Insulin icodec: evolution or revolution in diabetes therapy?

The isolation of insulin in 1922 was hailed as a miracle of medical science, life-saving for thousands and health-preserving for many more. 1 Efforts to develop longer-acting formulations, to allow for more sustained glycaemic control and improve treatment satisfaction, started in the 1930s with initially the development of protamine (NPH) and zinc (lente) insulins. 2 Subsequent decades saw the sequencing of the insulin molecule and a better understanding of its structure and action. 2 Further research led to the development of human and analogue insulins. These incremental advances allowed greater flexibility in insulin administration and the potential to tailor insulin regimens that more closely mimic normal physiology. Despite these developments, however, achieving sustained glycaemic control while avoiding hypoglycaemia and weight gain together with preserving quality of life and treatment satisfaction remains a considerable challenge. 3 The search for molecules with better pharmacodynamic profiles has therefore continued and has led to an expanding list of so-called designer insulins. One such formulation is insulin icodec, with a half-life of 196 h, suitable for once-weekly administration. 4 Its ultra-long-acting profile relates to a combination of lower affinity for the human insulin receptor and strong, but reversible, binding to human serum albumin.