Everyone has heard of Novo Nordisk. Europe’s largest company by market capitalisation and famed for Ozempic, WeGovy, Insulin and other diabetes related products.
Far fewer know about Zealand. But if you’re involved with Diabetes, you probably should. They’ve had a partnership with BetaBionics since 2016 to produce Dasiglucagon, the stable version of Glucagon that’s intended to work in a dual hormone Automated delivery system.
Note: all images in this article taken from December 2023 Company Presentation.
But they do so much more.
As the image above shows, while Zealand have done a lot of work with Dasiglucagon, they’re also heavily focused on peptides.
There’s a large block focused on some very interesting molecules, and if these are half as successful as the Lily and Novo GLP1 Receptor Agonists, they’re potentially on to something big. The phase 2 clinical trials for Servodutide suggested a 19% weight loss, for example…
From a type 1 perspective, however, I’m very interested in ZP8396. An Amylin analogue called Petrelintide.
Amylin analogues
Why are amylin analogues interesting? In type 1 they are one of the hormones missing when we lose beta cells and are responsible for slowing stomach emptying. They also appear to help in weight loss.
There is currently only one available, Pramlinatide, which has a license in the US, and pretty much nowhere else. It was approved in 2005, and is known as Symlin.
Clinical trials in type 1 suggest that its use reduced Hba1C by between 0.3 and 0.7 percentage points, and also reduced weight in both type 1 and type 2 diabetes.
One of the main benefits of use in type 1 is that by slowing stomach emptying, the rate of glucose increase can be mitigated, as most people with type 1 who don’t have complications have faster stomach emptying than non-t1ds.
Having an additional Amylin analogue with wider availability could be an interesting adjunct treatment for many people outside the US. It would also depend on the price, but just having it available outside the US would be a good start.
Will it be with us anytime soon?
I’m going to guess the answer to that is no. As the chart shows, it’s still in phase 1 trials, and is focused on Obesity, so whether Zealand will ever seek a license for Type 1 use is unclear.
Their website suggests that they see wider use options than just obesity, but gives nothing away, and their recent investor presentation focuses only on Glucagon for their type 1 portfolio, and not Petrelintide.
This is what they say about type 1:
But this appears to be how they intend to do it….
In summary, this looks like another potentially useful drug in type 1 that might never be licensed for it. And that would be a very sad state of affairs.
I guess the reason for this sad status is money related… so much more type2 to earn money with…trials are quite expensive and if you don’t expect big benefits you just go for the other side…
Thank you for such timely information in the diabetes world. What is missing is the neglected pillar of management of diabetes and that is diet. The Australian Diabetes Society, roughly equivalent to the ADA, has just released a Therapeutic Carbohydrate Restriction (TCR) guidelines for those with Type 2 Diabetes, but stating that for Type one diabetes TCR guidelines are ‘relatively contra-indicated’. The appearance of such guidelines is a monumental step in Australia. And there are, of course, many with T1D on such diets worldwide anyway – with which HBA1cs < 5.5% and bsl ranges 3.8 to 6.7 mmol/l are common so we in Australia, patients with lived experience of T1D including parents of children with diabetes in combination with enlightened clinicians will be pushing for similar guidelines, as appropriate for all diabetics. Whilst acknowledging that technology like cgms, insulin pumps, algorithms and looping are immensely important the low carb, particularly very low carb diets matters . And some of us unable to use insulin pumps and related technology can still manage near to complete non/diabetic level, too, Whether introducing amylin will help further will be interesting but unless testing the includes some participants on low and very low carb diets the research will be deficient.
Thanks so much for the post & the tantalising thoughts ahead. For CGM we need access to better insulin & the process of development is so frustrating. Llumjev is OKish for me at present but are any others close to release? Are the Insulins from Arecor Plc at Cambridge on your radar? They seem of interest & wondered on your thoughts & when we could get access.
I’m aware of the Arecor stuff. I spoke to one of their team at ATTD. Unfortunately I’ve not seen any evidence of them moving beyond the phase 1 trials in the US that were published earlier this year.