INSULIN THERAPY AND ITS SHORTCOMINGS - THE NEED FOR NEW APPROACHES

After its discovery in 1921, insulin rapidly became established as a t reatment for insulin-requiring diabetes mellitus (Type 1 and late-stag e Type 2), providing effective symptom control and significant reducti ons in diabetes-associated mortality. However, within 30 years of insu lin's discovery, physicians were faced with a new challenge - the trea tment of the long-term complications of chronic hyperglycaemia. The Di abetes Control and Complications Trial provided clear evidence of the benefits of improved glycaemic control, but also highlighted the diffi culties, such as an increased risk of hypoglycaemia, of attempting to achieve this using insulin as the only pharmacological agent. We now k now that the pancreatic islet hormone, amylin, is also deficient in pa tients 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 hy poglycaemia, while still reducing the long-term sequelae of chronic hy perglycaemia. (C) 1997 by John Wiley & Sons, Ltd.