Novel Preparations of Glucagon for the Prevention and Treatment of Hypoglycemia
Purpose of Review
New more stable formulations of glucagon have recently become available, and these provide an opportunity to expand the clinical roles of this hormone in the prevention and management of insulin-induced hypoglycemia. This is applicable in type 1 diabetes, hyperinsulinism, and alimentary hypoglycemia. The aim of this review is to describe these new formulations of glucagon and to provide an overview of current and future therapeutic opportunities that these may provide.
Four main categories of glucagon formulation have been studied: intranasal glucagon, biochaperone glucagon, dasiglucagon, and non-aqueous soluble glucagon. All four have demonstrated similar glycemic responses to standard glucagon formulations when administered during hypoglycemia. In addition, potential roles of these formulations in the management of congenital hyperinsulinism, alimentary hypoglycemia, and exercise-induced hypoglycemia in type 1 diabetes have been described.
As our experience with newer glucagon preparations increases, the role of glucagon is likely to expand beyond the emergency use that this medication has been limited to in the past. The innovations described in this review likely represent early examples of a pending large repertoire of indications for stable glucagon.
KeywordsGlucagon Hypoglycemia Diabetes Hyperinsulinism Alimentary Formulation
Type 1 diabetes
Hypoglycemia-associated autonomic failure
Michael R. Rickels is supported in part by Public Health Service Research Grant R01 DK091331. Diva D. De Leon is supported in part by Public Health Service Research Grants R01 DK056268 and R01 DK098517.
Compliance with Ethical Standards
Conflict of Interest
Colin P. Hawkes declares that he has no conflict of interest.
Diva D. De Leon reports grants from National Institute of Health, during the conduct of the study, grants and personal fees from Zealand Pharma A/S, grants and personal fees from Crinetics, personal fees from Soleno Therapeutics, non-financial support from Dexcom, personal fees from Novartis Pharmaceuticals, personal fees from NovoNordisk, personal fees from Xoma Corporation, personal fees from ProSciento, other from Merck, outside the submitted work.
Michael R. Rickels reports grants from National Institutes of Health, during the conduct of the study, grants and personal fees from Xeris Pharmaceuticals and personal fees from Hua Medicine, outside the submitted work.
Human and Animal Rights and Informed Consent
All procedures performed in studies conducted by the authors involving human participants were in accordance with the ethical standards of the University of Pennsylvania or Children’s Hospital of Philadelphia Institutional Review Boards and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Papers of particular interest, published recently, have been highlighted as: • Of importance
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