Despite the availability of new classes of glucose-lowering drugs that improve glycaemic levels and minimise long-term complications, at least 20–25% of people with type 2 diabetes require insulin therapy. Moreover, a substantial proportion of these individuals do not achieve adequate metabolic control following insulin initiation. This is due to several factors: therapeutic inertia, fear of hypoglycaemia and/or weight gain, poor communication, complexity of insulin titration, and the number of injections needed, with the associated reduced adherence to insulin therapy. Once-weekly insulins provide a unique opportunity to simplify basal insulin therapy and to allow good glycaemic control with a low risk of hypoglycaemia. Several approaches to developing a stable and effective once-weekly insulin have been proposed, but, to date, insulin icodec and basal insulin Fc (insulin efsitora alfa) are the only two formulations for which clinical studies have been reported. The results of Phase I and II studies emphasise both efficacy (in term of glucose levels) and potential risks and adverse events. Phase III studies involving insulin icodec are reassuring regarding the risk of hypoglycaemia compared with daily basal insulin analogues. Despite some concerns raised in ongoing clinical trials, the available data suggest that weekly insulins may also be an option for individuals with type 1 diabetes, especially when adherence is suboptimal. For the first time there is an opportunity to make an important breakthrough in basal insulin therapy, particularly in people with type 2 diabetes, and to improve not only the quality of life of people with diabetes, but also the practice of diabetologists.

Graphical Abstract

中文翻译：

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每周一次胰岛素：减轻糖尿病患者治疗负担的一种有前途的方法

尽管有新型降糖药物可以改善血糖水平并最大限度地减少长期并发症，但至少 20-25% 的 2 型糖尿病患者需要胰岛素治疗。此外，这些人中的很大一部分在开始胰岛素治疗后没有达到足够的代谢控制。这是由于多种因素造成的：治疗惰性、对低血糖和/或体重增加的恐惧、沟通不良、胰岛素滴定的复杂性以及所需的注射次数，以及相关的胰岛素治疗依从性降低。每周一次的胰岛素提供了一个独特的机会来简化基础胰岛素治疗并实现良好的血糖控制和低血糖风险。已经提出了几种开发稳定有效的每周一次胰岛素的方法，但迄今为止，胰岛素 icodec 和基础胰岛素 Fc (insulin efsitora alfa) 是仅有的两种已报道临床研究的制剂。 I 期和 II 期研究的结果强调了功效（就血糖水平而言）以及潜在风险和不良事件。与每日基础胰岛素类似物相比，涉及胰岛素 icodec 的 III 期研究令人放心地降低了低血糖风险。尽管正在进行的临床试验提出了一些担忧，但现有数据表明，每周注射一次胰岛素也可能是 1 型糖尿病患者的一种选择，尤其是在依从性不佳的情况下。这是第一次有机会在基础胰岛素治疗方面取得重要突破，特别是在 2 型糖尿病患者中，不仅可以改善糖尿病患者的生活质量，还可以改善糖尿病专家的实践。

图形概要