JDRF announced today another important step on the road to the development of an artificial pancreas - an automated system to better manage the blood sugar of people with type 1 diabetes - with the establishment of a research program to speed the development of faster-acting insulin.
JDRF is funding investigators at leading academic institutions to test novel insulin formulations and delivery systems that may speed insulin action - making it work faster than the insulin currently used by people with diabetes around the world today. The objective is to use faster-acting insulin in an artificial pancreas system to more closely mimic a human pancreas in sensing blood sugar and secreting insulin in response.
One means to improve the speed of insulin action is to reformulate the molecule. JDRF will fund Dr. Bruce Buckingham of Stanford University to test such an insulin, Viaject, which is currently in development at Connecticut-based Biodel Inc. JDRF will also fund Dr. W. Kenneth Ward of Oregon Health Sciences University to perform artificial pancreas experiments with Viaject Insulin.
In addition to modifying the insulin molecule, another way to speed insulin action may be to improve the route of delivery. Currently, insulin is delivered subcutaneously (under the surface of the skin); this contributes to the slow action compared to insulin made in the pancreas. JDRF will provide grant funding to Dr. Howard Zisser at the Sansum Diabetes Research Institute to conduct studies there with AFREZZA-, a rapid-acting insulin being developed by California's MannKind Corporation; inhaled at mealtime, AFREZZA achieves peak insulin levels quickly.
JDRF recently announced a collaboration with BD (Becton, Dickinson and Company) to develop a microneedle-based delivery system. In addition, JDRF will provide funding to test two new devices also aimed at providing mechanical means to achieve faster insulin action. The first will support Dr. Howard Zisser at the University of California, Santa Barbara's Sansum Diabetes Research Institute testing Roche Diabetes Care's Accu-Chek- DiaPort system. The Accu-Chek DiaPort is a percutaneous port system, connected with an external pump, that delivers insulin directly to the liver, the primary site of insulin action. The second JDRF grant will support Dr. William Tamborlane of Yale University to test a unique warming device, InsuPatch, made by InsuLine Medical Ltd. Preliminary data suggests that this device, adaptable to most infusion pumps, considerably accelerates the action of insulin.
This new JDRF Insulin Initiative is another component in the four-year-old Artificial Pancreas Program, which looks to automate blood sugar control by combining continuous glucose monitors with insulin pumps and a sophisticated computer program that links the two. With JDRF funding, numerous clinical trials of early-generation artificial pancreas systems in people have demonstrated an ability to better control diabetes and lower the risk of dangerous low-blood sugar emergencies in people with type 1 diabetes.
"But one of the missing pieces remains an insulin that works faster," said Aaron Kowalski, PhD, Assistant Vice President and Research Director of JDRF's Artificial Pancreas Program. "We can measure glucose levels in real-time, and through a computer program direct an insulin pump to give just the right amount of insulin in response to those levels. But currently available synthetic insulins can't keep up from a time standpoint - once in the body, they can take dramatically longer to be assimilated than insulin produced by someone who does not have type 1 diabetes."
Studies have shown that in people without diabetes, insulin is released and acts almost instantaneously. But even the fast-acting insulins currently available take more than 30 minutes to reach the bloodstream, and more than 90 minutes to reach peak effectiveness.
"A key to making an artificial pancreas system significantly better than current methods to manage diabetes is to mirror as much as possible how the human pancreas works," said Sanjoy Dutta, Director of JDRF's Insulin Initiative. "So we either need faster-acting insulin or devices or a combination of the two that more quickly and efficiently deliver insulin."
Dr. Dutta noted that while the JDRF insulin initiative is focused on developing new insulins and devices specifically to accelerate the development and commercial availability of artificial pancreas systems, faster-acting insulin would also have significant benefits for people with all types of diabetes who might chose not to use an artificial pancreas to manage their disease.
"Our work to date involving faster-acting insulin reflects the philosophy of JDRF's Artificial Pancreas Project to partner with multiple academic and corporate researchers to speed the development of artificial pancreas systems," Dr. Dutta said. "Each of these projects holds promise to demonstrate that faster-acting insulins will help improve glucose control. And that gets us one step closer to much better treatments for people with diabetes, healthier lives, and fewer complications - while we continue the ultimate search for a cure."
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