Icodec: A Novel Once-Weekly Basal Insulin for Diabetes Management

Abstract

Objective: To evaluate the efficacy, safety, and clinical implications of insulin icodec, a novel once-weekly basal insulin for the treatment of type 1 diabetes (T1D) and type 2 diabetes (T2D), with an emphasis on its advantages and challenges in comparison with existing daily basal insulins.

Data sources: A literature search was performed using PubMed, Google Scholar, Embase, and ClinicalTrials.gov up to August 26, 2024, using the search terms icodec and ONWARDS trial. Studies involving patients living with T1D or T2D on once-weekly insulin icodec compared with once-daily insulins glargine U100, glargine U300, and degludec were considered for this review.

Study selection and data extraction: Relevant English-language studies and those conducted in humans were considered.

Data synthesis: Insulin icodec offers reduced dosing frequency and potentially superior glycemic management with a safety profile comparable to existing basal insulins.

Relevance to patient care and clinical practice: Insulin icodec once-weekly dosing could significantly improve convenience and efficacy over daily basal insulins, representing a significant innovation in insulin therapy.

Conclusions: Insulin icodec emerges as a promising option for diabetes management, potentially improving treatment adherence and quality of life.

Keywords: diabetes mellitus; glycemic control; insulin; insulin icodec; long-acting; type 1; type 2.

Figure 1.

Flowchart of selection of articles.

Figure 2.

HbA1c percent change from baseline reported in ONWARDS trials. Abbreviations: app, application; degludec, insulin degludec; HbA1c, glycated hemoglobin; icodec, insulin icodec; glargine, insulin glargine; OD, once daily.^{-, a}The dosing guide application provided automated dose guidance for participants assigned to icodec. Dose recommendations were calculated by the cloud-based ICOBOT engine based on entered input from the participant’s app and a portal for healthcare professionals and were calculated based on a titration algorithm specific to icodec using 3 prebreakfast BGM values (measured 2 days before titration and on the scheduled dose day), injection data, and the response to the question of whether there was “any reason to reduce the dose,” which was posed to participants just before calculation of a new dose. ^bOD basal insulins: insulin degludec or insulin glargine U100/U300. ^cP value for noninferiority confirmed for icodec versus comparator basal insulin. ^dP value for superiority confirmed for icodec versus comparator basal insulin.

Figure 3.

Estimated rate of level 2 or 3 hypoglycemia in ONWARDS trials. Abbreviations: app, application; CI, confidence interval; degludec, insulin degludec; ERR, estimated rate ratio; icodec, insulin icodec; glargine, insulin glargine; NR, not reported; OD, once daily.^{-, a}The dosing guide application provided automated dose guidance for participants assigned to icodec. Dose recommendations were calculated by the cloud-based ICOBOT engine based on entered input from the participant’s app and a portal for healthcare professionals and were calculated based on a titration algorithm specific to icodec using 3 prebreakfast BGM values (measured 2 days before titration and on the scheduled dose day, injection data, and the response to the question of whether there was “any reason to reduce the dose,” which was posed to participants just before calculation of a new dose. ^bOD basal insulins: insulin degludec or insulin glargine U100/U300. ^cPYE, patient-year of exposure (1 PYE defined as 365.25 days).