Weekly insulin injections for diabetes management

Comparing weekly and daily insulin in type 1 diabetes (ONWARDS 6).


A once-weekly insulin injection called insulin codec, studied by the University of Surrey might be just as effective as daily insulin injections in treating type 1 diabetes.

In a year-long phase 3 clinical trial conducted across 12 countries and 99 sites, researchers led by Professor David Russell-Jones tested the safety and effectiveness of weekly insulin icodec compared to daily insulin degludec for adults with type 1 diabetes. Both groups also used short-acting insulin for meals. This research could transform diabetes care for millions of people.

Professor David Russell-Jones, Professor of Diabetes and Endocrinology at the University of Surrey and a Consultant at the Royal Surrey Foundation Trust, said:

“Many people find managing a long-term condition such as diabetes complicated and report missing vital insulin injections. Missed injections can affect glycaemic control, and a lack of consistency in the treatment has been linked to increased rates of diabetic ketoacidosis, a serious complication of the condition that can be life-threatening. Reducing insulin injection frequency could lessen the treatment burden for some people with the condition and improve their glycaemic control.”

Type 1 diabetes happens when the body can’t make enough insulin, which leads to high blood sugar levels and raises the risk of heart, eye, and kidney problems. To test the effectiveness of codec, researchers enrolled 582 people with type 1 diabetes. They split them into two groups: one got weekly Icodec injections, and the other got daily Degludec injections with short-acting insulin for meals.

After 26 weeks, they found that HbA1C levels (a marker for diabetes control) dropped in both groups, with codec showing noninferiority to degludec, meaning it worked as well but with fewer injections. However, the icodec group experienced more episodes of low blood sugar (hypoglycemia), which were generally mild and manageable. Icodec also sometimes fell below recommended targets in terms of low blood sugar.

Professor Russell-Jones said, “What we have found is that once-weekly icodec injections showed noninferiority to once-daily injections of degludec in reducing HbA1C after 26 weeks. Although there is a slightly higher rate of hypoglycemia under this regime, this could be easily managed. We’ve concluded that this new insulin may have a role in reducing the burden of daily basal injections for patients managing type 1 diabetes.”

“Our findings are very promising, but further analysis of continuous glucose monitoring data and real-world studies are needed,” he said.

Weekly insulin injections, like insulin codec, present a promising alternative to daily injections for diabetes management. These weekly injections have demonstrated noninferiority regarding diabetes control compared to daily injections while offering reduced injection frequency.

Although the weekly insulin group experienced more hypoglycemic episodes, they were typically manageable, highlighting the potential of weekly insulin injections as a convenient and effective option for diabetes treatment.

Journal reference:

  1. Prof David Russell-Jones, Prof Tetsuya Babazono, et al., Once-weekly insulin icodec versus once-daily insulin degludec as part of a basal-bolus regimen in individuals with type 1 diabetes (ONWARDS 6): a phase 3a, randomized, open-label, treat-to-target trial. The Lancet. DOI: 10.1016/S0140-6736(23)02179-7.