Once‑weekly insulins: a promising approach to reduce the treatment burden in people with diabetes – published online 29/04/2024

Roberto Trevisan, Matteo Conti, Stefano Ciardullo

Basal insulin represents a safe and effective therapeutic option for people with diabetes. One of the barriers to insulin therapy in clinical practice is related to perceived treatment complexity, in part due to the need for daily administration. Currently, novel basal insulin molecules administered once weekly (insulin icodec and basal insulin Fc [insulin efsitora alpha]) are being studied for the treatment of both type 1 and type 2 diabetes. In this issue, Trevisan et al (https://doi.org/10.1007/s00125-024-06158-9) summarise the available evidence from RCTs on once-weekly insulins. The authors highlight that the efficacy of once-weekly insulins in terms of blood glucose levels is similar to or slightly better than that achieved with once-daily analogues. Moreover, they have a good safety profile in people with type 2 diabetes, with a similar risk of hypoglycaemia to that seen with daily insulins and no data suggesting a longer time to recovery during hypoglycaemic events. In contrast, hypoglycaemic risk may be increased in type 1 diabetes. The authors conclude that once-weekly insulin analogues may represent a promising therapeutic approach to increase adherence and improve glycaemic management in real-world clinical practice. The figures from this review are available as a downloadable slideset.