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Icodec Vs Glargine: Changing Lives with Fewer Pricks, Better Glucose Control

Icodec Vs Glargine

Insulin Icodec Vs Glargine was investigated in a head-to-head comparison in the ONWARDS-1 Clinical Trial conducted by Novo Nordisk. Insulin Icodec or Glargine was added in a 1:1 to the treatment regimen of patients who were not using insulin before and had an A1C above 7%.

Once-weekly insulin Icodec was found superior to once-daily insulin glargine U-100 (Lantus) for optimizing blood glucose [Ref].

Results of the ONWARDS 1 Trial are summarized here comparing the efficacy of insulin Icodec Vs Glargine.

A1C reduction

Insulin Icodec



Percentage change in A1C at week 52-1.55-1.35P Value <0.001
Percentage change in A1C at week 78-1.55-1.44P: 0.05
Participants achieving A1C of less than 7% at week 5257.645.4Odds: 1.63
Participants achieving A1C of less than 7% at week 7856.849.1Odds: 1.37

The ONWARDS 1 Trial, one of the longest trials has demonstrated the superiority of Insulin Icodec Vs Glargine U-100.

There was a greater reduction in A1C and more percentage of patients achieved the target A1C of <7% at weeks 52 (57.6% Vs 45.3%) and at weeks 78 (56.8% Vs 49.1%).

In addition, Insulin Icodec was as safe as Insulin Glargine. There were a total of 226 clinically significant hypoglycemic events in 61 patients in the Insulin Icodec group Vs 114 hypoglycemic events in 66 participants in the Insulin Glargine group at week 52.

Weight gain associated with Insulin Icodec Vs Glargine U-100 at week 52 was 2.29 kgs vs 1.83 kgs.



Insulin Icodec Vs Glargine: Differences in Pharmacokinetics:

The mechanism of action of all insulins is the same. However, the major differences between the different types of insulin are based on their onset of action and duration of action.

Insulin Icodec is a peakless insulin with a half-life of about 196 hours. Compared to other insulins, it has the longest half-life of all currently available insulins. Here is a comparison of the half-life of insulin Icodec vs other insulins:

Basal Insulin

Half-life (hours)

NPH Insulin6.6
Glargine U-10012
Glargine U-30019
Degludec Insulin40.8

Icodec Insulin


The half-life of all currently available basal insulins is presented here:

half-life of insulin icodec vs glargine vs degludec vs detemir
The half-life of Insulin Icodec Vs Glargine Vs Degludec Vs Detemir Vs NPH

Insulin Icodec can be administered at any time of the day once a week only. It reduces the number of injections from daily to weekly i.e. 7 times that of insulin glargine, degludec, detemir, or NPH.

Not only does it reduces the number of injections per week from 7 to 1 injections per week, but it has also been found to be safe and more effective than most other basal insulins.

Here are some of the clinical trials underway to prove the efficacy of Insulin Icodec in Type 1 and Type 2 diabetic individuals in comparison to other commonly used insulins.

ONWARDS Clinical Trials

Studies in Type 2 and Type 1 Diabetics

ONWARDS 1Insulin Icodec Vs Glargine in Insulin naive individuals
ONWARDS 2Switching to Insulin Icodec Vs Degludec in patients taking a basal insulin
ONWARDS 3Insulin Icodec Vs Insulin Degludec in Insulin naive patients
ONWARDS 4Switching from a basal-bolus regimen of insulin to either once-weekly insulin Icodec or once-daily insulin Glargine
ONWARDS 5Insulin Icodec with DoseGuide vs other insulin in patients who are insulin naive
ONWARDS 6Once-weekly Insulin Vs Insulin Degludec in Type 1 Diabetes

What are the potential advantages of Insulin Icodec Vs Glargine or other basal insulins?

Here are some of the benefits of Insulin Icodec compared to other insulins:

  • Once-weekly administration:

Insulin Icodec is administered once a week. This is one of its greatest advantages. It reduces the number of needle pricks and may be best for children and adults who have needle phobia. It also improves treatment compliance.

In addition, it is best for people who travel frequently. They don’t have to buy insulin travel kits to carry their insulin or worry about getting injections while on their trips. They can simply get the injections and go out and not worry for a whole week. 

  • Better Efficacy:

The ONWARDS clinical trials have demonstrated the efficacy of Insulin Icodec in comparison to Insulin Degludec and Insulin Glargine U-100, the two commonly used basal insulins.

The average A1C lowering effect of Insulin Icodec is estimated to be around -0.2% more than Insulin Glargine and Degludec.

The better control of blood glucose, the fewer chances of developing diabetes-related complications.

  • Less severe hypoglycemia:

Although more effective than most basal insulins, insulin Icodec is associated with fewer events of hypoglycemia.

The overall hypoglycemic events were less than one event per patient-years of exposure in the clinical trial [Ref]

  • Minimal weight gain:

Weight gain is one of the common side effects of insulin. However, Insulin Icodec was not associated with significant weight gain compared to insulin glargine U-100.

It was associated with a weight gain of about 2.29 kgs compared to 1.83 kgs with insulin glargine.

  • Fewer chances of lipohypertrophy at the injection site

Since the number of injections is reduced 7 times, the chances of lipohypertrophy are minimal with insulin Iocdec.

  • More effective diabetes regimens:

Insulin Icodec can be combined with any of the following diabetes medications:

However, it should not be used in combination with Insulin glargine, Detemir, Toujeo, and Degludec (Tresiba).



In Summary:

Insulin Icodec is a once-weekly basal insulin that is more effective and equally safe as insulin glargine.

It is being studied in various clinical trials for managing both type 1 and type 2 diabetes along with other diabetes drugs.

What do you think?

Written by Dr. Ahmed

I am Dr. Ahmed (MBBS; FCPS Medicine), an Internist and a practicing physician. I am in the medical field for over fifteen years working in one of the busiest hospitals and writing medical posts for over 5 years.

I love my family, my profession, my blog, nature, hiking, and simple life. Read more about me, my family, and my qualifications

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