Is there an alternative to insulin?

Madrid (EFE).- Insulin is an important drug for the treatment of diabetes, especially for those people who have type 1 and for those in the later stages of the most common type, type 2, but there are treatments and research aimed at find an alternative.

On the occasion of World Diabetes Day, several experts from the Spanish Diabetes Society (SED) and the Ramon y Cajal Institute for Medical Research (IRYCIS) review current treatments for the disease and ongoing research to try to ensure that people with the disease do not have to rely on insulin injections .

Type 1 and Type 2, different diseases

It’s worth remembering that type 1 and type 2 diabetes are “completely different diseases,” Leah Nattero, head of the clinical and research unit for type 1 diabetes at IRYCIS, told EFE.

“Type 1 diabetes is an autoimmune disease in which there is primary destruction of the pancreas and, when it is no longer able to secrete insulin, hyperglycemia occurs, in which patients require insulin from the very beginning,” explains Nattero, who is also a researcher at the Network Center for Biomedical Research (CiberDEM).

According to the SED, this type represents approximately one in ten cases of diabetes in Spain, with a prevalence of 2% in the general population.

Those numbers are much lower than type 2, which accounts for about 90% of cases and is estimated to affect 14% of the Spanish population, although half of those affected are unaware they have it, Maria José Picon told EFE. President of the SED.

In many cases, it can be prevented because there are risk factors that contribute to its occurrence, such as being overweight or having a sedentary lifestyle.

Its causes are more complex, and there is no a priori insulin deficiency, but instead it “works hard”, causing insulin resistance, reaching the point where the pancreas is exhausted to counteract it.

In the initial stages, it can be treated with medication, and as the pathology progresses, insulin is needed.

therapeutic arsenal

Before moving on to insulin, “there are therapeutic arsenal” for treating type 2 diabetes, such as GLP-1 analog drugs, including semaglutide – ozempic – if the patient is overweight.

This is the first step in treatment because it improves insulin resistance, Picon says, and points to other older, cheaper drugs, such as metformin, as well as glucosurics, which promote glucose excretion through urine and offer “many benefits.”

This entire “battery” of medications, combined with a healthy lifestyle, aims to prevent the progression of type 2 diabetes and therefore prevent patients from having to resort to insulin.

“When patients with type 2 diabetes are prescribed insulin, it is because other medications are no longer sufficient and the beta cells located in the pancreas, responsible for insulin secretion, are depleted, so the treatment will last a lifetime,” emphasizes Picon.

For his part, Nattero clarifies that insulin “must be avoided at all costs, not because it is bad, but because it is not the best solution,” since we must first try to stop the progression of the disease.

So the researcher is also focusing on alternatives to avoiding insulin in drugs that fight obesity and improve insulin resistance, as well as bariatric surgery to prevent the disease from progressing.

Consolidated practices, others in research

When it comes to alternatives to insulin for people with type 1 diabetes, both experts highlight some options that are already in practice in specific cases, while others are still under investigation.

The study is focused on first-line prevention of disease onset using the first FDA-approved drug, Teplizumab, Nattero explains.

Once the disease has developed, efforts focus on replacing insulin in patients who can no longer produce it, with two options: pancreas transplantation and cell therapy.

“In the case of transplantation, the problem is the availability of donors and the need for lifelong immunosuppressive treatment,” explains Picon.

Cell therapy

In terms of cell therapy, pancreatic islets—a group of cells that produce insulin—can be transplanted from a donor by injection into the patient’s portal vein.

The disadvantage is that, like organ transplantation, immunosuppression is required.

According to Nattero, this method is FDA-approved for patients whose diabetes is “very difficult to manage, with very severe hypoglycemia.”

On the other hand, there is stem cell transplantation, which is “the most popular recently,” the researcher says.

These are “pluripotent stem cells, such as embryonic cells, and are either injected to differentiate into insulin-producing cells or are processed in the laboratory for this purpose and, after differentiation, are injected.”
Both technologies are at an experimental stage.