Novo Nordisk Japan

Jesper Lekdorf, MD

Last year marked the 100th anniversary of the discovery of insulin. Leonard Thompson became the first person with type 1 diabetes to be treated with insulin in 1921 in Banting and Best’s laboratories in Toronto, Canada. This discovery was not only ground-breaking for medical science but also lifesaving for people living with diabetes, it was therefore well deserved that Banting and Macleod were awarded the Nobel Prize for their discovery only two years later.

Today people living with diabetes are still benefitting from their discovery and to this day injectable insulin is still being used as the only treatment for type 1 diabetes mellitus. However, due to incremental innovation, the treatment of diabetes with insulin has improved dramatically since then. In the early days, the insulin administration was based on human insulin from purified pancreatic extract, later followed by human insulin preparations including additives such as protamine, zinc, or sulphur to change absorption mechanisms when injecting into the subcutis. Today insulin is manufactured by secretion from modified yeast cells by recombinant DNA technology. The amino acid sequence of the insulin molecule is today also modified to ensure specific biochemical characteristics such as increased receptor affinity or changed dissociation in the subcutaneous space to allow for faster absorption. In addition, the insulins are often biochemically engineered with an attachment of larger molecules to slow down absorption or delay receptor binding in the circulations.

These biochemical modifications to the human insulin molecule have enabled the insulin molecule to have a fast glucose-lowering effect or conversely protracted glucose-lowering effect in the body and thereby allowing people with diabetes to obtain insulin coverage both in relation to meals and throughout the day and night. Moreover, the advances in the biochemical engineering of insulin have facilitated less variability in the glucose-lowering effect, resulting in a lower risk of hypoglycaemia.

Furthermore, advances in both pen delivery devices and insulin pumps have reduced the treatment burden substantially for people with diabetes, allowing them to live with less interference in their daily routines and better quality of life.

"Advances in both pen delivery devices and insulin pumps have reduced the treatment burden substantially for people with diabetes"

Similarly, the advances in blood glucose monitoring and connected devices have made it more convenient to manage your insulin administration and allow for close and continued monitoring of both insulin doses and blood sugar.

Soon additional innovations to the insulin molecule can be expected with several exciting research activities currently undergoing. Some examples are liver-specific insulin (allowing for lower weight gain), longer-acting insulin allowing for weekly or monthly administration, and the so-called smart insulin activated only when the blood sugar increases and therefore reducing the risk of hypoglycaemia substantially.

Looking a little further ahead we may even be able to eliminate the need for external insulin administration. The recent advances in stem cell transplantation of insulin-producing cells (beta cells) in the last years will most likely allow for a cure for people living with type 1 diabetes. The first human trials with stem cell transplantation are currently undergoing allowing for a bright outlook on the future treatment of people living with type 1 diabetes.