Weekly diabetes injection
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Weekly Diabetes Injection: Efficacy and Safety
Introduction to Weekly Diabetes Injections
Managing diabetes often requires frequent medication, which can be burdensome for patients. Recent advancements have introduced once-weekly injections, aiming to improve adherence and quality of life. This article synthesizes research on various once-weekly diabetes treatments, focusing on their efficacy and safety.
Insulin Icodec: A Promising Once-Weekly Basal Insulin
Efficacy of Insulin Icodec
Insulin icodec, a novel basal insulin analogue, has shown promising results in managing type 2 diabetes. In a 26-week trial, insulin icodec demonstrated a significant reduction in glycated hemoglobin (HbA1c) levels, comparable to once-daily insulin glargine U100. The mean change in HbA1c was -1.33 percentage points for icodec, slightly better than the -1.15 percentage points for glargine1. Another study confirmed these findings, highlighting the consistent glucose-lowering effect of insulin icodec over a weekly dosing interval6.
Safety Profile of Insulin Icodec
The safety profile of insulin icodec is similar to that of daily insulin treatments. Hypoglycemia rates were low and comparable between icodec and glargine groups, with no significant differences in adverse events1 6. This suggests that insulin icodec is a safe alternative for patients requiring basal insulin therapy.
Once-Weekly GLP-1 Receptor Agonists
Exenatide and Dulaglutide for Youth and Adults
Exenatide and dulaglutide, both GLP-1 receptor agonists, have been evaluated for their efficacy and safety in both youth and adults with type 2 diabetes. In a study involving youths, once-weekly exenatide significantly reduced HbA1c levels by -0.36% compared to a +0.49% increase in the placebo group2. Similarly, dulaglutide showed a reduction in HbA1c levels by -0.6% and -0.9% for the 0.75 mg and 1.5 mg doses, respectively, compared to a 0.6% increase in the placebo group5.
Safety and Tolerability
Both exenatide and dulaglutide were well-tolerated, with gastrointestinal issues being the most common adverse events. These side effects were more frequent with dulaglutide but were consistent with those observed in adults2 5. The overall safety profiles of these medications make them viable options for managing type 2 diabetes in both youth and adults.
Semaglutide: Transitioning from Multiple Daily Injections
Efficacy of Semaglutide
Semaglutide, another GLP-1 receptor agonist, has been studied for its potential to replace multiple daily insulin injections. In a trial, patients transitioning from a basal-bolus regimen to once-weekly semaglutide maintained HbA1c levels ≤ 7.5% over 26 weeks3. Another study confirmed semaglutide's efficacy, showing significant reductions in HbA1c and body weight compared to placebo8.
Safety and Hypoglycemia
The safety profile of semaglutide is comparable to other GLP-1 receptor agonists, with gastrointestinal issues being the most common adverse events. Importantly, semaglutide was associated with fewer hypoglycemic events compared to traditional insulin regimens3 8.
Basal Insulin Fc (BIF): A Novel Approach
Efficacy and Safety of BIF
Basal Insulin Fc (BIF) is a fusion protein designed for once-weekly administration. In a phase 2 study, BIF demonstrated noninferior glycemic control compared to daily insulin degludec, with similar rates of hypoglycemia and other adverse events4. Another study in Japanese patients with type 2 diabetes confirmed these findings, showing prolonged pharmacokinetics and improved glycemic control with BIF7.
Conclusion
Once-weekly diabetes injections, including insulin icodec, exenatide, dulaglutide, semaglutide, and BIF, offer effective and safe alternatives to daily injections. These treatments have shown significant improvements in glycemic control and patient adherence, with manageable safety profiles. As research continues, these options may become standard practice, simplifying diabetes management and improving patient outcomes.
Sources and full results
Most relevant research papers on this topic
Once-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.
RCT
Rigorous Journal
Highly CitedOnce-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.
RCTRigorous Journal74-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.
RCTNovel Once-Weekly Basal Insulin Fc Achieved Similar Glycemic Control With a Safety Profile Comparable to Insulin Degludec in Patients With Type 1 Diabetes
Once-weekly BIF demonstrated noninferior glycemic control to once-daily degludec with no difference in hypoglycemia or other safety findings in patients with type 1 diabetes.
RCTOnce-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 Journal237-OR: Insulin Icodec: An Insulin Analog Suited for Once-Weekly Dosing in Type 2 Diabetes
Insulin icodec is a safe and well-tolerated once-weekly insulin analog for type 2 diabetes, with pharmacokinetics and pharmacodynamics supporting once-weekly administration at clinically relevant dose levels.
RCT
Very Rigorous 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.
RCTVery Rigorous JournalEfficacy and safety of once-weekly semaglutide monotherapy versus placebo in patients with type 2 diabetes (SUSTAIN 1): a double-blind, randomised, placebo-controlled, parallel-group, multinational, multicentre phase 3a trial.
Once-weekly semaglutide monotherapy effectively improves glycemic control in treatment-naive patients with type 2 diabetes, but may cause gastrointestinal adverse events.
RCT
Large Human TrialHighly CitedImpact of a Weekly Glucagon-Like Peptide 1 Receptor Agonist, Albiglutide, on Glycemic Control and on Reducing Prandial Insulin Use in Type 2 Diabetes Inadequately Controlled on Multiple Insulin Therapy: A Randomized Trial
Albiglutide effectively replaces prandial insulin in 54% of type 2 diabetes patients, improving glycemic control and reducing injection frequency.
RCTLarge Human TrialRigorous JournalExenatide once weekly versus insulin glargine for type 2 diabetes (DURATION-3): 3-year results of an open-label randomised trial.
Exenatide once weekly is more effective than insulin glargine for improving HbA1c levels in type 2 diabetes patients, with more frequent gastrointestinal adverse events.
RCTLarge Human TrialHighly Cited