This content originally appeared on diaTribe. Republished with permission.
By April Hopcroft
The most recent study of once-weekly insulins showed that insulin icodec led to similar reductions in A1C and similar time in range in comparison with once-daily Tresiba (degludec).
On the 2023 European Association for the Study of Diabetes (EASD) conference, researchers provided an update on the potential of once-weekly insulin icodec for the treatment of type 1 diabetes.
Dr. David Russell-Jones (University of Surrey, UK) presented data from a trial investigating the efficacy and safety of once-weekly insulin icodec in comparison with once-daily insulin degludec (Tresiba). While several other studies have investigated once-weekly insulins in type 2 diabetes, this was the primary data to be presented from a large-scale phase 3 study in type 1 diabetes.
The study, ONWARDS 6, included 582 individuals with type 1 diabetes who received either insulin icodec or insulin degludec. Participants had a median age of 44 years and a median diabetes duration of 20 years. Each the icodec and degludec group received basal insulin together with mealtime insulin (insulin aspart, or NovoLog) over a period of 57 weeks.
Overall, participants treated with once-weekly icodec and once-daily icodec had similar reductions in A1C of -0.5%, suggesting that this latest insulin may offer another choice for treating type 1 diabetes.
What were the important thing findings?
This study showed that insulin icodec was effective at reducing A1C in individuals with type 1 diabetes, although icodec did result in higher rates of hypoglycemia in comparison with degludec.
- Average A1C values fell from 7.6% initially of the study to 7.1% at week 26 in each the icodec and degludec groups, a difference of -0.5%. These results exhibit that insulin icodec is comparable (or “non-inferior”) to insulin degludec at reducing A1C – notice the 2 nearly an identical lines within the graph below.
- Time in range (70-180 mg/dL) and time above range (greater than 180 mg/dL) were similar between the 2 groups at each the center and end of the study, as shown within the graphs below.
- Hypoglycemia defined as lower than 54 mg/dL with CGM was significantly higher within the icodec group in comparison with the degludec group. Severe hypoglycemia is defined as an hypoglycemic event requiring assistance of one other person. The general rate of combined events of lower than 54 mg/dL and severe hypoglycemia was higher within the icodec group with 20 events per patient-year of treatment vs. 10 events per patient-year of treatment for degludec.
- Total weekly insulin dose was similar within the icodec and degludec groups. Nonetheless, the typical weekly basal dose was significantly higher for icodec at 170 units per week (~24 units per day) vs. degludec at 151 units per week (~22 units per day). Meanwhile, the typical weekly bolus dose was lower for icodec at 132 units per week (~19 units per day) in comparison with 161 units per week (~23 units per day) for degludec.
Should individuals with diabetes be concerned concerning the higher rates of hypoglycemia with insulin icodec?
While participants on icodec had the next rate of hypoglycemia in comparison with those on degludec, Russell-Jones emphasized that these rates are “incredibly low” overall. For comparison, he said that the rates of hypoglycemia ranged from 40 to 80 events for the unique clinical trials for Tresiba (degludec).
Researchers are still investigating some questions related to the hypoglycemia events that occurred on this trial, equivalent to how the time of injection and exercise may affect hypoglycemia.
What are the potential advantages of once-weekly insulins?
These results construct on preliminary data from June 2022, suggesting that once-weekly insulins could also be secure and effective in individuals with type 1 diabetes.
Reducing the frequency of basal injections could dramatically reduce the burden of diabetes self-management – from 365 injections per yr to 52 injections per yr. With fewer injections, there’s a greater likelihood that folks with diabetes will take their basal insulin consistently. Taking insulin consistently has the potential to improve clinical outcomes, which could reduce the danger of complications like DKA.
Insulin icodec can also be being investigated in several different trials in numerous subgroups of individuals with type 2 diabetes. Previous research has shown that icodec is just as effective at reducing A1c as once-daily insulin in type 2 diabetes, allowing people to attain blood sugar targets without experiencing severe hypoglycemia.
Learn more about latest insulins in development here: