For the several million Spaniards who suffer from diabetes – and more than 450 million in the rest of the world – it is a daily act; cyclic. Every certain time throughout the day, and regardless of the place or activity that is being carried out, it is time to click. It is the colloquial way of referring to the periodic need that these patients have to self-administer their basic treatment: insulin. A possibility – that of having a method to control a disease that has no cure – from which humanity has been benefiting for just now one hundred years .
And it is that this 2021 commemorates the first centenary of the discovery of what was a true therapeutic revolution . “To realize its importance, it is enough to remember that it has solved life and avoided direct death to people with diabetes since 1921 “, tells MUY Josep María Suñé, professor of Galénica Pharmacy and director of the Department of Drug Development Service of the University of Barcelona. “Without the discovery of insulin as a treatment, the current day-to-day life of patients would be very different,” they also say from the Spanish Diabetes Federation (FEDE). Now, it is a revolution that, as will be seen later, is reluctant to evolve in some aspects.
But, before doing so, it is convenient to analyze its historical past. As the FEDE recalls in its campaign “100 years with insulin”, the first diagnoses of the disease date back more than two thousand years , although it was unknown what caused the common symptoms experienced by those affected. And, above all, in what way could it be approached. The “before and after” came in August 1921, when Canadian researchers Frederick Banting and Charles Best managed to isolate insulin from the pancreas of animals to treat a dog with diabetes, and reduce its blood sugar levels in two hours. An investigation that was not published until 1922.
Two years later, Banting and Best received the Nobel Prize in Physiology and Medicine for their work. Not without controversy, incidentally, by the criticism from the jury of these awards – nineteen professors from the Karolinska Institute in Stockholm, at that time – considering that they had “taken advantage” of a series of previous studies by other scientists who did not they were to be recognized.
Thanks to the involvement of two pharmaceutical companies, one European and one American, insulin was able to be mass produced and spread rapidly around the world . Meanwhile, advances in improving this treatment continued throughout the following decades. For example, in 1936, in Denmark, Hans Hagedorn, Norman Jensen, and NB Kraup made their action last longer. Another remarkable event took place three decades later, when in 1965 the scientists Helmut Zahn and Johannes Meienhofer synthesized for the first time insulin of human origin , and, thanks to this, they stopped depending exclusively on that of animal origin.
Since then, there have been many other developments that insulin has undergone and, therefore, the approach to diabetes and the optimization of results. In parallel, there is the evolution of the devices designed for their administration. In a very general summary, it has gone from syringes that required inoculation by health workers to a multiple variety of easy-to-use devices that allow injection – puncture – by the patient himself, as well as the regulation of the units that have to be applied or dosage adjustment. This greater ease has resulted in very successful adherence rates.
The goal, however, is to stop depending on injections once. And this is where it has barely evolved for a hundred years. New alternatives have not been developed to avoid exclusive parenteral administration –subcutaneous injection–, such as oral methods. “Until now, all the studies and research focused on producing oral insulin presentations through nanotechnology and microcapsules that reach the stomach and intestine have not been successful because, in both organs, the insulin is completely broken down. Although it will end up being achieved ”, Suñé confirms, with a dose of optimism.
Recently, experts from the Massachusetts Institute of Technology (MIT) have devised a capsule capable of solving the aforementioned problem, but, for now, the test has only been carried out in pigs. In other words, it does not assure anything yet regarding a possible successful replication in humans. In any case, there would be a long way to go to prove it. At least three or four years, according to the researchers themselves.
Despite the general trend of unsuccessful attempts, “a lot of research has been studied and continues to be investigated in the search for other routes of administration than parenteral”, confirms Suñé. For example, an intranasal application –aspiring– that allowed absorption through the lungs did give a positive result . “It was even marketed by a company. The bad thing is that it only lasted one year on the market; it did not compensate economically ”, confirms this professor. Let’s hope that another hundred years will not have to pass for the approach to diabetes to give us the expected advance.
