An Investigational Once-Weekly Basal Insulin: More Data

Insulin degludec is the longest-acting insulin currently available in the U.S. (elimination half-life, ≈25 hours; once-daily dosing). Insulin icodec, which is not yet FDA-approved, is considered “ultra long–acting,” with a 1-week half-life and once-weekly dosing (NEJM JW Gen Med Nov 15 2020 and N Engl J Med 2020; 383:2107). In these two industry-sponsored studies, researchers compared insulin icodec and insulin glargine.

In one trial, 154 patients with type 2 diabetes (mean glycosylated hemoglobin [HbA_1c], 7.9%) who had been using daily basal insulin were randomized to daily glargine, weekly icodec initiated with a loading dose, or weekly icodec without a loading dose; doses were titrated to achieve fasting glucose between 80 mg/dL and 130 m…