Once-weekly insulin icodec better than once-daily insulin glargine for patients with type 2 diabetes: ONWARDS 4 trial

The study revealed the following findings:

• At week 26, the estimated mean change in HbA1c was −1·16 percentage points in the icodec group (baseline 8·29%) and −1·18 percentage points in the glargine U100 group (baseline 8·31%), showing non-inferiority for icodec versus glargine U100 (estimated treatment difference 0·02 percentage points).
• 59% of participants in the icodec group and 57% in the glargine U100 group had an adverse event.
• Thirty-five serious adverse events were reported in 8% of participants in the icodec group, and 33 serious adverse events were reported in 9% of participants receiving glargine U100.
• Combined level 2 and level 3 hypoglycaemia rates were similar between treatment groups. No new safety concerns were identified for icodec.

Key strengths of this trial were:

• The use of masked continuous glucose monitoring.
• The inclusion of a large, diverse, and multinational population.
• The high trial completion rate.

Limitations include the open-label design and relatively short trial duration.

Reference:

Mathieu C, Ásbjörnsdóttir B, Bajaj HS, Lane W, Matos ALSA, Murthy S, Stachlewska K, Rosenstock J. Switching to once-weekly insulin icodec versus once-daily insulin glargine U100 in individuals with basal-bolus insulin-treated type 2 diabetes (ONWARDS 4): a phase 3a, randomised, open-label, multicentre, treat-to-target, non-inferiority trial. Lancet. 2023 May 5:S0140-6736(23)00520-2. doi: 10.1016/S0140-6736(23)00520-2. Epub ahead of print. PMID: 37156252.