Insulin: evolution of insulin formulations and their application in clinical practice over 100 years

Abstract

The first preparation of insulin extracted from a pancreas and made suitable for use in humans after purification was achieved 100 years ago in Toronto, an epoch-making achievement, which has ultimately provided a life-giving treatment for millions of people worldwide. The earliest animal-derived formulations were short-acting and contained many impurities that caused adverse reactions, thereby limiting their therapeutic potential. However, since then, insulin production and purification improved with enhanced technologies, along with a full understanding of the insulin molecule structure. The availability of radio-immunoassays contributed to the unravelling of the physiology of glucose homeostasis, ultimately leading to the adoption of rational models of insulin replacement. The introduction of recombinant DNA technologies has since resulted in the era of both rapid-and long-acting human insulin analogues administered via the subcutaneous route which better mimic the physiology of insulin secretion, leading to the modern basal-bolus regimen. These advances, in combination with improved education and technologies for glucose monitoring, enable people with diabetes to better meet individual glycaemic goals with a lower risk of hypoglycaemia. While the prevalence of diabetes continues to rise globally, it is important to recognise the scientific endeavour that has led to insulin remaining the cornerstone of diabetes management, on the centenary of its first successful use in humans. KeywordsGlycaemic control • Hypoglycaemia • Insulin • Insulin analogues • 100 years insulin use * Geremia B. Bolli

Understanding Insulin: A Primer

“…Infusion pumps and insulin pens have allowed more efficient drug administration. Blood glucose monitoring with capillary glucose tests, continuous glucose monitoring and widespread availability of HbA1C test have allowed more precise glycemic control and attenuated the risks of diabetic complications [9].…”

“…Insulin therapy has been a cornerstone in the medical management of type 1 DM. It is also used in the treatment of type 2 DM being necessitated by beta cell exhaustion [9]. This review will attempt to feebly summarize the advances we have made over the years in understanding insulin pertaining to its structure, effects on the various tissues and the development of analogues.…”

Detection of insulin oligomeric forms by a novel surface plasmon resonance‐diffusion coefficient based approach

“…Indeed, copper and zinc ions have an important role in diabetic retinopathy and the interplay between these metal ions and insulin deserves attention (Dascalu et al, 2022; Miao et al, 2013). Although it is well known that zinc ions stabilize the formation of insulin hexamers, the search for optimal stable insulin formulations that can provide the most biologically active form of the hormone upon injection is still ongoing (Bolli et al, 2022).…”

Intensive Management of Type 1 Diabetes in Adults: One Centre Experience 1970–2022

“…The exciting milestones of the insulin era have already been described [6][7][8][9][10][11][12]. In the year 1922, the pharma industry started production of short-acting bovine/porcine insulin (Iletin, Eli Lilly, Indianapolis, USA).…”