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Future Treatments for Diabetes From Concept to Care

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Dr Shashank Joshi, Mumbai    24 November 2018

  1. Omarigliptin: It is not an extended release formulation; the mechanism of action is same as q.d siblings. The difference is in the duration of meaningful DPP-4  inhibition (gap between two doses: 168 hours for omarigliptin and 24 hours for sitagliptin; it has been launched in Japan and is currently the largest selling qw gliptin in Japan.
  2. Targeting hepatic mitochondrial uncoupling can help develop new class of agents for T2DM and NASH. Targeting hepatic mitochondrial uncoupling will increase hepatic fat oxidation → improved hepatic insulin sensitivity. VLDL production is also reduced → decrease in plasma TGs → decreased muscle fat content → increased muscle insulin activity.
  3. Semaglutide: New oral GLP1-RA – the semaglutide protein is co-formulated with SNAC in a tablet; SNAC acts as an enhancer facilitating transcellular absorption of semaglutide in stomach.
  4. Ultra-rapid Lispro: A novel formulation developed to more closely mimic physiological prandial insulins, improving PPG control and allow flexibility. It uses locally acting excipients citrate (increases vascular permeability at the injection site) and treprostinil (accelerates insulin lispro absorption by local vasodilation with no measurable systemic exposure).
  5. Future generation pump: Displays glucose values, recommends insulin dose to the patient and automatically adjusts basal and bolus insulin.
  6. Oral insulin: Insulin Tregopil administered orally 10-20 minutes before meal resulted in optimal post meal exposure and glucose-lowering effects; ORMD-0801 oral insulin formulation relies on recombinant protease inhibitors and absorption enhancer to ensure insulin integrity and bioavailability.
  7. Newer options: PPAR-γ agonists, β3-adrenergic receptor agonists, protein tyrosine phosphatase (PTP)-1B inhibitors, glycogen synthase kinase (GSK-3) inhibitors, retinoid X receptor (RXR) agonists.

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