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Insulin therapy—realising the potential

International Journal of Obesity volume 28, pages S1–S2 (2004)Cite this article

Since its discovery in 1922, insulin has been the basis for treating diabetes both in patients with type I diabetes and those with type II diabetes when oral agents fail. For many years, commercial insulin production used animal sources and extracted insulin from bovine and porcine pancreas. While effective clinically, these insulin preparations also contained small amounts of impurities from other pancreatic components and were highly immunogenic. A significant development in insulin chemistry and the production process was the ability to produce pure animal insulin, allowing the introduction of a range of monocomponent insulins. From here, it was a logical step to the production of human insulin, initially by enzymatic modification of porcine insulin and then more generally by bacterial or yeast biosynthesis.

It might have been thought that the production of human insulin would have brought to an end the search for new insulins. Such a view was only transient and in the 1980s development of recombinant technology allowed investigators to pursue more elegant modifications of the insulin molecule itself, heralding the advent of the insulin analogue age. First to be produced were the rapid-acting insulin analogues, insulin aspart and insulin lispro, that had more rapid absorption and shorter duration of action than short-acting human insulin and thus made them ideal candidates for the control of postprandial glucose levels.1, 2, 3, 4, 5 Further manipulations of the protein structure of insulin have created, in the last few years, the first basal insulin analogues, more suited to providing the constant, smooth basal insulin requirements than conventional long- and intermediate-acting human insulin preparations.6 The improved pharmacokinetics of these analogue insulins now allow us to aim for fasting and postprandial glycaemic targets which were previously out of reach for many patients.

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  1. M Nattrass
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Nattrass, M. Insulin therapy—realising the potential. Int J Obes 28 (Suppl 2), S1–S2 (2004). https://doi.org/10.1038/sj.ijo.0802742

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