Once-weekly Insulin?

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Many diabetes patients have to take multiple daily injections of insulin, so the potential for reduced frequency of dosing provided by an ultra-long-acting insulin sounds like a very convenient innovation.

Insulin icodec, a Novo Nordisk product, is currently in development and has a half life of about 196 hours which would allow for once-weekly dosing. Icodec is an insulin analog (a modified insulin), with 3 substituted amino acids. These substitutions provide stability and protect against degradation by enzymes in the body. The addition of a long chain fatty acid to the molecule allows it to bind to albumin, a protein in the blood. Binding to albumin creates an insulin depot that steadily releases over the course of about 7 days, providing sustained insulin levels from a single injection.

A 26-week study of 247 patients compared safety and efficacy of icodec to insulin glargine (Lantus, Basaglar). Results showed similar glucose-lowering effects and comparable safety profiles.

For many patients, including those with Type 1 diabetes, mealtime (short acting) insulin injections will still be necessary, but the convenience of once weekly basal insulin dosing may be appealing.

My concern with an insulin that has such a prolonged duration of action is one of safety. Dosing errors with a medication like this may require a hospital stay to monitor blood sugar levels and prevent potentially fatal hypoglycemia. The potential for reduced food intake due to illness, that occurs several days after an injection could also lead to dangerously low blood sugar levels.

Further studies will need to address safety issues that can occur outside of clinical trials. Ultimately this medication may prove to be a good alternative for carefully selected patients.

For more info:

238-OR: Once-Weekly Basal Insulin Icodec Offers Comparable Efficacy and Safety vs. Once-Daily Insulin Glargine U100 in Insulin-Naïve Patients with T2D Inadequately Controlled on OADS | Diabetes (diabetesjournals.org)

Once-Weekly Insulin for Type 2 Diabetes without Previous Insulin Treatment | NEJM

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