Improve Metabolic Control
Even using advanced treatment methods, achieving satisfactory glucose control is very difficult. Novel drugs are able to assist in providing better glucose control and prevent hypoglycemia in type 1 diabetes.
Faster-acting insulins, which are more reminiscent of the body's natural insulin, reduce the delay in action after injection and improve the efficiency of artificial pancreas therapy. Pharmaceutical companies have over time introduced enhanced insulins and are working to develop faster insulins.
One version of inhalable insulin (Afrezza) is on the market, but only in the US. User experiences suggest that it is easier to dose meal bolus with this type of insulin, with less risk of hypoglycemia.
Researchers are working to develop a glucose responsive insulin (GRI) that responds to blood sugar levels in real-time and releases insulin according to the body's requirements. One dose will cover typically one full day, and the insulin needed by the body will be continuously released, without the need for glucose measurements.
Glucagon in stable liquid form, which does not crystallize, can medically raise glucose level in case of an insulin overdose. This drug forms the basis for the development of a novel, easy to use emergency pen, the use of glucagon in an artificial pancreas system (dual-hormone), and the use of glucagon in a pen to adjust blood sugar upwards through microdoses.
SGLT1/2 inhibitors, GLP-1, and other drugs that stabilize blood sugar by reducing glucose fluctuations are under development. A few of these obtained EU approval for use in type 1 diabetes as adjunctive therapy in 2019, but under quite limiting indications.
Sodium-glucose cotransporter 2 (SGLT2) and 1 (SGLT1) inhibitors are relatively new classes of tablet drugs, which are attractive as adjunct therapies in type 1 diabetes. They work by increasing the glucose excretion in the urine in each their way. Several SGLT2 inhibitors are available on the market today for the treatment of type 2 diabetes and a few for type 1 diabetes, while SGLT1 inhibitors are currently being studied and are awaiting approval in the EU and the US.
Recent clinical trials, especially with SGLT2 inhibitors, show lower HbA1c and better Time In Range (TIR) when using the drug in type 1 diabetes. The side effects are an increased risk of genital infections, and the risk of masked diabetic ketoacidosis (DKA), ie. DKA without hyperglycemia.
GLP-1 and Amylin
Glucagon-Like Peptide 1 Receptor Agonist (GLP-1) is an injection drug for type 2 diabetes. It works by enhancing the glucose-stimulated insulin secretion while inhibiting the release of glucagon from the pancreas. The effect increases with increasing blood sugar levels. Furthermore, GLP-1 inhibits the rate of gastric emptying and reduces appetite. In type 1 diabetes, clinical trials have shown better blood glucose control using GLP-1.
Amylin works in a similar way as GLP-1, but without enhancing the glucose-stimulated insulin secretion.