Once-Weekly Insulin Better Than Daily in Type 2 Diabetes

Drishti Agarwal

TOPLINE:
Once-weekly insulin icodec shows a higher glycated A1c reduction than once-daily basal insulin analogs in patients with type 2 diabetes (T2D), without major safety concerns.

METHODOLOGY:
A meta-analysis of five phase 3 ONWARDS randomized controlled trials included 3764 patients with T2D.
The trials compared the effects of the weekly insulin icodec with those of the daily basal insulin analogs glargine and degludec over 26-78 months.
The primary outcome was the change in A1c levels.
Secondary outcomes included fasting plasma glucose levels, A1c levels < 7%, time in target glycemic range, body weight changes, insulin dose, hypoglycemia events, and adverse events.
TAKEAWAY:
Once-weekly insulin icodec demonstrated a greater reduction in A1c levels than conventional insulin analogs overall (mean difference, −0.17%; P = .003).
A1c levels < 7% were observed in a higher percentage of patients in the insulin icodec group than in the comparator group (odds ratio, 1.51; P = .004).
In subgroup analyses, insulin icodec was superior to insulin degludec by several measures but comparatively similar to glargine.
Insulin icodec was associated with no major safety concerns and had a higher level incidence of level 1 hypoglycemia, but no significant difference was seen for hypoglycemia incidence in levels 2, 3, and combined 2/3 compared with glargine.
IN PRACTICE:
“Sustained glycemic control with once-weekly injections of insulin icodec would lead to better patient acceptance and treatment satisfaction,” the authors wrote.

SOURCE:
This study, authored by Sahana Shetty, MD, and Renuka Suvarna, MSc, Manipal Academy of Higher Education, Department of Endocrinology, Kasturba Medical College, Manipal, Karnataka, was published online on January 8, 2024, in Diabetes, Obesity and Metabolism.

LIMITATIONS:
The comparator group included individuals who used different basal insulin analogs. This heterogeneity in the comparator group introduced a potential source of variability, making it challenging to isolate the specific effects of insulin icodec compared with a standardized comparator. Blinding or masking of participants was performed in only one of the five trials.

DISCLOSURES:
The authors declared no conflicts of interest. All five clinical trials in the meta-analysis were sponsored by Novo Nordisk.