Editorial: Long-acting insulin

Published in The Hindu on August 4, 2010

With animal studies trying out a single injection of a large assembly of insulin molecules (supramolecule insulin assembly) yielding promising results, the traditional method of treating Type I diabetes with multiple injections of insulin every day to maintain the normal glucose level can possibly be done away with. One injection of 200 microgram supramolecule was able to control and sustain the release of insulin in animals for a prolonged period of 120-140 days. The results of the study have been published online in The Proceedings of the National Academy of Sciences. The insulin supramolecular assembly was produced by altering the way the insulin protein folds. A slight misfolding of the protein attracted other insulin molecules to form a supramolecular assembly. The supramolecule, which is in itself an inert material, releases biologically active insulin on a sustained basis at a basal level (physiological range). Animal studies showed that sustained release of insulin through a novel drug delivery mechanism was able to maintain tight glycemic control both after a meal as well as during prolonged periods (12 to 18 hours) of starvation. Early morning low blood glucose level (hypoglycemia) episodes after a long gap between food intakes are a major problem with the traditional insulin therapy.

Unpublished data from studies on animals with Type II diabetes showed that the supramolecule was able to maintain normal glucose level for 30 days when higher doses were used. In India, there are more Type II than Type I diabetic patients who are on insulin. Human clinical trials, which will also include Type II patients, are set to begin next year. Initially, human trials are to start with once-a-week injection and will gradually switch to one shot in four weeks. Unlike in the case of Type I, maintaining tight glycemic control in Type II patients will be quite challenging. It often turned out that drugs producing excellent outcomes in animal studies are not so successful in humans. How exactly supramolecule acts on the humans remains to be seen. There is overwhelming scientific evidence of the number of new diabetic patients in India rising year by year. While new treatment methods will help those with the disease, making prevention a priority is the only way to reverse the trend. Healthy food habits and regular exercise can surely delay the onset of the disease; they can also go a long way in preventing it.