The effect of once-weekly insulin icodec vs once-daily basal insulin on physical activity-attributed hypoglycaemia in type 2 diabetes: a post hoc analysis of ONWARDS 1–5
Authors' conclusion
These findings do not suggest that there is an additional increase in hypoglycaemia risk attributed to physical activity with once-weekly basal icodec vs once-daily basal insulins in adults with type 2 diabetes.
Study context
- Population
- Adults with T2D, insulin-naive (ONWARDS 1, 3, 5) and insulin-experienced (ONWARDS 2, 4)5 RCTs
- Comparison
- Once-weekly icodec vs once-daily basal insulin
- Primary endpoint
- Proportion of hypoglycaemic episodes attributed to physical activity and OR of a physical activity-attributed hypoglycaemic episode, per trial
Methodological detailsfive separate randomised trials, phase 3a
- Five separate randomised trials
- Phase 3a
Primary result
As reported in the abstract
Physical activity-attributed hypoglycaemia
Incidence of physical activity-attributed clinically significant or severe hypoglycaemia in ONWARDS 1, 2, 3 and 5
≤3.0%
Further findings
- Physical activity-attributed hypoglycaemic episodes, ONWARDS 4 (basal-bolus) — Icodec
- 18.6%
- Physical activity-attributed hypoglycaemic episodes, ONWARDS 4 (basal-bolus): Insulin glargine U100 17.9%
- Physical activity-attributed hypoglycaemic episodes, ONWARDS 4 (basal-bolus): numerically higher in both groups; expected given basal-bolus regimen
Recurrent clinically significant or severe hypoglycaemia within 24 h after a physical activity-attributed episode
- Low frequency; none in ONWARDS 1, 3 and 5
- 0
- ONWARDS 2 and 4: recurrent clinically significant episodes numerically higher with icodec vs once-daily comparators
- No additional severe episodes in any participants across the trials
Original publication
The effect of once-weekly insulin icodec vs once-daily basal insulin on physical activity-attributed hypoglycaemia in type 2 diabetes: a post hoc analysis of ONWARDS 1–5. Diabetologia. Published 5 April 2025. doi:10.
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