If you’ve been following the ADA Scientific Sessions, you’ll have seen lots of big device announcements and AID information, but you may have missed this little gem.
Novo Nordisk announced on Monday that at the end of their phase 2 trial, the once weekly insulin, Icodec had performed AS WELL AS LANTUS in their 26 week trial with 247 people with Type 2 Diabetes.
So, what is insulin Icodec?
Well, it’s an investigational, long-acting basal insulin analogue with a half-life of 196 hours. Yes, that’s a half life of more than 8 days. It has also gone under the name IA287 in the past, and other trials (including one in people with Type 1) can be found with this name.
Once injected, insulin icodec binds strongly but reversibly to albumin, (a similar behaviour occurs in both Detemir and Degludec, but not to the same extent). This results in a continuous, slow and steady reduction of blood sugar over the week. The injection volume of once-weekly insulin icodec is equivalent to daily insulin glargine U100 due to the concentrated formulation that it uses.
It is intended for use amongst both type 1 and type 2 users.
And the trial?
It was a randomised, double-blind, double-dummy, treat-to-target trial of once-weekly insulin icodec compared with once-daily insulin glargine U100* involving 247 insulin-naïve adults with type 2 diabetes who were unable to maintain euglycaemic levels with metformin and/or DPP-4i. The primary endpoint was change in HbA1c from baseline to Week 26. Secondary endpoints included change in fasting plasma glucose from baseline to Week 26 and hypoglycaemic episodes.
The previous trial in people with type 1 diabetes
The results were remarkably impressive. The primary endpoint showed that the change from baseline to week 26 in HbA1c was similar in participants receiving once-weekly insulin icodec compared to once-daily insulin glargine U100 (-1.33% vs -1.15% points, respectively, p=0.08). Secondary endpoints included change in fasting plasma glucose (FPG) from baseline to week 26, which was similar for insulin icodec and insulin glargine U100 (-58mg/dL and -54mg/dL respectively), and the change from baseline to week 26 of the mean of the nine-point self-monitoring of blood glucose (SMBG) profile, which was greater for icodec (-7.9 mg/dL; p= 0.01).
Overall, for those with Type 2, this once per week background insulin appears to have worked really well.
Perhaps more importantly, there appears to be an ongoing trial with people with Type 1 which is due to complete later in June. Maybe that will be something we see at EASD later this year…
However you look at it, for many people, one basal shot per week can only be a good thing and will making living with any form of diabetes a much easier experience. Roll on the Type 1 trial data…