Introduction
Managing type 2 diabetes with insulin therapy presents challenges, particularly with daily injections. Recently, new clinical studies have emerged evaluating once-weekly insulin options that aim to reduce the burden of daily injections while maintaining effective blood sugar control. These innovative treatments, including once-weekly icodec (Awiqli, Novo Nordisk) and insulin efsitora alfa (efsitora, Eli Lilly), show promise in simplifying diabetes management for insulin-naive patients.
Both insulins are engineered for slow and sustained glucose control over seven days, targeting stable and long-lasting blood sugar levels. These innovations could alleviate the frequency of injections and reduce patient reluctance to initiate insulin therapy.
Current Regulatory Status
Icodec has been approved under the brand name Awiqli® in several regions, including the European Union, Canada, Australia, Japan, and Switzerland for both type 1 and type 2 diabetes. In China, it has been approved specifically for type 2 diabetes. Ongoing studies continue to evaluate its efficacy in other markets. Efsitora is still under investigation, with phase 3 trials ongoing, but it shows promising results in terms of safety and efficacy.
Trial Details
In a phase 3a trial for once-weekly icodec, participants were randomly assigned to either once-weekly icodec or once-daily degludec. After 26 weeks, both groups showed significant reductions in HbA1c levels. Icodec demonstrated a reduction from 8.6% to 7.0%, compared to degludec’s reduction from 8.5% to 7.2%. A small treatment difference of -0.2 percentage points confirmed the superiority of icodec over degludec. However, hypoglycemia rates were slightly higher with icodec.
Similarly, in a phase 3 trial for efsitora, 928 participants were assigned to either once-weekly efsitora or once-daily degludec. Both groups achieved substantial reductions in HbA1c levels at week 52, with efsitora reducing HbA1c by 1.26% and degludec by 1.17%. Efsitora was shown to be non-inferior to degludec, with an additional benefit of simplifying the injection burden for patients. Hypoglycemia events were comparable between the two treatments, with no severe hypoglycemia reported in the efsitora group.
Indication or Disease Details
Both icodec and efsitora target adult patients with diabetes who are insulin-naive or are transitioning from oral medications. These individuals often struggle with blood sugar control, and simplifying insulin administration could enhance adherence and treatment outcomes.
Conclusion
Once-weekly insulins such as icodec and efsitora represent a significant step forward in diabetes management. These treatments offer effective glucose control with a reduced injection frequency, which may improve patient adherence and outcomes. While the risks of hypoglycemia need to be carefully managed, the overall benefit of simplifying insulin therapy holds great promise for improving quality of life in patients with diabetes. Further studies and regulatory approvals will determine their place in the future of diabetes treatment.
Dr. Vinoth Khandelwal, PhD.
Sources
https://www.novonordisk.com/news-and-media/news-and-ir-materials/news-details.html?id=168532
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