Once-weekly Insulin Icodec as Compared to Once-daily Basal Insulins: A Meta-analysis

Background: Once -weekly basal insulin icodec has been tested in clinical trials for efficacy and safety over currently available glargine-10 0 and degludec in different clinical settings for type 2 diabetes. We performed this meta -analysis to evaluate its overall safety and efficacy as compared to glargine10 0 and degludec (nonicodec), from all available randomized controlled trials. Methods: Seven trials comparing once -daily basal insulin analogs to once -weekly basal insulin icodec were included. Based on available information, outcomes in terms of HbA1c, fasting plasma glucose reduction, and increase in time in range (TIR) were compared. Side -effects were compared for overall hypoglycemia, severe hypoglycemia, and weight gain. The pooled effect size for continuously distributed data was measured as a reduction in "estimated differences in mean (with 95% CI)." For categorical data, the pooled effect size was measured as the Mantel-Haenszel risk ratio (with 95% CI). Results: Analyzing against the nonicodec comparators together, the "estimated mean changes" in HbA1c and fasting plasma glucose favoring icodec were -0.22% (-0.35, -0.10) and -1.59 mg% (-9.26, 6.08) respectively. The "estimated mean increment" in weight for icodec was 0.64 kg (0.61, 0.67). The "estimated mean percentage" increment in TIR for icodec was 4.24% (2.99, 5.49). The Mantel-Haenszel risk ratios for all hypoglycemic events and severe hypoglycemia for icodec were 1.24 (1.02, 1.50) (P = .03) and 0.81 (0.31, 2.08) (P is not significant), respectively, suggesting a 24% increased incidence of all hypoglycemia with icodec. Conclusion: Once -weekly basal insulin icodec as compared to once -daily basal insulin analogs had a slight increase in the risk of overall hypoglycemia and weight gain, without any difference in severe hypoglycemia, with similar glycemic control (in terms of fasting plasma glucose, HbA1c, and TIR). (c) 2023 AACE. Published by Elsevier Inc. All rights reserved.