An insulin pill

Abstract

Nature reviews | Endocrinology Original article Halberg, I. B. et al. Efficacy and safety of oral basal insulin versus subcutaneous insulin glargine in type 2 diabetes: a randomised, double-blind, phase 2 trial. Lancet Diabetes Endocrinol. https://doi.org/10.1016/S2213-8587 (18)30372-3 (2019) Patients with type 2 diabetes mellitus (t2DM) currently administer insulin via a subcutaneous injection. Oral insulin therapy, however, holds multiple potential benefits; for example, it would be convenient for patients and would reduce peripheral hyperinsulinaemia. while oral insulin preparations have been explored for many years in both animal models and patients, a promising formulation for clinical application has not yet been created. i338, a long-acting oral insulin preparation that was the subject of a recent phase ii clinical trial, could be an important stepping stone on this path. “although the present formulation will not be taken forward, we have shown that insulin can be effectively administered orally to patients with t2DM,” says inge Halberg, lead author of the study. in the double-blind, randomized controlled trial, 49 patients with t2DM who were currently taking metformin or another oral anti-diabetic drug were given either iGlar, a subcutaneously administered insulin preparation, or i338 tablets once daily in the morning for 8 weeks. at the end of the study, the authors assessed plasma glucose concentration in both groups and found that both treatments were equally efficacious at lowering blood glucose values measured at ten time points throughout the day. Despite these encouraging findings, the authors note that total and within-patient variability of fasting blood-glucose levels were higher in the i338 group than in the iGlar group. “the potential benefits of oral basal insulin therapy versus other treatment options still need to be investigated in adequately powered, long-term clinical trials in various patient populations with diabetes mellitus,” explains Halberg. “the findings of the present study, however, are likely to encourage the further development of oral insulin products.” Anna Kriebs Associate Editor, Nature Communications D i a B e t e S