JDRF’s Insulin Initiative: Afrezza, Roche’s DiaPort, Smart Insulin and More

Last week, the New York Chapter of the Juvenile Diabetes Research Foundation hosted their annual research briefing. Many chapters around the country host similar research briefings, and I was excited to find out that our local meeting would feature Dr. Sanjoy Dutta, Director of Glucose Control Therapies within the Treatment Therapies Program.

I want to note that although there’s been a lot of controversy surrounding the addition of treatment goals to JDRF’s mission, I whole-heatedly believe that improved therapies can make a huge difference in helping us live healthy, productive lives until there is a cure.

At the event, Dr. Dutta touched briefly on several therapeutic areas that JDRF is working on, including the Artificial Pancreas Project, the Glucose-Modulating Drug Initiative, Prevention of Diabetic Complications, and the Treatment and Prevention of Diabetic Retinopathy. But the main focus of his talk was on the JDRF’s “Insulin Initiative,” which focuses on everything from creating new formulations of insulin to new delivery systems and absorption aids.

Here are some very interesting bits of info I picked up:

• Current formulations and delivery of insulin are on average 90 minutes slower than insulin produced in people without diabetes. This is caused by two things: the formulation of modern insulin, and the fact that our insulin is delivered subcutaneously, rather than in the blood stream. Insulin that is delivered directly into the blood stream works much faster, which is why an implantable pump could potentially work so well.

• Inhaled insulin is the fastest-acting type in clinical development. It reaches the blood stream very quickly, similar to oxygen. Dr. Dutta reports that MannKind’s new inhaled insulin, Afrezza, is performing quite well with type 1 diabetics in clinical studies, and the new delivery system they are testing (improved little inhaler) allows for more specific dosing amounts. This is meal-time insulin only, so patients will still need at least one injection of long-acting insulin.  But it is believed that Afrezza could speed up the action of meal-time doses, lowering post-prandial blood sugars.

• The DiaPort device from Roche looks like it could be a contender as an alternative to the implantable insulin pump! It is a surgically implanted tube that reaches further into the body, allowing insulin delivered via an external pump to go exactly where the insulin is meant to be. Used originally in Europe for people with “brittle” — or extraordinarily difficult to manage — diabetes, Roche has discovered that patients using the DiaPort tend to need 30-50% less total daily insulin. They are now pursuing the DiaPort for a wider audience. (Check back here for more about this device next week.)

• InsuPatch from InsuLine out of Israel is a device that uses a tiny heating coil near the pump site to “heat up” the skin to facilitate faster absorption of insulin because heat increases the speed of blood flow. (The same reason some people go low after enjoying a hot shower or jacuzzi.) The InsuPatch is undergoing human clinical trials now, and reports state that anticipating a successful outcome, it “may receive FDA approval by the end of 2011.”

• Leptin, originally targetted for extreme weight loss, is being investigated by Amylin to see if it has a role in glucose control. Studies in mice have shown that Leptin can reduce fluctuation in blood sugar, helping maintain normal blood sugars for several weeks, and also lowers the amount insulin required. Amylin is currently in Phase 3 clinical trials for the weight loss indication. In November, JDRF and Amylin partnered to investigate its use in people with type 1, and are currently conducting “proof-of-concept” studies in Texas (details on that TBD).

• Another Amylin drug, Symlin, is also crucial for blood glucose management. The hormone amylin is also missing in folks with type 1, and Symlin aims to replace that hormone. However, there have been issues with “adoption” among patients, who naturally don’t like the requirement for a second set of shots, in addition to insulin, and who also grapple with frequent hypoglycemia when taking both.  As we reported here last week, Amylin and JDRF are now partnering to study the efficacy and impact of a combined formulation of Symlin + insulin.

• SmartCells, makers of the very exciting Smart Insulin product — that can potentially that could potentially sense high glucose levels and automatically dispense insulin on demand — was acquired by Merck last fall.  They are moving into clinical trials!  Studies are preliminary, but things are looking hopeful, Dr. Dutta says.

Dr. Dutta was also kind enough to speak with me after the event. Here’s what he has to say about the work JDRF is doing, and what you can do as a patient to make sure you are getting the latest and greatest care: