A paradigm shift in diabetes care: clinical implications of once-weekly insulin icodec

Diabetes mellitus is a metabolic disorder characterized by hyperglycemia, which occurs due to problems in insulin secretion, insulin action, or both, and remains a major global health burden. Insulin therapy is central to the management of type 1 diabetes and is frequently required in advanced type 2 diabetes, with conventional regimens involving multiple daily injections that may negatively impact adherence. Awiqli™ (insulin icodec-abae), a novel once-weekly basal insulin analog, has recently been approved to improve glycemic control in adults with type 2 diabetes. Its mechanism involves reversible albumin binding, forming a circulating depot that enables a prolonged half-life of approximately 1 week and provides stable glucose-lowering effects. Evidence from multiple randomized, treat-to-target clinical trials demonstrates that once-weekly insulin icodec achieves glycemic control comparable to, and in some cases superior to, once-daily basal insulin analogs such as insulin glargine and insulin degludec. The most commonly reported adverse effects include hypoglycemia, injection site reactions, and weight gain. The reduced injection frequency offers a significant advantage in improving treatment convenience and adherence; however, its prolonged duration of action necessitates cautious dose titration and limits flexibility during acute clinical changes. Overall, insulin icodec represents an important advancement in diabetes care, with the potential to simplify insulin regimens and improve patient-centered outcomes, although further studies are warranted to evaluate long-term safety and broader clinical applications.