• Raheel Ahmed, Aimen Shafiq, and Mushood Ahmed.
• Department of Cardiology, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK.
• Brit J Hosp Med. 2025 Jan 24; 86 (1): 161-6.

AbstractThe advent of once-weekly insulin icodec is a promising development in the care of individuals with diabetes. These once-weekly formulations aimed to improve patient adherence and quality of life for patients who find daily injection administration challenging. Insulin icodec has demonstrated comparable glycemic control to conventionally used daily basal insulins, such as insulin glargine and degludec, in the ONWARDS clinical trials. This approach is aligned with patient-centred guidelines, offers better convenience, and can potentially improve adherence, particularly among older adults with type 2 diabetes and those experiencing distress related to frequent injection administration. However, several challenges persist before widespread adoption is feasible. One main concern is ensuring consistent insulin levels over a full week as fluctuations can lead to an increased risk of hypo- or hyperglycemia. Education, precise dosing, and further research are required to ensure long-term efficacy and safety. Moreover, logistical hurdles, including production costs and supply chain complexities need to be addressed especially in low-resource settings. Future studies should evaluate the broader health impacts of weekly insulin, including cardiovascular outcomes, quality of life, and personalized dosing strategies. Making weekly insulin safe, affordable, and widely available is important to fully realize its potential in diabetes management.

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