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April 25, 2002

Insulin

Question from Naperville, Illinois, USA:

My two year old was recently diagnosed with type 1 diabetes, and I have read several articles regarding new insulin delivery methods (oral sprays, inhalants, transdermal patches, etc.) as well as islet transplants which I know are still in trial. When can we expect to see one or more of these new insulin delivery modalities in main-stream medicine?

Answer:

I can understand your eagerness to see the day when insulin injections may be a thing of the past. As to your list of possible alternatives, I would have to say that I think that Exubera (inhaled insulin), even though it worked quite well, is unlikely to become a short term reality because of some early evidence of ultimate damage to the pulmonary alveoli. An insulin analog that seems to be readily absorbed from the buccal mucosa, Oralin, looks very promising; but it is only about 20% biologically efficient so that it is likely to be quite expensive, however convenient. Transdermal patches are really too uncertain even with iontophoresis.

At the moment, islet cell transplants are not a reality for small children because of the present need for lifetime immunosuppression. Xenotransplants of porcine islets are not working either. However, the philosopher’s stone of a ‘cure’ is being endlessly researched and my own feeling is that within ten years there will be surrogate islet cells that have been genetically engineered or derived from stem cells that will be available for transplantation in conjunction with new immunomoduatory products that will permit lifetime tolerance after a very short time. These ideas are already being actively explored, but are still a long way from clinical trials.

DOB