Achieving Guideline Control with New Pharmacotherapies: Albumin-Binding by Acylation of Insulin and GLP-1

Over the last 15 years, it has become apparent that substantial reduction in the risk of microand macro-vascular complications follows from intensified treatment regimens in type 1 and 2 diabetes [1–3]. In simple terms, reducing HbA1c from 9% to 7% in patients with type 1 diabetes leads to an approximate halving of the risk of angiopathyrelated diabetic complications [1,2]. Unfortunately, the flipside of the coin is the high risk of hypoglycaemia and weight gain associated with bringing HbA1c below the target of 7%, which is now recommended [1,2,4]. Since it is well-established that glycaemic control deteriorates during oral anti-diabetic drug therapy [5], recent research at Novo Nordisk has focused heavily on improving the pharmacodynamic profile of insulin and GLP-1, two human hormones that are known to provide superior blood glucose control over extended treatment periods [4,6]. Specifically, research has aimed at discovering predictable, long-acting compounds while minimizing the risk of hypoglycaemia and weight increase that together represent the treatment-related complications that are the most feared by patients [7].