Endocrine Abstracts

The major abnormality in type 1 diabetes is insulin deficiency. Type 2 diabetes is also characterized by an insulin secretory defect so that many patients are on insulin therapy. Methods of replacing insulin have improved throughout the decades, but there are still limiting factors that prevent the achievement of a better HbA1c levels such as hypoglycaemic events and glycaemic variability, weight gain and fatty liver. Additionally, most patients wish to do less insulin injections and less blood glucose self-monitoring! New insulins and newer delivery systems are being developed that can improve some of the limitations of current insulins or make the delivery of insulins more acceptable for some patients. Extending the duration of action of basal insulins (glargine U300, Insulin degludec, PEGylated insulin Lispro) may have advantages in reducing risk of hypoglycemia (and especially nocturnal hypoglycemia) and weight gain. PEGylated insulin Lispro is no more in development for safety reasons (high triglycerides and liver enzymes) and there is still no head-to-head comparison between glargine 300 U/ml and degludec. Shortening the peak of fast-acting insulins in order to mimic the physiological first phase insulin secretion (bioD-090, rHuPH20, Ultra-fast-acting insulin aspart, BioChaperone lyspro) may also have advantages. However, peer-reviewed evidence to date remains scarce. Biosimilars are developed to minimize insulin cost but do not bring something new for the patients. Combination of new long acting insulins with a short acting insulin or with a GLP-1 analogue are available in some countries. These combinations reduce the number of injections. Different delivery systems may make insulin more acceptable to patients. Whether these innovations permit a better glycemic control will be discussed. Lastly, we will see whether ‘smart’ insulin, that is glucose-responsive insulin, the Holy Grail promise, will be available in the next future.