Could Formoterol be the New Glucagon?

Nearly 100 years ago, researchers discovered a new drug that changed diabetes care forever. Unfortunately, after the discovery of insulin, there hasn’t been that many other drug breakthroughs to report on in the last century. Scientists are now testing existing drugs to see if they might provide effective treatments for Type 1 diabetes. Recently, it was reported that scientists were testing the hypertension drug methyldopa to see if it could delay the onset of Type 1. Now, researchers have explored whether a common asthma medication might be the next treatment for hypoglycemia.

A study published in the journal Diabetes Care found that inhaled formoterol has the potential to help treat hypoglycemia in people with Type 1 diabetes. The study involved 14 participants, half of whom had Type 1 diabetes and half of whom did not. They were treated with either inhaled formoterol, which is traditionally used to treat asthma, or a placebo.

In a phone interview with Insulin Nation, lead researcher, Dr. Renata Belfort de Aguilar, a professor of endocrinology at Yale University School of Medicine, says that formoterol was observed in past clinical trials to stimulate data receptors in the brain, causing glucose levels to rise. This sparked the idea to test its preventative capabilities on hypoglycemia.

For the first part of the hypoglycemia study, 14 participants fasted overnight for 10 hours and then were given either formoterol or a placebo. Next, participants were given a hyperinsulinemic-hypoglycemic clamp, which helps measure insulin resistance in the body through intravenous (IV) methods. Blood-glucose levels were allowed to fall for an hour, with vital signs checked twice for safety. In those given formoterol, glucose infusion rates that kept blood-glucose in range dropped at a rate that was 45-50% slower than those given the placebo.

In a second part of the study, five participants with Type 1 were given formoterol to see if it could prevent insulin-induced hypoglycemia, while others were given a placebo. After they doubled the basal insulin infusion rate, with blood-glucose levels checked every five to 10 minutes, the researchers found that placebo patients fell down to about 58 mg/dL, well into hypoglycemic range; those given formoterol avoided hypoglycemia.

“We prevented hypoglycemia, which was more than we expected,” says Dr. Belfort de Aguilar.

This doesn’t mean formoterol will be replacing glucagon anytime soon. This study would be just the first step to proving the drug controlled hypoglycemia as well as glucagon. As she explains, the results of the study were positive, but the drug would need to be tested in larger studies and in real-world conditions. It would also need to be tested against glucagon in head-to-head trials. Still, Dr. Belfort de Aguilar believes the drug has potential, if she or other researchers could have the funding to prove it.

“I think it would perform well,” she says. “The issue is more time and cost.”

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Travis served as a staff writer for Insulin Nation and Type 2 Nation in 2015. Previously, he was a staff writer for Insight, a high school newspaper, as well as a copywriter for The Emersonian, Emerson's yearbook.

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