More rapid than “rapid-acting”! As fast as rapid-acting insulin is, the phrase “slower than molasses in January” is a better descriptor for how quickly it works as compared to the insulin made by a normally functioning pancreas. It takes about 4 hours for it to finish working, for crying out loud! In the not-so-distant future, we may have insulins available that improve upon the action of our currently-approved mealtime insulins.
There’s some interesting information coming out of the 2016 EASD (European Association for the Study of Diabetes) virtual meeting.
There is a product in development called Ultra-Rapid BioChaperone Lispro. Lispro is better known as Humalog in the United States. The new version in development is designed to do a better job of working faster than the traditional formulation of Lispro. In this study, 38 participants with Type 1 diabetes were given either the traditional formulation or the ultra-rapid BioChaperone Lispro at the start of a liquid meal. Compared to the standard formulation of Lispro, BioChaperone Lispro displayed a statistically significant higher early insulin exposure after dosing, with less late exposure. This means it started working faster and finished working faster. With BioChaperone Lispro, there was significantly better control of the after meal glucose level. Hypoglycemia events were similar between the two formulations of the Lispro, and there were no issues with safety or tolerance. The study confirmed that BioChaperone Lispro is ultra-rapid and that this new formulation significantly improves after-meal blood glucose control. This may become available in 2017.
Another study looked at faster-acting insulin aspart, which is a speedier version of what we call Novolog in the US. This phase 3 trial looked at the effect of using faster aspart, an ultra-fast acting mealtime insulin given before at meal time, given 20 minutes after the start of the meal, and the traditional formulation of aspart. Faster aspart improved blood glucose control with superior after meal control when given at mealtime, as compared to the traditional formulation of aspart. The participants who were randomized to dosing their faster aspart after the meal maintained blood glucose control that was non-inferior to that obtained by giving the traditional aspart formulation at mealtime.
A final study found that faster-acting aspart started working faster and finished working faster in subjects with Type 1 Diabetes using an insulin pump. This helps to provide better after-meal glucose control without the risk of late post-meal hypoglycemia. Compared to the traditional formulation of aspart, faster aspart did a better job of mimicking the way naturally produced insulin works. The product in development has the potential to improve post-meal glucose control with a lower risk of late post-meal hypoglycemia.
We would all love to see a cure for diabetes. Until that happens, it’s encouraging to see that there are new products in development that should help us to manage better in the meantime!