ADA: Nasal powder and artificial pancreas with glucagon both show potential

Two new studies presented at the annual American Diabetes Association meeting have shown the benefits of the hormone glucagon--used to control the concentration of glucose in the bloodstream--in patients with Type 1 diabetes. One is a nasal powder to treat hypoglycemia in children and the other is an advance in the development of an effective artificial pancreas, finding the addition of glucagon could reduce nighttime hypoglycemia.

Researchers from Yale performed the first study of intranasal glucagon in children. And with a treatment that has shown to have a slight lag in adults, there was no such timing issue in the younger population, according to a report in Medpage Today.

Injecting the glucagon powder into a patient's nose with a single-use device allows the hormone to enter the body through the mucus membrane. And the researchers found that, of 48 patients aged 4 to 17, the nasal option had similar efficacy as injected glucagon. Also, regardless of age, all the patients were able to use the same 3 mg dose.

The patients were injected with insulin to lower their blood glucose to less than 80 mg/dL. With the nasal glucagon, the team recorded a greater than 25 mg/dL increase within 20 minutes. Side effects were statistically similar to intramuscular injection.

Yale's Jennifer Sherr

"We all know that the treatment of choice for severe hypoglycemia and the only one that is currently approved for use in an outpatient setting is injected glucagon, which requires multiple steps prior to administration," lead author Jennifer Sherr said in a statement. "And for our school-age children, it requires not just parents and family members but other people who are present throughout the child's day to provide assistance."

And in another bit of ADA news, a team from McGill University demonstrated that the addition of glucagon to an artificial pancreas--a self-contained insulin pump and glucose monitor--could help control nighttime hypoglycemia in patients with Type 1 diabetes.

Using a Medtronic ($MDT) pump and sensor, as well as Dexcom ($DXCM) sensors and Roche ($RHHBY) pumps in some patients, the researchers showed that patients with the dual-hormone pumps spent slightly less time in the hyperglycemic range overnight. Though the results weren't statistically significant, the study still shows the potential for the device is still there.

"Many advancements are needed to make a dual-hormonal automated system commercially viable, including the approval of a stable glucagon formulation, a dual-chamber pump for combined storage and delivery of insulin and glucagon, and preferably a specialized infusion set that allows for combined delivery through a single insertion site," said Jessica Castle, an outside researcher from the Oregon Health & Science University in Portland. "Despite these hurdles, the ongoing development of dual-hormonal systems is needed. Until a truly ultra-rapid insulin is available, an insulin-only system will be suboptimal, particularly in situations where insulin needs drop rapidly, such as during exercise."

- here's Medpage Today's nasal glucagon story
- and here's the artificial pancreas article

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