New directions in drug development: mixtures, analogues, and modeling

Success in modern medical research is achieved when basic and clinical information about a given disorder converges, either intentionally or fortuitously, with the availability of technology or other means to design and apply interventions for the disorder in question. A prime example is the discovery of insulin and its replacement in patients with IDDM in 1923. Seven decades later, the focus of diabetes management is on improvement in metabolic control to forestall the chronic complications of the disease and improve the quality of life of patients with the disease. Metabolic control is being addressed through the development of insulin analogues using sophisticated techniques to understand the chemistry of insulin and to modify it using rDNA technology. The objective of these efforts is to simulate normal insulin secretion with subcutaneously injected agonists. Quality-of-life needs are being addressed with delivery devices, insulin mixtures, and insulin analogues. Although none of these improvements parallel the discovery of insulin, they do provide an optimistic outlook for patients with diabetes mellitus.