If people were offered the choice between stabbing themselves with a needle and swallowing a pill, they would probably choose the latter. Unfortunately, this offer is not currently available to people with Type 1 diabetes, who have to receive multiple insulin injections daily. Research has long been underway to provide oral insulin. However, complex protein compounds cannot be taken orally as they break them down into simpler proteins when they come into contact with stomach acids, thus rendering them ineffective.

Research hubs are focusing on developing less intrusive ways to deliver insulin. Most research is taking place in the United States, followed by China and Japan. The key players are as follows:

  • Novo Nordisk;
  • Emisphere Technologies;
  • Sanofi; and
  • Hefei Huafang Pharmaceutical Sciences & Technology.

Some advances have been made. Researchers at the the Massachusetts Institute of Technology have developed a pill that can be taken orally. It contains a small needle made of compressed insulin, which is attached to a spring that is held in place by a disk of sugar. When water in the stomach dissolves the sugar, the spring is released and the insulin needle pierces the stomach wall. Another team of specialists from the Harvard John A Paulson School of Engineering and Applied Sciences in Cambridge, Massachusetts, has taken a different approach and has developed a pill with a complex coating, which shields the insulin from gastric acid and digestive enzymes. Insulin is inserted in an ionic liquid that contains choline and geranic acid, which is covered in an enteric coating that is resistant to gastric acid. Choline and geranic acid pierce both the mucus that lines the small intestine and the intestine cellular wall itself. Both of these pills are being tested on animals, although it could take years before they are readily available on the market.

According to the American Diabetes Association, nearly 1.25 million people have Type 1 diabetes and nearly 40,000 are diagnosed with it each year in United States alone. Although Type 1 diabetes accounts for 5% of total diagnosed cases only, these cases are increasing significantly worldwide.

Although innovation hubs for this technology are primarily based in the United States, China and Japan, this technology will find a market in other countries, including India, which is in the top 10 countries with people under 20 who have been diagnosed with Type 1 diabetes, according to the International Diabetes Federation.

The global injection pen market was valued at nearly $30 billion in 2017, with this market expected to grow significantly. These new pills could take over a large part of this market as they are more patient-friendly. It will be interesting to see further development in this field.

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