This content material initially appeared on diaTribe. Republished with permission.
By April Hopcroft
The latest examine 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 offered an replace on the potential of once-weekly insulin icodec for the remedy of sort 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 sort 2 diabetes, this was the primary knowledge to be introduced from a large-scale section 3 examine in sort 1 diabetes.
The examine, ONWARDS 6, included 582 folks with sort 1 diabetes who obtained both insulin icodec or insulin degludec. Individuals had a mean age of 44 years and a mean diabetes length 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, members handled with once-weekly icodec and once-daily icodec had related reductions in A1C of -0.5%, suggesting that this new insulin could provide another choice for treating sort 1 diabetes.
What had been the important thing findings?
This examine confirmed that insulin icodec was efficient at decreasing A1C in folks with sort 1 diabetes, though icodec did result in greater charges of hypoglycemia in comparison with degludec.
- Common A1C values fell from 7.6% at first of the examine 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 decreasing A1C – discover the 2 practically equivalent strains within the graph beneath.
- Time in vary (70-180 mg/dL) and time above vary (greater than 180 mg/dL) had been related between the 2 teams at each the center and finish of the examine, as proven within the graphs beneath.
- 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 fee 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.
- Whole 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 folks with diabetes be involved concerning the greater charges of hypoglycemia with insulin icodec?
Whereas members on icodec had the next fee of hypoglycemia in comparison with these on degludec, Russell-Jones emphasised that these charges are “extremely low” total. For comparability, he stated that the charges of hypoglycemia ranged from 40 to 80 occasions for the unique medical trials for Tresiba (degludec).
Researchers are nonetheless investigating some questions associated to the hypoglycemia occasions that occurred on this trial, reminiscent of how the time of injection and train could 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 folks with sort 1 diabetes.
Decreasing the frequency of basal injections may dramatically scale back the burden of diabetes self-management – from 365 injections per yr to 52 injections per yr. With fewer injections, there’s a larger probability that folks with diabetes will take their basal insulin persistently. Taking insulin persistently has the potential to enhance medical outcomes, which may scale back the danger of issues like DKA.
Insulin icodec can be being investigated in a number of completely different trials in numerous subgroups of individuals with sort 2 diabetes. Earlier analysis has proven that icodec is simply as efficient at decreasing A1c as once-daily insulin in sort 2 diabetes, permitting folks to realize blood sugar targets with out experiencing extreme hypoglycemia.
Be taught extra about new insulins in growth right here:
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