Insulin therapy and its shortcomings - the need for new approaches.

After its discovery in 1921, insulin rapidly became established as a treatment for insulin-requiring diabetes mellitus (Type 1 and late-stage Type 2), providing effective symptom control and significant reductions in diabetes-associated mortality. However, within 30 years of insulin's discovery, physicians were faced with a new challenge - the treatment of the long-term complications of chronic hyperglycaemia. The Diabetes Control and Complications Trial provided clear evidence of the benefits of improved glycaemic control, but also highlighted the difficulties, such as an increased risk of hypoglycaemia, of attempting to achieve this using insulin as the only pharmacological agent. We now know that the pancreatic islet hormone, amylin, is also deficient in patients with Type 1 and late-stage Type 2 diabetes. It is possible that parallel replacement of both amylin and insulin may improve glycaemic control more smoothly in patients with diabetes, with less risk of hypoglycaemia, while still reducing the long-term sequelae of chronic hyperglycaemia.