Editors' ChoiceMetabolism

Weekly insulin dosing: Are we there yet?

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Science Translational Medicine  14 Oct 2020:
Vol. 12, Issue 565, eabe8127
DOI: 10.1126/scitranslmed.abe8127


Once-weekly insulin is as efficacious as daily insulin.

Type 2 diabetes mellitus is a growing epidemic that causes high morbidity, mortality, and disability due to complications. Diabetes is characterized by progressive loss of insulin secretion, with many people progressing to insulin therapy over the long term to achieve adequate glucose control. Insulin therapy is cumbersome and requires at least daily injections, which may result in poor compliance and clinical inertia. Therefore, longer-acting insulins that provide glycemic control with fewer injections are needed.

Insulin icodec is a novel insulin with a half-life of 196 hours that allows for once-weekly dosing. Rosenstock et al. conducted a non-inferiority Phase 2 double-blind study that randomized 247 people with uncontrolled type 2 diabetes to once-weekly icodec or once-daily glargine insulin. All study participants were treated for 26 weeks with insulin doses titrated according to fasting glucose levels. The primary outcome was the change in hemoglobin A1c (a measure of average glucose over 3 months) from baseline to 26 weeks. Hemoglobin A1c was reduced similarly in both groups with more glucose readings in the goal glycemic range for icodec compared to once-daily glargine. Glycemic control was achieved with lower doses of icodec than glargine. There were more hypoglycemic episodes in the icodec group (53.6%) compared to the glargine group (37.7%). However, severe hypoglycemic episodes or nocturnal hypoglycemic episodes did not differ between the groups.

Overall, the results from this study show that once-weekly insulin injections are as efficacious as current standard of care. Real world pragmatic studies assessing quality of life and feasibility of weekly insulin are still needed in people with type 1 diabetes and in people with a history of poor compliance with insulin therapy before icodec can be widely used.

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