Since insulin was discovered and developed for medical use almost 100 years ago, the available tools to manage type 1 diabetes have expanded and improved enormously. The uniting principle behind many of these improvements is a greater ability to deliver the right amount of insulin to you at the right time — through improvements in blood glucose monitoring, insulin delivery and insulin formulations.
But even in the best of cases, injected or infused insulin in people with type 1 diabetes doesn’t behave exactly like natural insulin from the pancreas. In part, that’s because your pancreas is part of a vast network of biological processes that allow the organ to adjust its insulin secretion based on many different factors. And insulin isn’t the only hormone injected by the pancreas; it also secretes amylin and other hormones that work with insulin to regulate glucose throughout your body.
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All of this means there’s plenty of room for improvement in trying to regulate how injected insulin works in people with diabetes, especially type 1. And one new innovation in insulin technology, directed toward delivering insulin to the liver, recently showed promising results in a clinical study. In people without diabetes, the liver stores and releases glucose in response to insulin and other hormone signals — a process that may be less responsive in people with type 1 diabetes.
Published in the journal Diabetes Care, the study compared a new liver-targeted insulin formulation — called HDV-insulin lispro — with standard insulin lispro, a rapid-acting insulin, in 176 people with type 1 diabetes who were randomly assigned to take one or the other for 26 weeks. Overall, there was no significant difference in dosing, adverse events like hypoglycemia (low blood glucose), or blood glucose control between the two groups. But the HDV-insulin appeared to have slightly different effects depending on the initial HbA1c level (a measure of long-term blood glucose control) of participants.
In participants with a higher HbA1c level at the beginning of the study, lower doses of HDV-insulin lispro were required, compared with standard insulin lispro, to achieve a similar reduction in HbA1c by the end of the study. What’s more, there was a lower risk of hypoglycemia associated with these lower doses of HDV-insulin lispro. At the other end of the HbA1c spectrum, people with a lower HbA1c level at the beginning of the study tended to have a higher risk of hypoglycemia if they were assigned to take HDV-insulin lispro, with similar doses and HbA1c reductions seen compared with standard insulin lispro.
Overall, the researchers concluded that HDV-insulin lispro appeared to be safe and effective, and that it the outcomes appeared to reflect a greater effect on the liver than standard insulin lispro. Further research could determine whether HDV-insulin lispro — or other, new types of HDV-insulin — might be more beneficial to certain people than currently available varieties of insulin.
A freelance health writer and editor based in Wisconsin, Phillips has a degree in government from Harvard University. He writes on a variety of topics, but is especially interested in the intersection of health and public policy.