Scientists praise ‘smart’ insulin that responds to changes in blood sugar levels in real time | Diabetes

Scientists have developed a “holy grail” insulin that responds to changes in blood sugar levels in real time and could revolutionize the treatment of millions of people with type 1 diabetes worldwide.

Patients currently have to inject themselves with synthetic insulin up to ten times a day to survive. Constant fluctuations 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 a solution that, according to experts, comes closer to a cure for type 1 diabetes than any other drug therapy: intelligent insulin that remains inactive in the body and only becomes active when needed. Researchers in the USA, Australia and China have succeeded in developing new types of insulin that mimic the body’s natural response to changes in blood sugar levels and react immediately in real time.

Standard insulins stabilize blood sugar levels when they enter the body, but once their medication is administered, they usually cannot help with future fluctuations, meaning patients often have to inject more insulin again after just a few hours.

The new glucose-dependent insulins (GRIs) only become active when there is a certain level of sugar in the blood to prevent hyperglycemia (high blood sugar). When the blood sugar level falls below a certain level, they become inactive again to prevent hypoglycemia (low blood sugar). Experts believe that in the future, patients will only need insulin once a week.

The scientists behind the smart insulins have received millions in grants to drive their development forward. The funding comes from the Type 1 Diabetes Grand Challenge, a partnership between Diabetes UK, JDRF and the Steve Morgan Foundation, which 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 at the Type 1 Diabetes Grand Challenge, said smart insulin could usher in a new era in the fight against diabetes. “Even with the modern insulins currently available, people with type 1 diabetes have to make a great effort every day to control their diabetes and find a good balance between acceptable blood sugar control on the one hand and avoiding hypoglycaemia on the other.”

“Insulins that respond to blood sugar levels – so-called smart insulins – are considered the holy grail of insulin therapy because they come closer to curing type 1 diabetes than any other drug therapy.”

Almost £3 million has been awarded to six research projects developing different types of smart insulin, including 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 optimize smart insulin to work faster and more precisely, alleviating some or all of the enormous burden of treating type 1 diabetes and reducing the risk of long-term complications. Four of the projects focus exclusively on testing GRIs.

A fifth have developed a new ultra-rapid, short-acting insulin. Even with the fastest insulins currently available, there is still a delay between when the drug is administered and when it starts to act on blood sugar. This can cause blood sugar to rise to dangerous levels before insulin can lower it.

Faster insulins are also needed to improve the function of insulin pumps and hybrid closed-loop technology, a system that relies on stored insulin to respond to changes in blood sugar levels in real time.

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 sugar levels are low. Combining both hormones in one formulation could keep blood sugar levels stable by preventing high and low blood sugar levels.

“The six new research projects being funded address key deficits in insulin therapy,” said Heise. “Therefore, if successful, these research projects could usher in nothing less than a new era in insulin therapy.”

Rachel Connor, head of research partnerships at JDRF UK, said: “While insulin has been saving lives for over 100 years and previous research has made important changes for people with type 1 diabetes, it is still not good enough – controlling glucose levels with insulin is really difficult and it is time for science to find ways to reduce this burden.”

“We envision a world where insulins can respond to changing glucose levels in real time. With these six projects, we hope they will help create this new reality and free people with type 1 diabetes from the relentless demands that living with this disease places on them today.”

Dr Elizabeth Robertson, head of research at Diabetes UK, said the projects had the potential to revolutionise the treatment of type 1 diabetes. “By supporting these groundbreaking research projects, we aim to develop new insulins that better mimic the body’s natural responses to changes in 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 affected. We hope this research will lead to life-changing advances in the treatment of type 1 diabetes.”