Once a week shot for diabetes
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Once-Weekly Injections for Diabetes Management
Introduction to Once-Weekly Diabetes Treatments
Managing type 2 diabetes often involves daily medication, which can be burdensome for patients. Recent advancements have introduced once-weekly injections, offering a more convenient alternative. This article explores the efficacy and safety of various once-weekly treatments for type 2 diabetes, including exenatide, insulin icodec, dulaglutide, and semaglutide.
Once-Weekly Exenatide for Youth and Adults
Efficacy in Youth
A study evaluated the efficacy of once-weekly exenatide in youth aged 10 to 18 years with type 2 diabetes. The results showed a significant reduction in glycated hemoglobin (HbA1c) levels by 0.36% compared to an increase of 0.49% in the placebo group over 24 weeks. The treatment was well tolerated, with adverse events occurring in 61% of the exenatide group compared to 73.9% in the placebo group1.
Cardiovascular Outcomes in Adults
In adults, once-weekly exenatide was assessed for its cardiovascular effects. The study found that exenatide was noninferior to placebo in terms of safety but did not significantly reduce major adverse cardiovascular events6. Another trial comparing once-weekly exenatide to insulin glargine showed superior glycemic control with exenatide, with a greater reduction in HbA1c levels and weight loss8.
Once-Weekly Insulin Icodec
A phase 2 trial investigated the efficacy and safety of once-weekly insulin icodec compared to daily insulin glargine in patients with type 2 diabetes. The study found that insulin icodec had a similar glucose-lowering effect to insulin glargine, with a mean HbA1c reduction of 1.33 percentage points compared to 1.15 percentage points for glargine. The safety profiles were comparable, with low rates of hypoglycemia and other adverse events2.
Once-Weekly Dulaglutide
Dulaglutide, a glucagon-like peptide-1 receptor agonist, was tested in youths with type 2 diabetes. The study demonstrated that dulaglutide significantly improved glycemic control, with a reduction in HbA1c levels by 0.6 to 0.9 percentage points compared to an increase in the placebo group. The treatment was well tolerated, although gastrointestinal adverse events were more common with dulaglutide3.
Once-Weekly Semaglutide
Transition from Basal Bolus Insulin
A trial explored the transition from multiple daily insulin injections to once-weekly semaglutide in patients with type 2 diabetes. The study found that semaglutide effectively maintained glycemic control, with a significant number of patients achieving an HbA1c level of 7.5% or lower. The treatment also resulted in weight loss and reduced daily insulin requirements7.
Add-On to SGLT-2 Inhibitors
Another study assessed the efficacy of semaglutide as an add-on to SGLT-2 inhibitors. The results showed that semaglutide significantly improved glycemic control and reduced body weight compared to placebo. The treatment was generally well tolerated, with gastrointestinal issues being the most common adverse events9.
Conclusion
Once-weekly injections for type 2 diabetes, including exenatide, insulin icodec, dulaglutide, and semaglutide, offer effective glycemic control with a favorable safety profile. These treatments provide a convenient alternative to daily injections, potentially improving adherence and quality of life for patients. Further research and long-term studies will help solidify their place in diabetes management.
Sources and full results
Most relevant research papers on this topic
Once-Weekly Exenatide in Youth With Type 2 Diabetes
Once-weekly exenatide effectively reduced glycated hemoglobin in youth with type 2 diabetes and was well-tolerated.
RCT
Rigorous JournalOnce-Weekly Insulin for Type 2 Diabetes without Previous Insulin Treatment.
Once-weekly insulin icodec has glucose-lowering efficacy and a safety profile similar to once-daily insulin glargine U100 in patients with type 2 diabetes without previous insulin treatment.
RCTRigorous Journal
Highly CitedOnce-Weekly Dulaglutide for the Treatment of Youths with Type 2 Diabetes.
Once-weekly dulaglutide treatment improves glycemic control in youths with type 2 diabetes, regardless of metformin or basal insulin use, without affecting BMI.
RCTRigorous Journal802-P: Safety, Pharmacokinetics, and Pharmacodynamics of Once-Weekly Basal Insulin Fc (BIF) in Japanese Patients with Type 2 Diabetes: A Phase 1 Open-Label, Randomized, Active-Controlled Trial
Once-weekly Basal Insulin Fc (BIF) is well-tolerated and associated with prolonged pharmacokinetics and improved glycemic control in Japanese patients with Type 2 diabetes.
RCT
Very Rigorous JournalEncapsulation of exenatide in poly-(D,L-lactide-co-glycolide) microspheres produced an investigational long-acting once-weekly formulation for type 2 diabetes.
Exenatide once-weekly (EQW) shows potential as a once-weekly glucose-lowering agent for type 2 diabetes, with a gradual approach to steady state and improved tolerability compared to other treatments.
Rigorous JournalHighly CitedEffects of Once‐Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes
Once-weekly exenatide is noninferior to placebo in safety but not superior to placebo in terms of cardiovascular outcomes in patients with type 2 diabetes.
RCT
Large Human TrialRigorous JournalHighly Cited74-LB: Transition from Basal Bolus to Once-Weekly Subcutaneous Semaglutide and Basal Insulin in Patients with Type 2 Diabetes Mellitus (TRANSITION-T2D)—A Prospective Randomized Controlled Trial
Once-weekly subcutaneous semaglutide can safely replace prandial insulin in patients with type 2 diabetes on a regimen of multiple daily injections, potentially improving diabetes treatment satisfaction.
RCTOnce weekly exenatide compared with insulin glargine titrated to target in patients with type 2 diabetes (DURATION-3): an open-label randomised trial
Once weekly exenatide provides better glycemic control and convenience for patients with type 2 diabetes compared to insulin glargine, offering a potential alternative treatment option.
RCTLarge Human TrialRigorous JournalHighly CitedSemaglutide once weekly as add-on to SGLT-2 inhibitor therapy in type 2 diabetes (SUSTAIN 9): a randomised, placebo-controlled trial.
Semaglutide once weekly as an add-on to SGLT-2 inhibitor therapy significantly improves HbA1c levels and bodyweight in patients with inadequately controlled type 2 diabetes.
RCTLarge Human TrialHighly CitedDURATION-5: exenatide once weekly resulted in greater improvements in glycemic control compared with exenatide twice daily in patients with type 2 diabetes.
Exenatide once weekly provides superior glycemic control and less nausea compared to exenatide twice daily in patients with type 2 diabetes.
RCTVery Rigorous JournalHighly Cited