Insulin: A new era for an old hormone

All forms of diabetes have been treatable since insulin became medically available in 1921. While insulin alone produces a substantial reduction in blood-glucose levels and is thus the mainstay of treating type-1 diabetes, today's peroral agents used in treating type-2 diabetes struggle to achieve satisfactory clinical results in the absence of endogenous or exogeneous insulin. Emerging evidence suggests that insulin may not only produce symptomatic effects; recent data suggest that insulin may stimulate β-cell recovery. In fact, short-term insulin therapy appears to result in long-term improvement in blood-glucose control, especially when administered in early stages of type-2 diabetes. During the last decade the pharmaceutical industry has largely failed to introduce new agents that can fundamentally improve the course of diabetes and the safety of artificial insulin analogs is undergoing thorough investigation. In contrast, new delivery approaches that present natural recombinant insulin to the enterohepatic circulation holds the promise of radically improving the treatment of type-2 diabetes.