Q&A: Current Advancements in Insulin Delivery for Patients with Diabetes

From fast-acting and long-acting insulins to those requiring a meal, the standards of care for insulin delivery have changed over the years as researchers aim to develop insulin that best regulates the blood glucose of patients with diabetes.

“We have certainly made a lot of advances,” Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, told Drug Topics. “What I would almost ultimately love to see is a truly glucose-targeted insulin that just works when the glucose is high, and is truly physiologic, so that someone doesn't have hypoglycemia or is not at risk of hypoglycemia.”

Isaacs has an extensive career in diabetes management and education and recently caught up with Drug Topics to discuss insulin management. Also serving as director of education and training in diabetes at Cleveland Clinic, she shared her insights on the evolving technologies used in insulin delivery today.

Isaacs details the current advancements in insulin technology from her background as a certified diabetes expert. | image credit: erika8213 / stock.adobe.com

From her early days in the diabetes space to what she’s expecting to see in the future, learn about current advancements in insulin delivery from a certified diabetes expert.

READ MORE: Tandem’s Automated Insulin Delivery Technology Shows Improved Outcomes in T2D

Drug Topics: Throughout your time in diabetes care, how has insulin delivery improved and what common outcomes have those improvements led to?

Diana Isaacs: There's been a lot of exciting innovations in this space. For starters, when you think about where we originally came from, we had animal-derived insulins, we had NPH (Neutral Protamine Hagedorn), an intermediate insulin, which has a peak and needs to definitely be given twice a day, but if it peaks at the wrong time, someone experiences hypoglycemia. We had regular insulin, which it just doesn't quite work fast enough, so people have to take it at least 30 minutes before they eat for it to work at the right time.

We've had many innovations when it comes to long-acting insulins. Now, we have several long-actings that can be taken just once a day. We have insulin glargine and dagludec, and we also have the glargine u300, which is a more concentrated form of that insulin, which allows it to last longer in the body.

I'm very excited about the prospect of weekly insulin. So, there's insulin icodec and efsitora alfa. Both are being studied and they look really promising at least for type 2 diabetes, especially, where someone would only need to take it once a week and it would have a really steady state. It wouldn't be peaking at the wrong times. I think that's a really exciting prospect.

When it comes to mealtime insulin, we definitely have faster-acting insulins now. We have, for example, with aspart and lispro, they both have a faster-acting formulation. We also have the inhaled insulin, which is actually the fastest-acting insulin of all of them, and also a nice option for someone that doesn't want to inject at meal times.

We have certainly made a lot of advances. What I would almost ultimately love to see is a truly glucose-targeted insulin that just works when the glucose is high, and is truly physiologic, so that someone doesn't have hypoglycemia or is not at risk of hypoglycemia. So unfortunately, even with all of our amazing innovations, there still is that risk of hypoglycemia that we have to watch out for and make sure we educate our patients about.

READ MORE: Q&A: The Challenges, Importance of Insulin Delivery for People with Diabetes

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