There was a special event with academic experts, researchers, industry JDRF and funding organizations to discuss the current information on glucose responsive insulin also known as “smart insulin.” The highly interactive event brought together academic experts, researchers, industry, funding organizations, and patient advocates, including our own Kelly Close, to discuss the current state of the glucose responsive insulin field (also known as “smart insulin”). In theory, this next-generation insulin would work automatically in response to blood glucose: the higher the blood sugar, the more insulin is released or activated, and the lower the blood sugar, the less insulin is released or activated.
The idea of the “perfect” smart insulin is very compelling for people with diabetes on insulin: one injection per day, blood sugar levels that stay in zone without hypoglycemia, no more carb counting, no more guessing what dose is correct, no more feeling frightened, and a much safer and less stressful life. Plus less need for hours with a diabetes educator. The reality, as the leaders emphasized at this meeting, is that glucose responsive insulin (GRI) is still in its infancy, and development will likely proceed in steps: the first generation of these drugs may offer some, but not all, of the anticipated benefits. It was agreed that a perfect glucose-responsive insulin could eventually be an enormous game-changer for people with diabetes. In the discussion, they described an ideal GRI as a once-daily therapy that delivers the right amount of insulin at the right time in the right part of the body, leading to in-range blood sugars with little to no risk of hypoglycemia. But, like everything else, the first GRI may not have everything we would like and it probably will have to wait for the second-generation GRI.
It was agreed that a first-generation GRI would be a meaningful advance prior to development of the ideal product. There was some debate over exactly what that first product should look like. So they stated that most likely that the characteristics for the first-generation GRI would have the following benefits:
The next or ideal generation would be more like this:
Other proposed ideas for first-generation GRI products included (i) a combination of two different insulins, one for low glucose levels and one for high glucose levels; (ii) as many as five products approved for different populations (i.e., athletes vs. pregnant women vs. those with high hypoglycemia unawareness); (iii) a product approved only for type 2 diabetes; (iv) a post-meal GRI added on to existing basal insulin; and (v) a basal GRI added on to existing basal insulin. It is just a matter of time before we see the Smart Insulins
An overview of the companies and academic groups with GRI candidates in development shows over 11 groups currently working on smart insulin projects. All of these projects are at a very early stage: one (Merck’s MK-2640) is in its first study in humans, and the others are all still being tested in animals. The groups all have very different approaches to GRI development, ranging from a smart insulin patch (UNC/NC State) to glucose-sensing nanoparticles (Monash University). All three major insulin companies – Sanofi, Lilly, and Novo Nordisk – are working on smart insulin as well, with Lilly recently acquiring smart insulin technology from the startup company Glycostasis in February 2016.