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Once-Weekly Insulin Icodec in Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
Giuseppe Lisco1, Anna De Tullio1, Vincenzo De Geronimo2
1Interdisciplinary Department of Medicine, School of Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy.
Biomedicines
|August 29, 2024
Summary
Insulin Icodec, a new once-weekly basal analog, shows comparable efficacy to once-daily insulins for type 1 and type 2 diabetes. It offers a slightly improved chance of achieving glycemic control without increasing hypoglycemia risk, though weight gain is a consideration.
Area of Science:
- Endocrinology
- Pharmacology
- Metabolic Diseases
Background:
- The 100th anniversary of insulin discovery marks significant advancements in diabetes mellitus management.
- Novel molecules have improved glucose control, simplified regimens, and enhanced quality of life.
- The recent approval of once-weekly insulin Icodec has generated high expectations for diabetes treatment.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy and safety of insulin Icodec.
- To compare Icodec with once-daily insulin analogs in patients with type 1 and type 2 diabetes.
Main Methods:
- A systematic search of PubMed/MEDLINE, Cochrane Library, and ClinicalTrials.gov for randomized clinical trials (RCTs).
- Inclusion criteria: uncontrolled T1D or T2D, age ≥ 18 years, Icodec vs. once-daily basal analogs (Degludec, Glargine, Detemir), phase 3, multicenter, ≥ 24 weeks duration.
- Meta-analysis of data from 4347 patients (2172 on Icodec, 2175 on once-daily basal analogs).
Main Results:
- Insulin Icodec demonstrated a slight reduction in HbA1c (ETD -0.14%) compared to once-daily analogs, with a greater probability of achieving HbA1c < 7% without hypoglycemia.
- No significant differences were observed in fasting glucose, time in range, or time above range.
- A slight weight gain (0.62 kg) was noted with Icodec; risks of hypoglycemia and adverse events were similar. Icodec performed better in basal-only regimens.
Conclusions:
- Insulin Icodec is non-inferior to once-daily basal analogs in type 2 diabetes.
- Basal-only Icodec regimens showed improved glycemic control and reduced hyperglycemia compared to basal-bolus.
- Patient education and appropriate therapy adjustments are crucial to mitigate risks like weight gain and hypoglycemia.
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