What is the difference between Icodec (insulin icodec) and Glargine (insulin glargine) in diabetes management?

Insulin Icodec vs Glargine: Differences in Diabetes Management

Insulin icodec offers superior glycemic control compared to insulin glargine with the significant advantage of once-weekly versus daily administration, though with a slightly higher risk of hypoglycemia. 1

Key Differences Between Insulin Icodec and Insulin Glargine

Administration Schedule

• Insulin icodec is administered once weekly, reducing injection burden from 365 to 52 injections per year 2
• Insulin glargine requires daily administration (U100 or U300 formulations) 3

Efficacy

• Icodec demonstrated superior glycemic control compared to glargine U100 in insulin-naïve patients with type 2 diabetes:
  • Greater reduction in HbA1c (-1.55% vs -1.35%, p=0.02) 1
  • Higher time in range (71.9% vs 66.9%, p<0.001) 1
• When switching from daily basal insulin to icodec with a loading dose, time in range was significantly higher compared to glargine U100 (72.9% vs 65.0%) 4

Hypoglycemia Risk

• Icodec is associated with slightly higher rates of clinically significant hypoglycemia compared to glargine U100:
  • 0.30 vs 0.16 events per person-year in insulin-naïve patients 1
  • However, glargine U300 showed significantly lower rates of clinically significant hypoglycemia (<54 mg/dL) compared to glargine U100 (0% vs 6.0%, p=0.023) 3
• After triple doses (overdose scenario), the proportion of participants with severe hypoglycemia (PG ≤2.5 mmol/L) was lower with icodec than glargine U100 (2.6% vs 25.0%, p=0.03) 5

Pharmacokinetics

• Icodec reaches steady state after 2-3 weeks of treatment 6
• Icodec has a half-life of approximately one week, allowing for once-weekly dosing 2
• Glargine has a duration of action of approximately 24 hours, requiring daily dosing 3

Counterregulatory Response to Hypoglycemia

• Following triple doses, icodec elicits a greater counterregulatory hormone response than glargine U100:
  • Higher adrenaline response (2.54 times higher, p<0.001) 5
  • Higher cortisol response (1.64 times higher, p=0.01) 5
• This enhanced hormonal response may help patients recognize and respond to hypoglycemia more effectively 5

Clinical Applications and Recommendations

For Insulin-Naïve Patients with Type 2 Diabetes

• Icodec is a superior option compared to glargine U100 due to better glycemic control and convenience of once-weekly dosing 1
• Starting dose can be estimated based on body weight (0.1–0.2 units/kg/day equivalent) 3
• Monitor for hypoglycemia more carefully with icodec due to slightly higher risk 1

When Switching from Daily Basal Insulin

• Using a loading dose approach (doubling the first dose) when switching to icodec provides better glycemic control without increasing hypoglycemia risk 4
• No loading dose approach is also effective but results in slightly lower time in range 4

Special Populations

• In Japanese patients with type 1 diabetes, icodec showed effective glucose-lowering throughout the weekly dosing interval, supporting its use in different ethnic populations 6
• For patients with chronic kidney disease, insulin dose adjustments may be needed with either insulin, with careful monitoring for hypoglycemia 3

Practical Considerations

Advantages of Icodec

• Reduced injection burden may improve adherence and quality of life 2
• More consistent glucose control throughout the week 1
• Potentially better for patients with adherence issues to daily insulin regimens 2

Cautions with Icodec

• Longer duration of action means that dosage adjustments take longer to manifest 2
• Overdosing could potentially lead to prolonged hypoglycemia, though studies show comparable recovery times from hypoglycemia between icodec and glargine 5
• Higher rates of hypoglycemia, particularly in type 1 diabetes patients, require careful monitoring 2

Monitoring Recommendations

• More frequent blood glucose monitoring may be needed during initiation and dose adjustments of icodec 2
• Continuous glucose monitoring may be particularly beneficial for patients on icodec to detect patterns of glycemia throughout the weekly dosing interval 3

Conclusion

Insulin icodec represents a significant advancement in diabetes management, offering comparable or superior glycemic control to insulin glargine with the major advantage of once-weekly administration. While the risk of hypoglycemia is slightly higher with icodec, the convenience of weekly dosing may significantly improve treatment adherence and quality of life for many patients with diabetes.