This content material initially appeared on diaTribe. Republished with permission.
By April Hopcroft
The most recent research of once-weekly insulins confirmed that insulin icodec led to related reductions in A1C and related time in vary in comparison with once-daily Tresiba (degludec).
On the 2023 European Affiliation for the Examine of Diabetes (EASD) convention, researchers supplied an replace on the potential of once-weekly insulin icodec for the remedy of kind 1 diabetes.
Dr. David Russell-Jones (College of Surrey, UK) introduced knowledge from a trial investigating the efficacy and security of once-weekly insulin icodec in comparison with once-daily insulin degludec (Tresiba). Whereas a number of different research have investigated once-weekly insulins in kind 2 diabetes, this was the primary knowledge to be introduced from a large-scale section 3 research in kind 1 diabetes.
The research, ONWARDS 6, included 582 individuals with kind 1 diabetes who obtained both insulin icodec or insulin degludec. Members had a mean age of 44 years and a mean diabetes period of 20 years. Each the icodec and degludec group obtained basal insulin together with mealtime insulin (insulin aspart, or NovoLog) over a interval of 57 weeks.
Total, individuals handled with once-weekly icodec and once-daily icodec had related reductions in A1C of -0.5%, suggesting that this new insulin might provide another choice for treating kind 1 diabetes.
What have been the important thing findings?
This research confirmed that insulin icodec was efficient at lowering A1C in individuals with kind 1 diabetes, though icodec did result in greater charges of hypoglycemia in comparison with degludec.
- Common A1C values fell from 7.6% in the beginning of the research to 7.1% at week 26 in each the icodec and degludec teams, a distinction of -0.5%. These outcomes display that insulin icodec is comparable (or “non-inferior”) to insulin degludec at lowering A1C – discover the 2 almost similar traces within the graph under.
- Time in vary (70-180 mg/dL) and time above vary (greater than 180 mg/dL) have been related between the 2 teams at each the center and finish of the research, as proven within the graphs under.
- Hypoglycemia outlined as lower than 54 mg/dL with CGM was considerably greater within the icodec group in comparison with the degludec group. Extreme hypoglycemia is outlined as an hypoglycemic occasion requiring help of one other particular person. The general price of mixed occasions of lower than 54 mg/dL and extreme hypoglycemia was greater within the icodec group with 20 occasions per patient-year of remedy vs. 10 occasions per patient-year of remedy for degludec.
- Complete weekly insulin dose was related within the icodec and degludec teams. Nevertheless, the common weekly basal dose was considerably greater for icodec at 170 models per week (~24 models per day) vs. degludec at 151 models per week (~22 models per day). In the meantime, the common weekly bolus dose was decrease for icodec at 132 models per week (~19 models per day) in comparison with 161 models per week (~23 models per day) for degludec.
Ought to individuals with diabetes be involved in regards to the greater charges of hypoglycemia with insulin icodec?
Whereas individuals on icodec had a better price of hypoglycemia in comparison with these on degludec, Russell-Jones emphasised that these charges are “extremely low” total. For comparability, he mentioned that the charges of hypoglycemia ranged from 40 to 80 occasions for the unique scientific trials for Tresiba (degludec).
Researchers are nonetheless investigating some questions associated to the hypoglycemia occasions that occurred on this trial, akin to how the time of injection and train might have an effect on hypoglycemia.
What are the potential advantages of once-weekly insulins?
These outcomes construct on preliminary knowledge from June 2022, suggesting that once-weekly insulins could also be protected and efficient in individuals with kind 1 diabetes.
Decreasing the frequency of basal injections may dramatically scale back the burden of diabetes self-management – from 365 injections per 12 months to 52 injections per 12 months. With fewer injections, there’s a better likelihood that folks with diabetes will take their basal insulin persistently. Taking insulin persistently has the potential to enhance scientific outcomes, which may scale back the chance of problems like DKA.
Insulin icodec can also be being investigated in a number of completely different trials in several subgroups of individuals with kind 2 diabetes. Earlier analysis has proven that icodec is simply as efficient at lowering A1c as once-daily insulin in kind 2 diabetes, permitting individuals to attain blood sugar targets with out experiencing extreme hypoglycemia.