Type 1 diabetes

Will glucagon kits be superseded by autoinjectors?

Patients with diabetes and their carers shouldn’t have to waste time reconstituting glucagon and drawing up a dose under the pressure of a severe hypoglycaemic event.

The 2018 ADA Scientific Sessions was told a glucagon autoinjector, similar to an Epipen, could replace the glucagon kit and reduce associated fears or risks of administration failure.

Dr Mark Christiansen, from Diablo Clinical Research, said a ready-to-use stable liquid glucagon autoinjector was comparable in efficacy to the current glucagon products on the market.

In a phase 3 randomised controlled trial of 80 people with type 1 diabetes, the new autoinjector was compared to the current glucagon kit for the management of insulin-induced hypoglycaemia.

All rescues were successful in both groups and the time course to resolution of symptoms was similar. Symptoms began to ease within five minutes , autonomic symptoms resolved in 15.4 minutes with the autoinjector compared to 14.2 minutes with the glucagon kit.

Neuroglycopenic symptoms resolved in 16.3 minutes with the autoinjector versus 13.9 minutes with the kit.

The incidence of adverse effects, most commonly nausea, was similar with both rescue treatments.

Dr Christiansen told the meeting the new product was stable at room temperature for about two years.

Given most hypoglycaemic events occurred at home, the safety and convenience of the autoinjector for untrained users was compelling.

“I think hopefully products like this will improve the ability to save people from hypoglycaemia in a more effective way.”

“When given correctly, currently available preparations work. The problem is if you’re a parent or a caregiver – ‘where the heck is the glucagon and how do I do this?’

“All of us have stories about someone ending up injecting saline before they realised. It’s a problem and the hope for this prepared formulation is to make glucagon more readily available and used appropriately.”

A French phase 1 study of a similar stable liquid formulation was also presented at the meeting.

It was also found to be safe and well tolerated and led to rapid and marked increases in plasma glucose levels comparable to the glucagon kit.

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