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New Developments in Glucagon Treatment for Hypoglycemia

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Abstract

Glucagon is essential for endogenous glucose regulation along with the paired hormone, insulin. Unlike insulin, pharmaceutical use of glucagon has been limited due to the unstable nature of the peptide. Glucagon has the potential to address hypoglycemia as a major limiting factor in the treatment of diabetes, which remains very common in the type 1 and type 2 diabetes. Recent developments are poised to change this paradigm and expand the use of glucagon for people with diabetes. Glucagon emergency kits have major limitations for their use in treating severe hypoglycemia. A complicated reconstitution and injection process often results in incomplete or aborted administration. New preparations include intranasal glucagon with an easy-to-use and needle-free nasal applicator as well as two stable liquid formulations in pre-filled injection devices. These may ease the burden of severe hypoglycemia treatment. The liquid preparations may also have a role in the treatment of non-severe hypoglycemia. Despite potential benefits of expanded use of glucagon, undesirable side effects (nausea, vomiting), cost, and complexity of adding another medication may limit real-world use. Additionally, more long-term safety and outcome data are needed before widespread, frequent use of glucagon is recommended by providers.

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  1. Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, OR, USA

    LesleAnn Hayward Story & Leah M. Wilson

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LMW’s time to write this manuscript was supported by National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK129382-01) and the Oregon Health and Science University Wheels Up program.

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LHS has nothing to disclose. LMW participated in completion and publication of a study that was sponsored by Xeris Pharmaceuticals via subaward from JDRF. LMW has received research supplies from Dexcom.

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Story, L.H., Wilson, L.M. New Developments in Glucagon Treatment for Hypoglycemia. Drugs 82, 1179–1191 (2022). https://doi.org/10.1007/s40265-022-01754-8

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