Once-Weekly Insulin as effective as once-daily insulin in type 2 Diabetes: NEJM

It is quite often put to thought that decreased frequency of basal insulin injections might facilitate treatment acceptance and adherence among patients with type 2 diabetes. Insulin icodec is a basal insulin analog designed for once-weekly administration that is in development for the treatment of diabetes.

Hence, the authors conducted a 26-week, randomized, double-blind, double-dummy, phase 2 trial on a total of 247 participants who all were randomly assigned (1:1) to receive either icodec or glargine. The study aimed to investigate the efficacy and safety of once-weekly insulin icodec as compared with once-daily insulin glargine U100 in patients who had not previously received long-term insulin treatment and whose type 2 diabetes was inadequately controlled while taking metformin with or without a dipeptidyl peptidase 4 inhibitor.

The primary endpoint was the change in glycated hemoglobin level from baseline to week 26. Safety endpoints, including episodes of hypoglycemia and insulin-related adverse events, were also evaluated.

The authors observed the following results from the study-

8. a. Baseline characteristics were similar in the two groups; the mean baseline glycated hemoglobin level was 8.09% in the icodec group and 7.96% in the glargine group.
9. b.The estimated mean change from baseline in the glycated hemoglobin level was −1.33 percentage points in the icodec group and −1.15 percentage points in the glargine group, to estimated means of 6.69% and 6.87%, respectively, at week 26.
10. c.The estimated between-group difference in the change from baseline was −0.18 percentage points.
11. d.The observed rates of hypoglycemia with the severity of level 2 or level 3 was low.

The authors noted that there was no between-group difference in insulin-related key adverse events, and rates of hypersensitivity and injection-site reactions were low. Also, most of the adverse events were mild, and no serious events were deemed to be related to the trial medications, they added.

Therefore, they concluded that "once-weekly treatment with insulin icodec had glucose-lowering efficacy and a safety profile similar to those of once-daily insulin glargine U100 in patients with type 2 diabetes."