changing blood sugar levels, reacting directly in real time.
Standard insulins stabilize blood sugar levels when they enter the body, but once they’ve done their job, they’re usually no help with future fluctuations. This means patients often need to inject more insulin within a few hours.
The new glucose-responsive insulins (GRIs) only become active when there is a certain amount of sugar in the blood to prevent hyperglycemia (high blood glucose). They become inactive again when the levels fall below a certain point, to prevent hypoglycemia (low blood glucose). In the future, patients may only need insulin once a week, experts believe.
Scientists behind the smart insulins have been awarded millions of pounds in grants to accelerate their development. The funding comes from the Type 1 Diabetes Grand Challenge, a partnership between Diabetes UK, JDRF and the Steve Morgan Foundation. It is investing £50 million in cutting-edge research to find new treatments for type 1 diabetes.
Dr. Tim Heise, vice chair of the scientific advisory panel for novel insulins for the Type 1 Diabetes Grand Challenge, said that smart insulin could herald a new era in the fight against diabetes. “Even with today’s modern insulins, people with type 1 diabetes have to work hard every day to manage their diabetes to find a good balance between acceptable glycemic control on the one hand and avoiding hypoglycemia on the other.
“Glucose-responsive – so-called smart – insulins are considered the holy grail of insulin, as they come as close to a cure for type 1 diabetes as any drug therapy.”
Almost £3 million has been awarded to six research projects developing different types of smart insulin. The projects involve teams from Stanford University in the US, Monash University in Australia and Zhejiang University in China. The aim is to speed up development and start trials as soon as possible.
Each project aims to refine smart insulin to work faster and more accurately, thereby easing some or all of the enormous burden of managing type 1 diabetes and reducing the risk of long-term complications. Four of the projects are focused solely on testing GRIs.
A fifth have developed a new ultra-fast, short-acting insulin. Even with the fastest insulins now available, there is still a delay between when the drug is administered and when it starts working on glucose in the blood. This can cause blood glucose to rise to unsafe levels before insulin can work to bring it down.
Faster insulins are also needed to improve the performance of insulin pumps and hybrid closed-loop technology, a system that relies on stored insulin to respond in real time to changing blood glucose levels.
The sixth project focuses on a protein that combines insulin with another hormone, glucagon. Unlike insulin, which helps remove glucose from the blood, glucagon stimulates the liver to release more glucose when blood levels are low. By having both hormones in one formula, blood glucose levels can be kept stable by working to prevent high and low blood glucose levels.
“The six new research projects funded address major shortcomings in insulin therapy,” Heise said. “Therefore, if successful, these research projects could do nothing less than usher in a new era in insulin therapy.”
Rachel Connor, Director of Research Partnerships at JDRF UK, said: “Although insulin has been saving lives for over 100 years and previous research has made significant changes for people with type 1, it’s still not good enough – managing glucose levels with insulin is really hard, and it’s time for science to find ways to ease that burden.
“By imagining a world where insulins can respond in real time to changing glucose levels, we hope these six projects will help create that new reality, relieving people with type 1 of the relentless demands that living with the condition places on them today.”
Dr Elizabeth Robertson, director of research at Diabetes UK, said the projects had the potential to revolutionise the treatment of type 1 diabetes. “By supporting these ground-breaking research projects, we aim to develop new insulins that better 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 people with the condition. We hope this research will lead to life-changing advances in the care of type 1 diabetes.”